Pediatric Primary Care Case Studies (37 page)

Figure 10-1   Preparticipation physical examination form.

Table 10–1 Sports Participation Clearance Based on Medical Conditions

Advantages and Disadvantages of Sports Participation

The well-formulated PPE assesses both physical and psychosocial readiness factors. The sporting activity should lead to a reduction in stress rather than induce it. The individual’s personality, motivation, or other situational factors contribute to the level of stress experienced. Therefore, the provider should assess the individual’s level of awareness of the demands of the sport, the anticipated response to these demands (experiencing defeat), and consequences of participation within the context of the time commitment.

Positive aspects of any sport include an overall increase in fitness, gained social skills, increased self-esteem and confidence, increased coordination and physical skills, enjoyment, recreation, and a chance for increased family involvement. Negative factors can involve the stress of competition or meeting adult goals, potential injuries, and comparison of abilities to those of others.

The following items have been checked “yes” on the form that Nikola returned:

1. She had an injury since her last checkup.

2. She has been hospitalized overnight.

3. She has been told she had a heart murmur “as a child.”

4. She has had a head injury.

5. She wears soft contact lenses.

Under the explanation area on the form is written: “Motor vehicle accident 2 months ago; she spent night in hospital after hitting her head; had stress fracture left ankle 6 months ago–OK now.”

What other key questions do you need to ask Nikola?

You ask Nikola more questions about the motor vehicle accident (MVA) and hospital stay. She reports going to the emergency room 2 months ago after a family motor vehicle accident because “I hit my head against the side of the door, even though I had my seat-belt on. I was pretty dizzy and threw up a couple of times.” She stayed in the hospital overnight and then saw a physician a couple of times after that.

Then you ask Nikola about some health-related and lifestyle issues. She replies that she runs every day for an hour (weekends maybe more) and works out at her local gym (to build muscle). She is happy with her current weight. She has always liked to run a lot, but didn’t get into track and field at school until the beginning of the last school year. She also likes to play tennis, swim, cycle, and downhill ski.

Health Care

Other than after the MVA, her last physical examination was about 2 years ago.

Medications

She has always had some occasional headaches (have not increased since the MVA); acetaminophen relieves the pain. She has no nausea, vomiting, or photophobia. She takes a store-brand multivitamin daily. “My Mom buys whatever is cheapest for the whole family.”

Past Medical History

She had asthma as a child, but has not used her inhaler “in years.”

Psychosocial History

She admits to using alcohol and marijuana “a few times, but only if my friends have it.” She denies using any steroids or sports-enhancing drugs. She has had sex “off and on” since she was 15 years old, using condoms “most of the time.” She was on birth control pills last year, but is not on any birth control method now. She has had only one partner and vice versa with no steady boyfriend at this time.

She gets mostly A’s in school and hopes to run throughout high school.

Review of Systems

   Complaints: None; 0/10 pain scale.

   Gynecological: Her menses are mostly regular, with a cycle of 30 days. “Sometimes I skip a month.” Menarche at age 12 years. She used to have more irregular, heavy periods until she was on birth control pills last year. Last menstural period was 3 weeks ago, normal flow and duration.

   Head: Occasional headaches (1–2 per month), relieved with over-the-counter (OTC) medications.

   Musculoskeletal: Occasional right knee swelling, relieved with cold packs and OTC pain medications.

   Remainder of systems: No complaints; review of sudden death criteria negative. (See
Table 10-1
under Do Not Clear for Participation.)