Pediatric Primary Care Case Studies (17 page)

Cognitively, following the traditional Piagetian characterizations, the adolescent can deal with abstract concepts, thoughts of the future, and goals rather than just dealing with concrete or current issues.

Gathering Key Data

History

When obtaining a patient history for a fatigue complaint, the primary care provider should carefully try to determine the presence of underlying illness and also to establish the degree of impairment caused by fatigue. Ideally, the health history should be obtained from the teen and parent separately. Especially important is the need to distinguish among senses of tiredness, activity intolerance, weakness, and lethargy (Tunnessen & Roberts, 1999). The health history should include the following: Diseases:

•   History of present illness/symptom analysis

   Ranked scoring of energy level (scale of 1–10 sufficient)

   Onset of and duration of symptoms (acute symptoms defined as less than 2 months whereas chronic is 2 months or more)

   Associated symptoms including fever, rash, vomiting, abdominal pain, sore throat, myalgias, headache, back pain, polydipsia, polyuria, heart palpitations, and painful or swollen lymph nodes

   Feelings of sadness, loss of interest in normal activities, impaired concentration, quality of affect, interaction with others, and stress levels

   Alleviating/aggravating factors

   Pharmacologic and nonpharmacologic treatments used and effectiveness of these therapies (special care should be paid to note medications that are known to cause tiredness, e.g., first-generation antihistamines)

   Degree of impairment of normal activities (extracurricular, school, social) and presence of activity intolerance

•   Past medical history

   Anemia, allergies, CNS disorders

   Recent travel, insect/tick bites, or exposure to infectious disease

•   Review of systems

   Menstrual history and sexual history (to determine likelihood of pregnancy)

   Significant head injury, presence of dizziness, clumsiness

   Alcohol, tobacco, and illicit drug use