- 21 Mar, 2021
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WRITE ONE PAGE EACH RESPONDING TO EACH DISCUSSION SEPARATELY AND DO NOT COMPARE THE DISCUSSIONS. Each discussion needs at least 2 sources each. All references have to be from the year 2013 to present.
WRITE ONE PAGE EACH RESPONDING TO EACH DISCUSSION SEPARATELY AND DO NOT COMPARE THE DISCUSSIONS.
Each discussion needs at least 2 sources each. All references have to be from the year 2013 to present. Respond to each discussion in two of the following ways:
- 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
Discussion 1: Lindsay
Assessment Tools and Diagnostic Tests in Adults and Children
Health Risks Relevant to an Overweight 5-year-old Boy with Overweight Parents:
Figures reveal that in the United States, one-fifth of children are currently overweight or obese, leading to a number of physical and emotional health consequences as well as lower life expectancies than their parents (Randle, Okely, & Dolnicar, 2016, p. 350). Overweight and obese children are more likely to develop type 2 diabetes, non-alcoholic fatty liver disease, cardiovascular disease, orthopedic complications, psychological problems, and are less socially accepted by their peers (Randle, Okely, & Dolnicar, 2016, p. 350). More immediate risks can include high blood pressure and cholesterol, impaired glucose tolerance, breathing problems, joint and muscle problems, gallstones and heartburn, and psychological problems such as anxiety and depression and low self-esteem (Centers for Disease Control and Prevention, 2018).
Further Information I would Need to Gain a Full Understanding of the Child’s Health:
When gathering information regarding the child’s health, I would like to assess his past medical history, any chronic illnesses, congenital anomalies, family history, nutrition habits, and behavior and activity level (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p. 99). “Behaviors that influence excess weight gain include eating high-calorie, low-nutrient foods and beverages, not getting enough physical activity, sedentary activities such as watching television or other screen devices, medication use, and sleep routines” (Centers for Disease Control and Prevention, 2018). I would like to find out the living situation of this family in terms of financial resources, access to healthy foods, community, number of family members living in the home, and how meals are provided/prepared in the family. I would also want to know if this child primarily eats his meals at home or if they are provided at school or a care center, as well as whether or not the parents know what the child is consuming daily. I would ask the parents of this child if they have any underlying medical problems that could potentially carry a genetic or familial component to identify if this patient is at risk as well.
One tool I could use to assess the child’s health needs would be to follow the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program forms specific to my state. EPSDT is a federally mandated program that is used to assess the child’s health needs through initial and periodic examinations to ensure that health problems are diagnosed and treated early before they become more complex (Sullivan, 2019, p. 93). Components of this screening include growth and development screening, laboratory screening tests, immunization status, guidance and education, and risk factor identification (Sullivan, 2019, p. 94).
Gathering Information in a Sensitive Fashion
I would begin gathering information in a sensitive fashion by first obtaining factual information regarding the child’s weight status category. I could do this by obtaining the child’s BMI after measuring the child’s height and weight. Overweight is defined as a BMI at or above the 85thpercentile and below the 95thpercentile for children and teens of the same age and sex (Centers for Disease Control and Prevention, 2018). I could relay this information to the parents showing that this patient fits into the overweight category. I would attempt to ask the parents of this child questions around weight status in a sensitive manner in order to measure their concern or perception about their child’s weight. I could ask the parents “do you think your child is underweight, a normal weight, or overweight for his age?” I could also ask “how concerned are you about your child’s weight at the moment?” Although I do also believe that it is important to be straightforward in terms of my concerns regarding the child’s weight and potential health concerns in order to convey the severity of this patient’s health risks related to his weight. I would explain to the parents that it is important for me to gather this information so I can identify any potential health risks.
Specific Questions
- Do your child and your family follow any specific diet? What are some of the most common meals or foods that your child eats?
- What is your child’s activity level like? How much time does he spend per day watching TV, playing video games, or using electronic devices for recreation?
- Does your child have access to any type of food whenever he wants? Or is his food intake regulated or monitored in any way?
- Do you have any concerns related to your child’s weight or nutrition?
Strategies to Encourage Parents to be Proactive Toward the Child’s Health
It is important to teach and encourage parents to be concerned and proactive towards their child’s health, and this includes maintaining a healthy weight with diet and exercise. Marketing and health research has found that parents are the key determinants and agents of change in children’s eating and exercise behaviors (Randle, Okely, & Dolnicar, 2016, p. 350). One study found that most parents of children who are overweight or obese underestimate their child’s current BMI class, but they do estimate that their children are at greater risk for developing obesity-related diseases in adulthood (Wright et al., 2016, p. 475). Accurate parental perception of long-term health risks could motivate a family to engage in behavior change to improve a child’s BMI (Wright et al., 2016, p. 479). Findings of this study also suggest that improving physician communication about a child’s physical and emotional development and focusing on counseling on conditions for which there is a family history may have some benefit (Wright et al., 2016, p. 480). This also includes talking with parents about specific comorbidity risks as opposed to obesity in general in order to increase risk perception and subsequent action (Wright et al., 2016, p. 480). As providers, we must develop and learn ways to effectively communicate with parents about childhood obesity and know what and how to communicate in a way that will resonate with parents and influence their behavior in a positive manner. The belief that a child is at risk for adverse chronic health effects in adulthood could be an important motivator for a parent to initiate healthy lifestyle behavior changes, so it is important to be upfront with parents about the concerns you have as a clinician (Wright et al., 2016, p. 475). One strategy I would use would be to encourage family activities that involve physical activity such as going for a walk as a family, playing at the park, or joining a family sport.
