Assignment Prompt & Instructions
1-2 paragraphs, add or disagree to prompt attached.
include references
**files (1)**
– ## responds2week7.pdf
**## responds2week7.pdf**
Case Scenario 2: Elizabeth
Elizabeth is a 14-year-old female who has sickle cell disease and exercise-
induced asthma. Her asthma has been well managed so far but she is interested
in trying out for the volleyball team. She came to the clinic today for a sport
physical and clearance.
What more should you know about Elizabeth?
A detailed history is important prior to clearing Elizabeth for sports participation, with
attention to both sickle cell disease (SCD) and exercise-induced asthma. For her SCD,
it is important to assess the frequency and severity of vaso-occlusive crises, any prior
episodes of acute chest syndrome, baseline functional capacity, and history of exercise
intolerance. Individuals with SCD often have reduced exercise tolerance, and
physiologic stressors such as dehydration, hypoxia, and high intensity exertion can
increase the risk of complications (Connes et al., 2024). For asthma, her level of control
should be evaluated, including the frequency of symptoms, use of rescue inhalers,
known triggers, and any history of exercise induced bronchoconstriction (EIB).
Adolescent athletes with asthma commonly experience bronchoconstriction during
exercise, particularly without preventive therapy (Hashim et al., 2023). Medication
adherence and ensuring access to a rescue inhaler during activity are also essential.
Assuming you can clear Elizabeth for volleyball, what type of anticipatory
guidance would she and her family need? Include specific instructions for sickle
cell crisis and asthma exacerbation prevention.
If Elizabeth is cleared for volleyball, anticipatory guidance should focus on preventing
complications related to both SCD and Exercise-Induced Asthma. For SCD, she should
be encouraged to stay well hydrated before, during, and after exercise and avoid
extreme heat or intense overexertion. Activity should be increased gradually with
frequent rest breaks. She and her family should be taught to stop activity right away if
she develops unusual fatigue, muscle pain, dizziness, or shortness of breath, as these
may be early signs of a sickle cell crisis (Smith et al., 2022; Connes et al., 2024). It is
also important to seek medical care if symptoms do not improve with rest and hydration.
For asthma, she should use her rescue inhaler before exercise if prescribed and always
have it available during sports. A proper warming up and avoiding known triggers are
also important (Hashim et al., 2023). She should stop playing if she develops wheezing,
chest tightness, coughing, or difficulty breathing and use her inhaler as directed. If
symptoms do not improve, further medical evaluation is needed. Overall, education
should also include the importance of good hydration, recognizing early warning signs,
and communicating symptoms to coaches or family members to ensure safe
participation in sports.
What part of the sports physical exam should the APRN focus on given
Elizabeth's medical history?
The APRN should focus primarily on cardiopulmonary and functional assessment. A
thorough respiratory examination is necessary to evaluate for wheezing or airflow
limitation, along with assessment of baseline respiratory status. Cardiovascular
evaluation, including heart rate and rhythm, is also important given the impact of SCD
on oxygen delivery and exercise tolerance. Assessment of functional capacity and
exercise tolerance should also be included, as individuals with SCD may have reduced
cardiopulmonary performance. Cardiopulmonary exercise testing has been shown to be
generally safe in this population, with a low incidence of adverse events, and may be
useful when further evaluation is needed (Smith et al., 2022). Additionally, the exam
should include assessment for signs of anemia or dehydration, along with a review of
asthma control and inhaler technique in patients with Exercise Induced Asthma. These
focused components help ensure safe participation in sports. In the clinical setting, this
includes lung auscultation for wheezing, cardiac auscultation for rhythm abnormalities,
and brief functional evaluation (e.g., observing tolerance to mild exertion). If needed,
pulmonary function testing such as spirometry may be used to further evaluate asthma
control.
References
Connes, P., Stauffer, E., Liem, R. I., & Nader, E. (2024). Exercise and training in sickle
cell disease: Safety, potential benefits, and recommendations. American Journal of
Hematology, 99(10), 1988–2001. https://doi.org/10.1002/ajh.27454
Hashim, S. H., Alenezi, M. I., Alenezi, R. M., Alanazi, W. T., Alruwaili, M. M., Alali, A. A.,
& Alanazi, A. M. (2023). Exercise-Induced Bronchoconstriction Among Adolescent
Athletes With Asthma: A Systematic Review. Cureus, 15(6), e40643.
https://doi.org/10.7759/cureus.40643Links to an external site.
Maaks, D.L. G., Starr, N., & Gaylord, N. (2019). Burns' pediatric primary Care (7th ed.).
Elsevier https://online.vitalsource.com/books/9780323581967Links to an external site.
Smith, K. N., Baynard, T., Fischbach, P. S., Hankins, J. S., Hsu, L. L., Murphy, P. M.,
Ness, K. K., Radom-Aizik, S., Tang, A., & Liem, R. I. (2022). Safety of Maximal
Cardiopulmonary Exercise Testing in Individuals with Sickle Cell Disease: A Systematic
Review. British Journal of Sports Medicine, 56(13), 764–769.
https://doi.org/10.1136/bjsports-2021-104450Links to an external site.
