FNP REVIEW - AANP
Document created using Leik, Hollier and Fitzgerald – I do not own the copy rights to images, etc.
JULY 27, 2018
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
LEVEL OF PREVENTION IMMUNIZATION PEARLS SMOKING - PACK YEAR HX
PRIMARY HX of Anaphylactic Immunization to avoid Number of packs-per-day (PPD)
o Goal: preventing the health problem, the reaction Multiplied by # of years smoked
most cost-effective form of healthcare Neomycin IPV, MMR, varicella
o Example: immunizations, counseling about Streptomycin, IPV, smallpox
safety, injury and disease prevention polymyxin B, neomycin 5 A’S OF SMOKING CESSATION
SECONDARY Baker’s yeast Hepatitis B 1. Ask about tobacco use
o Goal: detecting disease in early, Gelatin, neomycin Varicella zoster
2. Advise to quit
asymptomatic, or preclinical state to minimize Gelatin MMR
3. Assess willingness to make a quit
its impact
o Example: screening tests, such as BP check, Previously unvaccinated adults age 19-59 with attempt
mammography, colonoscopy, ASA in hx MI
diabetes should be vaccinated against Hepatitis B 4. Assist in quit attempt
TERTIARY LIVE VACCINES 5. Arrange follow-up
o Goal: minimizing negative disease induced o MMR
outcomes Patients born before 1957 have
o Example: in established disease, adjusting likelihood of immunity due to PNEUMOCOCCAL IMMUNIZATION
therapy to avoid further target organ damage. natural infection
PCV13 associated with greater
Potentially viewed as a failure of primary Two doses 1 month apart for
those never immunized immunogenicity
prevention, support groups
o Varicella PPSV23 not licensed for children
o Zostavax under 2
IMMUNIZATION PRINCIPLES o Intranasal Flu Mist Indications: chronic lung disease,
Community (herd immunity) Avoid these with Pregnancy, immune suppression chronic cardiovascular disease,
o Immunize those who can be to protect those and with HIV (CD4 count < 200) – case by case
diabetes, chronic liver disease,
who cannot be immunized situation
chronic alcohol abuse, smokers,
Active immunity Rotavirus
o Avoid with SCID (severe combined malignancy, chronic renal failure,
o Resistance developed in response to an
immunodeficiency) asplenia, sickle cell,
antigen (either infection or vaccine)
immunocompromised, HIV.
Passive immunity
o Immunity conferred by an antibody produced HEPATITIS B PCV13 followed by PPSV23 one year
in another host (infant of mother or immune Chronic Hep B can lead to hepatocellular later and then again at 65
globulin carcinoma, cirrhosis and continued infectivity o Exception: HIV (8 weeks
later)
Childhood Hep B vaccines began in 1982
Immunize unless sending to the hospital in an ambulance If PPSV23 before age 65, repeat in 5
3 dose series 0, 1, 6 months
If not vaccinated and exposed – HBIG and series years
If vaccinated and exposed – single dose vaccine
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
TETANUS
VARICELLA Infection caused by Clostridium
SMALLPOX
Live virus; 2 dose series starting > 1 year of age tetani – found in soil lead to lockjaw
Caused by variola virus
Although highly protective, mild cases of chicken If no previous immunity - give Tdap
Infective droplets – contagious during fever, but
pox have been associated with the disease followed by Td in 1 and 6 months
most contagious during rash
Varicella antibody titers should be ordered on a Need vaccine every 10 years with a
o Contagious until last scab falls off
healthcare worker who had chicken pox as a child single dose of Tdap in adulthood
Stopped vaccinating in 1972
Varicella Zoster Immune Globulin (VZIG) is made If dirty wound – BOOST if not TD in
Incubation period 7-17 days
of pooled blood product with excellent safety 5 years (Tdap and Immunoglobin if
Prodromal stage – fever, malaise, headaches,
rating (given if contraindications for vaccine) no previous vaccine)
body aches
Pregnant women without immunity should be
Rash starts on face > arms/legs > hands/feet
vaccinated with two doses after giving birth
