Introduction
Diagnostic work-ups are an essential part of every nurse’s healthcare service delivery process as they help to make up informed diagnostics on a patient’s condition, allowing accurate and effective address to the presented health complications. A diagnostic work-up is vital in Mario’s case, where it is the first time the patient seeks the nurse practitioner’s services. Given that the subjective evaluation of Mario’s health condition has revealed complications such as pallor, fatigue, poor weight gain, nosebleeds, and fussiness, in addition to having low hemoglobin (Hgb) and hematocrit (Hct) levels from the fingerstick examination, an informed nursing practitioner will understand that the most likely condition affecting the patient is anemia. Anemia is a common condition in pediatrics and can be caused by various underlying factors. To further evaluate and determine whether Mario should be diagnosed with anemia and how the condition developed, a systematic diagnostic work-up is necessary.
Systematic Diagnostic Work-up
To have a comprehensive diagnosis process that will ensure the nursing practitioner attains a holistic understanding of the presented clinical problems and Mario’s condition is effectively addressed, the proposed systemic diagnostic work-up will comprise three sequential assessment and information-gathering stages of eight activities. The three sequential stages are initial screening and general assessment, specific anemia investigation, and further evaluation and consultation.
Initial Screening and General Assessment
Given that the patient’s history information provided by Mario’s mother and the initial examination of the patient by the nurse practitioner points out the possible healthcare complication at hand being anemia, the first diagnostic test that is recommended for the case is initial screening through complete blood count (CBC) with peripheral smear. Beginning with a CBC and peripheral smear will allow the nurse practitioner to investigate Mario’s blood cell counts effectively. According to Perry et al. (2022), CBC allows healthcare practitioners to effectively conduct red blood cell, white blood cell, and platelet counts. The CBC assessment will eventually provide the nursing practitioner with essential information concerning the type and severity of anemia and any signs of hemolysis or abnormal cell morphology.
At the same time, the nursing practitioner can supplement that initial screening and general assessment exercise by conducting reticulocyte count and lead-level testing investigations. It will be more beneficial for the nursing practitioner to proceed with a reticulocyte count exercise immediately after obtaining the CBC results. The reticulocyte count assessment will help the nursing practitioner determine if Mario’s bone marrow appropriately responds to the existing anemia condition. Bracho (2023) indicates that a low count will indicate issues related to bone marrow production, while a high count could suggest the existence of hemolysis. Given the potential risk of lead exposure due to the ongoing home renovation, performing lead-level testing will be necessary to have a general perspective of Mario’s health condition and recent experiences with anemia. Lead toxicity can lead to microcytic anemia and other developmental issues. Hence, knowing whether Mario has experienced lead exposure and toxicity is vital in effectively addressing the presented health issue and improving his overall health.
Specific Anemia Investigations:
Once the initial screening is completed, the nurse practitioner should conduct examinations that specifically take a deeper investigation into the anemia condition. The first specific anemia examination the nurse practitioner should conduct is iron studies which are vital in evaluating Mario’s iron status. As John (2022) notes, assessing serum iron, total iron-binding capacity (TIBC), and ferritin levels helps to differentiate between various types of anemia, particularly iron-deficiency anemia. After the iron studies, the nurse practitioner can check Mario’s vitamin B12 and folate levels. Deficiencies in these vitamins can contribute to anemia, and the assessments will help rule out these potential causes of Mario’s health complications. At the same time, the nurse practitioner can find the diagnostic work-up more productive by undertaking a stool guaiac or fecal occult blood test better to understand the specific details of the existing anemia condition. Given that Mario was found to have poor weight gain characteristics, performing a stool guaiac or fecal occult blood test will help the nurse practitioner better understand the possibility of Mario experiencing gastrointestinal bleeding, which could contribute to anemia.
Further Evaluation and Expert Consultation
The initial and anemia-specific tests can lead to findings with certain information on the patient’s healthcare condition lacking. Therefore, after engaging in the two recommended stages of diagnostic evaluation, the nurse practitioner should enhance their understanding of the patient’s condition by undertaking further examination and seeking advice from experts in the field. If the initial tests do not yield a clear diagnosis, it is recommendable for the nurse practitioner to consider other anemia-specific tests, such as hemoglobin electrophoresis. Hemoglobin electrophoresis is a specialized test that can help the nurse practitioner identify Mario’s experience with hemoglobinopathies like thalassemias or sickle cell disease, which are major contributors to anemia (Brown et al., 2023). Furthermore, there are times when a person’s perspective is insufficient in understanding a clinical situation comprehensively. Hence, if the nurse practitioner finds themselves in a decision-making dilemma, the results from the previous tests remain inconclusive, or if the anemia is severe, seek a consultation with a pediatric hematologist. The opinion of expert practitioners will assist and guide the nurse practitioner into more efficient investigations and ensure a comprehensive understanding of Mario’s condition.
Conclusion
In conclusion, by following the provided systematic sequence of diagnostic tests, the nursing practitioner is given an advanced opportunity to effectively and efficiently identify the underlying health condition affecting Mario and gain a holistic understanding of how to help the patient. The initial screening provides a general overview of Mario’s blood status and potential exposures. At the same time, the specific investigations take a deeper dig into the possibility of Mario being affected by anemia. Consulting with a pediatric hematologist will also ensure that specialized knowledge is applied to the case, leading to accurate diagnosis and effective treatment. Therefore, the diagnostic work-up provided can be the key to the nursing practitioner’s capacity to promptly and comprehensively address Mario’s health complications and positively contribute to his overall health and well-being.
References
Bracho, F. J. (2023). Reference intervals of automated reticulocyte count and immature reticulocyte fraction in a pediatric population. International Journal of Laboratory Hematology, 45(4), 469-480. Retrieved from https://doi.org/10.1111/ijlh.13776
Brown, T. S., Lakra, R., Master, S., & Ramadas, P. (2023). Sickle Cell Trait: Is It Always Benign? Journal of Hematology, 12(3), 123–127. Retrieved from https://doi.org/10.14740%2Fjh958
John, R. M. (2022). Pediatric Diagnostic Labs for Primary Care: An Evidence-based Approach. Springer Nature.
Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal Child Nursing Care. Elsevier Health Sciences.
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