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NURS 6512 Tools and Diagnostic Tests in Adults and Children

NURS 6512 Tools and Diagnostic Tests in Adults and Children

NURS 6512 Tools and Diagnostic Tests in Adults and Children

Assessment tests and tools play an important role in the diagnosis of various diseases conditions in both adults and children. In adults, the role of protein-specific antigen test vis-à-vis the diagnosis of prostate cancer cannot be underestimated. According to statistics, prostate cancer afflicts more people from the age of 65 and above in the United States (Adhyam & Gupta, 2012). Further, genetics play a role in the prevalence of the disease as more African-Americans have been found with the condition compared to their white counterparts whereas family history also predisposes men to it. Given that prostate cancer can advance either slowly or rapidly, screening plays an important role in its management. The purpose of this paper therefore is to examine the prostate-specific antigen test from the provided list of tools.

The IOM report has significant influence on nursing education and leadership. Firstly, as equal partners, nurses are leaders and have increased power to advocate change and revise restrictive barriers to practice. Nurses are recognized as primary care providers in certain states and can lead in care provision among inter-professional and multidisciplinary teams (Shelton et al., 2020). The IOM report has improved nurses access to better and advanced education as it recommended an increase in Bachelor of Science in Nursing (BSN) prepared-nurses to respond to the changing nature of healthcare provision. Through the recommendation and evidence-based practice (EBP) findings, many facilities introduced tuition reimbursement, instituted continuing education plans and promotions to incentivize nurses to attain higher educational qualifications.

Description of the Tool

            Prostate cancer is primarily screened through a blood-test referred to as the prostate-specific antigen-test (PSA). PSA is thus the biomarker for prostate cancer and is actually a protein produced by both malignant and non-malignant tissues in the affected region. The PSA test works through drawing of blood from a patient’s artery or vein, which will be sent to the laboratory for examination (Adhyam & Gupta, 2012). If the level of the PSA in the blood sample is more than 4 mg/ml, then cancer could be diagnosed. However, the utilization of this PSA level is still shrouded in controversy since such results may also indicate the presence of other diseases such as inflamed or enlarged prostate. Thus, in order to truly conclude the presence of prostate cancer, additional tests such as biopsy, ultrasound, prostate exams and even the recent multiparametric-prostate-magnetic resonance imagining (MP-MRI) become necessary (Stamatakis & Pinto, 2014).

PSA Test’s Validity, Reliability, Sensitivities, and Predictive Values

The validity of the PSA Test for screening cancer patients has always been a subject of discussion. Whereas the test is valid when it comes to cancer screening, particularly in early stages, its overall validity does not inspire confidence since its effect on mortality has not been determined (Leal, Welton, & Martin, 2018). Further, the PSA test’s reliability has also been called into question. Whereas the tool can detect abnormal levels of PSA in the blood, it does not offer an accurate diagnostic information concerning the state of one’s prostate. Thus, one needs to adopt the usage of other tests in order to achieve this objective. Also, it is not useful in screening early stages of this cancer as mentioned above without proving useful for late stage prostate cancer.

Moreover, the usage of PSA test has been characterized by diametrically different opinions from doctors and studies. For instance, while the tool has provided early detection of prostate cancer, its usefulness as regards saving lives has no clear cut answer. Also, the existence of the PSA levels of more than 4mg/ml has generated controversy in the scientific circles as it does not necessarily appear as a biomarker for prostate cancer (Laine, 2012).  Recommendations have also been made to use the upper range of values of normal when it comes to PSA for older adults. However, this only serves to reduce the sensitivity of the PSA tool for older adults’ prostate screening. Therefore, whereas the PSA cut off 4 ng/mL has expressed low sensitivities in studies, its specificity has increased as incidences of false positive tests are almost negligible.

References

Adhyam, M., & Gupta, A. K. (2012). A Review on the Clinical Utility of PSA in Cancer Prostate. Indian journal of surgical oncology, 3(2), 120-9.

Laine, C. (2012). High-value testing begins with a few simple questions. Annals of Internal Medicine, 156(2), 162–163. Retrieved from the Walden Library databases.