[https://doi.org/10.1002/ajh.27454](https://doi.org/10.1002/ajh.27454)
[https://doi.org/10.7759/cureus.40643](https://doi.org/10.7759/cureus.40643)
[https://online.vitalsource.com/books/9780323581967](https://online.vitalsource.com/books/9780323581967)
[https://doi.org/10.1136/bjsports-2021-104450](https://doi.org/10.1136/bjsports-2021-104450)
**## responds2week7.pdf**
Case Scenario 2: Elizabeth
Elizabeth is a 14-year-old female who has sickle cell disease and exercise-
induced asthma. Her asthma has been well managed so far but she is interested
in trying out for the volleyball team. She came to the clinic today for a sport
physical and clearance.
What more should you know about Elizabeth?
A detailed history is important prior to clearing Elizabeth for sports participation, with
attention to both sickle cell disease (SCD) and exercise-induced asthma. For her SCD,
it is important to assess the frequency and severity of vaso-occlusive crises, any prior
episodes of acute chest syndrome, baseline functional capacity, and history of exercise
intolerance. Individuals with SCD often have reduced exercise tolerance, and
physiologic stressors such as dehydration, hypoxia, and high intensity exertion can
increase the risk of complications (Connes et al., 2024). For asthma, her level of control
should be evaluated, including the frequency of symptoms, use of rescue inhalers,
known triggers, and any history of exercise induced bronchoconstriction (EIB).
Adolescent athletes with asthma commonly experience bronchoconstriction during
exercise, particularly without preventive therapy (Hashim et al., 2023). Medication
adherence and ensuring access to a rescue inhaler during activity are also essential.
Assuming you can clear Elizabeth for volleyball, what type of anticipatory
guidance would she and her family need? Include specific instructions for sickle
cell crisis and asthma exacerbation prevention.
If Elizabeth is cleared for volleyball, anticipatory guidance should focus on preventing
complications related to both SCD and Exercise-Induced Asthma. For SCD, she should
be encouraged to stay well hydrated before, during, and after exercise and avoid
extreme heat or intense overexertion. Activity should be increased gradually with
frequent rest breaks. She and her family should be taught to stop activity right away if
she develops unusual fatigue, muscle pain, dizziness, or shortness of breath, as these
may be early signs of a sickle cell crisis (Smith et al., 2022; Connes et al., 2024). It is
also important to seek medical care if symptoms do not improve with rest and hydration.
For asthma, she should use her rescue inhaler before exercise if prescribed and always
have it available during sports. A proper warming up and avoiding known triggers are
also important (Hashim et al., 2023). She should stop playing if she develops wheezing,
chest tightness, coughing, or difficulty breathing and use her inhaler as directed. If
symptoms do not improve, further medical evaluation is needed. Overall, education
should also include the importance of good hydration, recognizing early warning signs,
and communicating symptoms to coaches or family members to ensure safe
participation in sports.
What part of the sports physical exam should the APRN focus on given
Elizabeth's medical history?
The APRN should focus primarily on cardiopulmonary and functional assessment. A
thorough respiratory examination is necessary to evaluate for wheezing or airflow
limitation, along with assessment of baseline respiratory status. Cardiovascular
evaluation, including heart rate and rhythm, is also important given the impact of SCD
on oxygen delivery and exercise tolerance. Assessment of functional capacity and
exercise tolerance should also be included, as individuals with SCD may have reduced
cardiopulmonary performance. Cardiopulmonary exercise testing has been shown to be
generally safe in this population, with a low incidence of adverse events, and may be
useful when further evaluation is needed (Smith et al., 2022). Additionally, the exam
should include assessment for signs of anemia or dehydration, along with a review of
asthma control and inhaler technique in patients with Exercise Induced Asthma. These
focused components help ensure safe participation in sports. In the clinical setting, this
includes lung auscultation for wheezing, cardiac auscultation for rhythm abnormalities,
and brief functional evaluation (e.g., observing tolerance to mild exertion). If needed,
pulmonary function testing such as spirometry may be used to further evaluate asthma
control.
References
Connes, P., Stauffer, E., Liem, R. I., & Nader, E. (2024). Exercise and training in sickle
cell disease: Safety, potential benefits, and recommendations. American Journal of
Hematology, 99(10), 1988–2001. https://doi.org/10.1002/ajh.27454
Hashim, S. H., Alenezi, M. I., Alenezi, R. M., Alanazi, W. T., Alruwaili, M. M., Alali, A. A.,
& Alanazi, A. M. (2023). Exercise-Induced Bronchoconstriction Among Adolescent
Athletes With Asthma: A Systematic Review. Cureus, 15(6), e40643.
https://doi.org/10.7759/cureus.40643Links to an external site.
Maaks, D.L. G., Starr, N., & Gaylord, N. (2019). Burns' pediatric primary Care (7th ed.).
Elsevier https://online.vitalsource.com/books/9780323581967Links to an external site.
Smith, K. N., Baynard, T., Fischbach, P. S., Hankins, J. S., Hsu, L. L., Murphy, P. M.,
Ness, K. K., Radom-Aizik, S., Tang, A., & Liem, R. I. (2022). Safety of Maximal
Cardiopulmonary Exercise Testing in Individuals with Sickle Cell Disease: A Systematic
Review. British Journal of Sports Medicine, 56(13), 764–769.
https://doi.org/10.1136/bjsports-2021-104450Links to an external site.
[https://doi.org/10.1002/ajh.27454](https://doi.org/10.1002/ajh.27454)
[https://doi.org/10.7759/cureus.40643](https://doi.org/10.7759/cureus.40643)
[https://online.vitalsource.com/books/9780323581967](https://online.vitalsource.com/books/9780323581967)
[https://doi.org/10.1136/bjsports-2021-104450](https://doi.org/10.1136/bjsports-2021-104450)