Comprehensive Health Assessment / Health Screening

Question 1

What is screening?

Answer 1

“The presumptive identification of unrecognised disease or defects by the administration of tests, examinations or other procedures that can be applied rapidly”

“Identifies asymptomatic people who may unknowingly have a health problem.”

Question 2

What is the purpose of screening?

Answer 2

Rapid, economic identification of people, populations with high probability of having/developing a particular illness.

Potential resulting action:
 referral for definite diagnosis and treatment
 identifies risk factors in a population
 implementation of preventative measures and strategies.

Question 3

What is a Screening test

Answer 3

Screening
 1. Done on apparently healthy individuals
 2. Applied to groups
 3. Results are arbitrary and final
 4. Based on one criteria and cut-off
 5. Less accurate
 6. Less expensive
 7. Not a basis for treatment
 8. Initiative comes from investigator

Question 4

What is a Diagnostic test

Answer 4

 1. Done on sick or ill individuals
 2. Applied on single patient
 3. Diagnosis is not final
 4. Based on evaluation of a no. of signs/symptoms & lab findings
 5. More accurate
 6. More expensive
 7. Used as a basis for treatment
 8. Initiative comes from a patient

Question 5

What are types of screening

Answer 5

Organised:
 Mass/Unselective Screening
 Selective /high-risk/ targeted screening
 Multipurpose screening
 Multi-phasic screening

Opportunistic

Question 6

What are mass or non selective Screening

Answer 6

Entire population/setting/
community is screened

Entire population/setting/ community is screened

Eg 1. Breast screening: All NZ women aged 45-69 – just changing up to age 75!

Eg 2. Cardiovascular disease risk Assessment – Men 45; women 55; or
Maori, Pacific, or Indian 35 and 45.

Question 7

What is Selective/ targeted screening

Answer 7

Target’s high risk groups

EG: High risk groups sometimes screened for osteoporosis with Bone density testing:

1. post-menopausal woman: not taking
   estrogen; tall (over 5 feet 7 inches) or thin (less than 125 pounds).
2. Hx of hip fracture or smoking, use
   medications that are known to cause
   bone loss, type 1 diabetes, liver disease, kidney disease or a family history of osteoporosis, hyperthyroidism.

Question 8

What is Multi-purpose screening?

Answer 8

More than one condition tested for at once for large gp.

Eg 1. Antenatal: first antenatal bloods: full blood count, blood group and antibodies, hepatitis B, rubella, syphilis, HIV, diabetes. Urine (dipstick) tests for protein, sugar, bacteria

Eg 2. Well-child Tamariki ora checks: questions, assessments, observations, for child physical conditions and cognitive developmental. Family well-being.

Question 9

What is Multi-phasic screening

Answer 9

More than one test used at same time to check for same disease/condition

e.g. Screening for gestational
diabetes
Antenatal
bloods
plus: Fasting blood sugar, blood sugar random time of the day, oral glucose tolerance test, A1C blood test (Ave blood sugar past 2-3 months)

Question 10

What is opportunistic screening

Answer 10

Client is present, so screen.

Can be an individual; a family; a community

Question 11

3 components to screening considerations

Answer 11

 Disease considerations
 Test considerations
 Target group considerations

Question 12

What are disease considerations

Answer 12

 The disease affects a sufficient number of people to make screening cost effective

 The disease is relatively serious

 An effective treatment is available for the disease

 The pre-clinical period is sufficient to
allow treatment before symptoms occur

 Early diagnosis and treatment make a
difference in terms of outcome

Question 13

What are Test considerations

Answer 13

 The screening test is sensitive to detect most cases of the disease

 The screening test is specific enough to exclude most other causes of positive results

 The importance and implications of both false positive and false negative results must be remembered

 The screening test costs little, is easy to administer and has minimal side effects

Question 14

What are Target Group considerations

Answer 14

The target group is readily identifiable
The target group is accessible
The test is appropriate to the target group

Question 15

What is Genetic Screening for
populations

Answer 15

 Genetic screening of whole populations is under development, and offered to some groups

 Eg: Jews of Eastern European origin have greater chance of inheriting a specific genetic mutation in the BRCA1 and BRCA2 genes (Breast, Ovarian… CA)

Question 16

What are some ethical considerations with screening

Answer 16

Screening decisions involve beneficence, non- maleficence and confidentiality. The benefits of doing the test should be balanced against the potential for doing harm.

It differs from most health care in that it you are inviting well people to be tested to see if they are unwell.

 Is there equitable access to all types of screening?

 What are pros and cons of screening?

Question 17

What is the role of the nurse in
health screening

Answer 17

 The nurse may be involved at the start in decision making (community or hospital health policy)

 Nurses have been involved in initiating, encouraging participation and conducting health screening in NZ
for several years – BP, cholesterol, blood glucose, vision and hearing, developmental assessments, CVA, PHQ, STI and cervical smear taking…

Question 18

What must the nurse know when they are in a health screener role

Answer 18

In order to gain informed consent for the proposed screening test the nurse requires:
 full knowledge of the test
 the meaning of the test
 the limitations of the test
Be ready to:
Provide appropriate health education
Provide follow-up advice and support