NURS 6512 Assignment 1 Case Study Assignment Assessment Tools and Diagnostic Tests in Adults and Children

NURS 6512 Assignment 1 Case Study Assignment Assessment Tools and Diagnostic Tests in Adults and Children

NURS 6512 Assignment 1 Case Study Assignment Assessment Tools and Diagnostic Tests in Adults and Children

Colonoscopy is an essential procedure that evaluates the colon mucosa for cancer, adenomas, and inflammation. The purpose of this paper is to outline the function of colonoscopy, the procedure followed when using colonoscopy, and the information generated. The paper will also outline the validity, reliability, sensitivity, and positive predictive values of colonoscopy. 

Colonoscopy in Healthcare

Colonoscopy acts as a diagnostic, elective, and therapeutic tool within healthcare settings. It is executed using a colonoscope, a hand-held flexible tube-like tool with a high-definition camera at the tip (Saito et al., 2021). The colonoscope also constitutes accessory channels that help in the insertion and fluids to cleanse the colonic mucosa and the colonoscope lens. The camera project visual data on a screen that shows abnormalities and overgrowth of the colonic wall. The data also helps in evaluating, biopsy, and removal of mucosal lesions using the accessory channels. 

Colonoscopy Purpose

Colonoscopy is indicated for various reasons. First, it is used for screening colonoscopies to assess for colorectal cancer in patients at high risks like those with a history of inflammatory bowel disease, hereditary polyposis, a family history of colorectal cancer at age <60 years, and surveillance after resection of colorectal cancer (Saito et al., 2021). Healthcare guidelines recommend starting the screening at age 45 and after every 10 years. As an elective procedure, colonoscopy evaluates symptoms like inexplicable changes in bowel habits, inflammatory colitis, GI bleeding, weight loss among the geriatrics, persistent abdominal pain, and iron deficiency anemia (Saito et al., 2021). Therapeutically, colonoscopy helps with excision and ablation of lesions, removal of foreign bodies, stenosis dilation, palliative management of known neoplasms, and handling of bleeding lesions. 

Colonoscopy Performance

Generally, colonoscopy can be performed in an outpatient center or within a hospital. The process duration ranges between 30 and 60 minutes. It begins with the insertion of an IV needle in the arm for pain medicine, anesthesia, or sedatives. These help to numb pain during the procedure. Once sedated, the patient then lies on a table and the colonoscope is inserted into the colon through the anus. The scope inflates the large intestines with air for clarity as the camera sends a video image to a monitor (Saito et al., 2021). The scope is adjusted for clarity and better viewing. Once at the opening of the small intestines, the scope is withdrawn as the doctor inspects the lining of the large intestines again. The process looks for the presence of colon polyps and bowel cancer to address unexplained diarrhea, blood in the stool, and abdominal pain. 

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Reliability and Validity of Colonoscopy

Colonoscopy remains the gold standard for colon detection despite the emergence of new screening methods. It is safe and accurate since Mack et al. (2022) explain that it yields a 94% accuracy rate in both outpatient facilities and hospitals (Mack et al., 2022). Due to its high accuracy, experts recommend a baseline colonoscopy at age 50 and a repeat of the exam every 10 years. Colonoscopy is a reliable test because it reduces the risk of colorectal cancer by 72% and reduces mortality rates by 81% (Pilonis et al., 2020). With a high accuracy rate and higher positive outcomes, the procedure remains valid and reliable. 

Colonoscopy reliability, sensitivity, and Positive Predictive Values

Colonoscopy is a sensitive test that correctly identifies patients with colon diseases. Kadari et al. (2022) affirm that it is more sensitive compared to barium enema x-rays and “virtual” colonoscopy in detecting colon polyps and cancer. The researchers calculated the sensitivity of the three imaging methods based on a per-patient, per-lesion, and per histology basis. According to the study, colonoscopy found 98% of lesions 10 millimeters or larger compared to only 48% for barium enema and 59% for virtual colonoscopy (Kadari et al., 2022). Further, for smaller six-to-nine millimeters lesions, colonoscopy identified 99% of the lesions compared to 35% for barium enema and 51% for virtual colonoscopy. For adenomas, colonoscopy detected 98% of 10 millimeters or larger adenomas compared to only 55% in barium enema and 64%f for CT colonography. Accurate detection of polyps is essential because it dramatically reduces the chances of developing colon cancer. 

