NURS 6512 Week 2 Discussion 1: Assessment Tools and Diagnostic Tests Discussion

NURS 6512 Week 2 Discussion 2 Diversity and Health Assessments:

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.

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NURS 6512 Week 2 Discussion Case 1

Subjective Data

CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.”
History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis
PSH: S/P cholecystectomy
Drug Hx:
Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.
Neck: no pain or injury
Respiratory:
CV:
GI:
GU: no urinary hesitancy or change in urine stream
Integument: multiple bruises on his upper arms and back.
MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness
Psych:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.
Lungs: CTA AP&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
Ext: no cyanosis, clubbing or edema
Integument: multiple bruises in different stages of healing – on his upper arms and back.
Neuro: No obvious deformities, CN grossly intact II-XII

NURS 6512 Week 2 Discussion Case 2

Subjective Data

CC: “I am here for my annual physical exam and have been having vaginal discharge.”
History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank.

Drug Hx:

Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion
Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Review of Systems (ROS)

General: no fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT):
Neck: no pain or injury
Respiratory:
CV:
GI:
GU:
Integument: multiple piercings, and tattoos. Old scars related to “cutting”.
Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs: CTA AP&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII

NURS 6512 Week 2 Discussion Case 3

Subjective Data

CC: “Annual physical exam”

History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.

Drug Hx:

Current medication – denied
Allergies: no allergies to food or medications.
Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT):
Neck:
Respiratory:
CV: no chest discomfort or palpitations
GI:
GU:
Integument: history of eczema – not active
MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements
Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.
HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.
Lungs: CTA AP&L
Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop
Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII

To prepare FOR Assessment Tools and Diagnostic Tests Discussion Discussion :

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• Select one of the three case studies. Reflect on the provided patient information.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

Questions to be addressed in my paper:

• An explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected.
• Explain the issues that you would need to be sensitive to when interacting with the patient, and why.
• Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Summary with Conclusion

Assessment Tools and Diagnostic Tests Discussion REMINDERS:

1)      2 pages (addressing the 4 questions above excluding the title page and reference page).

2)      Kindly follow APA format for the citation and references! References should be between the period of 2011 and 2016. Please utilize the references at least three below as much as possible and the rest from yours.

3)     Make headings for each question.

Assessment Tools and Diagnostic Tests Discussion References:

Readings

A) Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 2, “Cultural Competency” (pp. 21–29). This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

o    Chapter 3, “Examination Techniques and Equipment” (pp. 30-49). 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.

B). Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 1, “Clinical Reasoning, Differential Diagnosis, 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.

C), Sullivan , D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

o    Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–36)

o    Appendices A–E (pp. 225–236)

D). 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. This article supplies a list of questions physicians should ask themselves before ordering tests. The authors provide general guidelines for maximizing the value received from testing.

E). Qaseem, A., Alguire, P., Dallas, P., Feinberg, L. E., Fitzgerald, F. T., Horwitch, C., & … Weinberger, S. (2012). Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Annals of Internal Medicine, 156(2), 147–150. Retrieved from the Walden Library databases. This article highlights the increasing cost of health care and stresses the need for high-value and cost-conscious testing. The authors provide a list of 37 situations in which more testing provides no benefit or may be harmful.

F). Shaw, S. J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant & Minority Health, 11(6), 460–467. Retrieved from the Walden Library databases. This article examines cultural influences on health literacy, cancer screening, and chronic disease outcomes. The authors postulate that cultural beliefs about health and illness affect a patient’s ability to comprehend and follow a health care provider’s instructions.

G) Wians, F. H. (2009). Clinical laboratory tests: Which, why, and what do the results mean? LabMedicine, 40, 105–113. Retrieved from http://labmed.ascpjournals.org/content/40/2/105.full. This article analyzes the laboratory testing cycle and its impact on diagnostic decision making. This article also examines important diagnostic performance characteristics of laboratory tests, methods of calculating performance, and tools used to assess the diagnostic accuracy of a laboratory test.

•  LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw- Hill Medical.

o    Chapter 3, “The Physical Screening Examination”

o    Chapter 17, “Principles of Diagnostic Testing”

o    Chapter 18, “Common Laboratory Tests”

Assessment Tools and Diagnostic Tests in Adults and Children

            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