N160 Final Study Guide

Primary Prevention

Focuses on eliminating risk factors before disease or injury develops. Includes health promotion (education, nutrition, environmental modifications, lifestyle changes, safe housing and working conditions) and specific protection (immunizations, hazard control, accident prevention, protection from carcinogens, and avoidance of allergens)

Secondary Prevention

Focuses on early detection and prompt treatment of disease in asymptomatic individuals. Includes screening, case finding, and selective examinations to treat or cure disease, prevent spread of communicable disease, prevent complications, and reduce disability. Goal is to detect and treat disease before it is clinically apparent

Tertiary Prevention

Focuses on limiting disability and providing rehabilitation after disease has already developed in symptomatic individuals. Examples include early ambulation after major surgery to reduce DVT risk, directly observed therapy for active TB, and physical or occupational therapy to restore highest level of functional ability

USPSTF Grade A

The service is recommended. High certainty that the net benefit is substantial. Clinicians should offer or provide this service

USPSTF Grade B

The service is recommended. High certainty that net benefit is moderate, or moderate certainty that net benefit is moderate to substantial. Clinicians should offer or provide this service

USPSTF Grade C

Clinicians should selectively offer or provide this service based on professional judgment and patient preferences. At least moderate certainty that the net benefit is small. Offer to selected patients depending on individual circumstances

USPSTF Grade D

The service is not recommended. Moderate or high certainty that it has no net benefit or that harms outweigh benefits. Clinicians should discourage use of this service

USPSTF Grade I

Current evidence is insufficient to assess the balance of benefits and harms. Evidence is lacking, poor quality, or conflicting. Clinicians should read the clinical considerations section; if the service is offered, patients should understand the uncertainty

Healthy People 2030 SDOH Domains

Five domains used to map social determinants of health and establish benchmarks for national health goals: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context

Screening: Key Principles

Five necessary elements must be present: a suitable condition, awareness of adverse consequences, a window of opportunity for detection, a valid test, and a follow

Sensitivity

The ability of a test to correctly identify those WITH the condition (true positives). Calculated as: True Positives divided by (True Positives plus False Negatives)

Specificity

The ability of a test to correctly identify those WITHOUT the condition (true negatives). Calculated as: True Negatives divided by (True Negatives plus False Positives)

Lead Time Bias

Overestimates the benefit of screening because survival time is measured from diagnosis to death. Earlier diagnosis makes survival time appear longer even if the person dies at the same time they would have without screening

Length Bias

The tendency for screening to disproportionately detect slow growing disease while completely missing fast growing disease simply because of the window of detectability between screenings

Selection Bias in Screening

People who are screened may differ from those who are not in important ways. If low risk people are disproportionately screened, screening benefits are overestimated. If high risk people are disproportionately screened, benefits are underestimated

Overdiagnosis Bias

Occurs when screen detected diseases are either non

Nurse Role in Screening

Requires a solid understanding of determinants of health, strong physical and psychosocial assessment skills, current knowledge of available resources, and the ability to convey respect, dignity, and value. Nurses must work collaboratively with clients to promote, maintain, and restore health

Maternal Mortality in the US

Approximately 700 to 900 women die annually from pregnancy or childbirth related causes. American women are more than 3 times as likely as Canadian women and 6 times as likely as Scandinavian women to die in the maternal period. Nearly 60% of deaths are preventable. More than 50% of pregnancy related deaths occur postpartum with the greatest concentration between 1 week and 1 year after delivery

Universal Infectious Disease Screening in Pregnancy

All pregnant persons are universally screened for syphilis, chlamydia, gonorrhea, HIV, and hepatitis B due to the risks of perinatal transmission and serious consequences to the newborn

Syphilis in Pregnancy

Rising incidence among women and newborns. Congenital syphilis can cause miscarriage, stillbirth, lesions on organs and bones, anemia, blindness, deafness, and death. It is treatable but has a high false positive rate

Chlamydia and Gonorrhea in Pregnancy

Most common STIs in the US and are often asymptomatic. Can have long term effects on health and fertility and can cause blindness in newborns. Both are treatable with antibiotics

HIV Transmission During Pregnancy

Can occur during pregnancy, labor and birth (through blood and fluid contact), and through breastmilk. Treatment can reduce transmission from approximately 25% to less than 1%

Hepatitis B in Pregnancy

Newborns of infected mothers are at risk for acute hepatitis that progresses to chronic disease in 80 to 90% of cases. Preventable with vaccine

