Untitled Flashcards Set

What is health promotion?
Enabling people to increase control over, and to improve, their health.

What is health education?
Combination of learning experiences that improve health knowledge and attitudes.

What is wellness?
The optimal state of health for individuals/groups, realizing full potential physically, mentally, socially, spiritually, and economically.

Healthy People 2030 vision?
A society where all people can achieve their full potential for health and well-being across the lifespan.

National Prevention Strategy goal?
Increase the number of Americans who are healthy at every stage of life.

4 strategic directions of National Prevention Strategy?
Healthy environments, preventive services, empowered people, elimination of disparities.

7 priorities of National Prevention Strategy?
Tobacco-free living, preventing drug/alcohol abuse, healthy eating, active living, mental/emotional well-being, reproductive/sexual health, injury/violence prevention.

When was the ACA signed into law?
March 23, 2010.

Main goal of ACA?
Expand access to preventive services and insurance coverage.

How does ACA promote prevention?
Requires insurance to cover USPSTF Grade A/B services without copay, funds primary care, emphasizes prevention nationally.

What are social determinants of health (SDOH)?
Conditions where people are born, live, learn, work, play, worship that impact health outcomes.

Examples of SDOH?
Safe housing, access to nutritious food, education, transportation, literacy skills.

What are clinical preventive services?
Primary and secondary preventive health services like screenings, counseling, immunizations.

Examples of clinical preventive services?
Mammograms, cholesterol checks, vaccines, counseling to stop smoking.

What does USPSTF do?
Evaluates preventive services and gives them grades (A, B, C, D, I).

USPSTF Grade A means?
Strongly recommended; high certainty of substantial benefit.

USPSTF Grade B means?
Recommended; high certainty of moderate to substantial benefit.

USPSTF Grade C means?
Offer selectively depending on patient situation; moderate certainty of small benefit.

USPSTF Grade D means?
Discourage use; moderate or high certainty service has no net benefit or harm.

USPSTF Grade I means?
Insufficient evidence to assess benefits vs harms.

What grades must be covered under ACA?
Grades A and B.

What makes a good screening test?
Simple, rapid, inexpensive, safe, acceptable to patients.

What is reliability in screenings?
Consistency of a test across time, raters, and tools.

What is validity in screenings?
Accuracy of a test in identifying disease correctly.

Types of reliability in screening?
Intra-subject, intra-rater, inter-rater, instrument reliability.

What is sensitivity in a screening test?
Ability of a test to correctly identify those with the disease.

What is specificity in a screening test?
Ability of a test to correctly identify those without the disease.

Difference between screening and diagnostic test?
Screening = asymptomatic people; Diagnostic = confirms disease in symptomatic people.

BMI normal range?
18.5–24.9

Overweight BMI range?
25–29.9

Obesity BMI range?
30 and above.

Waist circumference cutoff for men?

40 inches

Waist circumference cutoff for women?

35 inches

Normal blood pressure range?
<120/<80 mmHg

Fasting blood glucose normal?
70–99 mg/dL

Prediabetes fasting glucose?
100–125 mg/dL

Diabetes fasting glucose?
126+ mg/dL

Target A1c for diabetics?
≤7%

Total cholesterol desirable level?
<200 mg/dL

HDL cholesterol goal?

40 mg/dL for men, >50 mg/dL for women

LDL cholesterol goal?
<100 mg/dL.

Definition of Metabolic Syndrome?
Having at least 3 of: large waist, high glucose, high triglycerides, low HDL, high BP.

What are the top causes of death in the U.S.?
Heart disease, cancer, stroke, chronic lower respiratory diseases, diabetes, Alzheimer’s disease.

What is a chronic disease?
A condition lasting over a year, requiring ongoing medical attention or limiting daily activities.

What are noncommunicable diseases (NCDs)?
Chronic diseases not spread person to person (like heart disease, diabetes, cancer).

Modifiable risk factors for chronic diseases?
Smoking, physical inactivity, poor diet, obesity, high blood pressure, high cholesterol.