Leal, J., Welton, N., & Martin, R. (2018). Estimating the sensitivity of a prostate cancer screening programme for different PSA cut-off levels: A uk case study. Cancer Epidemiology, 52, 99-105.        

Stamatakis, L., & Pinto, P. A. (2014). Diagnostic value of biparametric magnetic resonance imaging (MRI) as an adjunct to prostate-specific antigen (PSA)-based detection of prostate cancer in men without prior biopsies. BJU International115(3), 381-388. doi:10.1111/bju.12639

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.
Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

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For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
• By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
• Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
• Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
• If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
o Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
o Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment

Assignment (3–4 pages, not including title and reference pages):
Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

• A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
o What is its purpose?
o How is it conducted?
o What information does it gather?
• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
Assignment Option 2: Child Health Case:

Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

By Day 6 of Week 3

Submit your Assignment.
Submission and Grading Information
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Submit Your Assignment by Day 6 of Week 3

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Week 3 Assignment 1

Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children

Many experts predict that genetic testing for disease susceptibility is well on its way to becoming a routine part of clinical care. Yet many of the genetic tests currently being developed are, in the words of the World Health Organization (WHO), of “questionable prognostic value.”
—Leslie Pray, PhD
Obesity remains one of the most common chronic diseases in the United States. As a leading cause of United States mortality, morbidity, disability, healthcare utilization and healthcare costs, the high prevalence of obesity continues to strain the United States healthcare system (Obesity Society, 2016).  More than one-third (39.8%) of U.S. adults have obesity (CDC, 2018). The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight (CDC, 2018).
According to the Centers for Disease Control and Prevention (CDC), the rate of childhood obesity has tripled in the past 30 years, with an estimated 13.7 million children and adolescents considered obese (CDC, 2018). When seeking insights about a patient’s overall health and nutritional state, body measurements can provide a valuable perspective. This is particularly important with pediatric patients. Measurements such as height and weight can provide clues to potential health problems and help predict how children will respond to illness. Nurses need to be proficient at using assessment tools, such as the Body Mass Index (BMI) and growth charts, in order to assess nutrition-related health risks and pediatric development while being sensitive to other factors that may affect these measures. Body Mass Index is also used as a predictor for measurement of adult weight and health.
Assessments are constantly being conducted on patients, but they may not provide useful information. In order to ensure that health assessments provide relevant data, nurses should familiarize themselves with test-specific factors that may affect the validity, reliability, and value of these tools.
This week, you will explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions. You will examine the validity and reliability of these tests and tools. You will also examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.

Learning Objectives

Students will:

• Evaluate validity and reliability of assessment tools and diagnostic tests
• Analyze diversity considerations in health assessments
• Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
• Apply assessment skills to collect patient health histories
________________________________________

Learning Resources

Required Readings (click to expand/reduce)

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 3, “Examination Techniques and Equipment”
This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.

• Chapter 8, “Growth and Nutrition”
In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.

• Chapter 5, “Recording Information” (Previously read in Week 1)
This chapter provides rationale and methods for maintaining clear and accurate records. The text also explores the legal aspects of patient records.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Centers for Disease Control and Prevention. (2018). Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood

This website provides information about overweight and obese children. Additionally, the website provides basic facts about obesity and strategies to counteracting obesity.

Chaudhry, M. A. I., & Nisar, A. (2017). Escalating health care cost due to unnecessary diagnostic testing. Mehran University Research Journal of Engineering and Technology, (3), 569.

This study explores the escalating healthcare cost due the unnecessary use of diagnostic testing. Consider the impact of health insurance coverage in each state and how nursing professionals must be cognizant when ordering diagnostics for different individuals.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

• Chapter 1, “Clinical Reasoning, Evidence-Based Practice, and Symptom Analysis”

This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.

Gibbs , H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120–124.

This study explores nutrition literacy. The authors examine the level of attention paid to health literacy among nutrition professionals and the skills and knowledge needed to understand nutrition education.

Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R. (2014). Weight status misperception as related to selected health risk behaviors among middle school students. Journal of School Health, 84(2), 116–123. doi:10.1111/josh.12128
Credit Line: Weight status misperception as related to selected health risk behaviors among middle school students by Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R., in Journal of School Health, Vol. 84/Issue 2. Copyright 2014 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research . Evidence Based Nursing, 18(2), pp. 34–35.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). History subjective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.

