Pediatric Primary Care Case Studies by Catherine E. Burns, Beth Richardson, Cpnp Rn Dns Beth Richardson, Margaret Brady Page B
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objective and subjective findings needed to establish a differential diagnosis in an adolescent with fatigue.
4. Formulate a tailored plan of care to manage an adolescent with fatigue.
Case Presentation and Discussion
Jennifer Styles is a 17-year-old who presents to your office with a complaint of “being tired all the time.” Jennifer admits that her fatigue has worsened significantly over the summer and is worried that she won’t make it through the day once school starts in a few weeks. She reports that she has two summer jobs, one at the community pool as a lifeguard and one where she helps babysit two school-age children. Jennifer is not accompanied by anyone else, but she says she can call her mother on the cell phone if “anyone needs her.” “But,” she tells you, “my mom thinks I have mono.”
What are the most common causes of fatigue in adolescents?
Fatigue as a Symptom
Fatigue is a common somatic complaint that often presents with other symptoms like sleepiness, altered ability to focus, irritability, and weakness. By definition, fatigue is a sense of abnormal or excessive tiredness that results in a need for rest and results in an impaired ability to perform normal activities. It is one of the most common complaints in pediatrics and is especially prevalentduring adolescence. Most teenagers complain of “being tired” at one time or another, and parents often complain that their adolescents seem exhausted or have very low energy. National studies show that 67% of adolescent females in 6th through 10th grade complain of morning fatigue at least once a week (Ghandour, Overpeck, Huang, Kogan, & Scheidt, 2004). The challenge of this condition is that fatigue can result from a self-limiting situation like staying up all night studying for final examinations, be a symptom of a mental illness like depression, or indicate the presence of a significant medical condition like anemia or cardiomyopathy.
Pathophysiology
There are multiple conditions that cause fatigue. It is the normal result of physical exertion or energy use that exceeds the body’s normal capacity (Ozuah & Sigler, 2001). Physiologic reasons for fatigue appear when the level of cellular metabolic need is greater than the cell’s adenosine triphosphate (ATP) stores, the body’s glucose or glycogen stores are depleted, metabolism is altered, or cerebral oxygenation is compromised. Busy school schedules, participation in extracurricular activities, inadequate sleep, inadequate caloric intake, substance use/abuse, and dysfunctional sleep patterns can all result in abnormally tired teens.
Many adolescents with fatigue experience symptoms as an abrupt complaint following an acute infection (Carter, Kronenberger, Edwards, Michalczyk, & Marshall, 1996). However, postinfectious fatigue can last for weeks to years. Illnesses that are known to cause fatigue include acute and chronic Epstein-Barr infection, cytomegalovirus, herpesvirus, human immunodeficiency virus (HIV), histoplasmosis, Mycoplasma pneumonia, toxoplasmosis, tuberculosis, rheumatoid arthritis, diabetes mellitus, cancer, Lyme disease, and hepatitis (Feins, 1999; Ozuah & Sigler, 2001; Tunnessen & Roberts, 1999).
Fatigue can also be a response to stress and is considered a symptom of depression.
Cultural Influences of Fatigue
Culture shapes and influences how individuals experience health symptoms and whether or not they seek medical attention. Fatigue is a universal human complaint and, therefore, occurs in all populations; however, there are some significant cultural variations that are worth noting. Some cultures value achievement and activity or “doing,” whereas others value just “being” (Giger & Davidhizer, 2004). Individuals from “doing” cultures may be less tolerant of fatigue symptoms and, therefore, are more likely to present to healthcare providers for treatment (Lubkin & Larsen, 2005; Ware & Kleinman, 1992). The belief that altered energy states
4. Formulate a tailored plan of care to manage an adolescent with fatigue.
Case Presentation and Discussion
Jennifer Styles is a 17-year-old who presents to your office with a complaint of “being tired all the time.” Jennifer admits that her fatigue has worsened significantly over the summer and is worried that she won’t make it through the day once school starts in a few weeks. She reports that she has two summer jobs, one at the community pool as a lifeguard and one where she helps babysit two school-age children. Jennifer is not accompanied by anyone else, but she says she can call her mother on the cell phone if “anyone needs her.” “But,” she tells you, “my mom thinks I have mono.”
What are the most common causes of fatigue in adolescents?
Fatigue as a Symptom
Fatigue is a common somatic complaint that often presents with other symptoms like sleepiness, altered ability to focus, irritability, and weakness. By definition, fatigue is a sense of abnormal or excessive tiredness that results in a need for rest and results in an impaired ability to perform normal activities. It is one of the most common complaints in pediatrics and is especially prevalentduring adolescence. Most teenagers complain of “being tired” at one time or another, and parents often complain that their adolescents seem exhausted or have very low energy. National studies show that 67% of adolescent females in 6th through 10th grade complain of morning fatigue at least once a week (Ghandour, Overpeck, Huang, Kogan, & Scheidt, 2004). The challenge of this condition is that fatigue can result from a self-limiting situation like staying up all night studying for final examinations, be a symptom of a mental illness like depression, or indicate the presence of a significant medical condition like anemia or cardiomyopathy.
Pathophysiology
There are multiple conditions that cause fatigue. It is the normal result of physical exertion or energy use that exceeds the body’s normal capacity (Ozuah & Sigler, 2001). Physiologic reasons for fatigue appear when the level of cellular metabolic need is greater than the cell’s adenosine triphosphate (ATP) stores, the body’s glucose or glycogen stores are depleted, metabolism is altered, or cerebral oxygenation is compromised. Busy school schedules, participation in extracurricular activities, inadequate sleep, inadequate caloric intake, substance use/abuse, and dysfunctional sleep patterns can all result in abnormally tired teens.
Many adolescents with fatigue experience symptoms as an abrupt complaint following an acute infection (Carter, Kronenberger, Edwards, Michalczyk, & Marshall, 1996). However, postinfectious fatigue can last for weeks to years. Illnesses that are known to cause fatigue include acute and chronic Epstein-Barr infection, cytomegalovirus, herpesvirus, human immunodeficiency virus (HIV), histoplasmosis, Mycoplasma pneumonia, toxoplasmosis, tuberculosis, rheumatoid arthritis, diabetes mellitus, cancer, Lyme disease, and hepatitis (Feins, 1999; Ozuah & Sigler, 2001; Tunnessen & Roberts, 1999).
Fatigue can also be a response to stress and is considered a symptom of depression.
Cultural Influences of Fatigue
Culture shapes and influences how individuals experience health symptoms and whether or not they seek medical attention. Fatigue is a universal human complaint and, therefore, occurs in all populations; however, there are some significant cultural variations that are worth noting. Some cultures value achievement and activity or “doing,” whereas others value just “being” (Giger & Davidhizer, 2004). Individuals from “doing” cultures may be less tolerant of fatigue symptoms and, therefore, are more likely to present to healthcare providers for treatment (Lubkin & Larsen, 2005; Ware & Kleinman, 1992). The belief that altered energy states
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