Non-modifiable risk factors for chronic diseases?
Age, genetics, family history, ethnicity.

What is the Risk Arch from the Framingham Study?
Shows how risk factors like high BP, cholesterol, and smoking predict cardiovascular disease.

How does lifestyle medicine differ from conventional medicine?
Lifestyle medicine focuses on preventing, arresting, and reversing disease through behavior change rather than symptom management.

What are examples of lifestyle interventions?
Diet changes, exercise, smoking cessation, stress management, social support.

What was found in the Alameda County Study?
7 habits (no smoking, exercising, healthy weight, sleep, low alcohol, eating breakfast, not snacking) linked to better health outcomes.

What were the 7 health habits from Alameda Study?
No smoking, daily exercise, 7–8 hours sleep, healthy weight, moderate alcohol, breakfast daily, no snacking.

Main finding of the EPIC study?
Following 4 behaviors (no smoking, physical activity, healthy eating, low alcohol) dramatically reduced death risk.

What does the China Study show?
Plant-based diets are associated with lower rates of heart disease and cancer.

What is Metabolic Syndrome?
Cluster of risk factors increasing risk for heart disease and diabetes.

Criteria for Metabolic Syndrome diagnosis?
At least 3 of: increased waist circumference, elevated fasting glucose, elevated BP, elevated triglycerides, low HDL.

What percent of U.S. medical spending is on chronic diseases?
About 86%.

Examples of lifestyle medicine in action?
Mediterranean diet for heart disease, Diabetes Prevention Program with diet + exercise.

What are the 5 components of Lifestyle Medicine?
Plant-based nutrition, regular physical activity, stress management, avoiding risky substances, healthy relationships.

Why has chronic disease risen over the past century?
Sedentary lifestyles, processed foods, tobacco use, longer life spans.

What is the Mediterranean Diet shown to help with?
Reduced cardiovascular disease events (PREDIMED Trial).

Key dietary shifts leading to chronic disease?
Increase in processed foods, refined sugars, and saturated fats.

How fast can lifestyle changes impact chronic disease?
Sometimes within 30 days (blood pressure, glucose, cholesterol improvements).

What is the difference between secondary and primary prevention for heart disease?
Secondary = treating after disease appears; Primary = preventing disease from developing.

How does statin use differ in primary vs secondary prevention?
Statins are very effective for secondary prevention but less dramatic benefit for primary prevention.

What are some criticisms of statin use?
Risk of side effects like muscle pain, diabetes, memory issues, minimal benefit in low-risk patients.

Best proven way to prevent chronic disease?
Healthy diet, physical activity, no smoking, moderate alcohol use.

What is epigenetics?
How lifestyle and environment affect gene expression without changing DNA sequence.

Example of epigenetics and lifestyle?
Exercise and healthy eating can “turn off” genes linked to disease.

Benefits of healthy lifestyle on cardiovascular disease?
Lowers blood pressure, reduces LDL cholesterol, reduces heart attacks and strokes.

How does coronary artery bypass surgery impact survival?
Only about 10% of patients extend life significantly.

What happens to grafts after coronary artery bypass?
Many fail within 12–18 months (38–46% failure rate).

What’s better: stenting or lifestyle changes?
Lifestyle changes are better for long-term survival unless stenting is done immediately after a heart attack.

What is the #3 cause of death in the U.S. according to some data?
Adverse drug reactions (prescription drugs).

Key point about chronic diseases?
They are mostly preventable but poorly managed because modern medicine focuses on treatment, not prevention.

What is the #1 preventable cause of death in the U.S.?
Tobacco use.

How many chemicals are in cigarette smoke?
Over 7,000, with at least 250 harmful substances.

What are the three most dangerous components of tobacco smoke?
Nicotine, tar, and carbon monoxide.

What is nicotine’s primary effect?
Stimulates dopamine release = pleasure and addiction.

What does tar in tobacco smoke do?
Contains carcinogens that cause cancer.

What does carbon monoxide in tobacco smoke do?
Interferes with blood’s ability to carry oxygen.

