the questions. Its Due on this Wednesday
The link for the text book is below:
1. 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.
- 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:
- Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)
- Prostate-specific antigen (PSA) test
- Dix-Hallpike test
- 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.
2. Case 1
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
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
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
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
- 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.
Main post 2 of week 2
The patient I have selected is a 86 year old Asian male who is dependent on his daughter for his survival. He is dependent on his daughter who is a single mother and care taker. From the given data, it is clear that their socio economic status is poor. He belongs to the ethnic minority group. The socioeconomic disparity negatively affect the health and medical care of individuals belonging to these groups (Ball, Dains, Flynn, Solomon, & Stewart, 2015). This also calls for using the cultural assessment guide where I can find out more about the patient’s health beliefs and practices, faith based influences and special rituals, language spoken at home, sources of support beyond family, and dietary practices.
An attempt towards being culturally competent
While communication with my patient, I will avoid firm gaze since it might be considered rude or immodest. I will emphasize more on attitude and feelings rather than being direct and coming to the point. I will find out about the ability of the patient to speak English and if there is any special signs of demonstrating respect (Ball, Dains, Flynn, Solomon, & Stewart, 2015).
The few things that caught my attention were the bruises on his upper arm and back, chronic prostatitis, falls, elevated blood pressure, and unexplained weight loss. He has no symptoms to relate these findings to any diagnoses. In fact, they all point towards physical abuse. I have my doubts about his nutrition and medications as well. This could be very sensitive issue to deal with. Also, it will be difficult for me to get any information out of him. This is mainly because of the language barrier and his fear of the consequences for confiding in me. In order to assess the social context. I would inquire about stressors and support networks, sense of life control, and literacy. I also need to have cultural humility in order to be able to recognize the patient’s limitations in knowledge and cultural perspective. (Ball, Dains, Flynn, Solomon, & Stewart, 2015).
Questions I would ask
The questions that I would ask for building up the health history and assess his health risks are as follows:
- How is food prepared and consumed?
- Are there periods of required fasting? What are they?
- Within the past year have you been hit, slapped, kicked, or otherwise physically hurt by someone?
- Are you in a relationship with a person who threatens or physically hurts you?
- Do you often feel sad or depressed?
- How many medicines do you take, including over the counter, and vitamins?
- What is the system for taking your medications?
Even though the patient is Asian and a challenge to assess, it is important to attend to the cues and findings that has no language and should not be ignored either way.
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.
Sullivan , D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A.