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Terms in this set (204)
What are the most common causes of urinary incontinence that you should know?
Atrophic urethritis/ vaginitis
Excess Urinary output
This is the most common type of urinary incontinence in the elderly.
This type of incontinence is characterized by detrusor overactivity causing spontaneous bladder contractions.
In this type of incontinence, a patient may experience urinary leakage after a strong urge to urinate which cannot be delayed.
This is the second most common cause of urinary incontinence in the elderly.
This type of incontinence is characterized by urethral sphincter failure when the intraabdominal pressure is increased (coughing, sneezing, lifting heavy objects), causing urinary leakage.
This type of incontinence is characterized by detrusor muscle underactivity which causes the bladder to engorge with urine wich then leaks through the urethra.
This is the least common cause of urinary incontinence in the elderly.
Diagnosis for a patient who is experiencing nocturia, frequent leakage of small amounts of urine, and who has a post-void residual of 475 mL.
What should be the main focus for the physical exam of a patient who is experiencing urinary incontinence?
What other exams/conditions may be relevant depending on the patient?
Neurologic, pelvic, and rectal exams.
Mental status, gait changes, lower extremity dysfunction, stool impaction/constipation, atrophic vaginitis/urethritis, prostate enlargement.
What labs/tests would you want to get for a patient with urinary incontinence?
UA with culture
BUN and creatinine
Cystometry may be helpful in the diagnosis of urge incontinence.
What are some preventitive strategies/instrutions that you could give to a patient who is experiencing urinary incontinence?
Avoid excessive fluid intake, caffeine, and alcohol. No fluid intake 3-4 hours prior to bedtime.
Bladder training/kegel exercises
referral to physical therapy for pelvic floor strengthening.
What medications might you prescribe a patient who is suffering from urinary incontinence?
Oxybutynin 2.5-5 mg. po BID-TID
Tolterodine 1-2 mg. po BID
What might you suggest for a patient who is experiencing overflow incontinence?
Bladder decompression with self cath to restore bladder function.
Treat underlying cause (BPH/cystocele).
Lifestyle modifications such as double voiding, Valsalva maneuver, and applying suprapubic pressure during voiding.
What might be required for a patient who is experiencing functional incontinence?
Incontinence undergarments and pads.
Bedside commode (making it easier to make it to the bathroom).
What is a significant risk factor for constipation in the elderly?
Living in a nursing home (50% increase)
What are the different types of primary/functional constipation?
Normal transit constipation
Slow transit constipation
Disorders of defecation
What are the different types/causes of secondary constipation?
Chronic disease processes
You have a patient who is experiencing abdominal pain who has a history of constipation but is now having diarrhea. What would you do and what condition might they have?
Rectal exam for concern of fecal impaction with overflow diarrhea.
What might you expect to find with a rectal exam on a patient who is suffering from constipation?
Palpation of hard stool or a mass.
What labs/tests might you order for a patient who has constipation?
Nothing is routinely recommended.
What are the goals of treatment for a patient who has constipation?
Primary goal is symptom releif.
Secondary goal is the passage of soft, formed stool, without straining, 3x per week.
What behavioral interventions might you recommend for a patient experiencing constipation?
Schedule toileting after meals
Use of a squatty potty
Increase fluid and fiber intake
What treatment for constipation should you avoid in a patient who has a fecal impaction?
Bulking agents such as psyllium or bran.
What are some common osmotic laxatives you should know?
Lactulose (Chronulac), Sorbitol
Polyethylene glycol (Miralax)
This medication for constipation is the most appropriate treatment option for long-term use.
Polyethylene glycol (Miralax)
What laxative for constipation might you try if increasing fiber and osmotic laxatives have been ineffective?
What medication is used to soften stool without any stimulant effect?
docusate sodium (Colace)
What is the next step in the treatment of constipation if you have had a poor response to behavioral changes (eg. increasing fluid and fiber intake and scheduled toileting)?
Polyethylene glycol (Miralax)
What is the next step in the treatment of constipation if you have had a poor response to behavioral changes (eg. increasing fluid and fiber intake and scheduled toileting) AND polyethylene glycol (Miralax)?
Stool softeners plus a stimulant laxative: docusate sodium (Colace) + bisacodyl (dulcolax) or senna (Senokot)
What medication might you use for constipation in a patient who has failed almost all treatment options and is also taking opioid medications?
