Advanced practice nurses might use various diagnostic tests and assessment tools when identifying a particular patient’s health condition. Medical practitioners must be aware of multiple factors that impact the reliability and validity of the clinical results produced by the tools and tests. As a result, they must choose the best and most suitable tool or test when dealing with adults or children to measure and interpret the findings or results accurately. Rapid strep and monospot testing are some of the commonly used tools or tests when assessing adults and children. In determining an infection that might lead to life-threatening aggressive conditions, the nurse practitioner must perform an easy and reliable strep diagnostic technique. There is a need to note that rapid strep diagnosis might be challenging, making it difficult to determine suitable therapy. A monospot testing or mononuclear spot testing is typically a type of heterophile antibody test for infectious mononucleosis. The paper will critically analyze an adult case study under rapid strep and monospot testing. It will also discuss the purpose of the diagnostic test, how it is performed, the information gathered and its reliability and validity.
Purpose of the Diagnostic Test
A rapid strep throat diagnostic test was initiated to facilitate quick diagnosis and avoid misusing antibiotics through efficient treatment techniques. Indeed, it is an antigen diagnostic test entailing a throat swab. Notably, the rapid strep test is a swift and precise diagnostic tool that nurses use to identify strep bacteria in the throat. Thus, the diagnostic test unveils group A streptococcus bacteria that contribute to strep throat and related infections, including pneumonia, abscesses and scarlet fever (Ball et al., 2019). This implies that a rapid strep test is utilized in evaluating if streptococcus is present in particular regions such as the vulvar in females and perianal infections in men. In most cases, a rapid strep test is performed when an adult has strep throat infection-like symptoms or reports a sore throat (Demoré et al., 2018).
Besides, a monospot diagnostic test is a latex agglutination technique that uses equine erythrocytes as the central substrate and often tests for particular heterophile antibodies the human immune system produces while responding to Epstein-Barr virus (EBV) infection. Such antibodies might cross-react with other cells, such as horse red blood cells. Thus, they are rapid testing tools since they are utilized for the swift screening of contagious mononucleosis. The diagnostic test might help in detecting the streptococcal pathogen rapidly, making it an ideal diagnostic test for an infection (Dains et al., 2019). Again, it facilitates the proper choice of antibodies and is cost-efficient compared to the traditional bacterial culture test. The presence of the specific antibodies in the patient’s blood specimen will cause clumping of the sample if exposed to equine erythrocytes. Such a result signals a positive agglutination reaction (Marshall-Andon & Heinz, 2017).
Conducting the Diagnostic Test
An appropriate rapid strep diagnostic test might be performed in the lab or the physician’s office. The procedure entails a cotton swab over the posterior pharynx or tonsils. A given throat swab kit is utilized in collecting the specimen in regions with inflammation, redness or pus. To produce accurate results, the swab specimens should be processed instantly (Dains et al., 2019). The QuickRead RADT is one of the standard techniques used in rapid strep tests. Besides, the monospot diagnostic test is conducted in the laboratory, where lab technicians put the blood sample on a specific microscope slide. Afterward, they mix the blood specimen with other substances and observe to determine if the blood starts to clump (Ball et al., 2019). Failure for the blood specimen to clump means the test is positive confirmation of mononucleosis.
The Information Gathered
A rapid strep throat test is used to determine possible strep infection. The test takes around 15 minutes to determine whether the test is positive or negative for strep infections. Again, the diagnostic test might test the contributing factors for the throat infections. A positive diagnostic test is obtained if the reaction occurs between the strep bacteria’s surface and the chemical or protein within the test samples. A person positively diagnosed with the infection must take warm fluids, antibiotics and gargle salty water (Dains et al., 2019). However, when the results are negative, the medical practitioner will examine other possible causes of the sore throat. If strep remains untreated, it might lead to streptococcal pneumonia, kidney infections, inflammation and meningitis. In monospot testing, the results are either negative or positive. When the equine erythrocytes are present in the blood sample, there will be an agglutination or clumping of the blood sample. This is the information required to have a positive or negative analysis. A positive clumping reaction is considered a positive diagnostic test, thus confirming the clinically suspected infectious mononucleosis (IM) (Ball et al., 2019). Apart from a positive response on the diagnostic test, an infected patient has more white blood cells and more than standard atypical lymphocytes. In addition, a positive diagnostic test shows that heterophile antibodies are present. A negative diagnostic test might imply that the patient lacks infectious mononucleosis (Marshall-Andon & Heinz, 2017).
Evaluating The Diagnostic Test Reliability and Validity
According to contemporary clinical studies, the rapid strep diagnostic test has a sensitivity of almost 95%. This implies that for every 100 patients presumed to have a sore throat, 95 of them will test positive for the infection. Thus, patients must always look for medical attention if signs persist (Noble & Smith, 2015). Again, the specificity for the diagnostic test is around 98%. This means that for every 100 people tested, 98 of them must have accurate results. The test will identify patients with strep bacteria in their tonsils (Dains et al., 2019). Further studies reveal the rapid strep test has a positive predictive value; of 100%. But, the negative predictive value is around 94%. As a result, the accuracy aligned with this diagnostic tool is more than in standard clinical results. While the monospot diagnostic test is considered to be quite specific, its sensitivity is around 80%. Besides, its specificity is almost 90.6%, with a positive predictive value of 36.4% and a negative predictive value of 98.5%. Indeed, the test is mainly weak among young patients, especially those below four years (Noble & Smith, 2015). As a result of its low sensitivity, the diagnostic test is unreliable and not recommended for diagnosing and treating clinical infectious mononucleosis.
In conclusion, advanced practice registered nurses (APRNs) must use various diagnostic tests and assessment tools to identify a particular patient’s health condition. Even though proper diagnosis and treatment are paramount, people must ensure optimum management of clinical infections such as the sore throat (Demoré et al., 2018). For instance, the rapid strep test is a fast and most convenient diagnostic tool medical practitioners use to diagnose strep throat. Besides, a monospot diagnostic test is a type of heterophile antibody for testing for infectious mononucleosis. In the diagnostic tests, medical practitioners must consider the specificity, reliability and predictive values for each while performing a diagnosis (Dains et al., 2019). As a result, they will select the optimum and most appropriate tool to deal with adults or children and accurately interpret the diagnostic results.
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.). St. Louis, MO: Elsevier Mosby.
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.
Demoré, B., Tebano, G., Gravoulet, J., Wilcke, C., Ruspini, E., Birgé, J., … & Malblanc, S. (2018). Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies. European Journal of Clinical Microbiology & Infectious Diseases, 37(9), 1637-1645. https://link.springer.com/article/10.1007/s10096-018-3293-8
Marshall-Andon, T., & Heinz, P. (2017). How to use… the Monospot and other heterophile antibody tests. Archives of Disease in Childhood-Education and Practice, 102(4), 188-193. https://ep.bmj.com/content/102/4/188.short
Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research. Evidence Based Nursing, 18(2), pp. 34–35.
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