Barkley Risk Assessment

Annually

Complete physical exam

1. Height/weight (check for eating disorders)

2. Skin exam

3. Oral cavity (gingivitis/caries/etc.)

4. Hearing

5. Abuse/neglect/depression

6. BP (normal = <120/80 mmHg)

Start: 11-14 years

How often?

Series of two, 6 months apart

HPV

Start: 9-14 years

How often?

Series of three at 0, 2, and 6 months

HPV

Start: Age 15-26

How often?

PRN or with Pap smear

Syphilis screening (males and females)

Start: When sexually active

How often?

Monthly

Males: Breast/testicular self exams

Start: Adolescence

How often?

At least once; assess knowledge of prevention, contraception, protective barriers, etc.

HIV

Start: Aged 13-64 years; also depending on level of sexual activity or IV drug use

How often?

At least once in a lifetime; susceptible people should be tested periodically (e.g., history of STI or hep C)

Hepatitis B (triple panel test)

Start: Aged 18 years

How often?

Screen at least once except where prevalence of HCV infection os <0.1%

Hepatitis C

Start: Aged 18 years

How often?

Every 10 years

Tetanus-diphtheria (Td); substitute 1 dose of Tdap (Adacel) for Td

Start: As early as aged 7 years

How often?

Controversial: Revaccinate 1 time only for high-risk (e.g., college freshman living in dorms) after 5 years from last

Meningococcal (Menactra; Menveo)

Start: All adolescents aged 11-18 years

How often?

Annually

Influenza vaccine

How often?

PCV15 followed by PPSV23 >1 year (minimum 8 weeks for immunocompromised OR PCV20

Pneumococcal (pneumococcal conjugate vaccine [PCV15 or PCV20], pneumococcal polysaccaride vaccine [PPSV23])

Start: Aged 19-64 years with certain underlying conditions AND aged 65 years

How often?

Every 2 years if at risk or with any exposure to tuberculosis; annually for high-risk populations

PPD screening

Start: Once during adolescence, young adult

How often?

Every 5-6 years

Complete PE

Start: Age 20-39 years

How often?

Every 3 years

Pap smear (with gonorrhea and chlamydia screens)

Cytology (conventional or liquid-based)—Age 21-29

Start: Aged 21 years; American Cancer Society (ACS) recommends 25 years; Chlamydia testing for all <25 years

Discontinue at >65 years of age with 3 consecutive normal cytology tests and no abnormal tests in the past 10 years.

How often?

Every 5 years

HPV co-test (cytology + HPV test administered together)

Start: Not to be used for women aged <30 years (30-65)

How often?

Optional

Breast self-exam

Start: Aged 21 years

Not recommended >40 years

How often?

Series of three at 0, 2, and 6 months after shared clinical decision making

HPV (Gardasil 9)

Start: Aged 27-45 years

How often?

With every health care visit or at least once per year (normal <120/80 mmHg)

Blood pressure

Start: Now

How often?

Every 4-6 years; More often if cholesterol >200 mg/dL

Total cholesterol and HDL (or full fasting panel)

Start: Aged 20 years

How often?

Regularly

Skin self exams

Start: Now

How often?

Single dose at 32-36 weeks’ gestation

RSV

Start: Pregnant patients

How often?

Single dose

RSV

Start: >60 years of age

How often?

Every 6-12 months

Dental cleaning and checkup

Start: Now

How often?

Every 5-6 years

Complete PE

Start: Aged 40 years

How often?

Continue as long as the woman is in good health and expected to live 10+ years

Mammography

Start:

ACS: Option to start at aged 40 years; Annually for aged 45-54 years; Every 2 years after aged 55 years

For how long according to ACS?

For aged 75 years and older, no specific recommendations to discontinue

Mammography

Start:

USPSTF: Every 2 years for aged 50-74 years

For how long according to USPSTF?

Continue until at least 75 years of age; no specific recommendations to discontinue

Mammography

Start:

ACOG: Every 1-2 years starting at aged 40 years; Must start by aged 50 years if not initiated earlier

For how long according to ACOG?

Test if patient expected to live 10+ years; DRE: annually; PSA: If no prostate cancer is found after first test: PSA <2.5 ng/ml: every 2 years; PSA >2.5 ng/ml: Annually

Prostate screening (digital rectal exam [DRE] and prostate specific antigen [PSA])

Start: Controversial;

1. No risk factors: 50 years of age

2. Risk factors (e.g., African American, family history of prostate cancer): 45 years of age

3. Multiple risk factors (e.g., multiple family members with prostate cancer): 40 years of age

How often?

Stool based (annual fecal immunochemical test; annual high-sensitivity, guaiac-based fecal occult blood test; or multi target stool DNA test every 3 years) OR Structural (colonoscopy every 10 years; CT colonography every 5 years; or flexible sigmoidoscopy every 5 years). All positive results on noncolonoscopy screening should be followed up with colonoscopy.

Colorectal cancer (second leading cause of cancer deaths)

Start: Aged 45-75 years (average-risk in good health with life expectancy > 10 years)

How often?

