Prevention Case Table & Timeline for Assignment Essay

Prevention Case Table & Timeline for Assignment Essay

MUST BE USED

Increase or Decrease Rows as needed.

 

1. A and B USPSTF recommendations
2. The rationale for the screening, counseling, and prevention med you have chosen
3. List references used in APA format at end of the assignment (just after the table)
4. Use a cover page for the assignment in APA format

 

 

 

 

SCREENING TESTS	Indicate A or B Recommendation (or other if you believe it is indicated) PLUS Rationale for this patient
Low-dose computed tomography (LDCT). This is a screening test for lung cancer. This is a radiographical test using CT scan technology. According to a review study by  Jonas et al. (2021), using low-dose CT scan screening for persons at high risk of lung cancer reduces mortalities.	Low-dose CT for lung cancer screening is a grade B recommendation according to the  (US Preventive Services Taskforce (2021). US Preventive Services Taskforce (USPSTF) recommends that adults Aged between 50 and 80 years with at least 20 park years of smoking should be screened for lung cancer. This patient has been smoking one park per year for 40 years before quitting five years ago. Even though he is not currently a smoker, he still meets the requirements for this screening because he quit smoking within the past fifteen years, as recommended by USPSTF. Smoking alongside aging has been considered a significant risk factor for various lung cancers. This patient has a chronic cough and reports relucent bronchitis suggestive of underlying chronic lung disease. Therefore, recommending this test is justifiable for this patient.
Postbronchodilator spirometry: This is a screening and diagnostic test for obstructive airway disease. This screening test will be used for screening for chronic obstructive pulmonary disease (COPD) in this patient.	The USPSTF does not recommend screening for COPD in asymptomatic patients. This is a grade D recommendation  (USPSTF, 2022). In this patient, spirometry will be indicated because of this presentation and his risk factors for COPD. I believe that this test is indicated in this patient because he has a chronic cough and 40-pack years of tobacco smoking.  Occasional early morning sputum and a history of recurrent bronchitis also warrant the use of this test in this patient. COPD belongs to a group of chronic lower lung diseases that contribute to the sixth leading cause of mortality in the United States. Therefore, early diagnosis through screening will benefit this patient’s quality of life.
Prostate-specific antigen (PSA) test: this is a blood test that assesses the level of a prostate-specific antigen in male patients. The level of PSA is expected to rise in men with prostate cancer because the malignancy would breach the basal membrane of prostate glands leading to structural distortion and leakage of PSA into the blood.	PSA-based screening for prostate cancer is a grade D recommendation by the USPSTF. These tests are discouraged for men above 70 years. Nevertheless, I would offer PSA tests for this patient to provide a baseline for subsequent assessment and diagnosis of prostate cancer. This test will be coupled with a kidney ureter and bladder ultrasound scan, whose results will be used in the subsequent visits to assess PSA velocity and doubling time. I would offer this test to this patient after having let him know about his risks for prostate cancer, such as his previous family shorty of prostate cancer.  Screening for his urinary symptoms using the International Prostate Symptom Score (IPSS) would rule out benign prostate hyperplasia before evaluating for prostate cancer. The digital rectal exam will be essential in making decisions regarding the appropriate screening tests for prostate problems in this patient.
Fasting Blood Glucose and HbA1c: These tests are commonly used to screen for type 2 diabetes mellitus and prediabetes. Fasting blood glucose provides an acute assessment for diabetes and prediabetes, while A1c qualitatively assesses chronic control of blood sugar.	Grade D recommendations by USPSTF discourage annual screening for prediabetes and type 2 diabetes mellitus for adults above 70 years of age. I believe that screening for prediabetes and type 2 diabetes (T2DM) these tests will be appropriate for this patient because his glycemic control for his years of stay in Africa is unknown. The American Diabetes Association recommends screening for T2DM and prediabetes among adults older than 45 years every three years. This is because the risk of prediabetes andT2DM increases with age, and adults above 75 years have an increased risk of worse outcomes (American Diabetes Association, 2020). This patient is also obese (BMI=32.4). In this patient, A1c levels will be an appropriate test to assess the quality of glycemic control in the past three months.  This will also set a baseline for future assessment of glycemic control and prediabetes screening.
Office blood pressure measurement (OBPM): Blood pressure measurement in the office is done as a routine physical exam for every patient. This examination is also a screening test for hypertension.	OBPM is for all adults (everyone above 18 years old) during the office visit and is a grade-A recommendation by the USPSTF. During this visit, this patient’s blood pressure was 142/88 mmHg. According to the  2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, this reading meets the diagnosis of hypertension  (Kaneko et al., 2020). However, I will have this patient’s blood pressure measured again outside the office setting to minimize the chances of using white coat hypertension as a diagnostic for hypertension in this patient. Obesity is a risk of hypertension in this patient that will warrant the use of this screening.
Antigen/antibody tests for HIV are rapid diagnostic tests for HIV. These tests are highly sensitive in HIV infection diagnosis.	This patient does not meet the USPSTF recommendation for HIV screening. However, he has risk factors because his HIV status is unknown, and he reports having multiple sexual partners occasionally when he was in Africa, where this disease is rampant.  On the grounds of unknown status and risky sexual behavior, I would offer this screening test to this patient despite falling out of the USPSTF age bracket (15-65 years) (USPSTF, 2019).  However, this screening will not be mandatory for this patient to show respect for his autonomy
Hepatitis C virus (HCV)	Adults between 18 and 79 years should be screened for hepatitis C virus infection per USPSTF grade B recommendations. In this patient, there is no clear risk factor for HCV part from the controversial sexual practices.
Ultrasonography for Abdominal aorta aneurysm	USPSTF recommends ultrasonography for men aged above 65 years. This patient needs this screening because he has a history of smoking. This is a grade B recommendation.
COUNSELING AREAS	Indicate A or B Recommendation (or other if you believe it is indicated)  PLUS Rationale for this patient
Diet	The USPSTF recommends behavioral counseling involving a healthy diet. This is a regrade B recommendation. The description of a healthy diet in this counseling aims at preventing disease, achieving a healthy weight, and supporting good health. For this patient, counseling will aim at reducing his daily coffee intake to less than 2 cups, including a variety of foods to balance his diet and reduce toast and frequent egg intake.
Physical activity	Grade B USPSTF recommendation also aims at achieving physical activity by ensuring that patient will engage in at least 150 minutes of moderate aerobic activity in a week  (USPSTF, 2020b). This counseling will ensure that the patient stays fit, manages his weight, and reduces his BMI from 32.4 to below 24.9.
Sexual behavior	High-intensity behavioral counseling is a grade B USPSTF recommendation aimed at STI prevention  (USPSTF, 2020a). This counseling will be appropriate for this patient because he has a history of occasional multiple sexual partners.  In-person counseling will be an appropriable intervention for this patient.
PREVENTION MEDS/Immunizations	Recommendation of USPSTF or CDC  PLUS Rationale for this patient
Covid-19 vaccine	To prevent coronavirus disease as recommended by the department of human and health services.
Shingles vaccine	The CDC recommends that older adults should receive the zoster (shingles) vaccine to protect them against herpes zoster virus infection  (Hall et al., 2021)
Pneumococcal conjugate vaccine	To protect against pneumococcal disease because there is no history of this vaccine’s use received by this patient in the past. Moreover, he is older than 65 years and thus eligible per CDC recommendations.
Tetanus, diphtheria, pertussis (Tdap) vaccine	Tdap vaccine will prevent this patient against tetanus and whooping cough. This patient has no evidence of receiving Tdap in adolescence. That notwithstanding, this vaccine will act as a booster vaccine for this patient in case he received the adolescent dose.
Multivitamin supplements (EquateTM  1 tab daily)	To boost the nutrient intake and prevent clinical delicacies. A study by Wallace et al. (2019) found that middle and adults above 60 who take multivitamin supplements have improved nutritional status and decreased odds of clinical deficiencies.