What is the next step in the treatment of constipation if you have had a poor response to behavioral changes AND Miralax AND stool softener + laxative?
Referral to GI, and/or
lubiprostone (Amitiza), or
What are the treatment options for a fecal impaction?
Enema (mineral oil/warm water).
Glycerin suppositories may be effective.
How often should you screen geriatric patients for hearing impairment and how might you do the screening?
Ask the patient or partner, whisper test, pure tone audiometry is the reference standard.
What is the term used to describe the sensorineural hearing loss that occurs with age?
What are the treatment options for presbycusis?
possible cochlear implant
How often should you screen patients over the age of 65 for visual acuity?
every 1-2 years
Snellen or Rosenbaum are adequate.
What are the 4 main causes of vision loss?
What treatment should you provide those who are suffering from vision loss?
Refer to optometrist or opthalmologist.
For a patient who has vision loss, what should you do during your physical exam?
Verbalize your physical exam process
What are the most common sites for a pressure injury to occur?
Sacrum most common, heels are second most common, 90% occur below the waist
What are the risk factors for the development of a pressure injury?
Immobility (primary risk factor)
Recent hospitalization (Most occur during hospital stays for acute illness)
Reduced sensory perception
Poor nutritional status
Friction and shear forces
Stage this pressure injury: Non-blanchable erythema of intact skin.
Stage this pressure injury: Partial-thickness skin loss with exposed dermis.
Stage this pressure injury: Full-thickness skin loss with fat exposed.
Stage this pressure injury: Full-thickness skin loss with bone, muscle, or tendon exposed.
Stage this pressure injury: Obscured full-thickness skin and tissue loss
Stage this pressure injury: Persistent non-blanchable deep red, maroon or purple discoloration
Deep tissue pressure injury
This is a transparent, thin, semi-permeable, self-adhesive dressing. It protects non-exuding wounds and prevents further skin breakdown.
Polyurethane film (Tegaderm)
This provides a moist and insulating healing environment, and protects uninfected wounds, allowing the body's own enzymes to heal wounds.
This dressing contains foamed polymer solutions with small, open cells that hold fluids.
Semipermeable foam dressing
Highly absorbent dressing derived from seaweed.
How should you treat a wound that is wet?
Use absorptive dressings to avoid buildup of chronic wound fluid:
How should you treat a wound that is dry?
Use dressings that maintain moist wound environments:
Treatment for a Stage 1 pressure injury:
Transparent film dressing
Treatment for a Stage 2 pressure injury:
Transparent film or Occlusive dressing
How would you treat a wound that has sinus tracts or ones that are deep?
Pack with gauze
How would you treat a wound with necrotic debris?
If you have a wound with eschar, what should you do?
Debride, unless it is on the heel
Treatment for an unstageable pressure injury:
Debride, then decide therapy
If you have a chronic non-healing wound, what should you do?
Consider squamous cell carcinoma as a possible cause.
How often should a patient who is bed-bound change position to avoid a pressure injury? What about chair bound?
Every 2 hours
What are the main strategies for the prevention of a pressure injury?
Moisturize sacral skin
What percent of muscle strength is lost per day in a patient who is inactive/under bed rest orders? What about the effect on bone loss?
5% per day
Bone loss from 10 days of bed rest takes 4 months to restore.
What are some general age-related changes that you should know?
Tissue becomes less pliable and less efficient.
Body fat increases until age 85, then decreases.
Bone mass decreases.
Less total body fluid.
Overall decline in cardiac, respiratory, and renal systems.
What are some general age-related changes with respect to the cardiovascular system that you should know?
Myocardial efficiency and strength decreases.
Stroke volume decreases.
Reduced elascticity of the arteries.
Vascular rigidity means more forse is needed to contract.
Reduced pliability of the aorta.
Higher incidence of orthostatic hypotension.
What are some general age-related changes with respect to the respiratory system that you should know?
Decreased vital capacity and oxygen saturation.
Reduction in alveoli and elastic recoil of the lungs.
Residual volume increases.
Less effective gas exchange.
What are some general age-related changes with respect to the gastrointestinal system that you should know?
Decreased salivary glands and drier mucous membranes.
Weak gag reflex and relaxation of esophageal sphincter.