In order for any education or resources to be effective, I would need to assess the health literacy of the patient’s parents to ensure that they are able to understand and apply the tools and resources that are given to them. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Gibbs & Chapman-Novakofski, 2012, p. 120). The article by Gibbs and Chapman-Novakofski (2012) states that “a 68% overweight/obesity rate suggests inadequacy in knowledge, motivation, and/or resources” (p. 120). One strategy I could use to assess this a nutrition literacy assessment algorithm or the Nutrition Literacy Scale to identify knowledge deficits and opportunities for specific education around nutrition (Gibbs & Chapman-Novakofski, 2012, p. 122).
Providers also need to consider sociodemographic characteristics, lifestyle behaviors, and overweight and obesity status of the parents when encouraging parents to be proactive about their child’s health. I would offer information and education around healthy diets by providing the 2015-2020 Dietary Guidelines for Americans as well as the Physical Activity Guidelines for Americans as resources for the parents (Centers for Disease Control and Prevention, 2018). I would stress the importance of leading by example and identifying the same risks for the parents suggesting that the entire family adopt healthy lifestyle changes in terms of diet and exercise as the parents are overweight as well. I would use another strategy of providing a meal plan for this family based on recommended dietary guidelines and encourage the parents to keep a food diary, prepare meals together, and limit intake of excess sugars and refined foods.
Discussion 2: Samuel
Assessment Tools and Diagnostic Tests in Adults and Children
How the prostate-specific antigen (PSA) diagnostic test is used in health care. What is its purpose, how is it conducted, and what information does it gather?
The purpose of a PSA test is that it is part of the screening process to detect and monitor prostate cancer (Dains, Baumann, & Scheibel, 2016). It is conducted via blood draw from the arm and the information it gathers displays how much PSA is being secreted by the prostate gland (Prostate Cancer Foundation, n.d.). Since PSA is regular protein secreted by the prostate, PSA level of 1 to 4 ng/mL is considered normal. A PSA level of 4 to 10 ng/mL is considered high, promoting additional testing such as a digital rectal exam (DRE) or transrectal ultrasound (TRUS) with biopsy. PSA levels greater than 10 ng/mL is suspicious of malignant activity (Dains, Baumann, & Scheibel, 2016). However, not all elevated levels of PSA are cancerous in origin.
Issues with sensitivity and reliability.
An elevated PSA does not always indicate that a malignant change is happening; there are non-cancerous circumstances that can give a false-positive. A false-positive test result may manifest undo anxiety for a patient and may lead to additional medical procedures, such as a prostate biopsy. Possible side effects of prostate biopsy can include infection, pain, and bleeding (National Cancer Institute, 2017). Prostatitis is a condition triggered by bacterial infection causing the prostate to become inflamed, tender, and swollen resulting in a high PSA. Benign prostatic hyperplasia (BPH) is a larger-than-usual prostate and may have a higher than usual baseline PSA. A urinary tract infection can also irritate the prostate gland causing increased production of PSA. In addition, prostate stimulation through sexual activity or a DRE can also result in a temporarily elevated PSA (Prostate Cancer Foundation, n.d.). Conversely, there are some drugs including finasteride and dutasteride that are used to treat BPH which will lower a man’s PSA level; this can create a false-negative. False-negative test results may give the patient false assurance that he does not have cancer when in fact they could requiring treatment (National Cancer Institute, 2017).
Evidence-based literature regarding validity and reliability.
Up until 2008, physician’s and professional organizations encouraged PSA screening on an annual basis for men beginning at age 50 (National Cancer Institute, 2017). However, the specific mortality benefit of early detection is unclear. This is in part due to the inconsistency between the two large trials comparing PSA screening to usual care (Kim & Andriole, 2015). A large randomized clinical trial conducted on prostate cancer mortality showed that there was no difference in mortality rates from prostate cancer between the control group and the screening group. The screening provided no reduction in death rates at seven years and no evidence of benefit with 67% of the subjects who completed 10 years of follow-up (Dains, Baumann, & Scheibel, 2016). Conversely, a European study brought evidence about mortality outcomes from prostate cancer screenings. The study demonstrated that the risk of prostate cancer was reduced by 20% in men aged 55-69 years that underwent PSA screening (Dains, Baumann, & Scheibel, 2016).
Ethical dilemmas or controversies related to the test.
Ethical dilemmas regarding prostate cancer screening are primarily related to PSA testing. As discussed, evidence-based literature from two large studies has opposing evidence on prostate cancer mortality with PSA screening. Due to the sensitivity and specificity associated with PSA screening, using PSA as a marker for early prostate cancer detection remains controversial (Qureshi, Bennett, Hermanson, Horner, Haider, et al., 2015). The PSA test can help identify small tumors, however many tumors discovered through PSA testing grow so slowly and not likely to threaten a man’s life. Detecting and treating tumors that are not life-threatening is “overdiagnosis,” and treating these tumors is considered “overtreatment” (National Cancer Institute, 2017). Overtreatment can expose the patient unnecessary complications and harmful side effects with treatment such as surgery or radiation therapy. These side effects can cause problems with bowel function, urinary incontinence, erectile dysfunction, and infection (National Cancer Institute, 2017). Because of the risks and benefits and assessment of balance, the U.S. Preventative Services Task Force recommends against routine PSA-based screening. PSA screening should only be done if benefits outweigh risk and the patient fully understands the uncertainties (Dains, Baumann, & Scheibel, 2016).