Bodhi Brown iHuman Case Scenario

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 loss of consciousness on the football field during practice. He reports having a headache, nausea, lightheadedness, cramps, excessive sweating, and decreased urination, as well as admitting to not hydrating well. Physical exam shows tachycardia, orthostatic hypotension, dry mucous membranes, and capillary refill of 3 seconds. Risk factors include antihistamine use, alcohol consumption, wearing heavy equipment in high heat and humidity, and obesity.

Primary Diagnosis

Heat Exhaustion:

The most likely diagnosis is heat exhaustion, as the patient experienced a heat index of 100°F, inadequate hydration, high-intensity exercise, and loss of consciousness. It is differentiated from simple dehydration by the heat index (Mayo Clinic, 2021). The presence of sweating, normal mentation, and a core body temperature below 104°F disqualifies the diagnosis of heat stroke.

Different Diagnoses

1. Bradycardia:

Bradycardia is one of the alternative diagnoses. Bradycardia refers to a slow heart rate. Some signs of bradycardia include fatigue, fainting, lightheadedness, confusion or memory loss, and chest pain (O’Connor and Casa, 2021). The patient collapsed after exercise and experienced lightheadedness, suggesting the possibility of bradycardia. However, the absence of chest pain and shortness of breath rules out bradycardia.

2. Syncope:

Another diagnosis to consider is syncope. Syncope is a term used to describe passing out or fainting. A person experiences syncope when they briefly lose consciousness and then quickly regain it. Symptoms of syncope include blacking out, falling for no apparent reason, feeling lightheaded, dizziness, grogginess, fainting, and changes in vision (O’Connor and Casa, 2021). The patient collapsed and fainted after exercise, which aligns with syncope. However, the absence of symptoms such as grogginess makes syncope less likely.

3. Dehydration:

Dehydration is another possible diagnosis for the patient. Dehydration occurs when an individual does not consume enough water or loses more fluids than they take in. Fluid loss can result from sweating, tears, vomiting, urination, and diarrhea (O’Connor and Casa, 2021). Given that the patient developed symptoms after exercise, sweating may have led to dehydration. Symptoms of dehydration include fatigue, headache, lightheadedness, dry mouth, and infrequent urination, all of which the patient exhibited.

Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

Pharmacological Care

– No intervention is required if the patient is stable and asymptomatic, but continuous monitoring for patient safety and well-being will continue.
– Cardiac monitoring, IV access, with continuous assessment: VS (vital signs) every 5-15 minutes every 4-6 hours for the first 24 hours, including oxygen saturation when indicated.
– Atropine 1 mg IV bolus. Repeat every 3-5 minutes as needed, but do not exceed a total dose of 3 mg.

Supportive Care

– The patient should refrain from returning to play or engaging in intense practice in hot conditions for at least 24 hours.
– The patient should develop an acclimatization plan and remain symptom-free before returning to play.
– Change wet clothes and sheets as needed.
– Stay hydrated with fluids high in electrolytes.
– Maintain a moderate room temperature.
– Loosen clothing.

Additional Ancillary Test Needed

– 12-lead electrocardiograms (ECG).

Social Determinants of Health to Consider, Health Promotion, and Patient Risk Factors

– Hyperglycemia may result from the patient’s heavy fast-food diet.
– Obesity is a risk factor for heat-related illness. Increased weight or excess weight can impede the body’s ability to regulate body temperature effectively.
– A nutritionist can provide guidance for the entire family.

Patient Education

– Explain the signs and symptoms to help the patient recognize them early.
– Educate the patient to consume sports drinks (e.g., Gatorade) or water (Buttaro et al., 2021).
– Educate the patient on a diet to prevent weight gain.
– Educate the patient about signs and symptoms of low blood pressure.

Follow-Up/Disposition

– Refer the patient to a cardiac consult.
– Schedule a follow-up appointment in 1 to 2 weeks.
– Advise the patient to call 911 if symptoms of bradycardia persist.
– Allow the patient to engage in activity as tolerated.
– Excuse the patient from school sports workouts for 5 days. They may return to school after 5 days if symptom-free.

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