Assignment: NR503 Discussion Week 2 Iron Deficiency Anemia 

Assignment: NR503 Discussion Week 2 Iron Deficiency Anemia 

Week 2 HAS
Activity Learning Outcomes
Through this assignment, demonstrate the ability to:
1. Discriminate among various screening tools that may be used in the provision of care as an Advanced Practice Nurse
Assignment Requirements
1. The week’s topics (Iron deficiency anemia) the following website:
Agency for Healthcare Research and Quality (Links to an external site.) (Links to an external site.)
2. Reply to the following prompt:
o Describe the diagnostic or screening tool selected, its purpose, and what age group it targets.
o Has it been specifically tested in this age group?
o Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not?

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3. You should include a minimum of two (2) scholarly articles from the last five (5) years (3 is recommended).
4. Respond to a minimum of two (2) individuals, peer and/or faculty, with a scholarly and reflective post of a minimum of two (2) paragraphs of 4-5 sentences. A minimum of one (1) scholarly article should be utilized to support the post in addition to your textbook.
5. Your work should have in-text citations integrating at a minimum one scholarly article and the course textbook. APA format should be utilized to include a reference list. Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first – person use.
During Week 2, in the Discussion Board and with the HP2020 Impact Paper, you are asked to select a screening or diagnostic tool to analyze. You are then required to provide a review of the statistics related to the diagnostic tool, for instance sensitivity, specificity and the predictive value of the screening/diagnostic tool.
What do these terms mean exactly?
In Chapter three (3) of your textbook Curly & Vitale (2016) discuss the implications of screening and the use of the following values (see the section “Screening”):
Screening
Screening is a tool used to detect disease in groups of asymptomatic individuals with the goal of reducing and/or preventing morbidity and mortality. Screening tests can be applied to groups of individuals or to high-risk populations. There are multiple examples of screening tests, including the Pap smear, the tuberculosis skin test (PPD test), the mammogram, and so on.
Determining whether a screening test is appropriate requires the APRN to address several aspects of the disease of interest. Screening is neither available nor appropriate for all diseases. In order for a screening program to be effective, certain criteria should be met. The target population needs to be identifiable and accessible and the disease should affect a sufficient number of people to make screening cost-effective. The preclinical period should be sufficient to allow treatment before symptoms appear so that early diagnosis and treatment make a difference in terms of outcome.
Finally, it is necessary for the screening test to be sensitive enough to detect most cases of the disease and to be specific enough to limit the number of false-positive tests. Screening tests should also be relatively inexpensive, easy to administer, and have minimal side effects.
The validity of a screening test refers to its ability to accurately identify those who have the disease. Sensitivity and specificity are measures of a screening test’s validity. Sensitivity is a measure of a screening test’s ability to accurately identify disease when it is present. Specificity is a measure of a screening test’s ability to correctly identify a person without disease with a negative test. The positive predictive value (PPV) is a measure of the probability of a positive test result when the disease is present. The negative predictive value (NPV) of a test is a measure of the probability that the disease is absent when there is a negative test (see Table 3.4).
Directing screening tests toward high-risk populations has many advantages. By screening populations with a higher disease prevalence, we can actually increase the PPV of that test. Screening low-prevalence populations can lead to more false positives, which can be costly and harmful to patients. Thus, selection of the disease to be tested and the patient population to be screened are both important to consider when designing a new test.
The APRN can evaluate the success of screening programs by looking at a variety of outcomes. For example, some of the outcomes that can be followed include the reduction in overall mortality in screened individuals, a reduction in the CFR in screened individuals, an increase in the percentage of cases detected at earlier stages, a reduction in complications, and improvement of quality of life in screened individuals.