Group B Streptococcus (GBS)

Normal vaginal flora that can pass to the baby during birth. Screened via vaginal swab close to delivery at 36 weeks. A positive result is managed with penicillin antibiotics during labor to prevent newborn infection

Rh Factor Incompatibility

Occurs when an Rh negative mother carries an Rh positive fetus. If fetal blood mixes with maternal blood, it triggers production of harmful antibodies. Prevented with RhoGAM given at 26 to 28 weeks and a second dose within 72 hours of delivery if the baby is confirmed Rh positive

RhoGAM and Consequences of Missed Prophylaxis

RhoGAM coats and hides foreign fetal cells from the mother's immune system. If prophylaxis is missed, antibodies formed during the first pregnancy can cross the placenta in subsequent pregnancies and attack fetal red blood cells, potentially causing severe anemia, brain damage, or stillbirth

Gestational Diabetes: Universal Screening

Screened between 24 and 28 weeks using a two step approach. Step 1: 50 gram non

Perinatal Depression Screening

10% of postpartum people meet criteria for major depressive disorder. Screened using the Edinburgh Postnatal Depression Screen at least once during pregnancy and postpartum (ACOG recommendation). Carries risk for suicide and postpartum psychosis

Genetic Carrier Screening vs. Diagnostic Testing

Genetic carrier screening evaluates the risk of passing on a genetic condition and does not change because it reflects the parents' genetic makeup. Genetic diagnostic testing definitively confirms whether a condition is present

Preeclampsia

A serious pregnancy complication typically occurring after 20 weeks, characterized by new onset high blood pressure (140/90 or higher) and signs of organ damage such as proteinuria. Severe features include BP of 160/110 or higher, severe neurological changes (confusion, altered mental status, seizures), breathing difficulties, and decreased fetal movement. Nurse role includes monitoring BP, urine, and deep tendon reflexes, medication administration (antihypertensives and magnesium sulfate), fetal surveillance, and emergency interventions

Vision Screening in Early Childhood

USPSTF recommends at least once in all children aged 3 to 5 years to detect amblyopia (lazy eye) or its risk factors including strabismus, media opacity/cataracts, myopia, and hyperopia

Visual Acuity Test

Tests the sharpness of central vision and determines whether corrective lenses are needed

Autorefractor

A machine that catches how well the eye focuses images and determines an initial baseline prescription for corrective lenses. Measures myopia, hyperopia, and astigmatism

Red Reflex Test

Rules out vision threatening or life threatening eye pathologies including congenital cataracts, retinoblastoma (a rare eye cancer), retinal detachments, and severe refractive errors

Cover Uncover Test

Assesses ocular alignment and detects eye movement disorders; used to rule out strabismus, phorias, and amblyopia

Corneal Light Reflex Test

Shines light into the eyes and observes its reflection; used to rule out strabismus and differentiate it from pseudostrabismus

Stereoacuity Test

Tests the brain's ability to combine slightly different images from each eye to perceive 3D space and fine depth perception. Used to screen for and monitor binocular vision disorders or conditions where the eyes do not work well together

Newborn Hearing Screening: 1

3

Otoacoustic Emissions Test

A newborn hearing test in which a tiny earphone is placed into the ear canal to play gentle clicking sounds and measure the acoustic echo reflected back by a healthy inner ear

Auditory Brainstem Response Test

A newborn hearing test in which small electrodes are placed on the baby's head along with soft earphones, measuring how the auditory nerve and brain respond to sound signals

Oral Health in Early Childhood

USPSTF recommends fluoride supplementation starting at 6 months for children in areas with fluoride deficient water, and fluoride varnish application starting at first tooth eruption. Clean gums with a soft damp cloth daily and brush teeth with a tiny amount of fluoridated toothpaste as soon as the first tooth erupts (usually 6 to 10 months); do not rinse after fluoride application. No juice for babies under 1 year and do not put infant to sleep with a bottle

Early Childhood Caries: Consequences

Cause pain, loss of teeth, future caries, impaired growth and weight gain, missed school days, and reduced quality of life

M

CHAT

Newborn Blood Screening

Performed at birth and again at 3 to 5 days up to 2 months using the Recommended Uniform Screening Panel (RUSP) to detect rare but serious conditions in asymptomatic newborns

Bilirubin Screening

Performed at birth to detect hyperbilirubinemia, which can lead to jaundice, neurotoxicity, and kernicterus if left untreated

