NURS 6512 Week 2 Discussion

DQ1: Assessment Tools and Diagnostic Tests

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:

1. Mammogram

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

3. Prostate-specific antigen (PSA) test

4. Dix-Hallpike test

5. 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.

By Day 3 OF Assessment Tools and Diagnostic Tests Discussion

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.

Read a selection of your colleagues’ responses.

By Day 6 OF Assessment Tools and Diagnostic Tests Discussion

Respond to at least one of your colleagues who selected a different tool or test 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.

 

NURS 6512 Week 2 DQ2: 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.

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 Week2 quiz

Question 1When percussing, a dull tone is expected to be heard over:

Question 2Which technique should be used to stabilize the stethoscope during auscultation?

Question 3The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?

Question 4Which of the following describes a physical, not a cultural, differentiator?

Question 5Your new patient is a 40-year-old Middle Eastern man with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

Question 6Which statement is true regarding the impoverished?

Question 7To perform a deep tendon reflex measurement, you should:

Question 8In terms of cultural communication differences, Americans are more likely to _____ than are other groups of patients.

Question 9Underestimation of blood pressure will occur if the blood pressure cuff s bladder:

Question 10Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing:

Question 11A patient in the emergency department has a concussion to the head. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?

Question 12A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate?

Question 13For a woman with a small vaginal opening, the examiner should use a _____ speculum.

Question 14Which statement is true regarding the relationship of physical characteristics and culture?

Question 15You are performing a vaginal examination for a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?

Question 16The infant should be placed in which position to have his or her height or length measured?

Question 17Which question has the most potential for exploring a patient s cultural beliefs related to a health problem?

Question 18Expected normal percussion tones include:

Question 19A naturalistic or holistic approach to health care often assumes:

Question 20Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?