How fast does nicotine reach the brain after inhaling?
7–10 seconds.

What neurotransmitter does nicotine primarily affect?
Dopamine.

What is the half-life of nicotine?
About 2 hours.

What is the half-life of cotinine (nicotine’s metabolite)?
About 16 hours.

Why do withdrawal symptoms occur?
Brain receptors reset during absence of nicotine, causing cravings and discomfort.

What are common nicotine withdrawal symptoms?
Irritability, anxiety, increased appetite, insomnia, cravings.

When do nicotine withdrawal symptoms peak?
2–3 days after quitting.

When do nicotine withdrawal symptoms usually subside?
Within 2–4 weeks.

What is Pack-Year History?
(Packs smoked per day) × (Years smoked).

Example of pack-year calculation: 1 pack/day for 20 years.
20 pack-years.

High-risk smoking history based on pack-years?
30+ pack-years.

Why is pack-year history important?
Guides lung cancer screening and cardiovascular risk assessment.

What is the Fagerstrom Test used for?
Measures nicotine dependence.

What Fagerstrom score indicates high dependence?
≥5 (on a 10-point scale).

Two key Fagerstrom questions for fast screening?
Time to first cigarette after waking, and number of cigarettes per day.

Symptoms of nicotine withdrawal to teach patients?
Cravings, mood swings, trouble sleeping, hunger.

Why do people smoke?
To cope with stress, emotions, habits, addiction.

Special considerations for adolescent smokers?
Highly influenced by peers, underestimate addiction risk.

Special considerations for pregnant smokers?
Increased risk of miscarriage, preterm birth, low birth weight.

Special considerations for non-daily smokers?
May still have dependence and withdrawal despite low frequency.

Why is smoking cessation difficult in patients with mental illness?
Higher addiction severity, use smoking for symptom management.

What is secondhand smoke?
Smoke inhaled from the environment, not directly from smoking.

What is the danger of secondhand smoke?
Causes lung cancer, heart disease, respiratory illnesses in nonsmokers.

What is thirdhand smoke?
Residue from tobacco smoke on surfaces that can cause harm.

What is the role of nurses in tobacco cessation?
Assess, educate, counsel, connect patients to quit resources.

What is the "5 A’s" approach for tobacco intervention?
Ask, Advise, Assess, Assist, Arrange.

What are the “5 R’s” for enhancing motivation to quit?
Relevance, Risks, Rewards, Roadblocks, Repetition.

Behavioral strategies for quitting smoking?
Identify triggers, develop coping strategies, use social support.

What is Nicotine Replacement Therapy (NRT)?
Provides controlled doses of nicotine to ease withdrawal symptoms.

What NRT products are available OTC?
Patch, gum, lozenge.

What NRT products require a prescription?
Nasal spray, inhaler.

How does Bupropion (Wellbutrin) help with smoking cessation?
Reduces cravings, decreases withdrawal symptoms, delays weight gain.

Who should NOT use Bupropion?
Patients with seizure disorders, eating disorders, or on MAO inhibitors.

When should Bupropion be started for smoking cessation?
1–2 weeks before the quit date.

How does Varenicline (Chantix) work?
Partially stimulates nicotine receptors to reduce cravings and block nicotine effects.

Major side effects of Varenicline?
Nausea, vivid dreams, mood changes.

When should Varenicline be started?
1 week before the quit date.

Which smoking cessation medication helps with weight control?
Bupropion (Wellbutrin).

How long should nicotine patches usually be worn?
16–24 hours depending on type.

Typical NRT patch starting dose for heavy smokers (>10 cigarettes/day)?
21 mg/day.

Key counseling point about nicotine gum use?
Chew and park between cheek and gum to absorb nicotine.

Key counseling point about nicotine lozenge use?
Let it dissolve slowly; do not chew or swallow.

What is the nicotine inhaler mainly used for?
Hand-to-mouth craving (habitual behavior support).

Key withdrawal symptom timing to teach patients?
Start: within 24 hours; Peak: 2–3 days; Duration: 2–4 weeks.