o All lesions within same phase and spreads HEPATITIS A
Varicella is transmitted via droplet
within 24 hours Peak infectivity occurs the 2-week
Vaccination within 3-5 days of exposure has
Vaccination within 3 days of exposure reduces period before the onset of jaundice
shown benefits to reduce disease
severity or elevated liver enzymes
Vaccinia – unique immunization method Approximately 50% of cases have
o 2-pronged needle dipped into vaccine and no specific risk factors identified
STAGES OF CHANGE MODEL
then pricks skin When traveling to developing
PRECONTEMPLATION
o Not interested or minimalizes nations, avoid foods that are eaten
CONTEMPLATION raw
POLIOVIRUS
o Considering change, looks at positive and Administer 4-6 weeks prior to
Transmission is fecal-oral
negative, feels “stuck” traveling to an area where disease is
PREPARATION endemic
SENSITIVITY AND SPECIFICITY o Exhibits some change behaviors, but does Treatment is supportive
Sensitivity – ability of a test to detect a person not have tools to proceed
who has disease (SEN rule in) ACTION SHINGLES VACCINE
Specificity – ability of a test to detect a person o Ready to go forward, takes concrete Recommended for everyone except
who is healthy (SPOUT – rule out) steps, but no consistency those contraindicated
MAINTENANCE/RELAPSE Infectious until lesions dry/crusted
o Learns to continue the change and Zostavax
embraced the healthy habit o Live; One-time dose age 60
Shingrix
o Non-live; 2 doses age 50
o Preferred vaccine
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
Prostate Cancer
US PREVENTATIVE SERVICES TASK FORCE CANCER PREVALENCE
o Benefits of PSA screening do not
Aspirin use to prevent cardiovascular disease and Skin cancer is most common cancer
outweigh the disadvantages
colorectal cancer o Basal cell carcinoma
o Risk factors:
o Age 50-59 with >10% ASCVD o Melanoma highest mortality
Age > 50
Breast Cancer Men – prostate cancer
African ancestry
o Mammography age 50-74 (every 2 years) Women – breast cancer
First degree relative
o Risk factors (start age 40 or BRCA1/2) Gynecological
Ovarian Cancer
Previous hx of breast cancer o Uterine/endometrial
o Routine screening not recommended
>2 first-degree relatives o Ovarian
o BRCA1/BRCA2 mutations – refer to
Early menarche, late menopause, Children – acute lymphoblastic
specialist
nulliparity leukemia (ALL)
Skin Cancer Counseling
obesity
o Recommend for those with fair skin
Cervical Cancer
Abdominal Aortic Aneurysm
o Age 21 – screen every 3 years
o Men age 65-75 who have smoked
o Age 30 – screen with HPV every 5 years
o One-time ultrasound MORTALITY
o Hysterectomy with removal of cervix –
Lipid Disorders Leading cause of death (all ages)
only need screening if hysterectomy due
o Start low – moderate statin when all: o Heart disease
to cervical cancer
Age 40-74 o Cancer
o Stop screening at age 65
CVD risk factor Men (lung,
o Risk factors:
ASCVD > 10% prostate, colorectal)
Multiple sex partners
Lung Cancer Women (lung,
Younger age at onset of sex
o Smoke 30 pack-years or quit in last 15 breast, colorectal)
Immunosuppression and smoker
years o Chronic respiratory
Colorectal Cancer
o Age 55-80 (annual screening with CT)
o Start age 50-75
Colonoscopy every 10 years
ADOLESCENTS
Flex sigmoidoscopy or CT OVARIAN CANCER
Death rate for teen males is higher
colonography every 5 years No recommendation for routine screening
than females
FOBT (3 consecutive stool In postmenopausal women with palpable ovary
o Accidents (MVC most
samples) annually o Intravaginal ultrasound and CA-125
common)
New Cologuard Strongest risk factor is BRCA1 or BRCA2
o Suicide
o Risk Factors Other risk factors include age, obesity, Clomid
o Homicide
Familial polyposis use or endometriosis
First degree relative w/ colon CA Prostate/testicular cancer screening not
Crohn’s (ulcerative colitis) recommended
Document created using Leik, Hollier and Fitzgerald – I do not own the copy rights to images, etc.
