MMHA 6265 Amarina_Study_Guide

PREVENTION/HEALTH PROMOTION/IMMUNIZATION LEVEL OF PREVENTION PRIMARY o Goal: preventing the health problem, the most cost-effective form of healthcare o Example: immunizations, counseling about safety, injury and disease prevention SECONDARY o Goal: detecting disease in early, asymptomatic, or preclinical state to minimize its impact o Example: screening tests, such as BP check, mammography, colonoscopy, ASA in hx MI TERTIARY o Goal: minimizing negative disease induced outcomes o Example: in established disease, adjusting therapy to avoid further target organ damage. Potentially viewed as a failure of primary prevention, support groups IMMUNIZATION PRINCIPLES Community (herd immunity) o Immunize those who can be to protect those who cannot be immunized Active immunity o Resistance developed in response to an antigen (either infection or vaccine) Passive immunity o Immunity conferred by an antibody produced in another host (infant of mother or immune globulin Immunize unless sending to the hospital in an ambulance IMMUNIZATION PEARLS HX of Anaphylactic reaction Immunization to avoid Neomycin IPV, MMR, varicella Streptomycin, polymyxin B, neomycin IPV, smallpox Baker’s yeast Hepatitis B Gelatin, neomycin Varicella zoster Gelatin MMR Previously unvaccinated adults age 19-59 with diabetes should be vaccinated against Hepatitis B LIVE VACCINES o MMR ▪ Patients born before 1957 have likelihood of immunity due to natural infection ▪ Two doses 1 month apart for those never immunized o Varicella o Zostavax o Intranasal Flu Mist Avoid these with Pregnancy, immune suppression and with HIV (CD4 count < 200) – case by case situation Rotavirus o Avoid with SCID (severe combined immunodeficiency) SMOKING - PACK YEAR HX Number of packs-per-day (PPD) Multiplied by # of years smoked 5 A’S OF SMOKING CESSATION 1. Ask about tobacco use 2. Advise to quit 3. Assess willingness to make a quit attempt 4. Assist in quit attempt 5. Arrange follow-up PNEUMOCOCCAL IMMUNIZATION PCV13 associated with greater immunogenicity PPSV23 not licensed for children under 2 Indications: chronic lung disease, chronic cardiovascular disease, diabetes, chronic liver disease, chronic alcohol abuse, smokers, malignancy, chronic renal failure, asplenia, sickle cell, immunocompromised, HIV. PCV13 followed by PPSV23 one year later and then again at 65 o Exception: HIV (8 weeks later) If PPSV23 before age 65, repeat in 5 years HEPATITIS B Chronic Hep B can lead to hepatocellular carcinoma, cirrhosis and continued infectivity Childhood Hep B vaccines began in 1982 3 dose series 0, 1, 6 months If not vaccinated and exposed – HBIG and series If vaccinated and exposed – single dose vaccine