This History Subjective Data Checklist was published as a companion to Seidel’s Guide to Physical Examination (8th ed.) by Ball, J. W., Dains, J. E., & Flynn, J.A. Copyright Elsevier (2015). From https://evolve.elsevier.com

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
• Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Tools and Diagnostic Tests in Adults and Children

Document: Shadow Health Support and Orientation Resources (PDF)

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Shadow Health Nursing Documentation Tutorial (Word document)

Optional Resource

, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 3, “The Physical Screening Examination”
• Chapter 17, “Principles of Diagnostic Testing”
• Chapter 18, “Common Laboratory Tests”

Required Media (click to expand/reduce)

Taking a Health History

How do nurses gather information and assess a patient’s health? Consider the importance of conducting an in-depth health assessment interview and the strategies you might use as you watch. (16m)
Assessment Tool, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children – Week 3 (11m)

Assessment Tools, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children

One of the most prevalent chronic diseases in the US continues to be obesity. The high incidence of obesity continues to pressure the American healthcare system since it significantly contributes to death, morbidity, disability, healthcare utilization, and costs (Anderson et al., 2019). Anthropometric measures and information gathering on a client’s medical history, clinical and biochemical characteristics, dietary habits, current treatments, and food security situation are all included in nutrition assessment. Nutritional status is the body’s state concerning each nutrient and its overall weight and condition, and it plays a significant role in promoting health and preventing and treating disorders.

Rapid and easy identification of individuals who may be malnourished or at risk of malnutrition and require a more thorough nutrition evaluation can be done before a complete nutrition assessment. Checking for bilateral pitting edema, evaluating weight and mid-upper arm circumference (MUAC), and asking about recent illnesses and hunger are all simple nutrition screening techniques. Standardized training is needed for nutrition screening per local and national health regulations. The paper highlights health issues identified in a 5 – year old overweight black boy with overweight parents that are full-time employees.

Relevant Health Issues and Risks

Preschoolers of color (ages 2–5) have slightly higher rates of obesity than white children. Black children, however, have greater obesity prevalence rates by age 6. Lifestyle choices like nutrition, activity level, culture, environment, and parental judgments are all connected to obesity in preschoolers (Anderson et al., 2019). Issues identified in the 5- year -old boy are age, race, family history of obesity, full-time parental employment, and grandparent’s care. A myriad of health issues, including diabetes, heart disease, sleep apnea, stress, anxiety, depression, low self-esteem, eating disorders, hypertension, stroke, asthma, cancer, breathing problems, bone, and joint disorders, gall bladder disease, infertility, eating disorders, dyslipidemia, liver problems, high cholesterol, and sleep issues are all at risk for patients with childhood obesity.

In many high-income countries, paid work has increased in two-parent and lone-parent families during the past few decades. These changes are primarily the result of more mothers entering the workforce. It has been proposed that parental employment, specifically maternal employment, is a risk factor for childhood obesity. Lack of adequate leisure outside of work has been cited as a major mechanism for a relationship between employment and childhood overweight (Fryar et al., 2018). Due to time constraints, it may be challenging to promote a healthy lifestyle, including a balanced diet and regular mealtimes, encouraging kids to participate in physical activity, limiting their screen time, and having kids walk to school rather than be driven.

Grandparents can have a significant impact on the growth and development of their grandchildren. Parent-child care is associated with a 30% greater incidence of childhood obesity and overweight (Sadruddin et al., 2019). Some believe that “the bigger, the healthier” is still valid. Some grandparents could view a child’s larger weight as a sign of health. As a result, some kids are advised to eat larger portions and more frequently. Some grandparents may give children candy and fried foods as a gesture of love and goodwill. In some cultures, grandparents may even be more willing to excuse kids from completing duties around the house, which is a crucial exercise.

