Adolescent Health Issues Flashcards
1
Q
Three Transitional Periods of Adolescence
Early: -1-
Middle: -2-
Late: -3-
A
- 10-13 years
- 14-17 years
- 18-20ish years
2
Q
Adolescent Physical Foci
-1- in the -2- systems; approaching -3-
A
- Rapid changes
- reproductive, musculoskeletal, & cardiovascular
- adult sizes
3
Q
Adolescent Physical Foci
> -1- development
> -2- in height -3-, then -4-
A
- Secondary sexual characteristic
- Females grow ~2-3 in
- after menarche
- usually stop growing
4
Q
Adolescent Cognitive and Psychosocial Foci > Logical, -1- > Sense of -2- > -3- > Body/-4-
A
- abstract thinking
- identity
- independence
- sexual consciousness
5
Q
Adolescent WCC Interview
> Establish -1-
» May need to structure part of -2-
» Be alert for -3- that the adolescent -4- in front of parents
> Follow HIPAA regarding the adolescent’s right to privacy and -5-
> Intervew the patient while they’re -6-
A
- trust
- the interview alone
- cues about topics
- doesn’t want to discuss
- witholding information from parents
- fully clothed
6
Q
Adolescent Screenings Dev > Relationships >> -1- >> -2- > Occupation >> School performance and attendance >> -3- >> -4-
A
- friends & romance
- family functioning
- work
- hobbies & activities
7
Q
Adolescent Screenings
> Physcial Activity
» Physical -1-: Girls who -2- (e.g., -3-) may have delayed menarche
> -4- usually takes a hit in this age group
> -5-: current and recent stressors
A
- stress-induced estrogen deficiency
- exercise intensively
- track, gymnastics
- diet/nutrition
- concerns and worries
8
Q
Adolescent Screenings
- 1- and reproductive issues; gender identity
- 2-: -3-, and -4- when depression risk factors are present to include a history of previous depressive episodes, family history, other psychiatric disorders, substance use, trauma, psychosocial adversity, -5-, or previous screening tools with high scores without a diagnosis of depression
A
- Sexual activities
- mental/emotional health
- depression screening annually
- more often
- frequent somatic complaints
9
Q
Adolescent Screenings
Risk factors/behaviors
Alcohol Drug Screening: CRAFFT Screening Tool
Have you ever -1- by someone using alcohol/drugs?
Do you ever use alcohol/drugs to -2-?
Do you ever use alcohol/drugs while you are -3-?
Do you ever -4- while using alcohol/drugs?
Do -5- on alcohol/drug use?
Have you -6- while using alcohol/drugs?
A
- ridden in a CAR driven
- RELAX, feel better, or fit in
- ALONE
- FORGET things you did
- FAMILY/FRIENDS ever tell you that you should cut down
- gotten into TROUBLE
10
Q
Adolescent Screenings
> -1- others
> Specific questions to ask when -2-
» -3- and -4-
A
- Injury to self or
- alone with parents
- family communication patterns
- relationships
11
Q
Adolescent Screenings
Elimination (e.g., -1-, diuretics, -2-, problems w/ -3-)
A
- laxatives
- constipation
- urination
12
Q
Adolescent Screenings MGMT > Immunizations -> -1- for -2- > -3- w/ medications (e.g., -4-)
A
- HPV
- boys and girls
- Illness mgmt
- ADHD
13
Q
Adolescent Screenings PE PE proceeds from -1- Vis/Hearing at each visit > vis acuity: -2-; may -3-
A
- Head to foot
- 20/20
- alter with hormone surging
14
Q
Adolescent Screenings PE VS each visit (-1-) Pulse: -2- RR: -3- BP: -4-
A
- more adult-like (lower)
- 70 bpm
- 15 breaths pm
- 117/75
15
Q
Adolescent Screenings
PE
Observation of the…
A
…parent/adolescent interactions
16
Q
Adolescent Screenings
PE
Assessment for scoliosis: symmetry of -1-, -2-, etc.; -3- test necessary, due to -4- of -5-
A
- scapulae
- hips
- Adams
- High occurance
- pubescent-onset scoliosis
17
Q
Adolescent Screenings PE Assessment for scoliosis > Females: -1- years and -2- years > Males: -3- years (-4-)
A
- Once at 10
- once at 12
- once b/t 13 & 14
- their pubescent growth spurt is later
18
Q
Adolescent Screenings
Labs
-1- as needed
-2- from sites of sexual acitivty (oral, anal, vaginal), and -3- if -4- or history of -5-
A
- Hematocrit (as for heavy period)
- Syphilis test (VDRL/RPR), gonorrhea test (GC)/chlamydia (CT)
- HIV
- Sexually active
- sexual abuse
19
Q
Adolescent Screenings
Labs
Pap smear: -1-
LFTs if PMH includes -2-
