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

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

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

Primary prevention measures are those provided to individuals to prevent the onset of a targeted condition. Examples of such measures 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 are those that involve identifying and treating 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 finding of asymptomatic disease that occurs commonly and carries significant risk for negative outcome without treatment.

Screening tests are examples of secondary prevention activities, as these are done on patients without clinical presentation of disease in order to identify diseases with a significant latency period, such as hyperlipidemia, hypertension, and 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 morbidity and mortality.

Tertiary prevention activities involve the care of established disease, with efforts made to restore the patient to highest function, minimize the negative effects of disease, and prevent disease-related complications. Since the disease is now established, it is possible that primary prevention activities were unsuccessful. Early detection through secondary prevention could have minimized the impact of the disease.

Consider the following situations and select the most appropriate answer:

Case Scenario 1. Ms. Leonard is a 72-year-old woman with chronic obstructive pulmonary disease who is a former cigarette smoker with a 60 pack-year history. Her medications include a long-acting beta₂-agonist with inhaled corticosteroid and as-needed use of a short-acting beta₂-agonist.

Which one of the following interventions addresses a primary prevention need of this patient?

1. Reviewing appropriate use of her medications
2. Administration of annual influenza immunization
3. Obtaining spirometry measurement
4. Periodic colonoscopy

The correct response in Ms. Leonard’s scenario is B. Of the options listed, influenza vaccine is the only activity that is aimed at disease prevention. Educating patients about their medications and assessment of pulmonary function are part of treating established disease. Periodic colonoscopy is an example of secondary prevention, as this is a screening test for colorectal cancer.

Case Scenario 2. Ms. Giordano is a 68-year-old woman with hypertension who resides alone in a private home. Which one of the following interventions addresses a secondary prevention need of this patient?

1. Administration of appropriate pneumococcal vaccine
2. Mammography
3. Discussion of home safety to minimize fall risks
4. Assessment for the presence of abnormalities on the cardiac exam

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. Assessing for abnormalities on the cardiac exam, such as the presence of the S₄, which is 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 such patients include avoiding or minimizing damage in the target organs of hypertension: brain, eye, cardiovascular system, and kidney.

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

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