CCHD Screening

Critical Congenital Heart Disease screening performed at birth using pulse oximetry to detect low oxygen levels that may indicate a serious heart defect, with the goal of reducing early infant deaths

Lead Screening Schedule

All children are screened at 6 months, 9 months, 12 months, and 24 months. Immigrant, refugee, and internationally adopted children may be at increased risk for lead exposure and are prioritized for additional targeted screening

Pediatric TB Screening

Targeted screening based on risk assessment, not universal. Methods include the Tuberculin Skin Test (TST), which requires 2 steps and is read 48 to 72 hours after administration by measuring induration (skin thickening, not redness) using diameter, or the Interferon Gamma Release Assay (IGRA) blood test

HPV Vaccination

Gardasil 9 targets high risk HPV strains 16 and 18, which are responsible for most HPV associated cancers. Recommended starting at age 9 to 12 years. Catch

Adolescent Depression Screening

Universal screening for ages 12 to 18. MDD is associated with lower school performance, recurrent depression in adulthood, other mental disorders, and increased risk for suicidal ideation, attempt, and completion. Validated tools: PHQ

Adolescent Anxiety Screening

Universal screening for ages 8 to 18. Anxiety disorders in childhood are associated with increased likelihood of future anxiety or depression. Validated tools include GAD

Adolescent Substance Use Screening

CRAFFT is the validated screening tool for adolescents aged 12 to 21. SBIRT is the broader framework (Screening, Brief Intervention, Referral to Treatment). USPSTF finds insufficient evidence to recommend screening for alcohol use in adolescents

HEEADSSS Interview

A developmentally appropriate psychosocial interview framework for adolescents covering: Home, Eating/Education/Employment, Activities, Drugs, Sexuality, and Self

Chlamydia and Gonorrhea: USPSTF Recommendations and Treatment

Screening recommended for sexually active women aged 24 and younger and older women at increased risk. Evidence is insufficient to assess benefits and harms of screening in men. Treatment: chlamydia typically with doxycycline or azithromycin; gonorrhea typically with cephalosporins

Syphilis: Natural History and Screening

USPSTF recommends screening asymptomatic nonpregnant adults and adolescents at increased risk. Stages: incubating (9 to 90 days), primary (chancre), secondary (6 months), early latent (1 year), late latent, then tertiary disease and/or neurosyphilis and/or late ocular/otic syphilis (usually 10 or more years after acquisition). Most common test is antibody blood test; treated with penicillin

Untreated Syphilis: Downstream Consequences

Can progress to late stage disease with inflammatory lesions throughout the body, cardiovascular or organ dysfunction, neurosyphilis, and increased risk of acquiring or transmitting HIV

HIV: USPSTF Recommendations and Testing

Screen all adolescents and adults aged 15 to 65 years; those younger or older and at increased risk should also be screened. All pregnant persons, including those presenting in labor with unknown status, should be screened. Test type is antigen/antibody immunoassay with very high sensitivity and specificity

HIV Treatment and PrEP

Treatable but no cure. Positive results lead to early initiation of antiretroviral therapy (ART) to reduce risk of progression to AIDS. When ART achieves viral suppression, no cases of virologically linked transmission have been observed. PrEP is a daily oral prophylactic treatment prescribed to persons at increased risk of HIV acquisition

STI Behavioral Counseling

USPSTF recommends behavioral counseling for all sexually active adolescents and adults at increased risk for STIs. STIs are frequently asymptomatic, which delays diagnosis and allows unknowing transmission to others

Intimate Partner Violence (IPV) Screening

Refers to physical, sexual, or psychological violence or stalking by a current or former partner. USPSTF recommends screening women of reproductive age including pregnant and postpartum women. Key nursing priorities: ensure privacy, use professional interpreter if needed, disclose confidentiality limits first, use trauma

HARK Assessment Tool

Used for intimate partner violence screening. Stands for: Humiliation, Afraid, Rape, Kick

HITS Assessment Tool

Used for intimate partner violence screening. Stands for: Hurt, Insult, Threaten, Scream

Unhealthy Alcohol Use Screening

USPSTF recommends screening in primary care settings for adults 18 and older including pregnant women, and providing brief behavioral counseling for those engaged in risky or hazardous drinking. Tools: AUDIT

Unhealthy Drug Use Screening

USPSTF recommends screening by asking about unhealthy drug use in adults 18 and older, when services for diagnosis, treatment, and care can be offered or referred. Tools include TAPS, NIDA Quick Screen, and DAST. USPSTF finds insufficient evidence to recommend screening for drug use in adolescents

