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PNCB CPNP-PC > Adolescent Health Issues > Flashcards

Adolescent Health Issues Flashcards

1
Q

Three Transitional Periods of Adolescence
Early: -1-
Middle: -2-
Late: -3-

A
  1. 10-13 years
  2. 14-17 years
  3. 18-20ish years
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2
Q

Adolescent Physical Foci

-1- in the -2- systems; approaching -3-

A
  1. Rapid changes
  2. reproductive, musculoskeletal, & cardiovascular
  3. adult sizes
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3
Q

Adolescent Physical Foci
> -1- development
> -2- in height -3-, then -4-

A
  1. Secondary sexual characteristic
  2. Females grow ~2-3 in
  3. after menarche
  4. usually stop growing
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4
Q 
Adolescent Cognitive and Psychosocial Foci
> Logical, -1-
> Sense of -2-
> -3-
> Body/-4-
A
  1. abstract thinking
  2. identity
  3. independence
  4. sexual consciousness
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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
  1. trust
  2. the interview alone
  3. cues about topics
  4. doesn’t want to discuss
  5. witholding information from parents
  6. fully clothed
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6
Q 
Adolescent Screenings
Dev
> Relationships
>> -1-
>> -2-
> Occupation
>> School performance and attendance
>> -3-
>> -4-
A
  1. friends & romance
  2. family functioning
  3. work
  4. hobbies & activities
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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
  1. stress-induced estrogen deficiency
  2. exercise intensively
  3. track, gymnastics
  4. diet/nutrition
  5. concerns and worries
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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
  1. Sexual activities
  2. mental/emotional health
  3. depression screening annually
  4. more often
  5. frequent somatic complaints
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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
  1. ridden in a CAR driven
  2. RELAX, feel better, or fit in
  3. ALONE
  4. FORGET things you did
  5. FAMILY/FRIENDS ever tell you that you should cut down
  6. gotten into TROUBLE
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10
Q

Adolescent Screenings
> -1- others
> Specific questions to ask when -2-
» -3- and -4-

A
  1. Injury to self or
  2. alone with parents
  3. family communication patterns
  4. relationships
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11
Q

Adolescent Screenings

Elimination (e.g., -1-, diuretics, -2-, problems w/ -3-)

A
  1. laxatives
  2. constipation
  3. urination
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12
Q 
Adolescent Screenings
MGMT
> Immunizations
-> -1- for -2-
> -3- w/ medications (e.g., -4-)
A
  1. HPV
  2. boys and girls
  3. Illness mgmt
  4. ADHD
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13
Q 
Adolescent Screenings
PE
PE proceeds from -1-
Vis/Hearing at each visit
> vis acuity: -2-; may -3-
A
  1. Head to foot
  2. 20/20
  3. alter with hormone surging
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14
Q 
Adolescent Screenings
PE
VS each visit (-1-)
Pulse: -2-
RR: -3-
BP: -4-
A
  1. more adult-like (lower)
  2. 70 bpm
  3. 15 breaths pm
  4. 117/75
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15
Q

Adolescent Screenings
PE
Observation of the…

A

…parent/adolescent interactions

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16
Q

Adolescent Screenings
PE
Assessment for scoliosis: symmetry of -1-, -2-, etc.; -3- test necessary, due to -4- of -5-

A
  1. scapulae
  2. hips
  3. Adams
  4. High occurance
  5. pubescent-onset scoliosis
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17
Q 
Adolescent Screenings
PE
Assessment for scoliosis
> Females: -1- years and -2- years
> Males: -3- years (-4-)
A
  1. Once at 10
  2. once at 12
  3. once b/t 13 & 14
  4. their pubescent growth spurt is later
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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
  1. Hematocrit (as for heavy period)
  2. Syphilis test (VDRL/RPR), gonorrhea test (GC)/chlamydia (CT)
  3. HIV
  4. Sexually active
  5. sexual abuse
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19
Q

