Bodhi Brown iHuman
Bodhi Brown iHuman Case Scenario
The patient is an 18 year /old male who presents to the clinic accompanied by his father after an exercise associated collapse with brief LOC on the football field during practice. He reports having headache, nausea, lightheadedness, cramps, excessive sweating, and decreased urination as well as admittedly not hydrating well. Physical exam shows tachycardia, orthostatic hypotension, dry mucous membranes, and capillary refill of 3 seconds. Risk factors include: antihistamine use, alcohol, wearing heavy equipment in high heat and humidity, and obesity.
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Primary Diagnosis
Heat Exhaustion:
The most likely diagnosis is heat exhaustion since the Pt has a heat index of 100F, inadequate hydration, high intensity exercise, and loss of consciousness. It is differentiated with simple dehydration by heat index (Mayo Clinic, 2021). His sweating, normal mentation and core body temp is below 104F and that disqualified the ruling of heat stroke.
Different Diagnosis
Bradycardia.
Bradycardia is one of the different diagnoses. The condition of having a slow heart rate is referred to as Bradycardia. Some of the signs for bradycardia include fatigue, fainting, lightheadedness, confusion or memory loss and chest pain (O’Connor and Casa, 2021). The Pt collapsed after the exercises and experienced lightheadedness meaning he might be suffering from bradycardia. The absence of chest pain and shortness of breath leading to ruling out of bradycardia condition.
Syncope.
Another diagnosis is Syncope. An alternative word for passing out or fainting is syncope.
A person is said to experience syncope if they pass out, go limp, and then quickly awaken. The symptoms for syncope include blacking out, falling for no reason, feeling lightheaded, dizziness, groggy, fainting and change in vision (O’Connor and Casa, 2021). After the exercise the Pt collapsed and fainted and awaked meaning that he could be experiencing syncope condition. Absence of symptoms such as feeling groggy leads to ruling out of syncope.
Dehydration.
Dehydration is another diagnosis possible for the Pt. When an individual does not drink enough water or loses more than they take in, they become dehydrated. Sweat, tears, vomiting, urination, and diarrhea all cause fluid loss (O’Connor and Casa, 2021) Bodhi Brown iHuman. The conditions developed after exercises meaning the Pt may have been dehydrated through sweating. Symptoms to dehydration include tiredness, headache, lightheadedness, dry mouth, and passing little urine infrequently. The patient was in possession of all these symptoms for dehydration.
Pharmacological Care
No intervention is required if the patient is stable and asymptomatic, but will continue to monitor for patient safety and well-being
Cardiac monitoring, IV access, with continuous assessment: VS: 5-15 min q 4-6 hours first 24 hours, including oxygen saturation when indicated
Atropine 1 mg IV bolus. Repeat q3-5min prn: do not excess 3mg/total does
Supportive Care
He should not return to play or engage in intense practice in heat for at least 24 hours
He should develop an acclimatization plan and be free from the symptoms before returning to play.
Change wet clothes and sheets, as needed.
Stay hydrated as much as possible high in electrolytes
Keep the room temperature moderate
Loosen clothing
Additional Ancillary Test Needed
12 lead electrocardiograms (ECG).
Social Determinants of Health to Consider, Health Promotion and Pt Risk Factors
Hyperglycemia can be as a result of his heavy fast-food diet.
Obesity is a risk factor for heat related illness. An increase in weight or excess weight hinders the body from regulating body temperature effectively.
A nutritionist can help the whole family.
Patient Education
Explain the signs and symptoms to assist him in recognizing them early.
Educate the patient to drink sports (Gatorade) drink or water (Buttaro et al., 2021).
Educate the patient on diet to avoid weight gain.
Educate the patient of signs and symptom of low blood pressure
Follow-Up/Disposition
Referral to cardiac consult
Follow up in 1 to 2 weeks
Call 911 if symptom of bradycardia persists
Activity as tolerate.
Bodhi Brown iHuman
Excuse from school sport workout for 5 days. May return back to school after 5 day if no symptoms
References
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier.
O’Connor F, Casa DJ. Exertion heat illness in Adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis. Updated. 2021.
Mayo Clinic (2021). Heat exhaustion. Retrieved November 2021, https://www.mayoclinic.org/diseases-conditions/heat-exhaustion/diagnosis-treatment/drc- 20373253 Bodhi Brown iHuman