A
- begins at 21
2. drug abuse (including steriods)
20
Q
Adolescent Screenings Labs Cholesterol if indicated > -1- and again at age 17-21 years > Additional screening may be indicated if -2-, -3-, family history of -4- or -5- is present
A
- Once at age 9-11
- DM
- overweight/obesity
- dyslipidemia
- cardiac disease
21
Q
Adolescent Screenings - PE - Secondary Sex Abnormalities
-1- in males may be caused by -2-, -3-, -4-, and -5- among others
A
- gynecomastia
- marijuana intake
- anabolic steroids
- alcohol
- antidepressants
22
Q
Adolescent Screenings - PE - Sexual Health
> Observe for -1-; rates of -1- is highest between -2- of age (-3- education, consisting of AG regarding -4- for -5-)
> -6- (perform retrun demonstration); -7- commonly discovered in late adolescence
A
- STIs
- 15 & 25 years
- safe sex
- condoms AND LARC (long acting reversible contraception)
- both males & females
- Testicular self-exam
- testicular cancer is
23
Q
Adolescent Screenings
Tanner staging
Boys: Secondary sexual characteristic development
Stage 1: preadolescent testes, scrotum, penis
2: enlargement of scrotum and testes; scrotum -1-
3: -2-
4. Penis enlarges in beradth and development of -3-; -4- appear
5: Adult shape and appearance
A
- roughens and reddens
- elongation of penis
- glans
- rugae
24
Q
Adolescent Screenings Tanner staging Breast 1. preadolescent breast 2. -1- with -2- 3. -3- w/o -4- --Menses-- 4. Areola -5- project -6- 5. adult breast: receding areolas and retracting nipples
A
- breast buds
- areolar enlargement
- breast enlargement
- separate nipple contour
- and nipple
- as secondary mound
25
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Adolescent Screenings
Tanner staging
Pubic hair
1. preadolescent hair
2. -1-, -2-, fine
3. -3-, -4-, -5-
4. adult in character, but not as voluminous
5. adult pattern
```
1. sparse
2. pale
3. increased amount
4. curlier
5. darker
26
Adolescent Screenings
Dev monitoring
> -1- reached; associated with Tanner staging
> Female menses: -2- after start of -3-
> Onset -4- age -5- is precocious puberty
1. Peak Height Velocity (PHV)
2. menarche 2-3 years
3. breast stage 2
4. of puberty before
5. 8/9 in girls/boys
27
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Adolescent Screenings
Cog dev monitoring
Erikson's -1- stage
Piaget's -2- stage
Enjoys -3-
Uses -4-
```
1. Identity vs. Role Confusion
2. formal operational (i.e., abstract thinking)
3. intellectual challenge
4. humor and formal thought
28
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Adolescent Screenings
Psychosocial Dev monitoring
Younger Adolescence
> Conforms -1-
> Characterized by -2-
> Expresses -3-
```
1. to peer groups
2. parent/child conflict
3. anger
29
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Adolescent Screenings
Psychosocial Dev monitoring
Older Adolescence
> Less -1-
> Reestablishes -2-
> More interested in -3-
> Better sense of -4-
```
1. emotionally labile
2. rapport w/ parents
3. romantic relationships & sexuality
4. self-esteem, confidence
30
Adolescence AG
General
> Focus on -1-, physical growth and dev, risk reduction, and emotional well-being
> encourage use of -2- for -3-
1. SDoH
2. mental health resources
3. coping with stressors
31
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Adolescence AG
Dev discussion/guidance
-1-
> Negotiation is essential
> Adults must be role models
Reinforce -2-
Respect the -3-
```
1. Discipline
2. honesty
3. need for privacy
32
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Adolescence AG
Nutrition
> Nutritional -1-
>> Discuss -2-
>>> Monitor -3-
```
1. requirements are higher
2. dieting (healthy eating as a lifestyle > diets)
3. vegetarian/alternative diets (B12 levels for vegetarians)
33
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Adolescence AG
Dental health
brushing -1- before bed
dental cleaning -2-
encourage -3-
```
1. after meals and
2. every 6 months
3. flossing
34
Adolescence AG
Sexuality
Increased -1- relationships and sexuality
Establish comms about -2-
Prepare for -3-, or nocturnal emissions
Give -4- sex, disease prevention, and pregnancy prevention.