Adolescent Screenings
Labs
Pap smear: -1-
LFTs if PMH includes -2-

A
  1. begins at 21

2. drug abuse (including steriods)

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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
  1. Once at age 9-11
  2. DM
  3. overweight/obesity
  4. dyslipidemia
  5. cardiac disease
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21
Q

Adolescent Screenings - PE - Secondary Sex Abnormalities

-1- in males may be caused by -2-, -3-, -4-, and -5- among others

A
  1. gynecomastia
  2. marijuana intake
  3. anabolic steroids
  4. alcohol
  5. antidepressants
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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
  1. STIs
  2. 15 & 25 years
  3. safe sex
  4. condoms AND LARC (long acting reversible contraception)
  5. both males & females
  6. Testicular self-exam
  7. testicular cancer is
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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
  1. roughens and reddens
  2. elongation of penis
  3. glans
  4. rugae
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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
  1. breast buds
  2. areolar enlargement
  3. breast enlargement
  4. separate nipple contour
  5. and nipple
  6. as secondary mound
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25
Q 
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
A
  1. sparse
  2. pale
  3. increased amount
  4. curlier
  5. darker
26
Q

Adolescent Screenings
Dev monitoring
> -1- reached; associated with Tanner staging
> Female menses: -2- after start of -3-
> Onset -4- age -5- is precocious puberty

A
  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
Q 
Adolescent Screenings
Cog dev monitoring
Erikson's -1- stage
Piaget's -2- stage
Enjoys -3-
Uses -4-
A
  1. Identity vs. Role Confusion
  2. formal operational (i.e., abstract thinking)
  3. intellectual challenge
  4. humor and formal thought
28
Q 
Adolescent Screenings
Psychosocial Dev monitoring
Younger Adolescence
> Conforms -1-
> Characterized by -2-
> Expresses -3-
A
  1. to peer groups
  2. parent/child conflict
  3. anger
29
Q 
Adolescent Screenings
Psychosocial Dev monitoring
Older Adolescence
> Less -1-
> Reestablishes -2-
> More interested in -3-
> Better sense of -4-
A
  1. emotionally labile
  2. rapport w/ parents
  3. romantic relationships & sexuality
  4. self-esteem, confidence
30
Q

Adolescence AG
General
> Focus on -1-, physical growth and dev, risk reduction, and emotional well-being
> encourage use of -2- for -3-

A
  1. SDoH
  2. mental health resources
  3. coping with stressors
31
Q 
Adolescence AG
Dev discussion/guidance
-1-
> Negotiation is essential
> Adults must be role models
Reinforce -2-
Respect the -3-
A
  1. Discipline
  2. honesty
  3. need for privacy
32
Q 
Adolescence AG
Nutrition
> Nutritional -1-
>> Discuss -2-
>>> Monitor -3-
A
  1. requirements are higher
  2. dieting (healthy eating as a lifestyle > diets)
  3. vegetarian/alternative diets (B12 levels for vegetarians)
33
Q 
Adolescence AG
Dental health
brushing -1- before bed
dental cleaning -2-
encourage -3-
A
  1. after meals and
  2. every 6 months
  3. flossing
34
Q

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-

A
  1. interest in romantic
  2. STIs and HIV/AIDS
  3. body changes, menstruation
  4. accurate information about
  5. gender identity
35
Q

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-.