Gastric mucosa thins.
Intestinal blood flow is decreased.
What are some general age-related changes with respect to the renal system that you should know?
Creatinine clearance reduced resulting in a lower GFR.
Kidneys are less effective at concentrating urine.
Smaller bladder capacity.
What are some general age-related changes with respect to sensory and perception that you should know?
Loss of near vision (presbyopia).
Changes to depth perception (stairs and curbs).
Adjusting to light changes takes longer (movie theater).
Sensorineural hearing loss (presbycusis).
Cerumen impaction due to higher keratin.
Nasal mucosa becomes less moist.
Decreased taste bud sensitivity.
Tactile sensation reduced.
What are some general age-related changes with respect to the neuromuscular system that you should know?
Bulk, strength, and number of muscle fibers decline.
DTR are sluggish.
Resting tremor may develop.
Loss of bone mass.
Nerve conduction velocity is slowed.
Frequent awakenings during sleep.
What are some general age-related changes with respect to the endocrine system that you should know?
The pituitary gland shrinks by 20%.
Decrease in estrogen/progestin, testosterone.
Decreased release of insulin and decreased insulin sensitivity.
What are some general age-related changes with respect to the immune system that you should know?
There is a significant decline in cell-mediated immunity.
Atypical presentations of illness.
Do not develop fevers as readily as younger individuals.
More susceptible to infections.
Higher risk for zoster.
Less responsive to vaccines.
What are some general age-related changes with respect to the patient's mental status that you should know?
Decline of cognitive function.
Short term memory is poorer.
Long term memory remains in-tact.
What are the 5 steps in the comprehensive geriatric assessment?
1. Targeting appropriate patients
2. Performing assessments/ develop recommendations
3. Implementing the recommendations
4. Monitor response to the treatment plan
5. Revise plan as necessary
What are the 2 main exclusion criteria when considering a comprehensive geriatric assessment?
Too sick to benefit
Too well to benefit
How long should a patient's life expectancy be for you to consider tests and treatments as though you are treating someone who is younger? What if they do not meet the criteria above?
> 10 years
When life expectancy is < 10 years, choices should be made based on their ability to improve prognosis and quality of life.
What are the 4 major components of the comprehensive geriatric assessment?
Functional assessment (Fall risk, ADLs)
Psychological assessment (cognition and mood)
Medical assessment (polypharmacty and nutrition)
Social assessment (financial concerns)
Additional considerations: Urinary incontinence, Sexual function, Vision/ hearing, Dentition, Living situation, Spirituality
What are the basic activities of daily living (ADLs)
Eating, dressing, bathing, transferring, toileting.
What are the instrumental activities of daily living (IADLs)
Shopping, managing money, driving, using the telephone, housekeeping, laundry, meal preparation, managing medications.
What is the functional assessment with respect to the comprehensive geriatric assessment?
Screening for gait and mobility problems.
(Have you fallen in the past 12 months? If positive you may need further assessment with possible referral to physical therapy for fall prevention)
What test should you perform to assess a patient's mobility status?
Get Up and Go mobility test.
Sit to stand, stand to walk (3 yards), turn around, walk back, turn around, sit back down. (should take about 10 seconds or less)
What psychological assessment identifies patients with moderate to severe cognitive impairment, and is highly correlated to patient's education level?
Mini-mental status exam (MMSE)
What psychological test is used for the detection of mild cognitive impairment?
Montreal Cognitive Assessment (MoCA)
What test would you do to determine if a patient is able to make their own decisions?
Aid to Capacity Evaluation (ACE)
What test would you do to screen for depression in the geriatric patient?
Geriatric Depression Scale
How many prescription medications constitutes polypharmacy, and why might this be an important consideration in the geriatric patient?
More than 4 drugs.
Increases risk for delirium and falls.
What common condition in the elderly may inhibit the mechanical ability for a patient to chew and swallow their food?