JULY 27, 2018
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
LEVEL OF PREVENTION IMMUNIZATION PEARLS SMOKING - PACK YEAR HX
PRIMARY HX of Anaphylactic Immunization to avoid Number of packs-per-day (PPD)
o Goal: preventing the health problem, the reaction Multiplied by # of years smoked
most cost-effective form of healthcare Neomycin IPV, MMR, varicella
o Example: immunizations, counseling about Streptomycin, IPV, smallpox
safety, injury and disease prevention polymyxin B, neomycin 5 A’S OF SMOKING CESSATION
SECONDARY Baker’s yeast Hepatitis B 1. Ask about tobacco use
o Goal: detecting disease in early, Gelatin, neomycin Varicella zoster
2. Advise to quit
asymptomatic, or preclinical state to minimize Gelatin MMR
3. Assess willingness to make a quit
its impact
o Example: screening tests, such as BP check, Previously unvaccinated adults age 19-59 with attempt
mammography, colonoscopy, ASA in hx MI
diabetes should be vaccinated against Hepatitis B 4. Assist in quit attempt
TERTIARY LIVE VACCINES 5. Arrange follow-up
o Goal: minimizing negative disease induced o MMR
outcomes Patients born before 1957 have
o Example: in established disease, adjusting likelihood of immunity due to PNEUMOCOCCAL IMMUNIZATION
therapy to avoid further target organ damage. natural infection
PCV13 associated with greater
Potentially viewed as a failure of primary Two doses 1 month apart for
those never immunized immunogenicity
prevention, support groups
o Varicella PPSV23 not licensed for children
o Zostavax under 2
IMMUNIZATION PRINCIPLES o Intranasal Flu Mist Indications: chronic lung disease,
Community (herd immunity) Avoid these with Pregnancy, immune suppression chronic cardiovascular disease,
o Immunize those who can be to protect those and with HIV (CD4 count < 200) – case by case
diabetes, chronic liver disease,
who cannot be immunized situation
chronic alcohol abuse, smokers,
Active immunity Rotavirus
o Avoid with SCID (severe combined malignancy, chronic renal failure,
o Resistance developed in response to an
immunodeficiency) asplenia, sickle cell,
antigen (either infection or vaccine)
immunocompromised, HIV.
Passive immunity
o Immunity conferred by an antibody produced HEPATITIS B PCV13 followed by PPSV23 one year
in another host (infant of mother or immune Chronic Hep B can lead to hepatocellular later and then again at 65
globulin carcinoma, cirrhosis and continued infectivity o Exception: HIV (8 weeks
later)
Childhood Hep B vaccines began in 1982
Immunize unless sending to the hospital in an ambulance If PPSV23 before age 65, repeat in 5
3 dose series 0, 1, 6 months
If not vaccinated and exposed – HBIG and series years
If vaccinated and exposed – single dose vaccine
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
TETANUS
VARICELLA Infection caused by Clostridium
SMALLPOX
Live virus; 2 dose series starting > 1 year of age tetani – found in soil lead to lockjaw
Caused by variola virus
Although highly protective, mild cases of chicken If no previous immunity - give Tdap
Infective droplets – contagious during fever, but
pox have been associated with the disease followed by Td in 1 and 6 months
most contagious during rash
Varicella antibody titers should be ordered on a Need vaccine every 10 years with a
o Contagious until last scab falls off
healthcare worker who had chicken pox as a child single dose of Tdap in adulthood
Stopped vaccinating in 1972
Varicella Zoster Immune Globulin (VZIG) is made If dirty wound – BOOST if not TD in
Incubation period 7-17 days
of pooled blood product with excellent safety 5 years (Tdap and Immunoglobin if
Prodromal stage – fever, malaise, headaches,
rating (given if contraindications for vaccine) no previous vaccine)
body aches
Pregnant women without immunity should be
Rash starts on face > arms/legs > hands/feet
vaccinated with two doses after giving birth