What are cognitive-behavioral strategies for quitting?
Problem solving, skills training, self-monitoring, stress management.

What is the ACCP Tobacco Treatment Algorithm?
Clinical guide for assessing dependence and creating a quit plan.

Why is setting a quit date important?
Provides a concrete goal and increases motivation.

What’s the advantage of combining NRTs?
Higher success rates by controlling both background and acute cravings.

Example of combining NRTs?
Patch + gum OR Patch + lozenge.

Why are household smoking bans important?
Encourage quitting, reduce relapse, protect nonsmokers.

Why are workplace smoking bans effective?
Decrease smoking prevalence and encourage quit attempts.

What impact does parental smoking have on children?
Increases likelihood of children becoming smokers.

How does secondhand smoke affect children?
Increases risk of asthma, respiratory infections, SIDS.

What is the major benefit of quitting smoking at any age?
Extends life expectancy and improves quality of life.

What is motivational interviewing’s role in tobacco cessation?
Helps clients resolve ambivalence and strengthen commitment to quit.

What are triggers for smoking relapse?
Stress, social situations, alcohol, boredom.

What is a lapse?
Temporary return to smoking after quitting.

What is a relapse?
Full return to regular smoking.

How to handle a lapse in smoking cessation?
Normalize it as a learning opportunity, encourage re-commitment.

Key patient education when starting smoking cessation meds?
Side effects, correct use, importance of adherence, setting realistic expectations.

Important factor for nicotine gum and lozenges effectiveness?
Use enough pieces per day — not just when cravings hit.

What is behavior change theory?
Framework explaining why and how people change behaviors.

What is the Social Ecological Model?
Health behaviors are influenced at multiple levels: individual, interpersonal, institutional, community, and public policy.

5 levels of the Social Ecological Model?
Individual, interpersonal, institutional, community, public policy.

Example of individual level influence?
Personal beliefs about exercise.

Example of interpersonal level influence?
Family encouraging healthy eating.

Example of institutional level influence?
Workplace offering gym memberships.

Example of community level influence?
Neighborhood has safe parks for exercise.

Example of public policy influence?
Laws banning smoking in public places.

What is reciprocal causation?
Behavior both shapes and is shaped by environment and social influences.

What is the Health Belief Model focus?
Beliefs about health problems, perceived benefits/barriers, self-efficacy.

What is the Theory of Planned Behavior focus?
Attitudes, subjective norms, and perceived control influence intention to perform a behavior.

What is the Social Cognitive Theory focus?
Behavior is influenced by personal factors, behavior itself, and environmental factors.

What is the Transtheoretical (Stages of Change) Model focus?
Motivation and readiness to change a behavior.

Stages of Change: Precontemplation?
No intention to change; unaware or in denial.

Key approach for Precontemplation stage?
Build awareness, empathy, no judgment.

Stages of Change: Contemplation?
Thinking about change but ambivalent.

Key approach for Contemplation stage?
Discuss pros/cons, connect change to personal values.

Stages of Change: Preparation?
Planning to act soon, gathering resources.

Key approach for Preparation stage?
Set small, realistic goals; action planning.

Stages of Change: Action?
Actively changing behavior.

Key approach for Action stage?
Provide support, reinforcement, problem-solving.

Stages of Change: Maintenance?
Sustained behavior change, working to prevent relapse.

Key approach for Maintenance stage?
Encourage long-term coping strategies and new goals.

What is Motivational Interviewing?
Client-centered counseling style to explore ambivalence and build motivation.

What is ambivalence?
Having mixed or conflicting feelings about behavior change.

Where is ambivalence most common in Stages of Change?
Contemplation stage.

Goal of Motivational Interviewing with ambivalence?
Explore both sides and strengthen change talk.

What does OARS stand for in MI?
Open-ended questions, Affirmations, Reflective listening, Summarizing.

Examples of open-ended questions?
"What worries you most about smoking?" "Tell me more about that."

Examples of affirmations?
"I can see you really care about your health."

Examples of reflective listening?
"It sounds like you're feeling torn about quitting."