Gathering Further Information

A comprehensive history is vital in the patient’s evaluation. The Pediatric Obesity Algorithm is an evidence-based guide for diagnosing and treating obese children (Fryar et al., 2018). A healthcare provider should gain further information on the diet, activity level, family social history, including the parent’s working hours, birth and developmental history, and parental perceptions of obesity, and screen for any obesity-related complications. Because controlling these behaviors is essential to the success of any weight-management program, it is important to rule out the possibility of food-seeking behavior, bingeing, lack of satiety, purging, night-eating syndrome, and other abnormal feeding patterns.

For diet inventory, the healthcare provider should utilize the 24 – hour recall, food group, and food frequency questionnaire. The history of the breast- or bottle-feeding, the timing of the introduction of complementary foods, parenting techniques, cultural expectations, screen time, mealtime locations, bullying or social exclusion, the family’s willingness and capacity to make changes, and finally, financial constraints are all part of the family and social history. A child’s activity level should also be evaluated, along with the child’s access to secure exercise places and any necessary support for high activity levels. The practitioner must also evaluate non-academic screen time and sedentary time.

Questions posed to the parents and child include: Kindly give me a 24-hour recall of the foods you have taken. How often do you prepare homemade food? What is the estimated time you have with your child outside work? Kindly explain your house plan. What are some of the exercises and play activities that your child takes part in? Can you name some of your child’s friends? Has your child reported bullying or isolation by friends at any time? Do you give the grandmother any instructions on feeding and exercise of the child? Are there other obese family members? Do you think that your child has a weight problem? What are some of the risks the child may suffer from being overweight? What measures have you taken to deal with the issue?

Encouraging Active Parents’ Involvement

Parents serve as powerful role models for children aged 5 to 9 years, so it is highly advised that the family be involved in the care of the child who is obese. There should be a strict limit on non-academic screen time overall (Chai et al., 2019). A reduction in obesity is linked to substituting moderately intense physical activity for screen time. Children in this age range still need between 11 and 14 hours of sleep, preferably all at once, and naps cannot accomplish this during the day due to deficiencies at night. Sleep is still essential. The recommended daily caloric intake for obese children aged 5 to 9 is three meals and one or two wholesome snacks. Three servings of protein, 1-2 servings of dairy, and 4-5 servings of non-starchy vegetables should be consumed daily from each food group. They should not consume any fast food or beverages with added sugar. Children should be encouraged to try different meals, and portion amounts should be age-appropriate.

The parents should be actively involved by reading materials regarding the management of obesity. They may join hands and form support groups with parents dealing with the same issue. A nutrition plan and exercise should be developed in consultation with the nutritionist. The parents should also lose weight to serve as role models to their children in the weight management journey. The grandmother should be informed of the measures so that she can implement them when with the child. The parents should be encouraged to seek more secure jobs that ensure that either parent is available, especially after school. The patient should be encouraged that it is a gradual process that needs patience and consistency.

Conclusion

Childhood obesity is a chronic condition that can cause early comorbidity, mortality, and physical and psychological consequences. Lifestyle choices like nutrition, activity level, culture, environment, and parental judgments are all connected to obesity in preschoolers. Promoting healthy behaviors could help eliminate health disparities and enhance the quality of life. Programs should target young Black children and their families to lower the incidence of obesity. To prevent childhood obesity and overweight, nurses must offer comprehensive, culturally relevant strategies at the community, individual, and family levels.

 

 

References

Anderson, P. M., Butcher, K. F., & Schanzenbach, D. W. (2019). Understanding recent trends in childhood obesity in the United States. Economics & Human Biology, 34, 16-25. https://doi.org/10.1016/j.ehb.2019.02.002

Chai, L. K., Collins, C., May, C., Brain, K., Wong See, D., & Burrows, T. (2019). Effectiveness of family-based weight management interventions for children with overweight and obesity: an umbrella review: An umbrella review. JBI Database of Systematic Reviews and Implementation Reports17(7), 1341–1427. https://doi.org/10.11124/JBISRIR-2017-003695

Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2018). Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2015–2016. https://stacks.cdc.gov/view/cdc/58669

Sadruddin, A. F., Ponguta, L. A., Zonderman, A. L., Wiley, K. S., Grimshaw, A., & Panter-Brick, C. (2019). How do grandparents influence child health and development? A systematic review. Social Science & Medicine, 239, 112476. https://doi.org/10.1016/j.socscimed.2019.112476