Adolescent Flashcards
1
Q
Adolescence
Age Range =
- Early Adolesence =
- Middle Adolescence =
- Late Adolescence =
A
11-21
- 11-14
- 15-17
- 18-21
2
Q
Health Disparities Impact Youth as a Class
- Differences in ____ to health care, including preventative and curative services
- Differences in the _____ of care received
- B___, prejudice, and st_____ on part of HCPs
A
- access
- quality
- Bias, stereotyping
Bias of HCP especially if they live in the same community as the pts they are treating
3
Q
Barriers to Care for Adolescents
-
Internal
- Reliance on p____ or ____ members for health _____
- ____ experience with health and/or social system
- Sense of in_____/v_____
- ___ self-esteem
- C_____ and lin_____ barriers
-
External
- Perceived lack of c______* and fear or p_____ disclosure
- Poor c_____ and/or counseling by providers
- In_____ attitudes in regard to culture and sexuality
- Provider lack of ______ and skills in regards to youth
- Lack of m_____, in_____ (or care) and tran______
- Inaccessible lo_____ and/or hours, especially after school
A
-
Internal
- peers, family, information
- Past experience
- invincibility/vulnerability
- Low
- Cultural, linguistic
-
External
- confidentiality*, parental
- communication
- insensitive
- knowledge
- money, insurance* (alot of times parents hold the insurance cards)I, transporation
- location
4
Q
Communication: Approaches to the Young Adolescent Patient
- Greet the ____ first, not the ____
- Treat each as an ______ (be respectful, warm, understanding, non-judgemental, and “___able”)
- Explain need for _____ to parents and youth together (ground rules for exception: abuse, homicide, suicide risk)
- Interview and exam with patient ___ of room
- C_____ appearance/achievements: pay attention, look interested, and listen
- ____ if some issues are confidential
- Transitions may be more difficult with over_____ parents or guardians, or with absent or in______ guardians
A
- youth, parent
- individual
- privacy
- out
- Complement
- Ask
- overprotective, inappropriate
5
Q
Guidelines in Interviewing Adolescents
- Ensure c______**
- Conduct interview and physical exam ______ parent present
- Show concern for adolescent’s _____ (ie. I’d like to know what you think is happening..)
- Health history mneumonic =
A
- confidentiality*
- without
- perspective
- HEADSS FIRST (home, education, activities/employment, drugs, suicidality, and sex)
6
Q
Erickson’s Theory of Psychosocial Development
What Stage?
A
Stage 5
Ego Identity vs. Role Confusion (12-18yo)
7
Q
Erickson’s Psychosocial Stage Summary Chart
A
8
Q
Psychosocial Development
- Erickson: Identity vs. Role Confusion
- “___ am I”?
- Begins at age __-__ young adulthood
- During this stage, adolescents search for a sense of ____ and personal ______, through an intense exploratio nof personal v____, b____, and g____.
- _____ developments process
- _____ developments process
A
- Identity vs. Role Confusion
- Who
- 9-11
- self, identity, values, beliefs, goals
- Positive
- Negative
9
Q
PMH/PSH
- _____/Medication and Food
- I______ history
- Pediatric _____ Clinic - know where
- Pediatric _ _ visits
- Common Questions
- PMH: (3)
- PSH (3)
A
- Allergies
- Immunization
- Wellness
- ER
- Astham, OM (recurrent), Fractures
- Appendectomy, Tonsillectomy, Myringotomy
- Children/Adolescents are healthy for the most part so ask about common conditions: Asthma, Recurrent OM, Fractures*
- Myringotomy - incision in eardrum to relieve pressure/drain fluid*
- NYS has immunization registry*
10
Q
Interview: Home
- “___ lives in the home with you?”
- “Do you live in a ____ or a_____?”
- Do you ____ a room or have your own?”
- Are there any n___ people living in your home?”
- How are your re_____ with siblings, parents, other important relatives?”
- What are the r____ like at home?”
- Ever been home____ or in sh____ care?”
- Ever been in f____ care or residential g____ home?”
A
- Who
- house, apt
- share
- new
- relationship
- rules
- homeless, shelter
- foster, group
11
Q
Teenagers Health Care and the Law
New York defines a minor as anyone under the age of __.
A
18
12
Q
Professional Consequences for Confidentiality Violations
- Violating confidentially is professional m_____
- HCP’s may face law___ by pts for breach of confidentiality.
