Assessment Tools and Diagnostic Tests in Adults and Children
Patient assessments often give health information that is pivotal in understanding the genesis of their suffering and the causal factor for their health-seeking behavior. Assessment approaches vary with age. Assessment of children often requires collaboration with the parents or guardians. Diagnostic tests augment assessment findings and help confirm the causal factors for the presentations. This paper reviews a case presentation and details further valid assessments of the patients.
Health Issues and Risks Relevant To the Patient in the Assigned Case
The case presented is of a 25-year-old Caucasian female student with anxiety. The patient is underweight and lives in a dorm with her normal-weight roommate. Several health issues and risks have been implicated in underweight adults. Family history is the most common non-pathologic reason for being skinny. Low BMI is more prevalent among individuals whose family members also have a low BMI. Being underweight has also been linked to a high rate of metabolism. This may be due to pathological reasons, as seen in hyperthyroidism, or sustained increased physical activities, as seen with athletes (Swift et al., 2018). Chronic disorders and other physical illnesses are also causal factors for being underweight. Diseases such as cancer, diabetes, and GI pathologies often cause profound decreases in body weight. Physical illnesses that cause frequent nausea, vomiting, and diarrhea also cause significant weight reduction. Mental health illnesses are another causal factor for being underweight. Anxiety, apparent in the case presented, and other mental health illnesses such as diabetes have been found to affect an individual’s ability to eat and maintain good nutrition. These individuals tend to lose weight and become underweight.
There are several risks to being underweight. Being underweight increases the likelihood of females developing osteoporosis. Additionally, being underweight predisposes individuals to lowered immunity as it results in somatic mutations, instability of the immune cells, and suppression of NK cells and cytotoxic T cells. Being underweight also has a strong positive correlation with increased incidence of communicable and non-communicable diseases. Irregular menstruation and premature births have also been linked to being underweight. Furthermore, the patient is at risk for reduced fertility due to hormonal imbalances that often characterize skinny females (Golubnitschaja et al., 2021). Other health risks that may be relevant to this patient because of her gender and age include mental disorders such as depression, anemic disorders, and impaired wound healing.
Additional Information Required To Assess the Patient’s Weight-Related Health Further
To better understand this patient’s presentation, additional information must be obtained from her. Information on her anxiety about onset and severity will enable the caregivers to rule out mental health illnesses as a causal factor for their weight. Information on the patient’s family history may help ascertain whether her condition is a consequence of heredity and not a systemic pathology. The family history of mental health illnesses will also help in ruling out other undiagnosed mental health illnesses that may be apparent in the patient and causal to her condition. Medical and medication history is also valuable in assessing the patient’s weight-related health. Information on the medical history indicates health conditions that the patients had experienced earlier. This information informs on the current condition or an undiagnosed underlying health condition that causes weight loss in the patient. Information on medication history can also advise on any past health condition the patients may have experienced. This information may enable a better and more elaborate understanding of the patient’s weight health and information on causal and risk factors for the patient’s condition.
Questions to Ask To Gather More Information
Being underweight presents specific health risks to individuals. Reproductive dysfunctionalities, the propensity to infectious and non-communicable diseases, and mental health illnesses such as depression are some health risks associated with being underweight. Reproductive constitutionality seen in skinny females includes irregular menstruation, infertility due to hormonal imbalances, and miscarriages or premature births. These presentations are disproportionately seen in females with lower BMI (Boutari et al., 2020). Information on these risks can be obtained during the subjective assessment of this patient. Information on the patient’s menstrual cycle and other aspects of her reproductive health can be obtained by asking when she last menstruated, the nature of her menstrual cycles, and the duration. She can also be asked if she has ever been pregnant before and if she is optimistic about the pregnancy’s success. Information on the patient’s propensity to develop infectious and non-communicable diseases can be obtained from the medical and medication history of the patients. In this regard, she can be asked when she last fell sick and the nature of the illnesses she experienced. Since some of these questions are sensitive, the assessment process should be private. The caregiver should also explain why the patients are asking those questions. The questions should be straightforward, and the tone should be consistent as with other questions.
The specific questions that can be asked to gather more information from the patient are: how many times the patient has felt sick or experienced an illness in the past six months, what was the length of the patient’s last two periods, and whether any member of her immediate family has a lean body mass, or has any mental health issue.
Assessment enables a better understanding of the patient’s clinical presentation. The assessment process also gives information on the health risks associated with the primary presentation. As seen in the case study, assessment enables the unearthing of many apparent undiagnosed issues in a patient. All nurses need to have exceptional assessment skills as a care strategy that enhances the quality of care provision.
Boutari, C., Pappas, P., Mintziori, G., Nigdelis, M., Athanasiadis, L., Goulis, D., & Mantzoros, C. (2020). The effect of underweight on female and male reproduction. Metabolism, 107, 154229. https://doi.org/10.1016/j.metabol.2020.154229
Golubnitschaja, O., Liskova, A., Koklesova, L., Samec, M., Biringer, K., & Büsselberg, D. et al. (2021). Caution, “normal” BMI: health risks associated with potentially masked individual underweight—EPMA Position Paper 2021. EPMA Journal, 12(3), 243-264. https://doi.org/10.1007/s13167-021-00251-4
Swift, D., McGee, J., Earnest, C., Carlisle, E., Nygard, M., & Johannsen, N. (2018). The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Progress In Cardiovascular Diseases, 61(2), 206-213. https://doi.org/10.1016/j.pcad.2018.07.014
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Child Health Case:
Case #2: 25-year-old Caucasian underweight female college student with anxiety who lives in a dorm with her normal-weight roommate (if you pick this one, you will not discuss caregiver information as this is an adult).
• If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
Considering the risks you identified, consider what further information you would need to understand the child’s health. Think about how you could sensitively gather this information.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
Include the following:
• An explanation of the health issues and risks relevant to the child you were assigned.
• Describe additional information you would need to assess their weight-related health further.
• Identify and describe any risks and consider what further information you would need to understand the child’s health. Think about how you could sensitively gather this information.
• List 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.