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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.
Students will:
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 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.
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Assignment (3–4 pages, not including title and reference pages):
Assignment: Child Health Case:
Include the following:
Case 1: Acklin, Alvarez, Amama, Basco, Black, Bolivard, Brown & Colyer
4-year-old overweight female with normal weight parents who are living with elderly grandparents in their home
Case 2: Curry, Fobanjong, Garcia, Green, Hutcheson, Iskander, Jean & Johnson
10-year-old severely underweight male in 3rd grade who lives with her normal weight mom on the weekends and her underweight father during the week.
Case 3: Jordan, Moore, Parfait, Pina, Queija, Raymond & Russell
5-year-old severely underweight male who lives with his normal weight adopted mother and father.
o 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.
o 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.
o 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.
o Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
o Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
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)
o Chapter 3, “The Screening Physical Examination”
o Chapter 17, “Principles of Diagnostic Testing”
o Chapter 18, “Common Laboratory Tests”
Nutrition, among other things, influences children’s growth and development. The nutritional need is especially important before a child reaches the age of five, owing to the robust physical and physiological development. At this stage of development, any dietary deficiency has both short- and long-term health repercussions. The case study is about a five-year-old severely underweight child who lives with his normal-weight adopted mother and father. His weight predisposes him to several health issues and hazards, as detailed below.
Given the consequences of malnutrition, especially during the first five years of life, adequate nutrition is paramount. Low weight for age is one of the signs of malnutrition, as demonstrated in the 5-year-old child’s case scenario. Concerning health issues and risks, the child will undergo immunological, cardiovascular, gastrointestinal, endocrine, genitourinary, and circulatory changes.
The immune system of malnourished children is significantly compromised due to decreased immunoglobin levels, reduced complement system, and low phagocytic activity, putting the child at risk of infections (Dipasquale et al., 2020). In the cardiovascular system, the patient is in danger of diminished cardiac output and low blood pressure, which may lead to hypoperfusion of the body’s vital organs (Dipasquale et al., 2020).
Because of the gut’s diminished absorptive capacity, nutritional absorption is substantially reduced, exacerbating undernutrition. Furthermore, in the genitourinary system, the kidney’s capacity to excrete excess acid and water is severely diminished, and the patient is vulnerable to urinary tract infections due to inadequate immunity (Dipasquale et al., 2020). The many biochemical and physiological changes are a response to the body’s already low energy levels.
Obtaining a medical history from children may be challenging; consequently, in most circumstances, proxy reporting by parents is helpful. It is critical to gather information on the various causes of the child’s malnutrition, as well as vital data for the child’s diagnosis.
Data on the child’s dietary intake may tell if child abuse is a likely cause of malnutrition. According to Burford et al. (2020), the underprivileged, such as adopted children, may encounter medical neglect in a variety of ways, one of which is a deprivation of adequate nutritious food. Asking the parents about the child’s dietary schedule, components, and capacity to acquire food is vital
Malnutrition may be caused by nutritional deprivation, but it can also be associated with other medical conditions. I would have to determine whether the child has any medical condition that causes significant wasting, such as HIV, tuberculosis, malignancies, or any other chronic disease. Laboratory testing would also provide further information to aid in determining the cause of malnutrition.
Among the valuable laboratory data that would be required are a complete blood count or blood culture, which may indicate an infection as a cause or a consequence of malnutrition, HIV testing, and Xpert MTB/RIF for tuberculosis (Keller, 2019). Because the child is adopted, obtaining information from the parents may be challenging because they are more likely to conceal any history of the child’s mistreatment.
As a result, emphasizing the significance of the medical history to the parents, explaining to them in clear, precise, and unadorned language, and acknowledging or speaking to them in their local language are critical in acquiring the information.
Burford, A., Alexander, R., & Lilly, C. (2020). Malnutrition and medical neglect. Journal of Child & Adolescent Trauma, 13(3), 305–316. https://doi.org/10.1007/s40653-019-00282-0
Dipasquale, V., Cucinotta, U., & Romano, C. (2020). Acute malnutrition in children: Pathophysiology, clinical effects and treatment. Nutrients, 12(8), 2413. https://doi.org/10.3390/nu12082413
Keller, U. (2019). Nutritional laboratory markers in malnutrition. Journal of Clinical Medicine, 8(6), 775. https://doi.org/10.3390/jcm8060775
Malnutrition in children is a weight and nutrition-related condition that has caused a significant morbidity and mortality both in the developing and developed countries. Underweight condition is defined by the body mass index (BMI) or body fat percentage that is too low for general sustainable health. According to the World Health Organization, weight is charted against the age of the child. The child is then considered underweight when their weight for age falls below negative two standard deviations (WHO, 2010).
