Replies two peers with 200 words each one 

1.Sensitivity and specificity are measures of the accuracy of a screening test that we use to identify the presence or absence of a particular condition in an individual.

Sensitivity measures the proportion of true positives that are correctly identified by a screening test. In other words, it tells us the percentage of people who have the condition and are correctly identified by the screening test as having it.

Specificity measures the proportion of true negatives that are correctly identified by a screening test. That is, it tells us the percentage of people who do not suffer from the condition and who the screening test correctly identifies as not suffering.

Both sensitivity and specificity are important in determining the accuracy of a screening test, as they inform us about how effective the test is in correctly identifying both positive and negative cases. Ideally, we want a screening test that has high sensitivity and specificity, so that we can accurately identify the presence or absence of the condition being tested.

There are several factors that can affect sensitivity and specificity:

The threshold or cutoff value used to define a positive screening result. The lower the threshold, the more sensitivity increases but specificity decreases, while a higher threshold increases specificity but decreases sensitivity.

Also important is the prevalence of the condition in the population tested. In a population with high prevalence, the positive predictive value of the test may be higher, while in a population with low prevalence, false positive results may be more common.

Characteristics of the population being tested, such as age, sex, and comorbidities, which may influence the accuracy of the test.

It is important to note that sensitivity and specificity are not absolute measures of a test’s accuracy, but rather represent a balance between correctly identifying true positives and true negatives. Therefore, the decision to use a particular screening test should be based on a thorough evaluation of its performance characteristics and its suitability for the population being screened.

Considering the aforementioned aspects of sensitivity and specificity, we will be able to accurately address research studies, achieving better results.

2. Building evidence-based practice requires difficult assessment of diagnostic tests and measures. Sensitivity and specificity are vital parameters in identifying the validity of this important study. Sensitivity measures the ability of a test to properly identify individuals with a specific condition, while specificity gauges the ability to correctly identify individuals without the condition. Understanding these metrics is a fundamental advance study for healthcare and research settings for accurate disease identification and treatment planning. Sensitivity, also known as the true positive rate, measures the proportion of actual positives correctly identified by the test. High sensitivity ensures that individuals with the condition are unlikely to be missed, reducing the chances of false negatives. For instance, in cancer screening, a highly sensitive test detects can even detect early-stage of the cancers, leading to timely interventions and improved outcomes and like this be able to act. Sensitivity is crucial when early detection significantly influences patient prognosis, allowing for prompt medical intervention. On the other hand, specificity, or by other definition the true negative rate, reflects the proportion of individuals without the condition who are correctly identified by the test. High specificity minimizes false positives, confirming that healthy individuals are not unnecessarily subjected to further, potentially invasive, testing or treatments. For example, in HIV testing, high specificity is vital to prevent unnecessary emotional distress and healthcare costs resulting from false-positive results. Specificity is particularly important when a positive test result can lead to significant consequences, such as starting potent treatments or imposing lifestyle changes. There is often a difference between sensitivity and specificity. Increasing sensitivity may decrease specificity and vice versa, leading to a balance dilemma. Reaching to an optimal equilibrium is essential; too much focus on sensitivity might lead to overdiagnosis and overtreatment, while too much specificity might result in missed diagnoses. Applying the right balance will help individuals and it will and varies based on the medical condition, available treatments, and potential consequences of false results. 

     In summary, sensitivity and specificity are fundamental components in the screening aspects, tests playing a crucial role in evidence-based practice. Understanding and optimizing these parameters are imperative for clinicians and researchers, ensuring that diagnostic tests are trustworthy, leading to improved patient outcomes. By appreciating the balance between sensitivity and specificity, healthcare professionals can make informed choices, enhancing the quality of care and advancing evidence-based medicine.

• Week 7: Change Project Final Paper

Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
3. What are three things the nurse can do to speed up the time between admission and intervention? 
4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
6. Why is morphine the drug of choice for cardiac pain?
7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
8. What are three differences between CKMB’s and Troponin blood tests?
9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

due @10am 11-12-23