Adolescent Health Issues Flashcards
Adolescent - Ages
-Early: 10-13 years
-Middle: 14-17 years
-Late: 18-20+ years
Adolescent - Physical Changes
-Rapid changes in reproductive, skeletal, muscular, and CV system
-Secondary sexual characteristics develop
-Growth spurt - peak height velocity
-Female grow an average of 2-3 inches in height after menarche - after a girl gets her period, she typically only grows another 2-2 inches more before she reaches her adult height
Adolescent - Well-Child Checks
-Establish trust
-Let the adolescent and parents know from the start of the interview that you will be interviewing the child along for a part of it
-Follow HIPAA regarding right to privacy - if they are seeking care for contraception or pregnancy-related cause, you do not have to tell the parents if the child does not want you to
-Interview while they are fully clothed and only expose as needed
Adolescent - Subjective Screenings
-Ask about friends and relationships
-Ask about family functioning
Adolescent - HEADSS Assessment
-Home: (Who do you live with? Do you have your own room? How are your family relationships?)
-Education and employment: (School performance? History of employment? Future education/employment plans?)
-Activities: (On own or with family or peers? Church, sports, hobbies, TV, music? History of arrests?)
-Drugs: (Personal use and frequency, use by family members.)
-Suicide/Depression: (Any sleep disorders/appetite changes? History of suicide attempts among peers or family? Suicidal ideology?)
Adolescents - SAFETEENS Mnemonic
-Sexuality
-Accidents and/or abuse
-Firearms/Violence, homicide
-Emotions (suicide/depression)
-Toxins (tobacco, alcohol, drugs)
-Environment (school, home, friends)
-Exercise
-Nutrition
-Shots (immunization status)
Adolescent - Physical Activity
-Girls who exercise intensively (track, figure skating, gymnastics) may have delayed menarche
Adolescent - Risk Factors or Behaviors
-Ask about use of alcohol, tobacco, drugs, or caffeine
-CRAFFT screening tool:
*Have you ever ridden in a CAR driven by someone (including yourself) using alcohol/drugs?
*Do you ever use alcohol/drugs to RELAX, feel better, or fit in?
*Do you ever use alcohol/drugs while you are ALONE?
*Do you ever FORGET things you did while using alcohol/drugs?
*Do family or FRIENDS ever tell you that you should cut down on alcohol/drug use?
*Have you gotten into TROUBLE while using alcohol/drugs?
Adolescent - Elimination Patterns
-Ask about use of laxatives or diuretics, constipation, problems with urination
-Example: Wrestlers that need to make weight may abuse laxatives or diuretics
-Overuse of laxatives can eventually constipation
Adolescent - Immunizations
-Tdap
-HPV
-Meningococcal
Adolescent - Visual Acuity
-20/20
-May alter with hormone surging
Adolescent - Vital Signs
-More adult like
-Pulse: 55-85 bpm
-Respirations: 12-18 breaths pm
-BP: SBP 110-124 mmHg, DBP 70-79 mmHg
Adolescent - Relationship with Parents
-Observe relationship with the parent
-Are the parents letting the adolescent answer questions?
-Are parents being supportive of adolescent?
Adolescent - Scoliosis
-Screening:
*Females: once at age 10 years and once at age 12 years
*Males: once between 13-14 years
-To test: have child standing with feet together, without socks - check shoulders, clavicle, and scapula height for symmetry
-Adam’s bend over test
Adolescent - Labs
-Hematocrit: check if concern about girl with heavy menses
-STI screening: syphilis (VDRL or RPR), gonorrhea (GC), chlamydia (CT), and HIV if sexually active or history of sexual abuse - highest risk for STI between 15-25 years
-Pap smears: begin at age 21
-LFTs: if history of alcohol or anabolic steroid use
-Cholesterol: Once at 9-11 years and then at 17-21 years
Adolescent - Gynecomastia
-Gynecomastia can be caused by marijuana intake, anabolic steroids, alcohol, antidepressants, and some GERD meds
-SSRIs can cause galactorrhea
Adolescent - Testicular Self-Exam
-Ask patient to perform return demonstration
-Testicular cancer is common, although highly treatable, in adolescent boys
Adolescent - Tanner Stages: Boys
-Stage 1: Preadolescent testes, scrotum, and penis
-Stage 2: Enlargement of scrotum and testes; scrotum roughens and reddens
-Stage 3: Penis elongates (nocturnal emissions happen after this stage)
-Stage 4: Penis enlarges in breadth and development of glans; rugae appear (spermarche occurs during this stage)
-Stage 5: Adult shape and appearance
Adolescent - Tanner Stages: Girls
-Stage 1: Preadolescent breasts
-Stage 2: Breast buds with areolar enlargement
-Stage 3: Breast enlargement without separate nipple contour
-Stage 4: Areola and nipple project as secondary mound
-Stage 5: Adult breast: Areola recedes, nipple retracts
Adolescent - Tanner Stages: Pubic Hair
-Stage 1: Preadolescent
-Stage 2: Sparse, pale, fine
-Stage 3: Darker, increased amount, curlier
-Stage 4: Adult in character but not as voluminous
-Stage 5: Adult pattern
Adolescent - Precocious Puberty
-Girls: onset of puberty before age 8
-Boys: onset of puberty before age 9
Adolescent - Cognitive Development
-Jean Piaget - formal operational stage
*Abstract thinking
*Younger adolescents daydream and have trouble staying focused
*Enjoys intellectual challenge
*Uses humor and formal thought
Adolescent - Psychosocial Development
-Erik Erikson - identity vs. role confusion
*Trying to figure out who they are
-2 main psychosocial developments: sense of identity and narcissism (internal reflection and development of a personal identity)
-Younger adolescence
*Conforms to peer groups - looks more to peers than parents
*Characterized by parent/child conflict
*Expresses anger
-Older adolescence
*Less emotionally liable
*Reestablishes rapport with parents
*More interested in romantic relationships and sexuality
Adolescents - Developmental Discussion/Guidance
-Discipline: negotiation is essential - allow flexibility on less important issues
-Reinforce honesty
-Respect need for privacy
