adolescent health Flashcards
1
Q
What is puberty?
A
- growth in stature
- development of secondary sexual characteristics
- achievement of fertility
- changes in most body systems:
neuroendocrine axis, bone size and mineralization, CV system
2
Q
Factors that contribute to onset of puberty?
A
- controlled by many factors
- overall earlier onset of puberty has been attributed to increase in obesity
- proposed that critical body wt or composition is perhaps impt in development of pubertal events
- leptin is also responsible for initiation and progression of puberty and is produced by adipocytes
3
Q
Results of puberty that are in normal range but pt or family view as abnormal?
A
- anemia: Fe deficiency in menstruating females
- gynecomastia: 50% of teenage boys develop this, can last 6-18 months
- acne
- psych fxning: prevalence of depression is 2x as great in girls compared to boys
- musculoskeletal injuries: unique injuries during this time
- STIs (not really normal)
4
Q
What is delayed puberty? Classification?
A
- absence or incomplete development of secondary sexual characteristics by an age at which 95% of kids of that sex and culture have initiated sexual maturation
- classification:
- primary: due to hypogonadism and or defects in their receptors on membrane of gonadal cells
- secondary: gonads intact, problem with secretion of LH, FSH, or GnRH: defects can be because of:
hypopituitarism
hypothyroidism
hyperprolactinemia
5
Q
3 primary values of a teenageer?
A
- freedom
- fun
- friends
6
Q
Goals of adolescence?
A
- become independent from parents
- develop a workable value system
- become comfortable with bodily changes
- build meaningful relationships
- begin est. economic independence
7
Q
Normal teen behaviors?
A
- express opinions
- test limits
- take risks
- experiment
- cognitive development:
abstract operations - widened scope of intellectual activity and increased capacity for insight
8
Q
top 5 leading causes of mortality in 15-24 yo in US?
A
- 1: MVAs (46%)
- 2: homicide (15%)
- 3: suicide (13%)
- 4: cancer (5%)
- 5: heart disease (3%)
9
Q
Risky behaviors of teens?
A
- involved in behaviors that may have adverse health outcomes:
alcohol, drug and tobacco use, sex and sedentary lifestyle - alcohol most abused substance
- engaging in risky behaviors earlier
- most causes of serious morbidity and mortality are result of personal behaviors - preventable
- teens who engage in 1 risky behavior are more likely to engage in mult risk behaviors (teen smokers likely to be sexually active)
- all teens, across socioeconomic lines are at risk for health risk behaviors
10
Q
Most impressionable group of peds?
A
- teenagers
- as their provider: have to act as interested and caring advocate, not as their friend. Must listen carefully and see clues, instill responsibility
11
Q
Confidentiality with teens?
A
- critical for most
- est parameters of confidentiality with parents if possible
- always state you will alert parents if safety is a concern (suicide or homicide)
- always attempt to meet with teen alone regardless of issues to discuss
- begin to stress their own responsibility for their health
12
Q
What are preventive services that we should be offering teens?
A
immunizations: varicella if no prior infection, booster - Tdap around 11-12 - newer vaccines: MCV4 11-12 yo, Gardasil age 9 - may catch up on Hep B, IPV, MMR
Screening:
- HTN (BP on teens)
- obesity and eating disorder (plot BMI)
- hyperlipidemia and or metabolic syndrome if indicated
- TB if at risk
- abuse: physical, sexual, emotional: fighting, weapons
- learning or school probe
- substance abuse
- behaviors or emotions - indicate recurrent or severe depression, risk of suicide
- risky sexual behaviors: STI screen, HIV, pregnancy, cervical cancer (HPV)
13
Q
Anticipatory guidance for teen?
A
- healthy diet: Ca impt, still laying down bone 18-21
- safe wt management
- regular exercise
- min. TV and video games
- responsible sexual behaviors
- avoidance of tobacco, alcohol, other abusable substances, and anabolic steroids
- family involvement is critical
14
Q
Impt of parent-family connectedness?
A
- protective against every health risk behavior measure except pregnancy
15
Q
HEADS for screening?
A
- H: home, habits
- E: education, employment, exercise
- A: accidents, ambition, activity, abuse
- D: drugs (alcohol, tobacco, recreational), diet, depression
- S: sex, suicide, sports, shots
16
Q
What should be included in developmentally oriented approach with adolescents?
A
- body image
- peer relationships
- independence
- identity
- sexuality
17
Q
Issues in substance abuse?
A
- alcohol still most highly abused chemical: binge drinking more common
- tobacco hardest to stop if use started by 10-15 (#1 cause of preventable long term health consequences..not only lung cancer)
- use ugly side of smoking to help advise teens
18
Q
Common STIs in adolescents?
A
- gonorrhea and syphilis are seen, gonorrhea more
- HIV is particular concerm
- Chlamydia and HPV infection rates are increasing
- herpes and trichomonas
- ABSTINENCE is best!
- condoms 2nd best, should be used even if other BC being used
- Condoms prevent gonorrhea, chlamydia and HIV the most
19
Q
Sports injuries are most common in which age groups?
A
- older age adolescents
- injuries may be multiple: laceration and fracture
- sprains (ankles most common)
20
Q
Eating disorders in teens?
A
- anorexia and bulimia most common causes of wt loss in adolescence
- 3rd most common chronic illness of adolescence surpassed only by asthma and obesity
- 0.5-1% of teen girls develop anorexia
- around 2% of teen girls fit dx criteria for bulimia
- much higher percentage have reported binge eating at times with or w/o purging
- 90-95% female
- puberty related
- comorbid with rape, depression
- many excel in sports, often have perfectionist personality
- lower self esteem, current media suggesting that thin is best
- do it to be popular
- more commonly seen b/t 15-20, seeing as young as 8
- red flag: wt loss of more than 10% of previous wt
21
Q
When should you consider that a pt may be anorexic?
A
- refusal or inability to maintain body wt over min normal wt
- intense fear of gaining wt or becoming fat despite being under wt
- distortion in perception of body shape
- in post menarchal females if 3 consecutive periods missed
22
Q
Physical findings in anorexia?
A
- hypothermia
- bradycardia
- bradypnea
- hypotension
- BMI below 5th percentile
- russell’s sign: if bulimia present, erosions of inside of front teeth from vomiting
- often appear depressed
23
Q
What is Bulimia nervosa?
A
- recurrent episodes of binge eating
- feeling lack of control over binge behavior
- regular use of self induced vomiting, laxatives, diuretics, strict dieting
- 2 binge episodes/week last 3 months
24
Q
What is DSM-V dx criteria for anorexia nervosa?
A
- persistent restriction of energy intake leading to sig low body wt
- either intense fear of gaining wt or becoming fat, or persistent behavior that interferes with wt gain (even though sig low wt)
- disturbance in way ones body wt or shape is experienced, lack of recognition of seriousness of current low body wt
25
Q
Approach at tx eating disorder?
A
- team approach:
pediatrician/internist - adolescent medicine subspecialist if available, nutritionist, counselor with eating D/O experience - long term tx plan: over a year, intense inpt followed by maintenance
26
Q
What is an emancipated minor?
A
younger than 18 that is:
- married
- living independently of parents and supports him/herself
- has kids
- serves or served in military
- varies by state
- mature minor: based upon health providers assessment of adolescent’s maturity in their ability to make their own health care decisions
- generally around age of 15 or 16, can be younger