81In 2018, the U.S. Preventive Services Task Force (USPSTF) released their final recommendations for cervical cancer screening (USPSTF, 2018). The complete recommendations can be found on the USPSTF web site (www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-issues-new-cervical-cancer-screening-recommendations). One of the recommendations for cervical cancer screening is that women aged 21 to 65 should get a Pap smear every 3 years. A second recommendation is that women aged 30 to 65 who wish to be screened less frequently can choose a combination Pap smear and human papillomavirus (HPV) testing every 5 years. The Task Force does not recommend cervical cancer screening using HPV testing in women younger than age 30. This is because evidence indicates that the expected harms (such as false positives) in this age group outweigh the potential benefits.
According to the Task Force, “since the implementation of widespread cervical cancer screening, there has been a dramatic reduction in cervical cancer deaths in the United States” (USPSTF, P4). For this reason, the Task Force urges healthcare providers to encourage women to be screened for cervical cancer, especially those who have never been screened, or who have not been screened within the past 5 years. These guidelines provide an example of how evidence on the specificity and sensitivity of a screening test can be used to create more evidence-based clinical guidelines. Therefore, screening tests need to be tailored to the disease under investigation, and many factors need to be taken into consideration; for example, How many false negatives can be missed? How many false positives are acceptable? Can screening and early detection really make a difference in the outcome of the disease? Understanding these factors and balancing them with targeted screening in high-risk populations are important considerations in screening implementation. The USPSTF provides screening guidelines on a variety of disease states with recommendations (e.g., colorectal, prostate, and breast cancers). APRNs can visit their website located at https://www.uspreventiveservicestaskforce.org for the latest recommendations.
(Curley 80-81)
Curley, Ann L., PhD, RN. Population-Based Nursing, 3rd Edition. Springer Publishing Company, 20190903. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.

FAQ: What is a…?
1. Screening or diagnostic tool: Instrument used to detect disease in groups of individuals with the goal of reducing and/or preventing morbidity and mortality. Examples: Beck’s Depression Screening Tool, Attention Deficit Screening Tool, Pap smear, mammography, colonoscopy, cologuard or the Mini-Nutritional Assessment screening tool (https://www.ncoa.org/center-for-healthy-aging/resourcehub/community-orgs-and-professionals/professional-resources/malnutrition-screening-tools/).
FAQ: What is the meaning of…?
2. Predictive value of a test: (PV) is a measure of the probability of a positive test result when the disease is present.

a. Positive predictive value: The number of the people who test positive who actually have the disease.

b. Negative predictive value: The number of the people who test negative who truly do not have the disease.

3. Sensitivity: measure of a screening test’s ability to accurately identify disease when it is present. The higher the sensitivity of a tool, the fewer the cases that will go undetected and the greater sensitivity of the tool to detect disease. For example, in-office tests for influenza or for Beta Hemolytic Strep Throat. They may be specific to influenza BUT are they also sensitive enough to pick up the organism?

4. Specificity: measure of a screening test’s ability to correctly identify those with the disease and to exclude the persons who do not have the disease. The higher the specificity of the screening tool the fewer persons will be incorrectly identified at-risk. So, this means the test is specific to the organism for instance, to influenza, and that it will be up influenza and not mononucleosis for example, of Beta Hemolytic Strep throat.

5. Validity: ability of the tool to actually measure what it says it measures.

Assignment: NR503 Discussion Week 2 Iron Deficiency Anemia Sample

Iron deficiency anemia is a chronic condition that results from inadequate healthy red blood cells, hence decreased capacity for hemoglobin and subsequent oxygen transport. Iron is a prerequisite for the growth and development of red blood cells. Iron deficiency anemia also results from torrential hemorrhages such as accidents, severe bleeding from surgery, or any other activity exposing an individual to torrential hemorrhage. Individuals with bleeding disorders also risk developing iron-deficiency anemia (Mirzy et al., 2018). Individuals with maladaptive syndromes are also at risk. Bleeding or decreased iron stores lead to the development of small RBCs with low hemoglobin levels. The symptoms of the disease include paleness, shortness of breath, strange cravings, leg tingling or crawling sensation, a fast heartbeat, brittle nails, and headaches.

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Serum ferritin Test for Iron Deficiency Anemia Screening

The selected diagnostic test is serum ferritin. Bone marrow aspirate is the most accurate test for Iron deficiency anemia, but it is invasive and not readily available. Hence, the serum ferritin test is the most clinically significant. Serum ferritin is the most practical test, measured through radioimmunoassay, and helps identify an iron deficiency. Healthcare providers order other tests to understand the characteristics of red blood cells when serum ferritin levels are lower than normal. Capellini et al. (2020) state that serum ferritin is sensitive to the depletion of iron stores and is the most important marker of iron levels. Ferritin is an iron-binding and transport protein. It is available in the bloodstream and transports iron to cells requiring it. When iron stores are low, serum ferritin level drops to detectable levels. The test has been used for a long time in healthcare facilities are the screening tool for iron deficiency anemia.

