1. Adult Health Prevention
Nsg 474

2. Primary Care: Definition
 The first point of care for the patient
 Primary care includes health
promotion, disease prevention, health
maintenance, counseling, patient
education, diagnosis and treatment of
acute and chronic illnesses in a variety of
health care settings
(e.g., office, inpatient, critical care, long-
term care, home care, day care, etc.).
 Primary care is performed and managed
by a provider often collaborating with
other health professionals, and utilizing
consultation or referral as appropriate.

3. USPSTF
Recommendations
 “A” and “B”discuss recommendations with eligible
patients and offer them as a priority.
 Give lower priority to services with “C”
recommendations; they need not be provided unless
there are individual considerations in of providing the
service.
 Discourage the use of services with “D”
recommendations unless there are unusual
additional considerations.
 “I” statements mean the evidence is insufficient to
determine net benefit.

4. Age 21-64
Leading causes of death
For primary care, consider biggest risks to health &
causes of mortality
 Malignant neoplasms
 Heart disease
 Motor vehicle crashes & unintentional injuries
 HIV infection
 Suicide & homicide

5. Ages 65 and older
Leading Causes of Death
 Heart diseases
 Malignant neoplasms: Lung, colorectal, breast
 Cerebrovascular diseases
 Chronic Obstructive Pulmonary Disease
 Pneumonia and Influenzae

6. The Well Adult Health
Exam
 Screening recommendations vary by age and underlying
risk factors
 Some differences between USPSTF and other groups
 Can consult AAFP, ACOG, American Cancer Society
 USPSTF will heavily influence what is covered under Affordable
Care Act of 2010
 All visits include current health history and physical
exam, lifestyle assessment, screening
 Health promotion also includes immunizations and
chemoprophylaxis (e.g. folic acid, etc)
 These screening recommendations are for individuals with
NO known risk factors.
 Presence of known risk factors shifts the perspective

7. Screening for all adults
USPSTF “A” and “B”
Rec.
 Behavioral
 Alcohol Misuse
 Substance abuse
 Tobacco
 Obesity/ inactivity
 Cardiovascular
 Aspirin for prevention of
heart disease
 Hypertension
 Lipid Disorders
 Sexual
 STIs, syphilis, HIV, pap
 Endocrine
 Diabetes
 Cancer
 Colorectal
 Mental
 Depression

8. The Well Adult (21-64 years) Visit
 Screening
 Blood pressure, pulse rate
 Height and weight, waist circumference (calculate
BMI)
 Lifestyle factors
 Obesity assessment, physical
activity, stress, sleep, social relationships, spiritual
health, safety
(home, sports, vehicular, firearms), tobacco/nicotin
e, alcohol use, other drug use, domestic
violence/abuse, financial (access to food and
medicine) – use a questionnaire or interview
 Preventive care – immunizations, chemoprophylaxis
 Screening – lipid disorders, STIs, diabetes, colorectal
cancer, depression, hypertension, breast cancer
(female)

9. 21-64 years of age
Injury Prevention
 Lap/shoulder belts
 Motorcycle/bicycle helmets
 Smoke detector
 Safe storage/removal of firearms

10. Older Adult 65+
Injury Prevention
 Lap/shoulder belts
 Fall prevention
 Safe storage of firearms
 Smoke detectors
 Set hot water heater to <120-130
 CPR training for household members

11. 21-64 years of age
Immunizations
 Tetanus-diphtheria (Td) boosters (one booster
every 10 years)
 Rubella (women of childbearing years)
 Influenza Vaccine
 Gardasil (up to age 26)

12. Screening for
Cardiovascular Disease -
Lipids
 USPSTF recommends
 A: Screening all men over age 35, and women>45 if
increased risk for CHD
 B: Screening men and women 20-34 who are at
increased risk for CHD
 C: No recommendation for men 20-35 or women >20
without increased risk for coronary heart disease
(CHD)

13. At risk for CHD…
 The presence of ANY of these factors constitutes
“risk”
 Diabetes
 Previous personal history of CHD (abdominal aortic
aneurysm, peripheral artery disease, carotid artery
stenosis)
 Family history of cardiovascular disease before age
50 in males or age 60 in females
 Tobacco use
 Hypertension
 Obesity (BMI=>30)

14. How to test
 Blood test for total cholesterol (TC) and HDL-C.
Can be fasting or non-fasting.
 Can use TC alone.
 To get LDL-C, need a fasting test & is more
expensive.
 No recommendation on using triglycerides in eval.
 Repeat abnormal tests.
 Diagnose dyslipidemia on basis of average value
of two separate tests.

15. Screening intervals
 Every 5 years
 Shorter for those with lipid levels near to stage
requiring treatment
 Longer for those with lower levels
 No clear guideline on age to stop screening
 If elderly client has never been screened – then test
 Most elders have elevated risk for CHD and would
benefit from screening

16. Evaluating test results
 See National Cholesterol Education Program of
the NIH for guidelines
 TC - <200 is desirable. If >200, do full lipids test
 HDL-C > 60 (F) is desirable. If <60, do full lipids test
 Treatment/mgmt of dyslipidemia not part of this
course
 Remember lifestyle modifications/diet are good for
all
 But not likely to be sufficient on their own
 Dietary modifications unlikely be sufficient
intervention

17. 21-64 years of age
Counseling
 STD Prevention: Avoid high-risk
behavior, condoms, female barriers, unintended
pregnancy
 Dental Health: Regular visits to dental care
provider; floss, brush teeth daily

18. Evaluate BP
 Remember correct procedures for collecting
accurate BP:
 Pt seated, back supported, feet on floor
 No tobacco, caffeine for 15 -30 minutes
 Pt resting in place 5-10 minutes
 Arm at heart level
 No talking by Pt or provider during test
 Check both arms. If more than 10 pts apart, repeat in
higher arm. Two readings 5 minutes apart.
 Use average of two highest readings

19. Evaluating BP
 Formal dx of hypertension is based on two
separate readings, more than one week apart.
 See JNC7 for full guidelines on management
 Dx and mgmt not part of this course

20. Lifestyle Interventions
 Weight reduction – ideally BMI <25
 DASH type eating plan
 Rich in fruits & vegetables
 Low-fat diary products
 Reduced overall saturated and total fat content
 Dietary sodium reduction to <2.4 mg Na or 6g NaCl
 Aerobic physical activity – 30 minutes brisk walking
almost every day
 Moderate alcohol consumption – max 2 drinks/day
for men, 1 drink/day for women