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Chapter 2 Primary and Secondary Prevention (immunizations, cancer screening guidelines)

Terms in this set (19)

When admin Tdap or Td IM with clean, minor wound

Tdap (tetanus, diphtheria, acellular pertussis)
Td (tetanus, diptheria)
Unknown vaccination status, or <3 doses
No need if >3 doses, but if its been >10 years then need another vaccination
When to admin Tdap or Td IM all other wounds besides clean minor wounds (wounds older than 6 hours, contaminated with soil, feces, saliva, dirt, puncture/crush/avulsions/missiles/burns/frostbite)
unknown vaccination status or <3 doses
No need if >3 doses, but if its been more than 5 years since last dose then need another vaccination
When to admin Tetanus immunoglobulin (TIG) 250 units IM
wounds that aren't clean or minor, and unknown vaccination status or <3 doses
which tetanus vaccine given w/ each pregnancy despite history
Tdap
define anaphylaxis- what happens & common presentation
-acute, life threatening systemic reaction results from sudden systemic release of mediators from mast cells and basophils
-rapid onset (minutes to hours) after exposure to allergen
-presentation: urticaria (hives), angioedema, sudden reduction of BP (less than systolic 90 or >30% decrease in BP from baseline), GI sx, respiratory compromise
what do you do if pt has anaphylactic reaction in primary care office?
1. ABCs
2. put pt in supine position
3. activate EMS, facilitate ED transfer
4. administer IM epinephrine anteriolateral thigh
5. give H1 blocker diphenhydramine, H2 blocker famotidine
6. obtain IV access, oxygen, monitor
where do immune globulin come from
concentrated solution of antibodies derived from pooled donated blood
1. define live, attenuated virus vaccines
2. what are the 3 live attenuated vaccines
3. who shouldn't receive them
1. vaccine prepared from live microorganisms cultured under adverse conditions leading to loss of virulence but retention of ability to induce protective immunity

2. MMR, Varicella, Intranasal influenza virus (FluMist)

3. pregnant women, severely immunocompromised, HIV with CD4 counts <200
who is at higher risk of influenza related complications
-kids 6-59months, adults older than 50
-adults/children with chronic pulmonary, cardiovascular (except isolated HTN), renal, hepatic, neurologic, metabolic disorders (including DM)
-immunocompromised
-women who are or will become pregnant during flu season
-nursing home residents/Long term care facilities
-american indians/alaska natives
-extremely obese (BMI >40)
what are the characteristics of a man who SHOULD be screened with PSA for prostate cancer
60 years old, african american, generally healthy, father HAD prostate cancer
who should have genetic risk assessment for BRCA mutation testing
women w/ personal or fam hx of breast, ovarian, tubal, or peritoneal cancer or ancestry associated w/ breast cancer susceptibilty 1 and 2 (BRCA 1/2) gene mutations

Not recommended routine risk assessment, genetic counseling or testing for women w/o personal or fam hx
when should you start screening for colorectal cancer?
annual test-
DNA test-
flex sig-
colonoscopy-
what age do you continue to?/ages that are gray area based on health?/when do harms outweigh benefits?
start age 45.
annual test- guaiac-based FOBT or FIT test
DNA test- 3 yrs
flex sig-5 yrs
colonoscopy-10 years
continue to age 75, 76-85 gray area based on health risk, 85+ harms outweigh benefits
Endometrial Cancer screening guidelines
Age to start for healthy women?
How is it performed?
Age to start screening for women with hereditary non-polyposis colon cancer (HNPCC)?
Healthy women- at time of menopause, report unexpected vag bleeding/discharge/spotting
Endometrial biopsy
HNPCC- age 35
Lung cancer screening guidelines
How often?
How is it done?
What ages + smoking amount + pack years?
When can it be discontinued?
annual
low dose computed tomography (LDCT)
start about age 50-74 in fairly good health, with >20-30 pack year history, who currently smoke or has been less than 15 years since quitting.
continue as long as pt in good health to age 74.
Breast cancer screening guidelines
age to start mammogram?
how often to get mammo?
when to stop screening?
start mammo- age 45-54
annually until age 55, then consider q2yrs
over 75 no real benefit to continue unless excellent health and functional status and may benefit either peace of mind/QOL by doing it
cervical screening guidelines
age to begin?
<30 years old how often for HPV?
<30 years old how often for Pap?
Ages 30-65 how often for pap, HPV, or HPV/pap co-test?
when can the screening stop?
Begin age 21, rate of HPV high in sexually active adolescents the immune system able to rid of the infection in 1-2 yrs. adolescent cervix is immature and more likely to have more HPV-related precancerous lesions but tend to resolve on their own. doing an excision of dysplasia increases risk for premature births.
<30 yrs old HPV- q5 yrs
<30 yrs old Pap- q3 yrs
30-65- pap q3, HPV q5, or pap/HPV q5 yrs
stop at age 65 if negative prior results
at what CD4 levels is it safe to give live vaccines?
>200
what 3 vaccines are live attenuated?
who do you need to be cautious giving to?
MMR (mumps/measles/rubella)- pregnancy r/t theoretical risk of passing virus to unborn child
Varicella
Intranasal influenza virus vaccine (LAIV4)

severe immunocompromised, adults w/ HIV-check guidelines
"egg allergy" when to give influenza vaccine
Okay to give normally: only hives
rxn to egg of angioedema, resp distress, lightheadedness, recurrent emesis, required epinephrine/emergency medical intervention are still appropriate to receive influenza vaccine (IIV, RIV4, LAIV4) best to do in medical setting & monitor for 15 min after

Contraindications- previous severe allergy to egg based IIV4 or LAIV4 influenza vaccine
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