Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Establishing the diagnosis for patient presentations requires reliable assessment criteria, including diagnostic tests and assessment tools. These assessments and investigations support the clinicians in managing the patient by identifying the cause, predicting treatment outcomes, or monitoring these outcomes. These investigations, tools, and tests need to be reliable and viable for the best outcomes.

Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Epstein Barr virus is associated with various diseases in humans. Human reaction to this viral infection is through the humoral immunity system. Identification of this virus can be done through various tests. Monospot testing is one of the tests to diagnose the presence of EBV in various diseases associated with it. This discussion explains Monospot testing regarding its reliability in children and adults.

Monospot Testing

Epstein Barr Virus (EBV) is commonly associated with infectious mononucleosis (IM) (Naughton et al., 2021). This disease is extremely common in the US and worldwide. Being a viral illness, most diagnostic tests for IM are serological. The human body produces heterophile antibodies toward EBV infection (Byrne et al., 2020). Monospot testing is a serological test that is classified under the agglutination type.

This test is a latex agglutination test that uses equine erythrocytes as the substrate. When the human serological sample containing antibodies against EBV is added to the substrate, the erythrocytes clump together due to agglutination with the antibodies and antigens on the red cell surface. The outcome is interpreted as a positive result. When the sample added does not contain these antibodies, agglutination will not occur.

The Purpose of Monospot Testing

The Monospot test replaced the Paul-Bunnell test that was used to diagnose infectious mononucleosis. Infectious mononucleosis presents with fever, malaise, sore throat, tonsilitis, fatigue, and lymphadenopathy. The triad of pharyngitis, lymphadenopathy, and fever is considered classical in infectious mononucleosis. However, atypical cases can also present to physicians and nurses, which can change the clinician’s decisions regarding diagnosis.

Monospot testing is, therefore, a rapid test that can be used to confirm the presence of disease. However, other disease entities can also present with symptoms similar to those of infectious mononucleosis. Bacterial tonsilitis and other viral upper respiratory tract infections (URTIs) can present with the above symptoms (Naughton et al., 2021).

The duration of the symptoms and the high clinician’s index suspicion are required. Infectious mononucleosis can have serious complications such as splenomegaly that risks rupture and hemorrhage. Therefore, early identification of infectious mononucleosis by Monospot testing is useful to provide a timely and insightful objective understanding of the patient’s presentation.

Conducting a Monospot Test

Monospot testing is rapid and requires few materials to conduct and interpret. The kit and the blood sample from the patient are the key requirements. The blood sample is obtained intravenously either through a finger prick or phlebotomy. The kits are commercially acquired. Once the blood sample is withdrawn, a drop is placed into the kit and left for about 5 to 10 minutes. The presence of an additional indicator to the control indicator shows a positive test, while the presence of the control indicator alone shows a negative test result.

The Kind of Information Gathered by Monospot Test

The Monospot test is a qualitative test whose findings are either interpreted as positive or negative. A positive test only indicates that antibodies against EBV are present and can be interpreted that the symptoms could be a result of infectious mononucleosis. Notably, antibodies against infections and illness sometimes stay in the patient’s system longer even after the recovery from the disease, the antibodies can still be identified. With time the quantities of these antibodies wane off, but the tests cannot quantify their amount and thus cannot be used to identify the stage or monitor the disease. The absence of these antibodies in a clinically evident disease also presents a challenge.

The Monospot test, from the above description, is a test that can have false positives and false negatives. It has high specificity but low sensitivity. Sensitivity is the ability of a test to identify true positives (Ball et al., 2022). According to Stuempfig & Seroy (2021), the Monospot test’s sensitivity ranges between 70 and 90%. Put into perspective, this implies that among 100 people with infectious mononucleosis confirmed by a gold standard test, Monospot will correctly identify about 70 to 90 people from the 100 people. Specificity, the ability to identify true negatives cases (Dains et al., 2019), is, however, higher for the Monospot test.

According to a study by Wang et al. (2021), the specific of this test ranged between 80.0% and 90.6%. However, this study acknowledged that these values were lower than previously reported values – 95% to 100% (Stuempfig & Seroy, 2021). Factors such as age and timing between sample collection and testing are critical contributors to false negatives. High rates of false negatives are in children younger than 4 years. The longer the sample delays before the test, the higher the rates of false negatives. Samples taken between the time of infection and 1 to 2 weeks can also yield false negatives.

Concussion

The Monospot test is a rapid and cheap test for diagnosing infectious mononucleosis. It is a latex agglutination test that qualitatively identifies heterophile antibodies against EBV in a patient’s sample. This test is highly specific but not highly sensitive. More tests with high specificity and sensitivity are currently in use, and Monospot should best be used in resource-limited settings. Timely and accurate diagnosis is essential in improving outcomes in patients with IM. Feared complications such as splenomegaly are preventable through early diagnosis and treatment.

References

  • Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2022). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). Elsevier – Health Sciences Division.
  • Byrne, A., Bush, R., Johns, F., & Upadhyay, K. (2020). Limited utility of serology and heterophile test in the early diagnosis of Epstein–Barr virus mononucleosis in a child after renal transplantation. Medicines (Basel, Switzerland)7(4), 21. https://doi.org/10.3390/medicines7040021
  • Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment & clinical diagnosis in primary care (6th ed.). Mosby.
  • Naughton, P., Healy, M., Enright, F., & Lucey, B. (2021). Infectious Mononucleosis: diagnosis and clinical interpretation. British Journal of Biomedical Science78(3), 107–116. https://doi.org/10.1080/09674845.2021.1903683
  • Stuempfig, N. D., & Seroy, J. (2021). Monospot Test. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539739/
  • Wang, E. X., Kussman, A., & Hwang, C. E. (2021). Use of Monospot testing in the diagnosis of infectious mononucleosis in the collegiate student-athlete population. Clinical Journal of Sports Medicine: Official Journal of the Canadian Academy of Sports MedicinePublish Ahead of Print. https://doi.org/10.1097/jsm.0000000000000996

Case Study Assignment Instructions: Assessment Tools and Diagnostic Tests in Adults and Children

                 NURS 6512N Module 2 Week 3 Case Study 	Monospot Testing 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.  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  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. (2021, April 9). Childhood overweight & obesity. 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.   Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research . Evidence Based Nursing, 18(2), pp. 34–35.   Nyante, S. J., Benefield, T. S., Kuzmiak, C. M., Earnhardt, K., Pritchard, M., & Henderson, L. M. (2021). Population‐level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer, 127(12), 2111–2121. https://doi.org/10.1002/cncr.33460   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)  Optional Resource LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical. •	Chapter 3, \"The Screening Physical Examination\" •	Chapter 17, \"Principles of Diagnostic Testing\" •	Chapter 18, \"Common Laboratory Tests\"  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. o	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. o	Consider how you could encourage parents or caregivers to be proactive toward the child’s health. The Assignment : Monospot testing  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. o	What is its purpose? o	How is it conducted? o	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. 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.   Excellent	Good In 3–4 pages, address the following:  A description of how the assessment tool or diagnostic test you were assigned is used in healthcare. o What is its purpose? o How is it conducted? o What information does it gather?	30 (30%) - 35 (35%) The response clearly, accurately, and with specific detail describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values.	45 (45%) - 50 (50%) The response accurately and thoroughly evaluates the test or tool\'s validity and reliability, and explains any issues with clear sensitivity, reliability, and predictive values. Student\'s research is clear, accurate, and appropriate for the evaluation. Written Expression and Formatting - Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused--neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) - 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Written Expression and Formatting - The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.	5 (5%) - 5 (5%) Uses correct APA format with no errors.