Depression and Anxiety Screening in Adults

USPSTF recommends screening for depression in all adults including pregnant and postpartum persons. Tools: PHQ

SIGECAPS

A mnemonic for identifying symptoms of major depressive disorder: Sleep disorders, Interest deficit, Guilt, Energy deficit, Concentration deficit, Appetite disorder, Psychomotor retardation or agitation, and Suicidality

Life's Essential 8

The American Heart Association framework for cardiovascular health: Eat better, Be more active, Quit tobacco, Get healthy sleep, Manage weight, Control cholesterol, Manage blood sugar, and Manage blood pressure

ABCs of Cardiovascular Health

A: Assess CVD risk and antiplatelet therapy; B: Blood pressure and body fat; C: Cholesterol, cigarettes, and alcohol; D: Diet, diabetes, and CKM syndrome; E: Exercise and extend healthspan; F: Heart failure and atrial fibrillation

CKM Syndrome

Cardiovascular Kidney Metabolic Syndrome. Recognizes that cardiovascular disease, chronic kidney disease, Type 2 diabetes, and obesity cluster pathophysiologically through shared mechanisms of metabolic dysfunction, inflammation, and insulin resistance. Treating one condition in isolation misses opportunities to prevent the others. Earlier identification leads to earlier intervention and better outcomes

PREVENT Equation

Predicts 10

Lp(a) Screening

Lipoprotein(a) is an inherited cardiovascular risk factor independent of lifestyle with atherogenic, thrombogenic, and proinflammatory properties. Universal screening is recommended once in a lifetime. Levels typically do not change after age 5 except during significant inflammation, liver disease, or kidney disease. Genetically determined with little to no environmental or lifestyle influence

hsCRP

High sensitivity C

CAC Scan

Coronary Artery Calcium scan; a CT scan measuring calcium content in coronary arteries. Used only for primary prevention in asymptomatic individuals, not for those already diagnosed with heart disease. Useful for borderline to intermediate risk populations. Scores: 0 is no plaque (low risk); 1 to 100 is mild plaque (early coronary disease); 101 to 300 is moderate plaque (increased risk); greater than 300 is high plaque (high risk of future event)

Women Specific Cardiovascular Risk Factors

Include preeclampsia, gestational hypertension, gestational diabetes, preterm delivery, premature menopause, PCOS, early menarche, lupus, rheumatoid arthritis (higher prevalence in women), depression, chronic stress, and intimate partner violence

AHA Blood Pressure Categories

Normal: less than 120/80; Elevated: 120 to 129 and less than 80; Stage 1 HTN: 130 to 139 or 80 to 89; Stage 2 HTN: 140 or higher or 90 or higher; Severe hypertension: 180 and/or 120 or higher with no symptoms (call healthcare provider); Hypertensive emergency: 180 and/or 120 or higher with symptoms (call 911)

Blood Pressure: Lifestyle Interventions

Weight loss of at least 5% of body weight, DASH diet, reduced sodium (2 gram sodium diet), enhanced potassium intake, physical activity (150 min/week), alcohol reduction or abstinence, and stress management

Cholesterol Management and Statins

Statins block LDL synthesis. Lower for longer is better: cumulative LDL exposure drives atherosclerosis. USPSTF Grade B: prescribe statins for primary CVD prevention when CVD risk factors are present and 10

LDL Targets by Risk Category

Primary prevention borderline/intermediate: LDL less than 100, non

Tobacco Cessation: USPSTF Recommendation

Clinicians should ask all adults about tobacco use, advise them to stop, and provide behavioral interventions and FDA approved pharmacotherapy for nonpregnant adults. Nicotine replacement therapy should be used in combination with behavioral therapy and pharmacotherapy. E

Diabetes Screening: USPSTF Recommendation

Recommends screening for prediabetes and Type 2 diabetes in adults aged 35 to 70 who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions

Physical Activity Recommendations

At least 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise weekly, plus muscle strengthening activities. Sedentary behavior is an independent risk factor for CVD. USPSTF recommends offering or referring adults with CVD risk factors to behavioral counseling to promote healthy diet and physical activity (Grade B)

Cancer Epidemiology: Leading New Cases and Lifetime Risk

Men new cases: prostate (31%), lung and bronchus (10%), colon and rectum (8%). Women new cases: breast (32%), lung and bronchus (12%), colon and rectum (7%). Lifetime risk is 1 in 3 for both men and women. Cancer death rate decreased 33% from 1991 to 2019

