Adolescent Flashcards
Early, Middle and Late Ages
Early: 11-14 Middle: 15-17 Late: 18-21
Internal Barriers to care
– Reliance on peers or family members for health information – Past experience with health and/or social system – Sense of invincibility/vulnerability – Low self-esteem – Cultural and linguistic barriers
External Barriers to care
– Perceived lack of confidentiality and fear of parental disclosure – Poor communication and/or counseling by providers – Insensitive attitudes in regard to culture and sexuality – Provider lack of knowledge and skills in re: youth – Lack of money, insurance (or card) and transportation – Inaccessible locations and/or hours, especially after school
How to communicate with young adolescent patient
Greet the youth first, not the parent Treat each as an individual (be respectful, warm, understanding, non-judgmental, and ‘askable’) Explain need for privacy to parents and youth together (ground rules for exceptions: abuse, homicide, suicide risk) Interview and exam with parent out of the room Complement appearance/achievements; pay attention, look interested, and listen Ask if some issues discussed are confidential Transition may be more difficult with overprotective parents or guardians, or with absent or inappropriate guardians
Erikson Developmental Stage
Identity v. Role Confusion - Who am I? - Foster a positive development process
Piaget Developmental Stage
Concrete thinking to formal operational - can think abstractly - sees big picture and the future
What questions could you ask about their home life?
• Who lives in the home with you? • Do you live in a house or apartment? • Do you share a room or have your own? • Are there any new people living in your home? • How are your relationships with siblings, parents, other important relatives? • What are the rules like at home? • Ever been homeless or in shelter care? • Ever been in foster care or residential group home?
How to discuss school achievement?
• Discuss any frustrations or anxiousness about school with parents, teacher, health care professionals • Be responsible for school attendance and homework • Identify talents and interests that you want to pursue for career or personal enrichment • Begin thinking about future plans for college options, vocational training, career choices, etc.
Who is defined as a minor in New York?
Anyone under the age of 18 - some exceptions (if they are parents, pregnant, emancipated minors, married minors)
How does confidentiality work for minors?
- If a minor consents on their own, it must remain confidential - In NY: information about STI’s or abortions, must remain confidential
Consent of Pregnant Minors
Can consent to any and all prenatal care Can consent to care that might impact their pregnancy: includes treatment of infections, dental, mental health treatment, hospital services
Consent of Married minors and Parent minors
Parents- consent to care for themselves and their children Married- consent to their own care, even if now separated or divorced
What types of care can minors consent to on their own:
- Reproductive health care - Testing and treatment for sexually transmitted infections - Sexual assault care - Emergency care - Some substance abuse treatment - Some mental health care
What is considered reproductive health care?
- Pregnancy tests - Birth control and emergency contraception - Abortion - Pregnancy counseling, prenatal care, labor and delivery services - Post-sexual assault care
Does the HPV vaccine need a parent consent or not?
Unsettled law - check to see if under STI or vaccine category before obtaining consent - is approved for women and girls ages 9-26
Is parent consent needed for non-medical substance abuse treatment? (i.e. counseling)
Not required
Is parent consent needed for medical substance abuse treatment? (i.e. inpatient or outpatient medical treatment)
Yes, unless: - Provider cannot reasonably find the parents - Parents refuse or fail to communicate with the provider and the program director okays treatment - A physician determines the involvement of the parent / guardian would have a detrimental effect on treatment - The parent / guardian refuses to consent and a physician believes that treatment is necessary and in the child’s best interest.
What should be included in routine vital signs?
- LMP, menstrual cycle - BMI
What are the average ages of puberty?
Female: - Beast development: 9-10 - Maximal growth rate: 6-12 months before menarche Male: - Testicular development: 11
When are facial features and adult stature established?
Females: 18 Males: 20
What is muscle strength/size influenced by?
sex hormones, nutrition, exercise
What is endurance dependent on?
lung capacity, heart size, muscle strength
What should the physical exam include?
Growth: HT and WT Appearance and Behavior: pt. should make eye contact Grooming and Hygiene Posture- assess for scoliosis, bend over and leg length discrepancies Coordination Communication Interest in health care
What are normal findings on the physical exam?
- Hair: Oily, body hair appears on chest and face in males, axilla in both sexes. - Skin: Acne on face, back, chest, large pores, presence of bruises, burns, bites must be evaluated. - Lymph: Decreased lymph tissue - Teeth: Carries, dental hygiene, need for orthodontia - Heart: decreased heart rate, increased blood pressure - Lungs: decreased respiratory rate - Breasts: Breasts developing, gynecomastia in males (may resolve on own, infected if red/swollen/warm)
Normal Male Genitalia findings
- Pubic hair increases in amount to adult distribution, becomes coarse and curly. - Penile enlargement continuing - Enlargement of testes
Normal Female Genitalia findings
- Pubic hair increases in amount to adult distribution, becomes coarse and curly. - Labia mature - Vaginal discharge
What tanner stage?