What is summarizing in MI?
Pulling together client’s statements to show understanding and reinforce motivation.

What is the PACE spirit of MI?
Partnership, Acceptance, Compassion, Evocation.

What is DARN in MI?
Desire, Ability, Reason, Need — types of change talk.

What is CAT in MI?
Commitment, Activation, Taking Steps — moving toward action.

Examples of Desire talk?
"I want to quit."

Examples of Ability talk?
"I think I can change."

Examples of Reason talk?
"I need to be healthy for my kids."

Examples of Need talk?
"I have to stop smoking."

Examples of Commitment talk?
"I will quit next month."

Examples of Activation talk?
"I bought nicotine patches."

Examples of Taking Steps talk?
"I didn't smoke yesterday."

What is the Importance/Confidence ruler?
Ask client to rate 0–10: Importance of change and Confidence to change.

Key MI Principle: Resist the Righting Reflex.
Don't argue or push your opinion; guide client to find own reasons for change.

Thomas Gordon's Roadblocks to communication?
Ordering, warning, judging, advising, persuading — avoid these!

What is discord in MI?
Tension, resistance, or disagreement between client and counselor.

How to respond to discord?
Reflective listening, reduce pressure, return to client’s goals.

What is sustain talk?
Client statements favoring staying the same (opposite of change talk).

How to strengthen change talk?
Ask for elaboration, affirm strengths, reflect change language.

Goal of MI sessions?
Increase client’s own motivation and commitment to action.

What are the risks of vaccines?
Mild side effects like fever, soreness; very rare severe reactions.

What are the benefits of vaccines?
Prevent serious diseases, protect public health, herd immunity.

What is herd immunity?
When enough people are vaccinated to protect those who cannot be vaccinated.

Effective communication strategy for vaccine hesitancy?
Listen without judgment, provide facts, connect to patient values.

Example response to "I don’t want vaccines because diseases are rare now."
Diseases are rare because of vaccines; without them, they will come back.

Example response to "The flu shot gave me the flu."
Flu vaccines cannot cause the flu; immunity takes about 2 weeks to build.

Common parental concern about MMR vaccine?
Incorrect belief it causes autism.

What ingredients in vaccines concern some patients?
Aluminum, thimerosal (mercury-based preservative).

Is aluminum in vaccines safe?
Yes; the amount is very small and safe.

Is thimerosal still used widely in vaccines?
No; it has been removed from most childhood vaccines.

What are major barriers to vaccination?
Cost, access, misinformation, fear of side effects, distrust of health care.

Role of the nurse in immunizations?
Communicator, educator, advocate, care coordinator.

Nurse's role: Communicator?
Use good listening skills, provide nonjudgmental education.

Nurse's role: Educator?
Teach about vaccine schedules, safety, and benefits.

Nurse's role: Advocate?
Support patient's rights while encouraging vaccination.

Nurse's role: Care Coordinator?
Ensure vaccines are available, stored, administered properly.

Ethical principle: Autonomy?
Respect patient's right to make their own health decisions.

Ethical principle: Beneficence?
Do good for the patient.

Ethical principle: Non-maleficence?
Do no harm.

Ethical principle: Justice?
Ensure fairness in healthcare access and treatment.

Ethical principle: Veracity?
Be truthful with patients.

Ethical principle: Confidentiality?
Protect patient’s private health information.

What diseases do childhood vaccines prevent?
Chickenpox, pertussis, rotavirus, measles, mumps, rubella.

Key adult vaccines?
Influenza, pneumococcal, hepatitis A and B.

Symptoms of chickenpox?
Itchy rash, fever, malaise.

Symptoms of pertussis (whooping cough)?
Severe cough with "whoop" sound, possible cyanosis.

Symptoms of rotavirus?
Vomiting and watery diarrhea.

Symptoms of hepatitis A?
Nausea, vomiting, jaundice, dark urine.

Symptoms of pneumococcal disease?
Fever, stiff neck, shortness of breath.

Symptoms of influenza?
Body aches, fever, sore throat, diarrhea, vomiting.