- If the person violating confidentiality is a g_____ employee (eg. school principal) disclosure of private information could violate the c_______
A
- misconduct
- lawsuits
- government, constitution
13
Q
Confidentiality and Parent Access
- The law requires _____ authorization before releasing a pts medical information to a third party.
- Parents or guardians may _______ access minors medical information
- when a parent or guardian has ______ for the care on ____ of the minor, or
- when care was provided to minor _____ parental consent bc of _____
- If minors consent to care on their own, providers _____ give parents info about the care without the minor’s _____ consent
A
- written
- independtly
- consented, behalf
- without, emergency
- cannot, written
14
Q
Confidentiality and Minors’ Health Care
- All services provided to minors, when they have the right and _____ to consent on their ____, must remain ______.
- In addition to this general rule, NY law specifically forbids disclosure of information pertaining to a minor’s _____ or ___ treatment to her parents or guardians without her consent.
A
- capacity, consent on their own, confidential
- abortion or STI tx
15
Q
Types of Minors Who Can Consent on their own
- P_____ minors
- Minors who are p_____
- M_____ minors
- E_____ minors
- Ma____ minors
- Review the THC pdf
A
- Pregnant
- parents
- Married
- Emancipated
- Mature
First 4 minors are most important- emancipated minor must be a designated legal status
16
Q
Pregnant Minors
- Can consent to any and all ______ care
- Can consent to care that might ____ their _____
A
- prenatal
- any care that impacts pregnancy
17
Q
Minors Who Are Parents and Married Minors
- Minors who are parents ___ consent to care
- Includes both ____ and _____
- Can consent to care for ____ and their ____
- Minors who have been married can consent to their ___ care - even if they are s____ or d_____.
A
- can
- mothers and fathers
- themselves and children
- own, separated, divorced
18
Q
Emancipated Minors
- “Emancipation” =
- Who is considered “emancipated”?
- Minors who are or have been in the?
- Minors who are ____ apart from parents and are _______ independent through gainful _____
A
- renunciation of parental rights to a child
- Who?
- Armed services
- living apart, economically, employment
19
Q
Types of Care to Which any Minor Can Consent on their own
- R______ health care
- Testing and treatment of __ __ ___
- Sexual _____ care
- E_____ care
- SOME _____ abuse treatment
- SOME _____ health care
A
- Reproductive
- STI’s
- assault
- Emergency
- substance abuse
- mental health
20
Q
Reproductive Health Care
(that minors can consent for)
- _______ tests
- Birth _____ and emergency ______
- A_____
- Pregnancy cou_____, ______ care, _/_ services
- Post sexual _____ care
A
- Pregnancy
- control, contraception
- counseling, prenatal, L/D
- assault
21
Q
STI Testing and Treatment
(that minors can consent to)
- T____ and T_____ for STI’s
- Testing for H _ _
- _ _ _ vaccine
- Approved for women and girls aged __ - __
- HCPs are also permitted to provide HPV vaccination to sexually ___ minors without parental/guardian consent
A
- Testing and Treatment
- HIV
- HPV
- 9-26
- sexually active minors (law changed in NY 2018- HCP allowed to give HPV vaccination wihtout parental/guardian consent)
22
Q
Substance Abuse Treatment
- Non-Medical
- For non-medical tx such as counseling, is parental consent required?
- Medical
- Parental consent is not required for inpatient or outpatient medical treatment for alcohol or substance abuse if:
- Provider cannot reasonably _____ the parents
- Parents refuse or ___ to communicate with provider and program _____ okays treatment
- A physician determines the involvement of parent/guardian would have a de_____ effect on tx
- Parent/guardian _____ to consent and physician believes that tx is ____ and in child’s best _____.
- Parental consent is not required for inpatient or outpatient medical treatment for alcohol or substance abuse if:
A
- Non-Medical
- No
- Medical
- find
- fail, director
- detrimental
- refuse, but necessary, best interest of child
With these situations, you should collaborate with a physician bc the law is written around the word physician
23
Q
Mental Health Care
(when minors can consent)
- Outpatient
- Parental Consent not required if? (3)
- Inpatient
- A minor > ___ can seek inpatient care, including m_____, on their own, but younger teens must obtain parental consent
- Special protections for a self-admitted minor exist
- Information about l____ services
- Notice to M____ Hy___ Legal Services
A
- Outpatient
- Parent not reasonably available
- Parental involvement detrimental to tx
- Parent refuses, physician determines tx is necessary/best interest of minor
- Inpatient
- > 16, medication
- younger teens
- legal
- Mental Hygiene Legal
24
Q
Example: Types of Care
- After testing HIV positive, a 15 yr old tells his physician that he won’t receive treatment if he has tot ell his parents, because they are deeply religious. He believes they will kick him out of the house when they find out he’s gay or HIV+. Can he receive treatment without parental involvement?