The tool sensitivity is further confirmed by Martín‐López et al. (2017) who estimated that the sensitivity and specificity per patient for polyp detection in asymptomatic patients is 92.5 percent and 73.2 percent for colonoscopy, but only 66.8 percent and 80.3% for CT colonoscopy. According to Issa and Noureddine (2017), colonoscopy finds and resects precancerous lesions and neoplasia across the whole large bowel. It is also a definitive examination when other screening tests are positive. The test is relatively safe because it results in less than 1/1000 perforation rate. 

For the predictive values, Issa and Noureddine (2017) outline a study among 1179 patients where 889 underwent colonoscopy. The result indicates that 253 colorectal neoplasia cases were diagnosed including 219 polyps and 35 cancers. The number of advanced adenomas diagnosed was 209. The authors calculated the predictive values of the colonoscopy to be 3.9% for cancer, 12,9% for advanced adenoma, and 25% for adenoma overall. The results were a bit dismal compared to the positive predictive value of the average risk population selected by a positive fecal occult blood test (FOBT). Colonoscopy positive predictive rate after positive FOBT ranges from 7.5% to 10% for cancer, 15% to 27% for advanced adenoma and 32% and37% for adenoma (Issa & Noureddine, 2017). The study confirms that patients at risk of colon-related pathologies may benefit from fecal occult blood testing to select the best candidate for colonoscopy. Regardless, the optimal method remains the colonoscopy in all patients. 

Conclusion

Colonoscopy remains a crucial tool when diagnosing colon-related pathologies. It evaluates the large intestines and the distal portion of the small intestines. The tool used consists of accessory channels, a camera, and fluid to cleanse the colonic mucosa. It helps in screening colonoscopies, for elective purposes, and therapeutic purposes like ablation of lesions and removal of foreign bodies among others. The procedure is executed in a hospital or an outpatient and it lasts for around thirty to sixty minutes. It is safe, accurate, well-tolerated, and has a higher sensitivity. The positive predictive values are slightly lower however it remains the most ideal choice when handling issues affecting the colon. 

References

Issa, I. A., & Noureddine, M. (2017). Colorectal cancer screening: An updated review of the available options. World journal of gastroenterology, 23(28), 5086. https://doi.org/10.3748/wjg.v23.i28.5086

Kadari, M., Subhan, M., Parel, N. S., Krishna, P. V., Gupta, A., Uthayaseelan, K., … & Sunkara, N. A. B. S. (2022). CT Colonography and Colorectal Carcinoma: Current Trends and Emerging Developments. Cureus, 14(5). https://doi.org/10.7759/cureus.24916

Mack, M., Luzum, M., & Wesorick, D. H. (2022). Annals for Hospitalists-March 2022. Annals of Internal Medicine, 176(3), HO3. https://doi.org/10.7326/AWHO202203150

Martín‐López, J. E., Beltrán‐Calvo, C., Rodríguez‐López, R., & Molina‐López, T. J. C. D. (2014). Comparison of the accuracy of CT colonography and colonoscopy in the diagnosis of colorectal cancer. Colorectal Disease, 16(3), O82-O89. https://doi.org/10.1111/codi.12506

Pilonis, N. D., Bugajski, M., Wieszczy, P., Franczyk, R., Didkowska, J., Wojciechowska, U., … & Kaminski, M. F. (2020). Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy. Annals of internal medicine, 173(2), 81-91. https://doi.org/10.7326/M19-2477

Saito, Y., Oka, S., Kawamura, T., Shimoda, R., Sekiguchi, M., Tamai, N., … & Inoue, H. (2021). Colonoscopy screening and surveillance guidelines. Digestive Endoscopy, 33(4), 486-519. https://doi.org/10.1111/den.13972

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 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