Xerostomia (dry mouth)
Geriatric assessment pearls
• Get prior medical records AHEAD of time
• Have caregiver/ family present if possible
• Detailed HISTORY is KEY
• May need several appointments to complete assessment (Utilize pre-appointment surveys)
• Perform a focused exam at least every 6 months for those with chronic issues (DM, HTN, Lipids, CHF)
• Often more sensitive to medications (Start low, go slow)
• May not be able to hear or see well - speak slowly and clearly
• Patients may underreport medical problems due to fear of losing their independence or being perceived as having an emotional or psychiatric illness (Often symptoms are rationalized as a "normal" component of aging)
Malnutrition is a broad term that encompasses multiple conditions including:
Diet related diseases
Micronutrient deficiencies or excess
What percent of unintentional weight loss is considered to be clinically significant?
2% or more decrease in baseline body weight in 1 month
5% or more decrease in three months
10% or more decrease in six months
What is a significant risk factor for malnutrition?
up to 1/3 of hospitalized patients
What are the most common causes of unintentional weight loss?
What workup might be required for unintentional weight loss?
CBC, CMP, TSH, UA
Fecal occult blood test
Upper endoscopy if early satiety
What medication might you prescribe for a patient to gain weight if they are cachectic?
Megestrol acetate (appetite stimulant that improves appetite and weight gain in cancer/AIDS patients)
What medication might you prescribe if a patient is underweight secondary to depression?
What psychosocial treatment should be recommended to help geriatric patients eat more food?
Encourage family/friends to be present for mealtimes.
In what patient population would an artificial feeding tube be contraindicated?
What is the term used to describe a severe form of constipation that makes the patient unable to pass stool or gas?
What are the common symptoms of dehydration?
Tachycardia and hypotension
Decreased urinary output
Decreased skin turgor
Dry mucus membranes
(less common: fevers and falls)
What is the minimum daily fluid intake?
What is the leading cause of injury among older adults?
Falls, complications from falls, are the leading cause of death from injury in the elderly.
What medications are considered high risk for adverse drug reaction in the elderly?
What are some patient-related factors that increase the risk for an adverse drug reaction?
Rural residential location
Low socioeconomic status
(others include history of falls, prior history of ADR, and limitations in ADLs)
How are geriatric patients affected by medication absorption secondary to their advanced age?
They have increased stomach pH (decreased absorption of iron, B12, Antifungals, and calcium).
Slower GI emptying (increased risk of stomach ulcers from medications like NSAIDs, aspirin, bisphosphonates, and KCL tablets).
Some patients have decreased subcutaneous fat (cachectic), which is required for transdermal patches to work.
How are geriatric patients affected by medication distribution secondary to their advanced age?
Lipid-soluble medications (benzo) have increased half life.
Water-soluble are more concentrated (decreased total body water).
Protein bound drugs (phenytoin) are more active (decreased lean body mass).
This equation is the most common method to estimate creatinine clearance for drug dosing.
50% of ADRs in older adults are caused by:
Also mentioned that ADRs due to errors of monitoring > ADRs due to errors of prescribing.
What are the main principles of appropriate prescribing for geriatric patients?
• Start low and go slow
• Start one medication at a time
• Use old medications rather than new medications (7-year rule)
• Quality of life versus mortality benefit
• Medication monitoring
• Use drug utilization review tools
What is the most commonly used criteria to assist in preventing ADRs in older adults, which can be used in the inpatient or outpatient settings?
You should avoid using medications other than ______ to achieve hemoglobin A1c <7.5% in most older adults as moderate control is generally better.
You should not use ______ as the first choice to treat behavioral and psychological symptoms of dementia.
You should not use ______ or other __________ in older adults as first choice for insomnia, agitation or delirium.
You should not use antimicrobials to treat _______ in older adults unless specific urinary tract symptoms are present
You should not prescribe _______ without conducting a drug regimen review.
The term used to describe: Patients have the right to make their own decisions and choices, and physician assistants should respect these decisions and choices.
The term used to describe: PAs should act in the patient's best interest. In certain cases, respecting the patient's autonomy and acting in their best interests maybe difficult to balance.
The term used to describe: do no harm, to impose no unnecessary or unacceptable burden upon the patient.
The term used to describe: patients in similar circumstances should receive similar care. This also applies to norms for the fair distribution of resources, risks, and costs.
The term used to describe: requirement that the practitioner be faithful and truthful to the patient.
The term used to describe: Aggressive treatment of pain at the end of life is legally and morally acceptable, even if death is hastened, provided the intention of the action (administering sedating medication) is to relieve pain and not to cause death.