-5-
1. interest in romantic
2. STIs and HIV/AIDS
3. body changes, menstruation
4. accurate information about
5. gender identity
35
Adolescence AG
Preventive Health Issues
> -1- health
> -2-: Multiple factors: single parent families, -3-, low IQ, -4-, poverty, and poor involvement in the community.
>> Other factors include: -5-, weak social connections or ties, and -6-
> -7- safety: States vary in their -8- with newly -9-.
1. Mental (depression/suicide)
2. Violence
3. family disconnectedness
4. alcohol or drug use
5. gang membership
6. antisocial behaviors
7. Automobile
8. passenger restrictions (and period of restriction)
9. licensed adolescent drivers
36
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Adolescence AG
Dev warning signs
Apparent -1-
Difficulty -2-
Talk -3-
-4- or family
```
1. personality changes
2. accepting failure
3. of suicide
4. withdrawal from friends
37
Adolescent Health Issues & Disorders
Eating Disorders
> Definition: chronic -1- accompanied by distorted body image
> General Concepts
-> Anorexia nervosa is characterized by fear of weight gain, distored or unrealistic body image or ideas about food, and -2- to -3-
-> Bulimia nervosa is characterized by episodic -4-
1. disturbances in eating patterns
2. food restriction leaidng
3. significant weight loss
4. binge and purge episodes
38
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Adolescent Health Issues & Disorders
Eating Disorders
> General Concepts
-> Cause is not clearly defined but is believed to arise from familial issues, -1-, -2-, and a desire for control
-> -3- of all -4-: Combination of -5-
```
1. social pressures
2. low self-esteem
3. highest mortality rates
4. mental illnesses
5. suicide and consequential death
39
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Adolescent Health Issues & Disorders
Eating Disorders
> S/S
-> -1-
-> -2-
-> -3-
-> -4-
-> -5-
```
1. weight loss
2. dry skin
3. constipation
4. tooth enamel erosion
5. Russell's sign (bruised knuckles)
40
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Adolescent Health Issues & Disorders
Eating Disorders
>DDx
-> -1- producing weight loss
-> -2-
-> -3-
-> -4-
```
1. organic disease
2. pregnancy
3. depression
4. substance abuse
41
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Adolescent Health Issues & Disorders
Eating Disorders
> Labs
-> as indicated to -1-
> Mgmt
-> -2-
-> may -3-
```
1. rule out organic disease
2. psychotherapy
3. need hospitalization
42
Health Considerations in Adolescence
> Chest pain: common complaint, -1- in nature
>> most commonly the result of a -2-
>>> pain -3-: indicative of -4-/other -2-
>> important to rule out -1- causes
>>> -5- support -1- causes
1. rare(ly) cardiac
2. musculoskeletal problem
3. on palpation
4. costochondritis
5. Palpitations, syncope/LOC
43
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Health Considerations in Adolescence
Contemporary Body Piercings
> -1- dependent on site
>> navel: -2-
>> nipple: -3-
```
1. Healing time
2. 2-12 months
3. 1.5 - 6 months
44
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Health Considerations in Adolescence
Contemporary Body Piercings
> -1-: common complication following body piercing
>> no -2-
>> Oral -3-
>> cleansing (-4-)
>> -5- cream
```
1. Infection
2. uniform treatment
3. antibiotics (v. Staphylococcus aureus)
4. soap/saline, not peroxide
5. topical antibiotic
45
Finding an -1- who is qualified to care for young adults with -2- needs is the most commonly perceived barrier to -3- as identified by family and young adults, pediatric healthcare providers, and -4-. -3- requires time and communication with the -5- involved.
1. adult healthcare provider
2. special health care
3. successful healthcare transition
4. adult internists
5. parents and adolescent
46
Many families may be -1- the nurturing environment of -2- and may perceive that adjusting to an adult practice as difficult. Internists may -3- and qualifications to address many of the -4- of adolescents with chronic illnesses.
1. hesitant to leave
2. pediatric care
3. lack the training
4. complicated healthcare needs
47
Because of the delicate -1- about the complicated -2- of some adolescents, some -3- may not be comfortable in dealing with the complexities of transitioning care.
1. nature of conversations
2. healthcare needs
3. pediatric providers
48
Disordered or dysfunctional eating occurs -1-. Both anorexia and bulimia nervosa are characterized by a -2-, often accompanied by -3-. Anorexia nervosa's physical signs and symptoms are related to -4-; hence amenorrhea, -5-, hypotension, and bradycardia are often seen.