- _____. If physician determines that the minor has the _____ and _____ capacity to give informed consent. That he can co___ with tx regimen and involving parents might prove harmful. She can treat him under the _____ minors doctrine. Physicians should document determination of maturity in the MR.
A
- PROBABLY. emotional, intellectual, comply, “mature minors doctrine”
25
Q
For More Information on Confidentiality in NY
(2)
A
Teen Health Initiative
NY Civial Liberties Union
26
Q
State Policies/Minors Consent
Where can we find policies by state?
A
Guttmacher.org/state-policy/explore/overview-minors-consent-law
27
Q
Vital Signs
Routine VS also include (2)
A
Menstrual Cycle (recommendation of AAP and ACOG)
BMI
28
Q
Puberty (not on test)
- Female
- Breast development ave age: __-__
- Maximal Growth Rate: __-__ months before ____
- Males
- Testicular Development ave age:
- Growth “spurt” - _____ peak height velocity
A
- Female
- 0-10
- 6-12m before menarche
- Males
- 11
- greater
29
Q
Physical Growth –Review
- Slower rate of growth in (2)
- Facial features and adult stature established at ___ yrs for female and __ yrs for males
- Muscle strength and size influenced by sex h____, nut____, and ex____
- Endurance depends ___ capacity, ___ size, ___ strength
- Voice changes in r____ and st____, more pronounced in males than females
A
- HT and WT
- 18, 20
- hormones, nutrition, exercise
- resonance, strength
30
Q
Physical Exam/Include
- Growth: __ and __
- App____ and Be___
- Gr____ and Hy____
- Po____
- Coo____
- Comm____
- In____ in health care
A
- HT, WT
- Appearance, Behavior
- Grooming, Hygiene
- Posture
- Coordination
- Communication
- Interest
31
Q
Physical Exam/Review
- Hair: O____, Body hair appears on ___ and ___ in males, ____ in both sexes
- Skin: A___ on face, back, chest, large pores, presence of bruises, burns, bites must be _____
- Lymph: ____ lymph tissue
- Teeth: Ca___, dental hy____, need for ortho___
- Heart: __ HR, __ BP
- Lungs: ___ RR
- Breasts: Breasts dev_____, gyn_____ in males
A
- Oily, chest, face, axilla
- Acne, evaluated
- decreased
- Carries, hygiene, orthodontia
- Low, High
- Low
- developing, gynecomastia
32
Q
**Physical Exam**
- Genitalia:
- Males
- Pubic hair =
- Penile =
- Testes =
- Females
- Pubic hair =
- Labia =
- Vaginal =
- Males
A
- Males
- increases in amount to adult distribution, becomes coarse and curly
- enlargement continues
- enlargement
- Females
- increases in amount to adult distribtuion, becomes course and curly
- matures
- discharge
33
Q
Physical Exam
- Musculoskeletal
- Increased (3)
- Assess for (1)
- Sleep Patterns & Elimination: should be able to?
A
- MSK
- Muscle mass, strength, tone
- scoliosis
- Sleep
- maintain an established schedule
- Scoliosis often diagnosed with growth spurts*
- Red flag: sleeping 16 hr/day (get to the bottom f it, sometimes not pathologic, maybe stress, etc)*
34
Q
Sexual Maturity
- Menstruation
- Regular _____
- Premenstrual _____
- Menstrual dis_____
- _____ Emission part of normal physical development
- Experimentation is normal, if frequent and obsessive practice intrvention and referral is needed = _______
A
- Menstruation
- Periods
- symptoms
- discomfort
- Nocturnal Emission
- Masturbation
Sometimes we don’t see regular periods until late adolescence , and ask about last menstrual cycle
35
Q
Male Tanner Stages (not on test)
-
Male Genital Development
-
Which stage do these describe?
- The testes, scrotal sac, and penis have size/proportion similar as seen in early childhood (preadolescent)
- Adult genitalia with regard to size and shape
- Further growth in penile length and circumference, growth in testes and scrotum
- Penis significantly enlarged in length and circumference & development of glans penis, darkening of scrotal skin
- Enlargement of scrotum and testes, and change in texture of scrotal skin. Reddening of scrotal skin is normal.
