The following clients are presented with signs and symptoms of heat-related illness. Which of them needs to be attended first?
A. A relatively healthy homemaker who reports that the air conditioner has been broken for days and who manifest fatigue, hypotension, tachypnea, and profuse sweating.
B. An elderly person who complains of dizziness and syncope after standing in the sun for several hours to view a parade.
C. A homeless person who is a poor historian; has altered mental status, poor muscle coordination, and hot, dry ashen skin; and whose duration of heat exposure is unknown.
D. A marathon runner who complains of severe leg cramps and nausea, and manifests weakness, pallor, diaphoresis, and tachycardia.
Correct Answer: C. A homeless person who is a poor historian; has altered mental status, poor muscle coordination, and hot, dry ashen skin; and whose duration of heat exposure is unknown.
The signs and symptoms manifested by the homeless person indicate that a heat stroke is happening, a medical emergency, which can lead to brain damage. Also, there must be clinical signs of central nervous system dysfunction that may include ataxia, delirium, or seizures, in the setting of exposure to hot weather or strenuous physical exertion. Patients who present with heat stroke typically have vital sign abnormalities to include an elevated core body temperature, sinus tachycardia, tachypnea, a widened pulse pressure, and a quarter of patients will be hypotensive.
Option A: The homemaker is experiencing heat exhaustion, which can be managed by fluids and cooling measures. It is important to differentiate where the patient is on the heat illness continuum. The signs and symptoms of heat exhaustion may present similarly include cramping, fatigue, dizziness, nausea, vomiting, headache. If progression to end-organ damage occurs it then becomes heat injury.
Option B: The elderly client is at risk for heat syncope and should be advised to rest in a cool area and avoid similar situations. Heat syncope is the temporary, self-limited dizziness, weakness, or loss of consciousness during prolonged standing or positional changes in a hot environment, including physical activity. The thinking is that it is due to a combination of dehydration, pooling of blood in the venous system, decreased cardiac filling, and low blood pressure, which leads to decreased cerebral blood flow.
Option D: The runner is experiencing heat cramps, which can be managed with fluid and rest. Heat cramps: include involuntary spasmodic contractions of large muscle groups as opposed to an isolated muscle spasm/cramp that can also occur during or after exertion. This condition is due to a relative deficiency of sodium, potassium, chloride, or magnesium. Other symptoms may include nausea, vomiting, fatigue, weakness, sweating, and tachycardia.
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