Cancer Screening Barriers

Patient level: lack of awareness, cost concerns, discomfort, lack of trust, stigma, fear, lack of time, lack of paid time off, and transportation issues. Provider level: lack of familiarity with guidelines, insufficient time, disagreement with guidelines, and anticipated burden of managing abnormal results

Alcohol and Cancer

Alcohol is a known carcinogen and increases risk of developing mouth, throat, esophagus, larynx, breast, liver, and colon/rectum cancers. Public awareness of this link is low

Cancer Associated Infections

H. pylori: stomach cancer and non

Cervical Cancer: HPV Infection and Timeline

Nearly all cervical cancers are caused by HPV, transmitted through sexual contact and skin to skin contact. Most infections are transient and asymptomatic. Timeline: HPV infection occurs, viral replication over a few weeks, 90% of infections heal within 2 years, 10 to 30 years later HPV DNA integrates into tumor cell DNA, 0.8% develop cancer. Most cervical cancers are squamous cell carcinomas (9 out of 10 cases)

Cervical Cancer Risk Factors

Family history, smoking, weakened immune system, chlamydia infection, long

Cervical Cancer Screening: USPSTF Recommendations

Ages 21 to 29: cervical cytology (Pap test) every 3 years (Grade A). Ages 30 to 65: cervical cytology every 3 years only; high risk HPV testing only every 5 years; or co

Cervical Cancer Screening: ACS Recommendations

Ages 25 to 65: primary HPV test every 5 years preferred; co

Cervical Cancer Symptoms

Abnormal vaginal bleeding (after sex, between periods, or after menopause), heavier menstrual cycles, watery or foul smelling vaginal discharge, pelvic pain, and pain during intercourse

Colorectal Cancer Screening: USPSTF Recommendations

Ages 45 to 49: colorectal screening (Grade B). Ages 50 to 75: colorectal screening (Grade A). Ages 76 to 86: individualized decision. Polyps are the source of most colon cancers but fewer than 5% progress to colorectal cancer over 7 to 10 years

Colorectal Cancer Screening: ACS Recommendations

Ages 45 to 75: stool based or direct visualization tests. Ages 76 to 85: individualized decision based on preferences, life expectancy, overall health, and prior screening history. Ages 85 and older: no longer screened

Colorectal Cancer Screening Modalities

Stool based: guaiac based fecal occult blood test (yearly), fecal immunochemical test (yearly), FIT

Colorectal Cancer: Early vs. Advanced Symptoms

Early disease: none for precancerous polyps and early colon cancer. Advanced disease: red or black blood in stool, rectal bleeding, change in stool shape, abdominal discomfort, urge to have a bowel movement, new constipation or diarrhea, decreased appetite, and unintentional weight loss

Colorectal Cancer Risk Factors

Modifiable: excess body weight, physical inactivity, long term cigarette smoking, heavy alcohol consumption, high red or processed meat intake, and low calcium/whole grain/fiber diet. Non

Lynch Syndrome

An inherited genetic condition caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2, and EPCAM) that significantly increases risk for several cancers including colorectal cancer. Without these genes, DNA copying mistakes accumulate and can lead to cancerous growth

Breast Cancer Classifications

Ductal: begins in ducts that carry milk to the nipple. Lobular: starts in milk making glands. In situ: pre cancer, usually ductal carcinoma in situ (DCIS). Invasive/infiltrating: cancer that has spread beyond the duct or lobule

Breast Cancer Risk Factors

Prior breast cancer or DCIS, dense breasts, atypical hyperplasia on prior biopsy, chest radiation before age 30, combination HRT after menopause, early menarche or late menopause, later age at first birth or no full term pregnancy, never breastfed, first degree relative with breast cancer, known mutations (BRCA1/2, PALB2, TP53, PTEN, CHEK2, ATM, CDH1, STK11), alcohol, physical inactivity, and excess body weight after menopause

Breast Cancer Screening: USPSTF Recommendation

Biennial screening mammography for women aged 40 to 74 (Grade B). Insufficient evidence for women 75 years or older or those with dense breasts

Breast Cancer Screening by Risk Level

Average risk: standard mammography starting at age 40. Elevated moderate risk: annual mammography, consider supplemental screening, chemoprevention discussion. High risk: annual mammography plus MRI starting at age 30, genetic counseling, and risk reduction strategies