Tanner Stage: I
Breast: only papilla is elevated above chest wall area
Pubic Hair: No sexual hair
What tanner stage?
Tanner Stage: II
Breast: evelation of breast and papillaw as a small mount with some increased diameter of areola
Pubic Hair: Spare long, pigmented downy hair, seen along labia, curly or straight
What tanner stage?
Tanner Stage: III
Breast: Breasts and areola continue to enlarge but with no separation of contour
Pubic Hair: Darker, coarser, curlier hair. Distribution at junction of pubes
What tanner stage?
Tanner Stage: IV
Breast: Areola and papillae elevate above level of breasts and forms secondary mounds with fuller development of overall breast tissue
Pubic Hair: distribution is adult like, but less in quantity. No spread to medial suface of thighs.
What tanner stage?
Tanner Stage: V
Breast: Mature female breasts have developed. Recession of areola.
Pubic hair: appears as inverse triangle, same as adult hair quantity and type, spreads to medial surface of the thighs, but not above bse of inverse triangle
What tanner stage?
Tanner stage: I
Genital: testes, scrotal sac, and penis have size/proportion similar as seen in early childhood
Pubic Hair: no androgen-sensititve pubic hair
What tanner stage?
Tanner Stage: II
Genitals: Enlargement of scrotum and testes, and change in texture of scrotal skin. Reddening of scrotal skin is normal
Pubic Hair: Sparse long, pigmented downy hair, can be curled or straight, seen at base of penis
What tanner stage?
Tanner Stage: III
Genitals: Further growth in penile length and circumference. Growth in testes and scrotum
Pubic Hair: Darker, coarser, curlier hair. Distribution now at junction of pubes.
What tanner stage?
Tanner Stage: IV
Genitals: Penis significantly enlarged in length and circumference & development of glans penis, darkening of scrotal skin
Pubic Hair: Distribution is adult like, but still less in quantity. No spread to medial surface of thighs
What tanner stage?
Tanner Stage: V
Genital: Adult genitalia with regard to size and shape
Pubic Hair: Distribution is adult in quantity and type, can spread to medial surface of the thighs
How many meals are suggested for better absorption?
How many calories/kg are needed for males and females?
Meals: >3 meals/day
Males: 55 kcal/kg/day
Females: 47 kcal/kg/day
How many servings are recommended per day:
- protein
- milk products
- cereal and grains
- fluids
- Protein- 2 servings/day
- Milk- 2 servings/day
- Cereal/grains- 4 servings/day
- Fluids- increase intake to counteract increase in sweat glands
What are most common vitamin deficiencies?
How can they be replenished?
- Iron- meat
- Calcium- milk
- Zinc- green vgetables
Anorexia
- Depression, restrictive diet
- Problems: body image, menstruation, organ/metabolic damage, heart problems, electrolyte imbalance
Bulemia
- binge and purge cycle
- Problems: erosion on back of teeth, esophageal erosion, normal BMI
Sings of depression
- Adolescent feels “low” most of the time, and is irritable.
– Weight loss or weight gain (more than 10% of normal weight)
– Insomnia or sleeplessness, or the opposite, excessive need for sleep, or low energy
– Low self-esteem or feelings of worthlessness, and frequent bouts of crying often “for no reason”
– Suicidal thoughts, ideation, or threats (with or without a plan)
– Drop in grades, social activities, interactions with peers, or sudden change in friend
What vaccine is recommended for YMSM?
Hep A
What is the goal of treating scoliosis?
When to screen?
Goal: preventing progression
Sreen: no longer recommended for asymptomatic pt.
Screen: forward bend test.
Treatment is controversial
What are priority issues every visit?
- Physical Growth and Development: Physical and Oral Health, Body Image, Healthy Eating and Physical Activity
- Social and Academic Competence
- Emotional Well Being: Coping, mood regulation, mental health, sexuality
- Risk Reduction: Tobacco, alcohol, drugs, pregnancy, STI, piercing/tatto
- Violence and Injury Prevention: Safety belts, helmets, driving , SA, access to weapons ,interpersonal violence,gangs, depression
When should routine HIV screening begin?
Routine screening starting at age 18
What are important topics to talk with adolescents about?
(H-E-A-D-S)
- H-home, habits
- E-education, employment,exercise
- A-accidents,ambition,activities,abuse
- D-drugs (tobacco, alcohol, others) diet,depression
- S-sex, suicide
What does the SAFETEENS mneomonic stand for?
- S-sexuality
- A-accidents, abuse
- F-firearms,homicide
- E-emotions
- T-toxins ( tobacco,alcohol and others)
- E-environment (school, home, friends)
- E-exercise
- N-nutrition
- S-shots (immunization status), school performance
What is The Door?
- Medical, psychiatric and legal assistance for teens