Mirzy et al. (2018) note that women of reproductive/childbearing age are the most affected by iron deficiency anemia due to the monthly blood loss through menstruation. Some women experience menorrhagia and are at more risk. Iron is lost with blood loss, and lack of access to iron-rich foods or maladaptive syndromes leads to depletion of iron stores, and the demand increases more than the supply.

Serum Ferritin Test Analysis

Serum ferritin is a screening test and not a good diagnostic test. The test is widely used to determine iron deficiency of iron in many healthcare conditions, and thus the test cannot be used to determine. Serum ferritin tests have a high sensitivity (95%) and specificity (91%) in detecting iron deficiency (Fothergill et al., 2018). The test does not test for iron deficiency but is a primary predictor because it tests iron levels in the blood. Forthergil et al. (2018) tested iron deficiency anemia diagnostic tests such as hemoglobin and serum ferritin. The study showed that serum ferritin tests have a high sensitivity and a low specificity in screening for iron deficiency anemia in women of reproductive age. Mei et al. (2021) note that the test can be used to determine the various stages of iron deficiency hence its significance in iron deficiency anemia. Serum ferritin tests help determine the level of iron stores and are not an indicator of iron deficiency anemia. However, it is effective in detecting the disease in its early stages of development, as is the role of screening (Capellini et al., 2020).

The test alone cannot help diagnose or rule out iron deficiency but is rather the first step in diagnosing iron deficiency anemia hence its significance. Iron deficiency anemia develops over time, and hemoglobin tests may not detect it early (Capellini et al., 2020). Incorporating this test is important in advanced nursing practice. Iron deficiency anemia begins early, and iron deficiency is the precursor of the problem. Thus, detecting and acting on low Iron levels is vital to preventing iron deficiency anemia. The screening test will thus be important in preventing iron deficiency anemia in many populations, including women of childbearing age.

Conclusion

Iron deficiency anemia is common among women of reproductive age. Screening helps detect problems early and helps prevent them. Screening tests may target the problem or changes it causes or precipitates it in the body. All individuals with iron deficiency anemia have low ferritin levels, but not all individuals with low serum ferritin levels have iron deficiency anemia hence the high sensitivity and low specificity. Thus, the test determines iron deficiency, a precursor to iron deficiency anemia. The test can also diagnose other healthcare conditions such as liver problems and preterm labor. Understanding the predictive ability of a test helps healthcare providers implement the best tests for optimum health outcomes.

References

Addo, O. Y., Mei, Z., Hod, E. A., Jefferds, M. E., Sharma, A. J., Flores-Ayala, R. C., Spitalnik, S. L., & Brittenham, G. M. (2022). Physiologically based serum ferritin thresholds for iron deficiency in women of reproductive age who are blood donors. Blood Advances. https://doi.org/10.1182/bloodadvances.2022007066

Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020). Iron deficiency anemia revisited. Journal of Internal Medicine, 287(2), 153-170. https://doi.org/10.1111/joim.13004

Fothergill, A., Crider, K., Johnson, C., Raj, M., Guetterman, H., Bose, B., Rose, C., Qi, P. Y., Williams, J., Kuriyan, R., Bonam, W., & Finkelstein, J. (2022). Comparison of Anemia Screening Methods Using Paired Venous Samples in Women of Reproductive Age in Southern India. Current Developments in Nutrition, 6(Supp. 1), 567-567. https://doi.org/10.1093/cdn/nzac060.025

Mei, Z., Addo, O. Y., Jefferds, M. E., Sharma, A. J., Flores-Ayala, R. C., & Brittenham, G. M. (2021). Physiologically based serum ferritin thresholds for iron deficiency in children and non-pregnant women: a US National Health and Nutrition Examination Surveys (NHANES) serial cross-sectional study. The Lancet Haematology, 8(8), e572-e582. https://doi.org/10.1016/S2352-3026(21)00168-X

Mirza, F. G., Abdul-Kadir, R., Breymann, C., Fraser, I. S., & Taher, A. (2018). Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert Review Of Hematology, 11(9), 727-736. https://doi.org/10.1080/17474086.2018.1502081