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 (39.8%) of U.S. adults have obesity (CDC, 2018). 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, 2018).
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 13.7 million children and adolescents considered obese (CDC, 2018). 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.
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.
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
- Apply assessment skills to collect patient health histories
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. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
· Chapter 3, “Examination Techniques and Equipment”
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 8, “Growth and Nutrition”
In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.
· Chapter 5, “Recording Information” (Previously read in Week 1)
This chapter provides rationale and methods for maintaining clear and accurate records. The text also explores the legal aspects of patient records.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Centers for Disease Control and Prevention. (2018). 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.
Chaudhry, M. A. I., & Nisar, A. (2017). Escalating health care cost due to unnecessary diagnostic testing. Mehran University Research Journal of Engineering and Technology, (3), 569.
This study explores the escalating healthcare cost due the unnecessary use of diagnostic testing. Consider the impact of health insurance coverage in each state and how nursing professionals must be cognizant when ordering diagnostics for different individuals.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
· Chapter 1, “Clinical Reasoning, 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.
Gibbs , H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120–124.
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
Credit Line: Weight status misperception as related to selected health risk behaviors among middle school students by Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R., in Journal of School Health, Vol. 84/Issue 2. Copyright 2014 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.
Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research . Evidence Based Nursing, 18(2), pp. 34–35.
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.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.
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
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
- Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Document: Shadow Health Support and Orientation Resources (PDF)
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: Shadow Health Nursing Documentation Tutorial (Word document)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 3, “The Physical Screening Examination”
- Chapter 17, “Principles of Diagnostic Testing”
- Chapter 18, “Common Laboratory Tests”
Required Media
Taking a Health History
How do nurses gather information and assess a patient’s health? Consider the importance of conducting an in-depth health assessment interview and the strategies you might use as you watch. (16m)
Assessment Tool, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children – Week 3 (11m)
Assignment 1: Case Study Assignment: 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.
For this Assignment, 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
- Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
- By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
- Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
- Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
- If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
- 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.
The Assignment
Assignment (3–4 pages, not including title and reference pages):
Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:
Include the following:
- A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
- What is its purpose?
- How is it conducted?
- What information does it gather?
- 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.
Assignment Option 2: Child Health Case:
Include the following:
- An explanation of the health issues and risks that are relevant to the child you were assigned.
- Describe additional information you would need in order to further assess his or her weight-related health.
- Identify and describe any risks and 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.
- 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.
Week 3 Discussion Sample Paper
NURS 6512 Week 3 Assignment – Assessment Tools and Diagnostic Tests in Adults and Children
BMI Assessment Tool
Student’s Name:
Institutional Affiliation:
Uses of BMI in Healthcare
Body Mass Index (BMI) is in the present times is one of the most effective anthropometric estimates of fatness for all public health purposes. BMI indicates the body size of an individual by comparing the person’s weight with their height (Hall & Cole, 2016). The results of a BMI provide a clear indication of whether a subject will have the ideal weight for their height. The BMI helps indicate if a person is underweight, has excess weight, is obese, or has healthy weight. If an individual’s BMI range is above the healthy range, such people will experience substantial health risks. For instance, having excess weight will increase the dangers of developing chronic conditions such as type 2 diabetes, cardiovascular problems and high blood pressure (Hall & Cole, 2016). Among adults, BMI is not linked with their age or their sex. However, for teens and children age and sex. Will be considered in calculating BMI. This is because, among children, girls and boys grow at different rates and will have varying levels of body fat in varying ages. For these reasons, when taking BMI measurements for children and teens, sex and age have to be taken into consideration. In measuring the BMI for children and teens, health practitioners have to locate the BMI numbers and the child’s specific age on a sex-specific BMI –for- age- chart (CDC, 2018). Such measurements provide a clear picture of whether a child has a healthy weight, is underweight or is overweight or obese. Children will be considered obese if they have a BMI for –age- equal to or greater than 95th percentile and overweight when they post a BMI for age percentile of 84th to 94th percentile (CDC, 2018).
BMI’s Validity and Reliability
The validity and reliability of BMI as a tool for determining the risk of obesity is questionable on different levels in that the measurement of body fat should be reliable and correlate with the body fat an individual may have regardless of their age, sex or ethnicity. On this count, BMI cannot be categorized as a reliable and valid measure of body fat in that the relationship between BMI and the fat percentage will be affected by different factors such as age, physical activity level, ethnicity and gender (Freedman & Sherry, 2015). Considering individual factors, other measures of adiposity may be more reliable and useful than BMI. For example, aging will be associated with many changes in the composition of the body. As a person grows older, there will be a massive reduction in muscle mass and fat-free mass and subsequent increase visceral fat even though their body weight will remain general unchanged (Zhang, Fos, Johnson, Kamali, Cox, Zuniga, & Kittle, 2018). Health risks will be more associated with visceral fat mass. Therefore as BMI does not correlate accurately with visceral fat mass, it may therefore not be considered a reliable indicator of whether a given individual is healthy or not especially children. Among children, there are considerable disparities in body mass among different sexes such as in boys and girls. Such disparities affect the reliability and validity of BMI as tools for measuring adiposity in such a population. Apart from age and gender, there are substantial ethnicity differences in body composition. Among races such as African Americans, Asians, and Hispanics, different BMI values will predispose the population to different health risks. Using BMI to determine the risk of individuals to specific issues may, therefore, not be sufficient (Freedman & Sherry, 2015).