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References

American Diabetes Association. (2020). 12. Older adults: standards of Medical Care in diabetes—2020. Diabetes Care, 43(Supplement_1), S152–S162. https://doi.org/10.2337/dc20-s012

Hall, E., Patricia Wodi, A., Hamborsky, J., Morelli, V., & Schillie, S. (2021). Centers for Disease Control and Prevention: Epidemiology and Prevention of Vaccine-Preventable Diseases. Public Health Foundation.

Jonas, D. E., Reuland, D. S., Reddy, S. M., Nagle, M., Clark, S. D., Weber, R. P., Enyioha, C., Malo, T. L., Brenner, A. T., Armstrong, C., Coker-Schwimmer, M., Middleton, J. C., Voisin, C., & Harris, R. P. (2021). Screening for lung cancer with low-dose computed tomography: Updated evidence report and systematic review for the US Preventive Services Task Force: Updated evidence report and systematic review for the US preventive services task force. JAMA: The Journal of the American Medical Association, 325(10), 971–987. https://doi.org/10.1001/jama.2021.0377

Kaneko, H., Itoh, H., Yotsumoto, H., Kiriyama, H., Kamon, T., Fujiu, K., Morita, K., Michihata, N., Jo, T., Takeda, N., Morita, H., Yasunaga, H., & Komuro, I. (2020). Association of isolated diastolic hypertension based on the cutoff value in the 2017 American College of Cardiology/American Heart Association blood pressure guidelines with subsequent cardiovascular events in the general population. Journal of the American Heart Association, 9(19), e017963. https://doi.org/10.1161/JAHA.120.017963

