NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
NURS 6512 Assessment Tools and Diagnostic Tests 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.
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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 Reports, 17(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
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In nursing practice, diagnostic testing is a frequently regulated activity performed by midwives and nurse practitioners. Patient assessment and screening for further testing require special skills that are crucial in nursing practice. Over the years, several studies have evaluated the effectiveness of assessment and diagnostic tools in the management of medical conditions in both children and adults (Kiiskinen et al., 2020). However, the methodological quality of most of these researches has been poor. As a result, nurses are required to utilize credible and reliable sources to promote the use of the highest quality assessment and diagnostic tools based on available evidence. This discussion illustrates the use and effectiveness of the monospot test for adults based on available evidence from literature sources.
Mononucleosis (Mono) Spot Test
A monospot test is a form of Heterophile antibody blood test used in the assessment and diagnosis of infectious mononucleosis (IM) by determining whether the patient has contracted Epstein-Barr virus (EBV (Stuempfig & Seroy, 2020)). The test is mainly looking for two heterophile antibodies in the patient’s blood, which normally appear during the process of infection or after an infection with EBV causing mononucleosis. The disease is common among late teens and young adults in their 20s (Cai et al., 2021). The test is usually requested for patients with symptoms of mononucleosis such as sore throat, fever, enlarged spleen, fatigue, and tender lymph nodes around the back of the neck. Just like any other blood test, during the monospot test, a sample of blood is collected from the patient and taken to the lab, and placed on a microscopic slide where it is mixed with other substances and observed for clumping (Wang et al., 2021). If the blood clumps, the test is considered positive, confirming the diagnosis of mononucleosis. Negative results would however mean that there are no heterophile antibodies in the patient’s blood, which is common within the first 1 to 2 weeks of infection. the highest number of heterophile antibodies are normally present after 2 to 5 weeks of infection with EBV.
Validity and Reliability of Monospot Test
Previous evidence report optimum sensitivity and specificity displayed by the monospot test supporting its high validity and reliability for use among the adult population. A study conducted by Kiiskinen et al. (2020) revealed that the monospot test is very specific with a sensitivity falling between the range of 70% and 90% in the diagnosis of infectious mononucleosis. The test has only been reported to be weak among the pediatric population, but effective among the adult population. Cai et al. (2021) also found that the monospot test has similar validity to the Paul–Bunnell test, with a specificity of 100% and a sensitivity of 92.9%. The monospot test is thus considered reliable.
However, some cases of false positive results with the use of the monospot test have been reported from other disease processes like herpes simplex virus, rubella, lymphoma, lupus, human immunodeficiency virus, and Cytomegalovirus (Stuempfig & Seroy, 2020). High rates of false negative results have also been reported among patients within the first or second week of infection. The sensitivity rates have been reported to peak at about 6 weeks of presentation of symptoms. In addition to the varying rates of sensitivity, the monospot test has also been reported to be unable to identify cases of heterophile negative infectious mononucleosis (Wang et al., 2021). Despite 90% of cases of infectious mononucleosis being caused by EBV, the remaining cases of heterophile negative infectious mononucleosis will display negative results with the monospot test even though the patient continues to present with symptoms. Serum testing is usually recommended at this point.
Just like any other diagnostic test, clinicians must understand the above limitations associated with the use of the monospot test and appreciate the population in which the test works best. Even though it is an inexpensive and rapid test, significant limitations and concerns especially with its sensitivity must be taken into account. As such, it should only be utilized among adults and children above the age of 4 years (Kiiskinen et al., 2020). The clinician must also ensure that the patient has presented with the symptoms of infectious mononucleosis for not less than 2 weeks. The EBV-specific antibody testing should however be considered for actual confirmation of infectious mononucleosis caused by EBV. Serum testing is recommended for specific causative agents for patients with symptoms of IM but negative for spot tests.
Conclusion
In the assessment and diagnosis of patients, the selection of which screening tool to utilize is crucial. Clinicians are thus encouraged to utilize literature sources for evidence-based diagnostic tools, to promote accurate diagnosis of the patient. As discussed above, the monospot test is recommended for the diagnosis of infectious mononucleosis caused by EBV preferable among adults. The test is however weak among the pediatric population but can be used among children above the age of 4 years. Despite the high validity and reliability of the diagnostic tool, EBV-specific antibody testing is recommended to confirm the diagnosis of infectious mononucleosis caused by EBV.
References
Cai, X., Ebell, M. H., & Haines, L. (2021). Accuracy of Signs, Symptoms, and Hematologic Parameters for the Diagnosis of Infectious Mononucleosis: A Systematic Review and Meta-Analysis. The Journal of the American Board of Family Medicine, 34(6), 1141–1156. https://doi.org/10.3122/jabfm.2021.06.210217
Kiiskinen, S. J., Luomala, O., Häkkinen, T., Lukinmaa-Åberg, S., & Siitonen, A. (2020). Evaluation of the Serological Point-of-Care Testing of Infectious Mononucleosis by Data of External Quality Control Samples. Microbiology Insights, 13. https://doi.org/10.1177/1178636120977481
Stuempfig, N. D., & Seroy, J. (2020). Monospot Test. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539739/
Wang, E. X., Kussman, A., & Hwang, C. E. (2021). Use of Monospot Testing in the Diagnosis of Infectious Mononucleosis in the Collegiate Student-Athlete Population. Clinical Journal of Sports Medicine, Publish Ahead of Print. https://doi.org/10.1097/jsm.0000000000000996
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