o All lesions within same phase and spreads HEPATITIS A
Varicella is transmitted via droplet
within 24 hours Peak infectivity occurs the 2-week
Vaccination within 3-5 days of exposure has
Vaccination within 3 days of exposure reduces period before the onset of jaundice
shown benefits to reduce disease
severity or elevated liver enzymes
Vaccinia – unique immunization method Approximately 50% of cases have
o 2-pronged needle dipped into vaccine and no specific risk factors identified
STAGES OF CHANGE MODEL
then pricks skin When traveling to developing
PRECONTEMPLATION
o Not interested or minimalizes nations, avoid foods that are eaten
CONTEMPLATION raw
POLIOVIRUS
o Considering change, looks at positive and Administer 4-6 weeks prior to
Transmission is fecal-oral
negative, feels “stuck” traveling to an area where disease is
PREPARATION endemic
SENSITIVITY AND SPECIFICITY o Exhibits some change behaviors, but does Treatment is supportive
Sensitivity – ability of a test to detect a person not have tools to proceed
who has disease (SEN rule in) ACTION SHINGLES VACCINE
Specificity – ability of a test to detect a person o Ready to go forward, takes concrete Recommended for everyone except
who is healthy (SPOUT – rule out) steps, but no consistency those contraindicated
MAINTENANCE/RELAPSE Infectious until lesions dry/crusted
o Learns to continue the change and Zostavax
embraced the healthy habit o Live; One-time dose age 60
Shingrix
o Non-live; 2 doses age 50
o Preferred vaccine
, PREVENTION/HEALTH PROMOTION/IMMUNIZATION
Prostate Cancer
US PREVENTATIVE SERVICES TASK FORCE CANCER PREVALENCE
o Benefits of PSA screening do not
Aspirin use to prevent cardiovascular disease and Skin cancer is most common cancer
outweigh the disadvantages
colorectal cancer o Basal cell carcinoma
o Risk factors:
o Age 50-59 with >10% ASCVD o Melanoma highest mortality
Age > 50
Breast Cancer Men – prostate cancer
African ancestry
o Mammography age 50-74 (every 2 years) Women – breast cancer
First degree relative
o Risk factors (start age 40 or BRCA1/2) Gynecological
Ovarian Cancer
Previous hx of breast cancer o Uterine/endometrial
o Routine screening not recommended
>2 first-degree relatives o Ovarian
o BRCA1/BRCA2 mutations – refer to
Early menarche, late menopause, Children – acute lymphoblastic
specialist
nulliparity leukemia (ALL)
Skin Cancer Counseling
obesity
o Recommend for those with fair skin
Cervical Cancer
Abdominal Aortic Aneurysm
o Age 21 – screen every 3 years
o Men age 65-75 who have smoked
o Age 30 – screen with HPV every 5 years
o One-time ultrasound MORTALITY
o Hysterectomy with removal of cervix –
Lipid Disorders Leading cause of death (all ages)
only need screening if hysterectomy due
o Start low – moderate statin when all: o Heart disease
to cervical cancer
Age 40-74 o Cancer
o Stop screening at age 65
CVD risk factor Men (lung,
o Risk factors:
ASCVD > 10% prostate, colorectal)
Multiple sex partners
Lung Cancer Women (lung,
Younger age at onset of sex
o Smoke 30 pack-years or quit in last 15 breast, colorectal)
Immunosuppression and smoker
years o Chronic respiratory
Colorectal Cancer
o Age 55-80 (annual screening with CT)
o Start age 50-75
Colonoscopy every 10 years
ADOLESCENTS
Flex sigmoidoscopy or CT OVARIAN CANCER
Death rate for teen males is higher
colonography every 5 years No recommendation for routine screening
than females
FOBT (3 consecutive stool In postmenopausal women with palpable ovary
o Accidents (MVC most
samples) annually o Intravaginal ultrasound and CA-125
common)
New Cologuard Strongest risk factor is BRCA1 or BRCA2
o Suicide
o Risk Factors Other risk factors include age, obesity, Clomid
o Homicide
Familial polyposis use or endometriosis
First degree relative w/ colon CA Prostate/testicular cancer screening not
Crohn’s (ulcerative colitis) recommended