US Preventive Services Taskforce. (2021, March 9). Lung Cancer: Screening. Uspreventiveservicestaskforce.org; US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

USPSTF. (2019, June 11). Human Immunodeficiency Virus (HIV) Infection: Screening. Uspreventiveservicestaskforce.org; US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening

USPSTF. (2020a, August 18). Sexually transmitted infections: Behavioral counseling. Uspreventiveservicestaskforce.org; US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/sexually-transmitted-infections-behavioral-counseling

USPSTF. (2020b, November 24). Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling Interventions. Uspreventiveservicestaskforce.org; US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd

USPSTF. (2022, May 10). Chronic Obstructive Pulmonary Disease: Screening. Uspreventiveservicestaskforce.org; US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chronic-obstructive-pulmonary-disease-screening

Wallace, T. C., Frankenfeld, C. L., Frei, B., Shah, A. V., Yu, C.-R., van Klinken, B. J.-W., & Adeleke, M. (2019). Multivitamin/multimineral supplement use is associated with increased micronutrient intakes and biomarkers and decreased prevalence of inadequacies and deficiencies in middle-aged and older adults in the United States. Journal of Nutrition in Gerontology and Geriatrics, 38(4), 307–328. https://doi.org/10.1080/21551197.2019.1656135

 

 

Timeline for Implementing Prevention

 

A timeline must be negotiated with the patient using shared decision-making: (use the timeframe YOU think is best based on patient needs and risks—e.g., you may think all outstanding prevention activities should be completed within 2 months and not use the 1-year timeline.  This is up to you and the patient.  For this assignment, assume the patient agrees with your recommended timeline. (Space things out as needed).  Provide your rationale for how you have made your decisions.  It is best to use bullets for the plan.

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Highest Priority:  Today or within the next two weeks:

• COVID-19 vaccine: as soon as today to prevent the adverse outcomes of covid-1 pandemic
• Blood pressure measurements within the next two weeks outside this office setting will be important to make a diagnosis of hypertension early and initiate treatment in time to prevent the risk of complications
• Fasting blood glucose and HbA1c within the next two weeks to diagnose prediabetes and T2DM
• Antigen/antibody tests for HIV and other STI screens within the next two weeks: to rule out these conditions as part of his predictive health prevention and promotion
• Hepatitis C virus (HCV) today: to rule out this infection despite lack of symptoms and risks

2 weeks-1 – Month:

• Spirometry to screen for COPD due to his chronic cough and start early treatment
• Low-dose CT scan to rule lung cancer as a cause of his respiratory symptoms

2-3 Months:

• Shingles vaccine: one-time shot
• Pneumococcal conjugate vaccine: one-time shot
• Tetanus, diphtheria, pertussis (Tdap) vaccine: one-time shot

4-5 Months:

• Prostate-specific antigen (PSA) test: this will depend on the progress and outcomes of genitourinary function and symptoms if the benign prostate hyperplasia is not diagnosed

6 Months:

• Ultrasonography for Abdominal aorta aneurysm

By 1 year:

• Dietary change and physical activity improvement to improve cardiovascular outcomes

 

Instructions:  You will use the assigned case study to prepare this assignment.  This assignment does NOT involve a live person–just the case study.

1. 1. Make a complete Prevention Plan for the case study patient provided to you based on the information you are given in the case study. Focus on the A & B USPSTF recommendations and ACIP Adult Immunizations. However, also be aware of any special risks the patient may have that need to be considered that might not routinely be listed in the A & B recommendations or even in the USPSTF.  FORor example, be sure to review the mini case study as a guide.  Please put the Screening, Counseling, and Prevention meds/Immunizations interventions in the table provided for this assignment—-you must use the table.  After listing the recommended intervention, in that same cell of the table, list your rationale for why the patient needs the service. For example, a service may be age recommended for this patient of 49 years or the patient may be a 20 pack year smoker.  It is required that you also identify HOW you will do the screening–e.g., which lab test or specific screening tool.
   2. You will upload the assignment when completed.  Be sure to include the authoritative source that supports what you recommend as a reference at end of the table (e.g., A or B recommendation USPSTF or ACIP-CDC or any other).
   3.  Develop and include a timed/staged Prevention Plan to address the Prevention Plan you developed in #1. Be sure to indicate the time frame you would consider for your interventions (e.g., this visit, next visit (when), by 1 month, by 6 months, and by 1 year).  You need to list the specific intervention in the time frame. This will be variable; you do not have to use the suggested time points we have listed.  Cite your brief rationale for your staging of the interventions.

3. List references used in APA format at end of assignment (just after the table)
4. Use a cover page for assignments in APA format.