Medical and Family History – Sports Physicals (APRN)

00:01 Hello, I'm Professor Rhonda Lawes.

00:03 And in this webinar, we're going to talk about an issue that's important to nurse practitioners.

00:09 Nurse Practitioners are often involved in the ones who complete the examinations of sports physicals.

00:14 Now, sometimes you'll hear them called preparticipation physicals because that's what the goal is.

00:20 Your job is to determine if this athlete is physically, mentally, ready to go to be safe on the field to participate in sports.

00:30 So, we're going to hit these four learning objectives.

00:34 I want you to understand the recommended five main components of a sports physical.

00:38 We'll will show you key assessment cues for you to watch for with a pediatric or an adolescent preparticipation athlete.

00:45 I want you to understand the clinical risks of cardiomyopathy that is a big one with sports physicals and understand the application of physical examination skills in the sports physical outpatient setting.

00:58 So, well, I won't be demonstrating how to do the assessment.

01:02 we're going to talk about the key components of all the assessments.

01:06 So, moving on to the five components of the sports physical.

01:11 One is a medical and family history.

01:14 Two is a physical examination, which has several parts.

01:18 Three is a nutritional assessment.

01:21 Four, heat and hydration related risk factors, which you know is a big deal when your students, or your athletes are in a very warm climate and exercising outside.

01:32 And the fifth one is a mental health assessment.

01:36 So first, we're going to kind of talk about the key considerations overall for sports physical exams.

01:43 Now be sure that the environment where you perform these, it should allow the patient privacy, and it should allow you to perform a thorough examination.

01:52 Now, this means if you're in a large room with lots of people, and lots of noises can be very difficult for you to do an appropriate physical.

02:00 So, you want to make sure that before you go and do the sports exams of physicals that you know what the environment is going to look like.

02:08 Now, part of these exams could involve examining the testicles.

02:12 So this is something that you want to make sure you've provided for privacy.

02:17 Next, the length of your appointment time.

02:20 You want to make sure that you have adequate time for these assessments that you don't have to be rushed through anything.

02:26 Remember, you could likely be the only health care practitioner, this student athlete sees during the year.

02:34 So you want to make sure that you can catch anything in your assessment that needs to be referred.

02:41 Lastly, the appropriate referrals are the key here.

02:45 If you recognize anything that requires more detailed assessment and follow up, you need to make that referral and make sure that it gets communicated to the parent.

02:55 So let's start with the first of the five components in this webinar.

02:58 We're looking for medical and family history.

03:01 Now, I know you've had lots of practice in your nurse practitioner program, taking histories.

03:06 But this is where we really get to drill down and see if we can recognize anything that is concerning.

03:13 So let's start with some general key history questions.

03:16 First of all, you need a complete medication history for the student athlete.

03:21 You're also going to have to ask them about things that they don't consider medications.

03:26 So, you want to know if they're on any prescription medications, of course.

03:29 you'd also like to know which physician has prescribed that.

03:32 Then the other questions are things that aren't involving prescription medications.

03:37 So you can ask them things like, do you take any supplements? Do you take any vitamins? Do you take pre-workout? Have you taken a supplement to help you gain muscle or enhance your performance? You're going to have to be really specific, because the students may not be meaning to hide this from you.

03:53 But they may not think of those things that they can take from a health food store or GNC as things that they need to talk to you about or make you aware that they're taking.

04:03 Kids can overdo pre workout, just like they do energy drinks.

04:07 So you want to make sure that you use all that wording so that you can help them to think about all the things that they may be exposing to.

04:15 So, the fourth one is have you taken a supplement to help you lose weight? This can particularly be challenging for females, athletes, or any sport that causes the athlete to have to cut weight.

04:30 Now the last one, that's kind of a unusual term.

04:33 Have you ever taken anabolic steroids? You're going to have to, they may not understand anabolic steroids, they most likely will recognize the word steroids.

04:45 So just make sure that you're always doing an assessment that's age appropriate, and appropriate to the developmental stage and the language that you use to ask the questions.

04:55 Now, here's some history questions I'd like to go over.

04:58 And remember again, I know we keep reminding you, but it's really important that you want to adjust your language to the developmental age of your client, to be sure that they understand what you're asking them.

05:10 So these may seem really odd, especially to a younger student athlete, but ask them if they've ever had chest pain.

05:17 Have they ever passed out? Have they felt fatigued or really tired? Have they been diagnosed with a heart murmur? And have they ever been diagnosed with a heart condition? Now we have this in the medical and family history.

05:30 So this is focused on the student.

05:33 Now we're going to focus on the family members.

05:36 But remember, ventricular dysrhythmias, and sudden cardiac death is a concern with student athletes.

05:43 But now, we're going to talk about their family history of cardiac issues.

05:47 So ask them if anyone in their family has had a heart condition.

05:50 Has anyone in their family had a heart attack? And how old were they? Now, if you can ask in a way that is appropriate, you might also ask what was the outcome of that heart attack, to know if the family members survived, or if it was a significant life ending event.

06:09 So that wraps up medical and family history.