Health Screenings and Immunizations

Health Screenings and Immunizations

Introduction

  • Speaker: Jessica Klipsch, MSN RN CNE
  • Date Updated: 2/18/25

Levels of Prevention

Classification of Preventive Measures
  • Primary Prevention
    • Health Promotion
    • Specific Protection
  • Secondary Prevention
    • Early Diagnosis
    • Prompt Treatment
    • Disability Limitation
  • Tertiary Prevention
    • Recovery
    • Rehabilitation

Primary Prevention

Definition and Scope
  • Precedes disease/dysfunction
  • Interventions include:
    • Health promotion (e.g., education)
    • Specific protection (e.g., immunization, reducing exposure to carcinogens, occupational hazards)
  • Focus is to maintain/improve general individual/family/community health.
    • Types:
    • Passive: Not personally involved, e.g., public health efforts like clean water/sewage.
    • Active: Personally involved, e.g., lifestyle changes.

Secondary Prevention

Definition and Goal
  • Screening as a key component.
    • Goal: Identify individuals in the early, detectable stage of disease, limit disability, and treat early stages of the disease.
    • Interventions:
    • Similar to primary prevention but focused on individuals/populations with existing disease.

Tertiary Prevention

Objective and Actions
  • Objective: Return to an engaged place in society, maximize remaining capacity.
    • Includes:
    • Surveillance
    • Maintenance
    • Rehabilitation
    • Focuses on minimizing effects to prevent further spread, complications, or deterioration.
    • Applicable to diseases/disabilities that are permanent or irreversible (e.g., stroke, HIV infection).

Practice Activity

Matching Activities to Prevention Levels
  1. Cardiac rehabilitation, medication & surgery - Tertiary Prevention
  2. Cholesterol screening - Secondary Prevention
  3. Educate about healthy eating and exercise habits - Primary Prevention
  4. Flu shot - Primary Prevention
  5. BP check by pharmacist at the local pharmacy - Secondary Prevention

The Role of Public Health

Goals and Services
  • Decrease:
    • Preventable death rates.
  • Increase:
    • Life expectancy and quality of life.
  • Ensure:
    • Health equity through public programming (vaccines, screenings, education).
  • Provide:
    • Health surveillance/protection (e.g., monitoring water quality, food service inspections, sanitary sewage disposal, housing standards).

A Framework for Reducing Health Inequities

Key Factors Impacting Health Inequities
  • Social Inequities:
    • Prejudice based on race, gender, wealth, sexual orientation, ability.
  • Institutional Inequities:
    • Distribution of investments, power.
  • Living Conditions:
    • Physical environment, land use, housing, transportation, social environment.
  • Health Behaviors:
    • Tobacco use, low physical activity, poor nutrition, violence.
    • Access to healthcare, education, and social services.
Risk Factors
  • Increased chances of infections and injuries.
  • Diseases like chronic disease and substance use disorder.

Health Screening Importance

Purpose and Impacts
  • Vital tool for health care professionals to identify chronic conditions and risk factors prior to worsening.
  • Benefits include:
    • Early disease detection.
    • Reduced disease progression.
    • Early treatment of disease.
  • Acts as a preliminary step to identify individuals needing further diagnostic workup.

Advantages and Disadvantages of Screenings

Advantages
  • Usually simple and inexpensive.
  • Decreased time and cost for healthcare personnel.
  • Skilled professionals can offer care during the diagnostic stage.
  • Various screening options can be available, including group and individual screenings.
  • Educational opportunities for underserved populations.
Disadvantages
  • Potential for imperfection/margin of error.
  • Anxiety over false positives.
  • Costs associated with follow-up and difficulty in engaging follow-up providers.

Screening Instruments: Requirements and Validity

Key Elements
  • Must be safe, accurate, socially acceptable, and cost-effective.
  • Reliability: Can outcomes be reproduced across different settings?
  • Validity: How accurate is the tool in measuring what it claims to measure?

Considerations in Screening Processes

  • Typically performed by community health nurses, occupational health nurses, and school nurses.
  • Importance of follow-up:
    • Responsibility of care post-screening.
    • Clear communication regarding results.
  • Be aware of misinterpretation of results, including false negatives and positives.

Screening Guidelines and Organizations

Variation in Guidelines
  • Different organizations maintain unique guidelines regarding cancer screenings:
    • U.S. Preventive Services Task Force (USPSTF)
    • American Cancer Society
    • American College of Obstetricians & Gynecologists
    • National Institutes of Health.

Grading and Recommendations by USPSTF

Grades and Meanings
  • A: Service recommended with high certainty of substantial benefit.
  • B: Service recommended with high certainty of moderate benefit.
  • C: Selectively offer service based on patient preferences.
  • D: Recommend against service due to lack of net benefit.
  • I: Insufficient evidence to determine benefits versus harms.

Cancer Screenings

Breast Cancer
  • Risk increases with age, particularly for nulliparous women.
  • Recommendations:
    • Biennial mammography for women aged 40-74.
    • Notable disparities in diagnosis and outcomes for Black women versus White women.
    • Important significance as breast cancer is the second most common cause of cancer death among women in the U.S.
Cervical Cancer
  • Recommended to screen women aged 21-65:
    • Every 3 years with cytology alone or every 5 years with high-risk HPV testing alone.
    • Higher risk due to HIV infection, compromised immune system, etc.
Colorectal Cancer
  • Screening recommended for adults 45-75 years and selectively for ages 76-85.
  • Various screening methods include:
    • High-sensitivity guaiac fecal occult blood tests, stool DNA-FIT, colonoscopy.
Prostate Cancer
  • PSA screening recommendation for men aged 55-69 should be individualized.
  • Discussion of risks/benefits is encouraged before screening.
Blood Pressure and Other Screenings
  • Blood cholesterol and hypertension screening are key components for coronary health.
  • Screening for diabetes beginning at age 45 or younger depending on risk factors.

Immunizations

Definition and Significance
  • Immunization: The process of becoming protected against disease, often referred interchangeably with vaccination.
  • Vaccinations involve either live/attenuated or inactivated vaccines, each having distinct mechanisms of action and administration.
Types of Immunity
  • Active Immunity: Long-lasting protection developed by the immune system through exposure to disease-causing microorganisms.
  • Passive Immunity: Short-term protection obtained through injection of antibodies from another source.
Herd Immunity
  • Defined as when a significant portion of a community becomes immune, making spread of disease difficult.
  • A minimum vaccination percentage is required for herd immunity to be effective depending on disease virulence (e.g., measles requires 90-95% coverage).
Role of Nurses in Immunization
  • Key responsibilities include patient education, documentation of vaccination status, and motivating caregivers to ensure vaccinations are completed according to recommendations.

Common Vaccine Myths and Facts

Addressing Misconceptions
  • Myth: Giving too many vaccines at once is dangerous.
    • Fact: The immune system can handle multiple exposures effectively.
  • Myth: Vaccines cause diseases.
    • Fact: Inactivated vaccines are incapable of causing illness; live vaccines may mimic mild disease as proof of immune response.
Reliable Resources for Information
  • Indiana Immunization Coalition: Educates parents and professionals on vaccination.
  • CDC: Offers extensive vaccine and health information.