response 2 week 7

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.