NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

The health and well-being of children are critical milestones in the growth and development of children. The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) have reported that one in six or 17% of children aged between three and seventeen years had a developmental disability in the 2009-2017 period (Zablotsky et al., 2019). According to Zablotsky et al. (2019), the number of affected children increased from 16.2% in 2009–2011 to 17.8% in 2015–2017. On the other hand, Ford et al. (2017) have found that developmental and behavioral disorders are now among the top-five chronic conditions in the pediatric population. The main concern is that minority children and those living in rural areas carry a disproportionate burden of developmental disabilities. A combination of these issues highlights the critical role that Nurse Practitioners (NPs) play in screening and care management of children. As such, the purpose of this assignment is to explore a case involving a severely underweight 12-year-old Hispanic girl with underweight parents who has been bullied in school just recently.

Health Issues and Risks

The patient presented in the case is underweight, which is one of the four broad sub-categories of undernutrition. Nutrition plays a critical role in the adolescence stage of growth and development. According to Burns et al. (2017), adolescence is a unique and crucial stage of development characterized by intense cognitive, physical, and psychosocial development. Burns et al. (2017) has identified malnutrition as a key miscellaneous cause of delayed growth and puberty. Undernutrition particularly causes a short stature with a delayed pattern of growth. The patient has an increased risk of delayed puberty considering that the stage begins early in girls compared to boys. Research findings have shown that severe states of undernutrition impair the normal activity of the reproductive process (Zablotsky et al., 2019). Zablotsky et al. (2019) have found that undernutrition that occurs in late childhood can delay the onset of puberty. Nutrition is vital for the patient since the growth spurt triggered by puberty increases the demand for nutritional needs, including micro and macronutrients.

Moreover, macro and micronutrients are also crucial for normal health and well-being. Therefore, being underweight has significantly increased the risk of the 12-year-old girl to multiple health issues. Specifically, the girl’s underweight status means that she is not getting enough nutrients to achieve developmental milestones. As such, she has a higher risk of nutritional deficiencies, impaired immunity, and hormonal imbalances. The three expose the patient to a myriad of health problems and complications. For example, lack of calcium and vitamin D increase the risk of fragile bones and osteoporosis while iron, vitamin B12, and folate deficiencies cause anemia (Ball et al., 2019). On the other hand, underweight increases the risk of infection because of decreased or compromised immune function. A notable example is where underweight individuals often take long to heal wounds compared to the general population. Furthermore, underweight persons have poor general health, including problems related to skin, hair, and teeth; general body weakness; and frequent infections (Burns et al., 2017).

The current information shows that the patient is underweight. However, it is crucial to gather additional information about the underlying causes of the patient’s underweight. First, the patient’s parents are also underweight, which highlights the need for assessing any underlying genetic factors. A person’s genetic background has been shown to influence the risk of underweight, overweight, and obesity (Ball et al., 2019). Thus, it is critical to assess the plausibility of this theory through a focused patient history. The second issue to consider is whether the patient has an underlying disease condition. Co-existing diseases, including thyroid disease, digestive problems, and cancer contribute to cases of underweight (Burns et al., 2017). Therefore, examining the patient’s medical history is useful to confirm or rule out co-occurring medical concerns. Third, a comprehensive assessment of the patient’s socioeconomic status could provide valuable clues about the cause of underweight in the family. The assessment will focus on social determinants of health and how they influence the family’s nutritional status. Poverty is a powerful social determinant of health associated with the growing burden of undernutrition in the US (Ball et al., 2019).

Assessment tools will play a fundamental role in gleaning additional information from the case. The Sexual Maturity Rating (SMR) or Tanner Staging is the first screening to consider to find out if the child’s undernutrition is affecting her sexual development. Tanner Staging will allow the NP to assess whether the patient is achieving her sexual developmental milestones to inform referral decisions. The 24-hour diet recall is another tool that will help the NP to have a general overview of the patient’s diet. The tool provides “list all the food, beverages, and snacks eaten during the past 24 hours” (Ball et al., 2019). The second test is necessary to find out if the patient’s underweight is a consequence of poor nutrition and deprivation. Furthermore, the NP will also measure the patient’s weight and BMI as part of the differential diagnosis for undernutrition. The four broad sub-types of undernutrition include underweight stunting, wasting, and severe weight loss. Thus, assessment/screening tools specific to the child will allow the NP to make the right diagnosis and develop an individualized care plan for the patient.

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Depression and anxiety are two additional risks to consider for further information. Screening for depression and anxiety is crucial since the patient has been bullied in school most recently. Underweight brings forward concerns about body image and self-esteem, which then exposes the child to the risk of bullying. Research findings have shown that a combination of bullying and weight status are strong predictors of depression and anxiety among children (Ford et al., 2017). The child is also at a high risk of internalizing disorders because she is currently in the adolescence stage of development. A major concern is that an underlying mental health problem is the main cause of suicide in more than 90% of children and teenagers (Burns et al., 2017). Thus, it is of the essence to screen and evaluate the risk of depression, including the presence of comorbid conditions and differential diagnosis. The HEEADSSS psychosocial assessment tool will help the NP to gather comprehensive information about the case. The HEEADSSS will specifically support the collection of comprehensive information on the social economic status of the family, including the patient’s risk profile and developmental milestones (Smith & McGuinness, 2017).

Specific Assessment Questions

Malnutrition and the risk of depression are the primary concerns for the patient. A detailed patient and medical history are necessary to establish the underlying etiology of malnutrition. Issues of body image and self-esteem underpin the risk of depression and anxiety. However, it is critical to be sensitive when exploring these issues. The following questions will guide the assessment process.

1. Could you describe your eating habits on a normal day, including the food choices?
2. Has your daughter been underweight since childhood or is it a recent phenomenon?
3. Has your daughter been

diagnosed or received treatment for a medical condition in the past six months?
4. Has your family experienced food insecurity recently?
5. Have you sought food assistance from welfare agencies over the past three months?
6. Has your family experienced any changes in economic status in the recent past?

Proactive Strategies

Patient education will form the hallmark of the care management plan for the family. Patient education will focus on creating awareness about the role that nutrition plays in promoting optimal growth and development. Both the patient and her parents will verbalize meals and food choices that will terminate the underweight status. The family members will also verbalize the health risks and implications of inadequate nutrition. The second strategy will entail assessing the needs of the family and connecting them to community-based resources. Social and welfare support at the community level is particularly important if the family lives in a deprived community. The best approach is to assess the level of support that the family is getting, including accessibility to available resources. The NP will then identify gaps and areas where support is needed the most. The third strategy is to sustain the family within the healthcare system. Patient follow-up is necessary to access progress in clinical outcomes.

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.). Elsevier Mosby.

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). Elsevier.

Ford, S. H., Choi, H., Brunssen, S., & Van Riper, M. (2017). Delays and disabilities: NP screening and care management. Journal for Nurse Practitioners, 13(2), e67-e73. https://doi.org/10.1016/j.nurpra.2016.11.005

Smith, G. L, & McGuinness, T. M. (2017). Adolescent psychosocial assessment: The HEEADSSS. Journal of Psychosocial Nursing and Mental Health Services, 55(5), 24-27. https://doi.org/10.3928/02793695-20170420-03

Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. (2019). Prevalence and trends of developmental disabilities among children in the US: 2009–2017. Pediatrics, 144(4), e20190811. https://doi.org/10.1542/peds.2019-0811