Physician assistants have an obligation to ______ and ______ for patients at the end of life. PAs are encouraged to facilitate open discussion with patients and their family members concerning end of life treatment choices.
maximize quality of life
PAs should ______ in all near-death planning. The PA should only withdraw life support with ______ and in accordance with the policies of the health care institution.
involve the physician
the supervising physician's agreement
This is when a patient announces, in advance, what type of care s/he wants/doesn't want.
This is when a patient picks someone to make decisions for him/her.
Power of attorney
This is often a decision about how a patient will die, not so much about living.
If it would be more appropriate to treat pneumonia with morphine and antipyretics rather than antibiotics, the patient is likely ______?
In hospice care
All adults patients are, as a matter of accepted ethical and legal practice and standards, assumed to have ______?
intact decision-making capacity
What are the signs of the pre-active phase of dying?
▫ Increased restlessness, confusion, agitation, frequent position changes
▫ Withdrawal from active participation in activities
▫ Increased sleep, lethargy
▫ Decreased intake of food and liquids
▫ Begins to show periods of apnea (awake & asleep)
▫ Report seeing deceased acquaintances
▫ States they are dying
▫ Wants to settle "unfinished business"
▫ Increased swelling of extremities or body generally
What are the signs of the active phase of dying?
▫ Inability to arouse
▫ Severe agitation, hallucinations, acting "crazy"
▫ Longer periods of apnea
▫ More dramatic changes in respiratory pattern (cheyne-stokes)
▫ Respiratory congestion (death rattle [rales])
▫ Inability to swallow fluids (coughing, choking)
▫ States they are dying
▫ Mouth open continuously, no longer speaking
▫ Urinary/bowel incontinence
▫ Decreased urine output/concentrated urine
▫ Blood pressure drops (20-30 pts or more)
▫ Systolic below 70, diastolic below 50
▫ Extremities cold to touch
▫ Legs/feet feel numb
▫ Cyanosis of extremities
▫ Body held in rigid, unchanging position
▫ It is felt that hearing may be last sensation to disappear
______ is a process of supporting and enabling people to: Express their views, thoughts and concerns. Access information, advice and guidance. Explore choices and options for services and care.
The ______ act, requires states to target services to older individuals with the greatest economic need.
Older American Act
What are the primary reasons for people to call Idaho Commission for Aging?
Lost someone who took care of them.
Signs of dementia.
Calls from banks because someone is not handling finances well.
People become caregivers all of a sudden
Fraud prevention side (Scams): Insurance, Financial, Providers
Term used to describe: knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult (age > 60)
Who are most likely to commit adult abuse?
What are common characteristics of an adult abuser?
History of mental illness (Especially depression)
What are common characteristics of an elder who is being abused?
Shared living situations
What is the most common form of adult abuse?
Self neglect: Elder self-neglect occurs when an elderly person is no longer able to meet his or her basic daily needs. Although elder self-neglect doesn't involve a third-party perpetrator, it's still considered a form of elder abuse that raises serious health and safety concerns.
Idaho requires reporting of abuse, neglect or exploitation to Adult Protective Services by all health care professionals (doctors, nurses, PAs, PT, pharmacists, social worker, chiropractor, podiatrist, etc..). In addition you must also report the information to the appropriate law enforcement agency within _____. Failure to report is a misdemeanor.
If an elderly patient is out of the hospital but is complicated, and readmission to the hospital is likely, it would be a good idea to ______?
Refer to intensivist for consult
If a patient is not just old, but is also complicated, may lack family support, and the PCP does not have time to treat adequately, it would be a good idea to ______?
Referral to Specialty Geriatric Clinic
______ is planned or emergency temporary care provided to caregivers of a child or adult. These programs provide planned short-term and time-limited breaks for families and other unpaid caregivers of children with a developmental delay or behavioral problems, and adults with an intellectual disability or cognitive loss in order to support and maintain the primary caregiving relationship.
Facilities or homes that take adults that cannot care for themselves in during the day while the caregiver works or gives a respite for the caregiver.
Adult day care
A place to sleep when you have nowhere else to go. If you are homeless, feel unsafe in your own home, or are in an emergent situation, and you need a place to stay
______ are places like senior centers where lunch is served on weekdays to individuals age 60 or older.
Congregate meal sites
A facility that provides rehabilitative, restorative, and/or ongoing care to patients or residents in need of assistance with activities of daily living.