1. along a spectrum
2. distorted body perception
3. depression
4. chronic malnutrition
5. hypothermia
49
Bulimia nervosa involves episodes of -1- and -2- to prevent weight gain. If the -2- involves -3-, -4- can be present.
1. binge eating
2. compensatory behavior (often purging)
3. vomiting
4. salivary gland enlargement
50
Obesity can be difficult to treat, with patients and their parents often appearing to lack sufficient -1- to make significant changes in eating behaviors, -2-, and physical activity. Motivational interviewing uses a -3-, supportive mode of communication between the -4-, designed to enhance -1- for behavior change rather than the more traditional emphasis on the -5- about a healthy diet or exercise.
1. motivation
2. dietary composition
3. nonjudgmental
4. provider and patient
5. transfer of information
51
The steps in motivational interviewing include: -1- with the patient, setting an -2-, identifying the patient’s -3-, and establishing a -4-. When beginning a motivational interview, -1- facilitates a trusting relationship between the provider and patient, which includes -5- and thoughtful reflection.
1. establishing rapport
2. agenda
3. ability to change
4. plan
5. active listening
52
Motivational Interviewing
The provider must engage in -1- to respond effectively to the patient's or parent's questions and statements. Once the patient or parent acknowledges both -2- and a belief that behavior change will be -3- the problem, it then becomes much more likely that -4- can be articulated, agreed on, and -5-.
1. active reflective listening
2. concern about problem(s) (BP for obesity, for instance)
3. effective in overcoming
4. behavior change goals
5. ultimately achieved
53
An emergency contraceptive can be prescribed for adolescents who are -1- to prevent a pregnancy in the event that -2- was used during -3-. Some references advise a -4- emergency contraception prescription to be written for all female adolescents who are -1-. There are -5- for medications for emergency contraception.
1. sexually active
2. no/faulty contraceptive
3. vaginal intercourse
4. preemptive
5. limited choices
54
It is recommended that emergency contraceptives be taken -1- sex and are most effective if taken within 72 hours.
Guidance should include that -2- an emergency contraceptive, the -3- for a pregnancy test within -4- if -5-.
1. ASAP after unprotected
2. after taking
3. adolescent should return
4. 3 weeks
5. menses haven't started
55
In the time after use of emergency contraceptives, the adolescent should -1- or -2- until the next cycle starts. Emergency contraceptives may also alter the -3- but, in general, they'll likely come -4-. Although ectopic pregnancy is rare, guidance should also include the importance of seeking immediate evaluation should severe abdominal pain occur -5- use of emergency contraception.
1. use condoms
2. refrain from sex
3. schedule of menses
4. sooner than expected
5. 3-5 weeks after
56
Adolescent lesbian and bisexual females are -1- to have been -2- when compared to their heterosexual peers. Some adolescents who self-identify as -3-, only had sexual contact with -4- while others who self-identified as LGB had either no sexual contact or only had -5-.
1. more likely
2. pregnant
3. heterosexual
4. same sex partners
5. heterosexual sexual contact
57
LGB adolescents and young adults are at -1- for -2- and, it is important to counsel about -2- pregnancy even with -3-. Providing sexual and reproductive health education that includes information about -4-, -5-, and STIs is necessary for all adolescents and young adults.
1. greater risk
2. unplanned/accidental pregnancy
3. FSF
4. abstinence
5. contraception
58
LGB adolescents and young adults
Additionally, -1- should be offered to all females regardless of -2-.
Pre-college visits present an excellent opportunity to ensure that all -3-, not just the -4-.
1. information about contraception
2. their sexual orientation
3. immunizations are current
4. HPV vaccine
59
Adolescents and young adults, including those who know or are unsure -1-, may have psychosocial concerns. Providing care that is -2-, current, factual, and -3- is required with all patients, regardless of -4-.
1. about their sexuality
2. confidential
3. nonjudgmental
4. their sexual orientation
60
Girls in -1- begin to develop noticeable breasts with no discernible developed nipple separation; pubic hair begins to grow in dark and coarse, and some teens experience acne vulgaris.
In -2-, the preadolescent will develop breasts that appear with papilla elevation, and the pubic hair is villa hair. In -3-, the breast buds are palpable, and the areolae are enlarged. During -4-, the areola and nipple project as a -5-, and the pubic hair has reached adult quality.
1. Tanner Stage III
2. Tanner Stage I
3. Tanner Stage II
4. Tanner Stage IV
5. secondary mound
