NURS 6512 Week 2 Discussion 1 Essay

Assessment Tools and Diagnostic Tests

The Assessment Tool or Diagnostic Test Selected

Mammogram Validity and Reliability

Assessment Tools and Diagnostic Tests Discussion

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.

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.

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To prepare FOR Assessment Tools and Diagnostic Tests Discussion:

Review this week’s Learning Resources, and consider the factors that impact the validity and reliability of various assessment tools and diagnostic tests.
Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:

o Mammogram

o Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)

o Prostate-specific antigen (PSA) test

o Dix-Hallpike test

o Body-mass index (BMI) using waist circumference for adults

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?
Examine the literature and resources you located for information about the validity and reliability of the test or tool you selected. What issues with sensitivity, specificity, and predictive values are related to the test or tool?
Are there any controversies or issues related to any of these tests or tools?
Consider any ethical dilemmas that could arise by using these tests or tools. NURS 6512 Week 2 Discussion 1 Essay

Post 1 page paper APA format 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.

Assessment Tools and Diagnostic Tests Discussion Readings

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. NURS 6512 Week 2 Discussion 1 Essay

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.

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.

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) NURS 6512 Week 2 Discussion 1 Essay

o Appendices A–E (pp. 225–236)

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. 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.
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.
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. NURS 6512 Week 2 Discussion 1 Essay

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NURS 6512 Week 2 Discussion 2 (Walden)

Diversity and Health Assessments

Cultural Factors Associated

Sensitive Issues when Interacting with the Patient

Targeted Questions

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.

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

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

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:

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?

By Day 3

Post 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.
Read a selection of your colleagues’ responses.

By Day 6

Respond on or before Day 6 to at leastone of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

NURS 6512 Week 3 Initial Post Answer (Walden)

NURS 6512N-26: Advanced Health Assessment

INITIAL POST

Health Issues and Risks of Children’s Weight

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.

For this Discussion, you will 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:

Consider the following examples of pediatric patients and their families:

Overweight 5-year-old boy with overweight parents
Slightly overweight 10-year-old girl with parents of normal weight
5-year-old girl of normal weight with obese parents
Slightly underweight 8-year-old boy with parents of normal weight
Severely underweight 12-year-old girl with underweight parents
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?
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

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.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days who selected a different example than you, using one or more of the following approaches:

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.

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NURS 6512 Week 4 Initial Post Answer (Walden)

NURS 6512N-26: Advanced Health Assessment

INITIAL POST

Skin Conditions and their Differential Diagnoses

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.
Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.

By Day 3

Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days. Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following:

Critique your colleague’s clinical description of the physical characteristics of each.
Suggest an additional possible condition for each graphic, and explain your reasoning.
Provide an alternative correct diagnosis, and explain your reasoning.
Validate an idea with your own experience and additional research.