Skilled nursing care facility (SNF)
This senior living facility providers intensive, specialized care for people with memory issues.
Memory care center
99% of the aged population in the US is enrolled in Medicare part _____?
This provides payments for physicians, physician ordered supplies and services, outpatient hospital services, rural health clinic visits, ambulance services and home health visits for those with Part A
Medicare part B
This part of medicare offers extra coverage for things such as vision, hearing, and dental.
Medicare part C
This part of medicare offers prescription drug benefits and free medication therapy management.
Medicare part D
What is the different between major and minor neurocognitive disorders?
Mild = no interference with ADLs
Major = interferes with ADLs
The term used to describe: progressive neurocognitive disorders of the elderly.
What are some common symptoms associated with dementia?
Depression, anxiety, delusions, wandering, aggression, and sleep problems.
Term used to describe: inability to interpret sensations and hence to recognize things, typically as a result of brain damage.
What comorbid medical condition is highly correlated with dementia?
What are high risk medications associated with worsening dementia?
What are some examples of anticholinergic medications?
Antihistamines (diphenhydramine, hydroxyzine)
Antidepressants (TCA, antipsychotics, antiparkinson)
Bladder muscarinics (oxybutynin, Ditropan)
What labs would you order in a patient with suspected dementia?
CBC, CMP, TSH, B12, HIV, syphilis
What are some ways to prevent the development of dementia?
Use your brain, eat a healthy diet, and exercise.
What are the acetylcholinesterase inhibitors used in the symptomatic treatment of Alzheimer's dementia?
What are the NMDA antagonists used in the symptomatic treatment of Alzheimer's dementia?
What is the number one cause of dementia in the US?
If a patient presents with fluctuations in cognitive functioning-including alertness and staring, has visual hallucinations, and acts out while asleep as if interacting with dreams, the patient likely has?
Dementia with Lewy Bodies
This neurocognitive disorder is associated with hypertension and metabolic syndrome.
Vascular neurocognitive dementia
Term used to describe: disturbance in attention and awareness that develops over hours to days, and can fluctuate throughout the day.
What tests would you order for a patient who is delirious?
CBC, CMP, TSH, BG, ammonia level, UA
Head CT, drug levels/tox screen, ECG
Sources of infection: blood cultures, spinal tap, chest x-ray
What medication would you use for a patient who has neurocognitive dementia and is suffering from depression?
What medication would you use to help a geriatric patient with sleep?
What medication might you use to help with pain, cognition, and depression in a geriatric patient?
Atypical, very vivid visual or auditory hallucinations in otherwise completely lucid patient, may be related to sensory deprivation.
Charles Bonnet syndrome
What is the most likely way that men over 60 will kill themselves?
Difference between primary, secondary, and tertiary prevention.
Primary: vaccine to prevent disease
Secondary: Screening to detect disease
Tertiary: Treatment to avoid further complications
How should we screen for cervical cancer?
Pap every 3 years from ages 21-65 years old.
Pap and HPV testing, or hrHPV alone, every 5 years from ages 30-65 years old.
How should we screen for breast cancer?
Mammogram every other year from ages 50-74 years old.
Patients may have mammogram ages 40-49 if they want.
How should we screen for osteoporosis?
DEXA scan, women ages 65 and older
How should we screen for prostate cancer?
Consider in men age 55-69 years old. Inform about the potential benefits and harms of prostate-specific antigen-based screening for prostate cancer.
Men, age 70 and older, recommend against PSA screening.
How should we screen for testicular cancer?
Recommend against screening for testicular cancer in adolescent or adult males.
How should we screen for colon cancer?
Colonoscopy: Age 45-75 and repeat every 5-10 years
76 and older on an individual basis
Discontinue after 85 years old.
How should we screen for Hep C?
Adults 18-79 years old (once a lifetime)
How should we screen for lung cancer?
Age 50-80 with 20 pack year smoking history who currently Smoke OR quit in the past 15 years. Annual low dose chest CT screen.
Discontinue if not smoked for past 15 years or limited life expectancy.
What is the recommendation for adults 65 years or older regarding the PCV13 vaccine? (For those who do not have an immunocompromised condition, cerebrospinal fluid leak, or cochlear implant.)