A
  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
Q 
Adolescence AG
Dev warning signs
Apparent -1-
Difficulty -2-
Talk -3-
-4- or family
A
  1. personality changes
  2. accepting failure
  3. of suicide
  4. withdrawal from friends
37
Q

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-

A
  1. disturbances in eating patterns
  2. food restriction leaidng
  3. significant weight loss
  4. binge and purge episodes
38
Q 
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-
A
  1. social pressures
  2. low self-esteem
  3. highest mortality rates
  4. mental illnesses
  5. suicide and consequential death
39
Q 
Adolescent Health Issues & Disorders
Eating Disorders
> S/S
-> -1-
-> -2-
-> -3-
-> -4-
-> -5-
A
  1. weight loss
  2. dry skin
  3. constipation
  4. tooth enamel erosion
  5. Russell’s sign (bruised knuckles)
40
Q 
Adolescent Health Issues & Disorders
Eating Disorders
>DDx
-> -1- producing weight loss
-> -2-
-> -3-
-> -4-
A
  1. organic disease
  2. pregnancy
  3. depression
  4. substance abuse
41
Q 
Adolescent Health Issues & Disorders
Eating Disorders
> Labs
-> as indicated to -1-
> Mgmt
-> -2-
-> may -3-
A
  1. rule out organic disease
  2. psychotherapy
  3. need hospitalization
42
Q

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

A
  1. rare(ly) cardiac
  2. musculoskeletal problem
  3. on palpation
  4. costochondritis
  5. Palpitations, syncope/LOC
43
Q 
Health Considerations in Adolescence
Contemporary Body Piercings
> -1- dependent on site
>> navel: -2-
>> nipple: -3-
A
  1. Healing time
  2. 2-12 months
  3. 1.5 - 6 months
44
Q 
Health Considerations in Adolescence
Contemporary Body Piercings
> -1-: common complication following body piercing
>> no -2-
>> Oral -3-
>> cleansing (-4-)
>> -5- cream
A
  1. Infection
  2. uniform treatment
  3. antibiotics (v. Staphylococcus aureus)
  4. soap/saline, not peroxide
  5. topical antibiotic
45
Q

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.

A
  1. adult healthcare provider
  2. special health care
  3. successful healthcare transition
  4. adult internists
  5. parents and adolescent
46
Q

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.

A
  1. hesitant to leave
  2. pediatric care
  3. lack the training
  4. complicated healthcare needs
47
Q

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.

A
  1. nature of conversations
  2. healthcare needs
  3. pediatric providers
48
Q

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.

A
  1. along a spectrum
  2. distorted body perception
  3. depression
  4. chronic malnutrition
  5. hypothermia
49
Q

Bulimia nervosa involves episodes of -1- and -2- to prevent weight gain. If the -2- involves -3-, -4- can be present.

A
  1. binge eating
  2. compensatory behavior (often purging)
  3. vomiting
  4. salivary gland enlargement
50
Q

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.

A
  1. motivation
  2. dietary composition
  3. nonjudgmental
  4. provider and patient
  5. transfer of information
51
Q

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.

A
  1. establishing rapport
  2. agenda
  3. ability to change
  4. plan
  5. active listening
52
Q

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-.

A
  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
Q

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.

A
  1. sexually active
  2. no/faulty contraceptive
  3. vaginal intercourse
  4. preemptive
  5. limited choices
54
Q

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-.

A
  1. ASAP after unprotected
  2. after taking
  3. adolescent should return
  4. 3 weeks
  5. menses haven’t started
55
Q

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.

A
  1. use condoms
  2. refrain from sex
  3. schedule of menses
  4. sooner than expected
  5. 3-5 weeks after
56
Q

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-.

A
  1. more likely
  2. pregnant
  3. heterosexual
  4. same sex partners
  5. heterosexual sexual contact
57
Q

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.

A
  1. greater risk
  2. unplanned/accidental pregnancy
  3. FSF
  4. abstinence
  5. contraception
58
Q

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-.

A
  1. information about contraception
  2. their sexual orientation
  3. immunizations are current
  4. HPV vaccine
59
Q

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-.

A
  1. about their sexuality
  2. confidential
  3. nonjudgmental
  4. their sexual orientation
60
Q

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.

A
  1. Tanner Stage III
  2. Tanner Stage I
  3. Tanner Stage II
  4. Tanner Stage IV
  5. secondary mound

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