Annually

Glaucoma screening

Start: Now

How often?

Series of two, second dose 2-6 months later

Herpes zoster (shingrix)

Start: Aged 50 years

How often?

Every 2 years

Complete PE

Laboratory assessments are warranted at this time.

Start: Aged 60 years

How often?

Once

Abdominal aortic aneurysm screen with ultrasonography

Start: Aged 65-75 years who have ever smoked; selectively screen if never smoked.

How often?

Risk assessment

This and patient education are vitally important components of the nurse practitioner role. Therefore, NPs need to be familiar with major causes of mortality among various age groups.

Adolescents (12-19)

Major causes of death in this age group:

1. Accident (unintentional injuries, including motor vehicle crashes [MVCs])

2. Suicide

3. Homicide

4. Malignancy

5. COVID-19

Young adult (20-39)

Major causes of death in this age group:

1. Accident

2. Suicide

3. Homicide

4. Heart disease

5. Malignancy

6. COVID-19

Middle Aged Adult (40-59)

Major causes of death in this age group:

1. Malignancy

2. Heart disease

3. Accidents

4. COVID-19

5. Liver disease

6. Diabetes mellitus

Elderly adult (>60)

Major causes of death in this age group:

1. Heart disease

2. Malignancy

3. COVID-19

4. Cerebrovascular disease

5. Chronic lower respiratory disease

Heart disease, cancer, COVID-19, unintentional accidents, stroke

Top killers of adults in the US

Lung

Cancer responsible for the highest mortality in women?

Ovarian

Leading GYN-associated cancer “killer?”

Breast

Highest incidence other than skin cancer in women?

Lung

Cancer responsible for the highest mortality in men?

Prostate

Other than skin cancer, the 2nd most common cancer in men and #2 cancer “killer?”

Lung

Leading cancer killer in both men AND women?

Colorectal

Second leading cancer in men AND women?

Dietary carbohydrate, fats, and protein dietary guidelines

1. Carbohydrates: 55%-60%

2. Fats: <30% total calories with <10% total calories being saturated fats

3. Protein: 0.8-1.0 g/kg/day (remainder of diet)

4. Overall nutritional and protein needs increase with illness, trauma, etc.

Exercise and health promotion

Patients over 35 years who have never had a program of exercise should have the following before instituting an exercise program:

1. Complete history

2. Physical exam

Antigens

Substances capable of inducing a specific immune respone

Antibodies

Molecules synthesized in reaction to an antigen

Active immunity

Conferred by antibody formation stimulated with a specific antigen such as typhoid fever immunization and toxoids

Passive immunity

Conferred by the introduction of antibody proteins such as gamma globulin injections or maternal immunity transferred to the fetus

Pneumococcal vaccine (PCV15, PCV20, PPSV23)

1. Those age 65 or older

2. Those age 19-64 who smoke or have asthma

3. People with lung, heart, liver, or kidney disease

4. Those with a chronic (long-term) diseases or conditions (e.g., diabetes, cirrhosis, sickle cell disease, cerebrospinal fluid leak, cochlear implant, and alcoholism)

5. People with a weakened immune system due to conditions or diseases (e.g., Hodgkin’s disease, lymphoma or leukemia, multiple myeloma, HIV/AIDs, kidney failure, spleen damage or no spleen, and an organ transplant)

6. Patients who take medications that weaken the immune system (e.g., chemotherapy drugs and long-term steroids, or who are receiving radiation therapy)

7. Those living in a nursing home home or long-term care home.

Hepatitis A vaccine

Should be considered for military personnel, travelers to endemic areas, and men who have sex with men, among others.

Hepatitis B vaccine (PreHevbio)

Should be given to all health care workers and high-risk patients including sexually active adults.

Mumps (MMR)

Vaccination for healthcare workers:

1. If born before 1957: Consider 1 dose of vaccine unless evidence of immunity

2. Immunity: Clinically diagnosed mumps or positive serology

3. Unless immune, employ 2 doses during mumps outbreak

4. If born during or after 1957: 2 doses of vaccine (if not previously given) unless immunity can be documented

5. Note: Post-vaccination serology may be negative (vaccination gives lower antibody titers than natural infection)

Meningococcal vaccine

Approved for ages 2-55

Recommended routinely for adolescents at ages of 11-12

Year visit and “catch up” for college students, military personnel, immunocompromised, travelers (Africa)

Clinical efficacy not determined

No current revaccination recommendations

Cost effectiveness is questionable

Herpes zoster vaccine

Shingrix: Recommended for immunocompetent adults aged 50 years and older

Asplenia

Vaccines for patients with this:

1. Both types of meningococcal vaccine (i.e., meningococcal conjugate [MenACWY] and serogroup B [MenB])

2. Pneumococcal vaccine

3. Hib vaccine

4. Influenza vaccine each year

5. Tdap vaccine

6. Zoster vaccine

7. HPV vaccine

8. Measles, mumps, rubella (MMR)

9. Varicella vaccine

Tdap, Influenza, Pneumococcal, Shingles

Routine vaccine for adults 65 yrs and older

“TIPS”