-
Which stage do these describe?
A
- Stage 1
- Stage 5
- Stage 3
- Stage 4
- Stag 2
36
Q
Male
-
Male Pubic Hair Development Stages
- (Preadolescent) No androgen-sensitive pubic hair
- Hair Distribution is adult in quantity and type, can spread to medial surface of thighs
- Darker, coarser, curlier, hair. Distribution now at junctin of pubes
- Distribution is adult like, but still less in quantity. No spread to medial surface of thighs
- Sparse long, pigmented downy hair, can be curled or straight, seen at base of penis
A
- Stage 1
- Stage 5
- Stage 3
- Stage 4
- Stage 2
37
Q
Female Tanner Stages
-
Female Breast Development
- Mature female breasts have developed. Recession of areola
- (Preadolescent) Only the papilla is elevated above chest wall level
- (Breast Budding) Elevation of breasts and papillae as a small mound with some increased diameter of areola
- Areola and papillae elevate above level of breasts and forms secondary mounds with further development of overall breast tissue
- Breasts and areola continue to enlarge, but with no separation of contour
A
- Stage 5
- Stage 1
- Stage 2
- Stage 4
- Stage 3
38
Q
Female
-
Female Pubic Hair Development Stages
- (Preadolescent) No sexual hair
- Darker, coarser, curlier hair. Distribution now at junction of pubes
- Distribution is adult like, but still less in quantitiy. No spread to medial surface of thighs.
- Appears as inverse triangle in shape. Hair distribtuion is adult in quantity and type, can spread to medial surface of thighs but not above base of inverse triangle.
- Sparse, long, pigmented downy hair, can be curled or straight, seen along labia.
A
- Stage 1
- Stage 3
- Stage 4
- Stage 5
- Stage 2
39
Q
Smoking
- For adolescents, the provider should ask about nicotine use including? at each health maintenance visit
- In addition to e-cigarettes, the provider should ask about other types of electronic nicotine delivery systems including?
- Clinicians should allow time during each visit to speak with the patient _____ parents present to facilitate disclosure. The clinician should establish _______ rules with the pt at start of these visits, to faciiltate disclosure and frank discussion.
A
- smoking, e-cigs, other alternative
- e cigars, e-pipes, e-hookahs, vape pens or pipes, or atomizers
- without parents, confidentiality
40
Q
United States National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- 9-14
- Do you have any ____ who drank beer, wine, or drink containing alcohol in the past year?
- Followed by: How about ____ - in the past ____, on how many ___ have you had more than a few ___ of beer, wine, or other alcohol?
- Younger than ___ yo, any drinking is?
- 14-18
- In the past ___, on how many ___ have you had more than a few ___ of beer, wine, or drink containing alcohol?
- If your _____s drink, how many ____ do they usually drink on _____?
A
- 9-14
- friends
- you, year, days, sips
- <14, CAUSE FOR CONCERN* Intervention is important! And needs to happen immediately (probably pediatric psychiatry needs to be involved)
- 14-18
- year, days, sips
- friends, drinks on occasion
60
Q
DSM-5 Diagnostic criteria for Anorexia Nervosa
Mild: BMI =
Moderate: BMI =
Severe: BMI =
Extreme: BMI =
A
> 17
16-16.99
15-15.99
<15
Important to gather history and know the BMI when you refer to programs
61
Q
DSM-5 diagnostic criteria for Bulimia Nervosa
- Mild =
- Moderate =
- Severe =
- Extreme =
A
- 1-3 episodes/wk
- 4-7 ep/wk
- 8-13 ep/wk
- 14 or more ep/wk
- Diagnosis is done by specialist, Just know that these 2 eating disroders are most common in adolescents*
- Vomiting -> electrolyte disturbances -> Arrhthmias**
64
Q
Hepatitis B Screening AAFP 2019
- Who especially needs to be screened? (2)
- Hep B vaccine is recommended for all medically ____ infants weight 2,000g or more within 24 hrs of birth
- Acute hep B should not be treated with ______
- All infants born to mothers positive with Hep B should receive?
- First line tx for chronic Hep B (3)
A
- Pregnant women, Adolescents/Adults with high risk of chronic infection
- Stable infants
- Antivirals
- Immunoglobulin and Hep vaccine by 24 hrs of life
- Pegylated interferon alfa-2a (Pegasys), Entecavir (Baraclude), Tenofovir
All pregnant women should be screened, RF such as IVDU
95
Q
Bright Futures
Periodicity Schedule
A