Prevnar 13 is based on shared clinical decision-making.
What is the recommendation for all adults 65 years and older regarding the pneumococcal polysaccharide vaccine (PPSV23).
At least 1 dose, 5 years after prior dose (but not recommended every 5 years unless underlying chronic disease).
Recommended for ages 19-64 years old for chronic medical conditions or cigarette smoking.
What is the recommendation for adults regarding the varicella vaccine?
2 doses if born in 1980 or later, if previously did not receive vaccine as a child.
If previously received 1 vaccine, deliver the second vaccine at least 4 weeks after the first dose.
What is the recommendation for adults regarding the MMR vaccine?
If no evidence of immunity, adults 19-65 years old x 1
Avoid in pregnancy
What is the recommendation for adults regarding the Herpes Zoster vaccine?
Adults 50 years and older, Shingrix (RZV) Recombinant Vaccine
2 doses (second dose 2-6 months after initial)
Recommended if previously received Zostavax
What is the recommendation for adults regarding the influenza vaccine?
All adults annually
What is the recommendation for adults regarding the HPV vaccine?
Recommended for males and females through age 26
Shared clinical decision-making 27-45 years
2 or 3 vaccine series
What is the recommendation for adults regarding the Hep A vaccine?
2 (Havrix) or 3 (Twinrix [hep a+b]) dose vaccine series
Adults 19+ not at risk but want protection
Those at high risk: Chronic liver disease, IV drug use, Men who have sex with men, Homelessness, Travel to endemic areas.
What is the recommendation for adults regarding the Tetanus/pertussis vaccine?
Single dose of Tdap 19 and older if not previously vaccinated for pertussis.
TD or Tdap booster every 10 years.
What is the recommendation for adults regarding the Hep B vaccine?
2 or 3 vaccine series
Adults 19+ not at risk but want protection.
High risk populations: High risk sex or drug behavior (IV drug use), incarcerated persons, Residents/ staff for care facilities Healthcare workers, Comorbid conditions (End stage kidney disease, Chronic liver disease, DM <60 years, HIV).
What is the recommendation for adults regarding cardiovascular disease screening?
Routine assessment of global cardiovascular risk in adults 40-79 years without known cardiovascular disease.
Framingham risk score.
What is the recommendation for adults regarding abdominal aortic aneurysm screening?
Men 65 - 75 years who have ever smoked, one-time AAA ultrasonography screen.
What are the drugs you should know that could help patients with smoking cessation?
What is the recommendation for adults regarding hyperlipidemia screening?
Perform lipid screening at 40-75 years.
What is the criteria to start a patient on a low to moderate dose statin for prevention of CVD events and mortality?
Any 1 of the following:
Age 40-75 years old.
No history of CVD.
One or more CVD risk factors.
10-year CVD risk of 10% or greater.
What is the recommendation for adults regarding hypertension screening?
Screen adults 18 years and older.
Annual screening for adults 40 and older; high risk, overweight, or African American patients; patients with prehypertension levels.
Screen every 3-5 years for adults 18-39 with normal blood pressure and no risk factors.
Obtain measurements outside the clinical setting for diagnostic confirmation prior to treatment.
What is the recommendation for the use of Aspirin in cardiovascular disease?
Only those who are the highest cardiovascular risk (ASCVD scores 20% or greater) and low risk of bleeding, and use 81 mg.
What is the recommendation for adults regarding diabetes screening?
Adults who have Hypertension OR Hyperlipidemia OR Ages 40-70 with BMI 25 or greater.
Use fasting plasma glucose / A1C
What is the amount of physical activity that is recommended for adults?
150 min moderate-intensity (brisk walking) exercise weekly (30 minutes per day, five to seven days per week)
75 min vigorous-intensity (jogging/ running) exercise weekly
What is the recommendation for adults regarding Chlamydia and Gonorrhea screening?
All sexually active women age 24 and younger.
Older women at increased risk for infection.
What is the recommendation for adults regarding HIV screening?
Ages 15 to 65 years, at least once
What is the recommendation for adults regarding unhealthy alcohol use screening?
All adult primary care patients should be screened annually for unhealthy alcohol use
What is considered unhealthy alcohol use in men and women?
Women: 7 drinks per week, 3 drinks on any one day
Men: 14 drinks per week, 4 drinks on any one day
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