Health Issues/Risks Relevant To the 5- Year Old Overweight African American Boy
As the 5-year-old African American boy is already overweight and spends their time after schools with their grandmother, which means they are not that much physically active, they risk developing different health complications and risks. This includes accumulating high cholesterol rates and high blood pressures which are significant risk factors for cardiovascular diseases and developing breathing problems such as sleep apnea and asthma (Gibbs & Chapman-Novakofski, 2012). The overweight African American boy is also at a high risk of developing impaired glucose resistance which may lead to type 2 diabetes, fatty liver diseases, musculoskeletal discomfort and joint problems, gastro-esophageal reflux and gallstones, among many health risks (Gibbs & Chapman-Novakofski, 2012).
Additional Information on the 5- Year Old Overweight African American Boy
To assess the weight-related health of the African American boy, one of the primary additional information I would need is information related to the nutrition the boy receives. This would include the food the family consumes based on the five food groups, the availability of food, whether the meals are healthy, snacks consumed, the method of preparation of food and the mealtime environment (Gibbs & Chapman-Novakofski, 2012).
Identification of Risks to the Childs Health
By asking about the types of food, the child is feed and also their social behaviors such, and if they play more often friends, I would be able to discern the health risks which may be facing the boy. For example, by taking a high amount of fast foods and processed foods such as snacks and not participating in physical activities, the boy could be more susceptible to obesity and accompanying health risks.
Such sensitive information would be gathered from parents. By explaining the goal of the study and the benefits it can have on the health of their children, such parents would agree to cooperate. Promising confidentiality of the information provided to the parents would also help encourage the parents to cooperate fully in the assessment of their child (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Specific Question Relating to the Child
- How many meals does the child consume in a day?
- What is the composition of meals the child consumes throughout the day?
- Is the child involved in any physical activities? How frequently?
Strategies to Help Parents Control Child’s Weight and Health
One of the strategies that the African American boy’s parents would adopt to be proactive about their child’s health and weight would be encouraging the child to be involved in physical activities, for example, taking walks, cycling, and swimming. The parents would need to create time to perform such activities with their children. The next strategy would be to provide the parents with a food pyramid which they would use to determine the healthy foods and the right food combination to give their children to ensure a healthy weight. Such tools would guide the parents’ decision in preparing meals and would help the child and the parents to lose weight gradually.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Centers for Disease Control and Prevention. (2018). Childhood overweight and obesity.
Retrieved from http://www.cdc.gov/obesity/childhood.
Freedman, D. S., & Sherry, B. (2015). The Validity of BMI as an Indicator of Body Fatness and
Risk Among Children. Pediatrics, 124(Supplement 1), S23–S34. DOI:10.1542/peds.2008-3586e
Gibbs, H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to
assessment and the skills clients need. Health, 4(3), 120–124.
Hall, D. M., & Cole, T. J. (2016). What use is the BMI?. Archives of disease in childhood, 91(4),
283–286. DOI:10.1136/adc.2005.077339.
Zhang, L., Fos, P. J., Johnson, W. D., Kamali, V., Cox, R. G., Zuniga, M. A., & Kittle, T. (2018).
Body mass index and health-related quality of life in elementary school children: a pilot study. Health and quality of life outcomes, 6, 77. DOI:10.1186/1477-7525-6-77.
By Day 6 of Week 3
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 3 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 3 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 3 Assignment 1 Option 1 Rubric
To access your rubric:
Week 3 Assignment 1 Option 2 Rubric
To check your Assignment draft for authenticity:
Submit your Week 3 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 3
To participate in this Assignment:
Week 3 Assignment 1
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment
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 DCE Assignment, you begin building your communication and assessment skills as you collect a health history from a volunteer “patient.”
To Prepare
- Review this week’s Learning Resources as well as the Taking a Health History media program, and consider how you might incorporate these strategies. Download and review the Student Checklist: Health History Guide and the History Subjective Data Checklist, provided in this week’s Learning Resources, to guide you through the necessary components of the assessment.
- Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
- Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document provided in the week’s Learning Resources to guide you through Shadow Health.
- Review the Week 4 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation (Required, you will not be able to access the Health History without completing the requirements).
- DCE Orientation (15 minutes)
- Conversation Concept Lab (50 minutes)
Health History
- Health History of Tina Jones (180 minutes)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve total score of 80% or better(includes BOTH DCE and Documentation), but you must take all attempts by the Week 4 Day 7 deadline.
Submission and Grading Information
No Assignment submission due this week but will be due Day 7, Week 4.
Grading Criteria
To access your rubric:
Week 4 Assignment 2 DCE Rubric
What’s Coming Up in Module 3?
In Module 3, you will examine advanced health assessments using a system focused approach.
Next week, you will specifically explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings while conducting health assessments. You will also complete your first Lab Assignment: Differential Diagnosis for Skin Conditions as well as complete your DCE: Health History Assessment in the simulation tool, Shadow Health.
Week 4 Required Media
Next week, you will need to view several videos and animations in Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Lab Assignment. There are several videos in varied lengths. Please plan ahead to ensure you have time to view these media programs to complete your Assignment on time.
Next Module
To go to the next module:
Module 3
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