Running head: PREVENTION AND TREATMEMT PLAN FOR JUSTIN PERDUE

Prevention and Treatment Plan for Justin Perdue

October 9, 2015
Prevention and Treatment Plan for Justin Perdue Justin Perdue is a Caucasian, non-Hispanic twelve year old male brought in by his Mother for complaint of shortness of breath and wheezing while playing soccer. Patient also states that he has had a headache, and feels dizzy, and very tired since he moved to Colorado. Patient is up to date on immunizations per CDC recommendations. The patient’s Mother stated that he was a normal vaginal delivery, normal birth weight, at nine months. He does not take any medications, and has no known allergies, and no history of recent illness, or travel out of the country. Jason’s BMI is within normal range for his age, and he eats a diet low in fiber, and high in carbohydrates. He does not smoke, or use drugs or alcohol. Patient goes to public school, and participates in physical education. Jason also plays weekly baseball, soccer, and basketball. No history of any injuries. Jason moved from Southern California to Denver, Colorado 3 days ago.
The family flew from California to Colorado. Patient lives in a single family home with his Mother, Father, younger sister, and one small terrier dog. Jason’s Father has a history of cardiovascular disease, he had a myocardial infarction in 2000, and both Mother and Father have diabetes. Paternal Grandfather died from complications of a myocardial infarction. No family history of cancer.
Physical Assessment of patient is an alert and oriented, well developed twelve year old male, appears anxious, in mild distress. His skin is pale, warm, and dry, with adequate skin turgor, capillary refill is < 2 seconds. He has nasal flaring, tripod positioning. Clear and diminished breath sounds, with a non-productive cough. Normal rise and fall of chest. Abdomen is soft non-distended with bowel sounds equal in all four quadrants. Last bowel movement was yesterday, normal and formed. Patient has normal genitals for his age, with no complaints of urinary problems. Patient moves all extremities with no difficulty, no edema, and all pulses are palpable. Vital signs are temperature 100.9◦ F, heart rate is 116 normal rhythm with no murmurs, respirations 33 breaths per minute, oxygen saturation is 90% on room air.
Supplemental oxygen via nasal cannula at 2 liters oxygen saturation is at 98%.
Jason is most likely suffering from altitude illness based on history of recent rapid ascension from California to Colorado, and positive signs and symptoms that correlate. It appears the patient may be progressing from altitude mountain sickness to high altitude pulmonary edema (HAPE). Altitude illness has four stages, the first is acute mountain sickness (AMS), symptoms include fatigue, headache, dizziness, insomnia, nausea. This occurs when the body does not have time to adjust from ascending to higher elevations. Decreased oxygen in the blood is what starts the symptoms of altitude sickness. If more serious symptoms develop, such as tissue edema, high altitude cerebral edema (HACE), is the response to the decreased oxygenation in the blood will cause endothelium to release a cascade of signaling molecules that cause the blood vessels in the brain to dilate, which increases the blood brain barrier permeability. Activation of the sympathetic nervous system causes the kidneys to retain water. Symptoms such as altered mental status, ataxia, seizures can occur. The patient does not exhibit any of these symptoms. The other more serious altitude illness of tissue edema is high altitude pulmonary edema (HAPE). The physiological cause of altitude-induced edema is not conclusively established. It is believed, that HAPE may be caused by general vasoconstriction in the pulmonary circulation which, with constant or increased cardiac output, also leads to increases in capillary pressures, ("Altitude ," 2009, para. 6-10).
Patient will be directly admitted to the local hospital. Patient will be on bed rest for the next 48 hours, and instructed to decrease physical activity for up to one year, supplemental oxygen to maintain oxygen saturation > 98%. Patient will be prescribed a diet high in complex carbohydrates including whole grains, fruits, vegetables and legumes. Plenty of fluid, but careful not to over-hydrate, no caffeine. Complex carbohydrates assist with oxygen usage. Patient will be prescribed Acetazolamide orally pediatric dose at 2.5 mg/kg every 12 hours. Acetazolamide may assist in altitude acclimatization. Acetazolamide is a carbonic andryose inhibitor. If given before or as soon as symptoms start, it may improve arterial oxygenation, and prevents further impairment of pulmonary gas exchange. An undesirable side-effect of acetazolamide is a reduction in aerobic endurance performance. Other minor side effects include a tingle-sensation in hands and feet, and it can make carbonated drinks taste odd.
Mother and patient will be educated about altitude illness, and how to prevent this from occurring. Mother and child were referred to the CDC travel website for more information on altitude sickness and illness. The Mother states that this will be helpful when family comes to visit. They offered no other information, questions, or concerns. A follow-up visit after discharge from hospital will be recommended to ensure patient continues to acclimate to his new environment.
Both verbalize understanding,
References
Altitude hypoxia explained. (2009). Retrieved from http://www.altituderesearch.org/hypoxia
Hackett, P. H., & Shlim, D. R. (n.d.). The pre-travel consultation: Altitude illness. In (Ed.), The yellowbook (Ch. 2). : CDC.