Severe underweight in children is associated with nutritional and immunity deficiencies that place the individuals at risks of growth impairment presenting with stunting, osteoporosis, and recurrent infections. The body requires minerals and nutrients for growth, sustenance and immune system development.
Underweight individuals are also at risks of developing cardiovascular diseases. However, their risk of developing cardiovascular disease is less than that of the obese and overweight individuals (Park et al., 2017). In comparison, the risk in overweight individuals depends on coexisting comorbidities while that in underweight individual does not.
Being underweight has been recently associated with higher mortality than normal. The impact is worse in older populations than younger age groups (Lorem et al., 2017). Underweight individuals are also at risk of developing acute recurrent infections. Common infections include the upper respiratory tract infections (URTIs) and skin infections (Harpsøe et al., 2016). For this reason, comprehensive interventions are necessary to mitigate the effects of being underweight on long-term health outcomes.
The patient for this week’s case study is a twelve-year old Hispanic girl who is severely underweight. Her parents are underweight as well. She recently experienced bullying in school, probably due to her condition. Weight below the normal for age can be acute or chronic depending on the duration and onset of decline in weight.
Additional information required to assess her health would further include the family nutrition, health conditions during the pregnancy, birth, and postnatal life (Kumar et al., 2019); and presence of chronic familial illnesses (Tatsumi et al., 2016). The information acquired would determine the type of under-nutrition and the most appropriate management approach.
Since the girl’s parents are also underweight, it would be prudent to examine the history of genetic or familial chronic illnesses in the nuclear and extended families. The circumstances during pregnancy that are worth examining include the maternal nutritional knowledge level. The mother’s nutrition during the prenatal period and nutrition of the child in the postnatal life would be responsible for the weight status of the patient.
Information about sugar control and diabetes in the family is also important in assessing the weight status of the child. Type I diabetes, common in childhood, sometimes has a genetic component. Diabetes presents with weight loss that could be responsible for the child’s underweight status (Balcha et al., 2018). Other chronic illnesses too inhibit proper growth and weight increase.
The etio-pathogenesis of underweight status and malnutrition in not limited to nutritional causes. Therefore, specific questions will be necessary to gather more information to make more accurate diagnosis and build a more accurate health history. I would ask the child’s informant the following specific questions:
These three questions would assess the nutritional status of the family, inherited conditions, and the severity or developmental consequences of the low weight for age.
Barriers in health promotion for weight and nutritional management exist between healthcare providers and the caretakers or the parents of children. The fulltime caregivers for the child are the parents and therefore, I would enhance patient education and health maintenance through collaboration with the parents. The two strategies that I would use include proper and effective communication and nutritional recommendations.
Further, I would need to fully understand the cultural origin and eating patterns of the patient’s family. This will be achieved through nutritional assessment before applying the recommendations and strategies. Often, social stigma arises due to low weights and malnutrition among families. Sometimes parents are not willing to discuss these with their care providers. They end up holding vital information that would help the clinician to solve the nutritional issues in a cheaper and more efficient ways (Dev et al., 2017).
I would ensure open and free communication to discuss with the parents about their knowledge of under-nutrition and low weight for age, as well as the risks associated with child under-nutrition. At this time, the actual etiologies of under-nutrition for the patient are unknown and this discussion would provide the possible etiologies and therapies. I would reassure the parents on their abilities and role in maintaining an adequate weight and health for their child and that their child’s low weight may not primarily be the result of their parenting skills.
Finally, the nutritional strategy would include advising the parents on their role on the child’s food intake and lifestyle. I would encourage the parents to give the child more meals in small quantities in a day. Increasing the frequency and reducing the amount of food intake allows the body to maximize the calories intake and absorption.
I would also encourage adequate sleep and increase in playing time for the child to promote cardiovascular function (Centers for Disease Control and Prevention, n.d.). The parents would also be advised to provide adequate amounts of water to their child after meals and limit too much fatty foods as it would not be healthy for the child’s cardiovascular system.
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