Primary, Secondary, and Tertiary Prevention:
Important in Certification and Practice

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC

The NP certification exam is a test of the broad-based knowledge base needed for practice. Primary, secondary and tertiary prevention activities, or promoting health, early disease detection and treatment of established disease are crucial parts of the NP role. This is typically reflected in exam content. A sound understanding of these concepts is important to being successful in your pursuit of certification and will also help you in clinical practice.

The US Preventative Services Task Forces’ Guide to Clinical Preventive Services (USPSTF) defines primary prevention measures as those provided to individualsto prevent the onset of a targeted condition.  Primary prevention measures include activities that help avoid a given health care problem. Examples include passive and active immunization against disease as well as health protecting education and counseling promoting the use of automobile passenger restraints and bicycle helmets. Since successful primary prevention helps avoid the suffering, cost and burden associated with disease, it is typically considered the most cost-effective form of health care.

Secondary prevention measures as those that identify and treat asymptomatic persons who have already developed risk factors or preclinical disease but in whom the condition is not clinically apparent.  These activities are focused on early case findings of asymptomatic disease that occurs commonly and has significant risk for negative outcome without treatment. Screening tests are examples of secondary prevention activities, as these are done on those without clinical presentation of disease that has a significant latency period such as hyperlipidemia, hypertension, breast and prostate cancer. With early case finding, the natural history of disease or how the course of an illness unfolds over time without treatment can often be altered to maximize well-being and minimize suffering.

Tertiary prevention activities involve the care of established disease, with attempts made to restore to highest function, minimize the negative effects of disease, and prevent disease-related complications. Since the disease is now established, primary prevention activities may have been unsuccessful. Early detection through secondary prevention may have minimized the impact of the disease.

Consider the following situations.

Ms. Leonard is a 72-year-old woman with chronic bronchitis who is a former cigarette smoker. Her medications include ipratropium bromide (Atrovent) and albuterol. Her primary prevention needs include:

A. Reviewing appropriate use of her medications
B. Receiving an annual influenza immunization
C. Obtaining spirometry measurement
D. Periodic colonoscopy.

Ms. Giordano is a 68-year-old woman with hypertension who resides alone in a private home. Her secondary prevention needs include:

A. Administration of pneumococcal vaccine
B. Mammography
C. Discussion of home safety to minimize fall risks
D. Assessment of the presence of S4 heart sound

The correct response in Ms. Leonard’s scenario is B. Influenza vaccine is the only activity that is aimed at disease prevention. Medication teaching and assessment of pulmonary function are part of treating her established disease. Periodic colonoscopy is an example of secondary prevention as it is a screening test for colorectal cancer.

The correct response in Ms. Giordano’s scenario is B. Secondary prevention activities are aimed at early disease detection; mammography is an example. Pneumococcal vaccine is an example of primary prevention as is education to minimize falls. The presence of S4 heard sound, indicative of diastolic dysfunction and frequently found in the presence of protracted blood pressure elevation, is part of the ongoing evaluation of the person with established hypertension. The goal of treating a person with hypertension is not simply to achieve normotensive status. Rather, tertiary prevention measures for Ms.
Giordano include avoiding or minimizing damage in the target organs of hypertensive; brain, eye, cardiovascular system, and kidney.

Whether preparing for NP certification or practice, keep in mind the patient’s primary, secondary as well as tertiary prevention needs. These concepts help prioritize and guide care.  
Reference, accessed 12.26.11
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Updated 12.30.11