Feb 23, 2024 Assessment Tools and Diagnostic Tests in Adults and Children Discussion
Assessment Tools and Diagnostic Tests in Adults and Children Discussion
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.
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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.
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
Discussion: Assessment Tools and Diagnostic Tests in Adults and Children: 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.
In this Discussion, 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 for Assessment Tools and Diagnostic Tests in Adults and Children:
Review this week’s learning resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. We will also review examples of pediatric patients and their families as it relates to BMI.
This week you will be assigned one of the following DB by your instructor.
Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:
Mammogram
Prostate-specific antigen (PSA) test
Body-mass index (BMI) using waist circumference for adults
Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?
Overweight 5-year-old boy with overweight parents
5-year-old girl of normal weight with obese parents
Severely underweight 12-year-old girl with underweight parents
Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?
What does the literature discuss regarding the validity, reliability, and are there any issues with sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool?
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.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
By Day 3 of Assessment Tools and Diagnostic Tests in Adults and Children
Post a description of how the assessment tool or diagnostic test you selected is used in health care. 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.
OR
Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. 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. Assessment Tools and Diagnostic Tests in Adults and Children Discussion
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Assessment Tools and Diagnostic Tests in Adults and Children
Respond to at least two of your colleagues who selected a different tool test, or child health example than you, using one or more of the following approaches:
Critique your colleague’s evaluation of the validity and reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should be considered when gathering information about specific conditions or symptoms.
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.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
Suggest additional health risks or issues that could be relevant to the child.
Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.
Suggest an additional strategy for gathering patient information or promoting proactivity.
Assignment: Health History Assessment Video
A comprehensive health history is essential to providing quality care for patients across the lifespan, as it helps to properly identify health risks, diagnose patients, and develop individualized treatment plans. To effectively collect these heath histories, you must not only have strong communication skills, but also the ability to quickly establish trust and confidence with your patients. For this Assignment, you begin building your communication and assessment skills as you collect a health history from a volunteer “patient.” Assessment Tools and Diagnostic Tests in Adults and Children Discussion
To prepare:
Arrange an appropriate time and setting with your volunteer “patient” to collect a health history.Note: Your volunteer’s Video Release Form must be submitted prior to collecting the health history. Refer to the Week 1 Looking Ahead for release form details.
Download and review the History Subjective Data Checklist provided in this week’s Learning Resources.
Ensure that you have appropriate lighting to record yourself collecting the patient’s health history.
To complete:
Record yourself collecting the patient’s health history, covering all of the areas listed in the checklist.
By Day 7 of Week 4
Your Assignment is due.
NURS 6512 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 (36.5%) of U.S. adults have obesity (CDC, 2016). 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, 2016).
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 12.5 million children considered obese (CDC, 2012). 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. Assessment Tools and Diagnostic Tests in Adults and Children Discussion
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. Assessment Tools and Diagnostic Tests in Adults and Children Discussion
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.
Assess weight-related health risks for pediatric patients.
Design effective strategies for communicating with parents or caregivers about children’s weight-related health.
Apply concepts, theories, and principles relating to health assessment techniques and considerations related to growth, measurement, and nutrition.
Apply assessment skills to collect patient health histories*
*The Assignment related to this Learning Objective is introduced this week and submitted in Week 4.
Photo Credit: Image Source/DigitalVision/Getty Images
Learning Resources
Required Readings
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. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
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.
Chapter 6, “Growth and Measurement” (pp. 79-94). In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth amongst the organ systems.
Chapter 7, “Nutrition” (pp. 95-113). This chapter focuses on how nutrition affects growth, development, and health maintenance. The authors also provide guidelines for assessing nutrient intake.
Review of Chapter 26, “Recording Information” (pp. 616-631). This chapter provides rationale and methods for maintaining clear and accurate records. The text also explores the legal aspects of patient records.
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.
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.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 2, “The Comprehensive History and Physical Exam” (pp. 23-32)
Appendices B-C (pp. 373-376)
Chapter 6, “Adult Preventative Care Visits” (pp. 125-139)
Chapter 5, “Pediatric Preventative Care Visits” (pp. 93-108)
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.
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.
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. (PDF), 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/
Gibbs, H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120–124. Retrieved from the Walden Library databases. 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,
Centers for Disease Control and Prevention. (2012). 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.
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
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