Adolescents Flashcards
overview and assessment
-Concerns and health issues mainly center around puberty and psychosocial development
-Leading causes of morbidity and mortality in adolescents are behaviorally mediated
-MVAs and other injuries account for 75% of all deaths; unhealthy dietary behaviors and inadequate physical activity result in adolescent obesity with associated health complications
-Our responsibility is to use every opportunity to inquire about risk-taking and protective behaviors (HEADDSSS)
interviewing adolescents
-Interviewing alone and discussing confidentiality are the cornerstones of obtaining an accurate history
-Nature of questions should consider the developmental age of the adolescent
-Conversations about sports, friends, video games, and activities outside of school can be useful for all ages and help build rapport
-Confidentiality
-Certain issues cannot be kept confidential: Suicidal intent, serious harm to others, and disclosure of sexual or physical abuse
-Law confers certain rights on adolescents, depending on health condition and personal characteristics (allows them to receive care without parental permission)
-During the physical examination, the adolescent must be offered a choice between having a parent or a chaperone present
physical growth/development: girls
-Adrenarche: First physiologic change associated with puberty
-Increased production of androgens by the adrenal glands
-Thelarche: Breast development
-First external manifestations of puberty (secondary sexual characteristics)
-Pubarche: Growth of pubic hair (after breast)
-Progression through puberty is denoted by Tanner staging for breast and pubic hair growth
-Not all girls achieve Tanner 5 pubic hair
-Growth spurt usually 1 year after thelarche, at Tanner stage 3; females only grow an additional 2-5 cm in height after menarche
-Menarche: Onset of menstruation; occurs at stage 4 breast development
-Average age ~ 12 years
-Most important predictor is when mother had menarche
-Interval from initiation of thelarche to onset of menses is 2.3 years + 1 year
physical growth/development: boys
-Testicular enlargement (Tanner stages 1-2), followed by pubic hair development at base of penis, and then axillary hair within the year
-Growth spurt between 10.5 to 16 years of age
-Deepening of voice, facial hair, and acne indicate early stages of puberty
tanner stage males
know this
early adolescence (10-14yrs)
-Rapid changes in physical appearance and behavior
-History focuses on physical and psychosocial health
middle adolescence (15-17yrs)
-Autonomy and global sense of identity, high-risk behaviors due to experimentation are common
-History focuses on interactions with family, school, and peers
late adolescence (18-21yrs)
-Individuality and planning for the future
-Greater emphasis on own health care responsibilities
well-adolescent: physical exam
breast changes
-Breast Asymmetry and Masses in Girls
-Breast bud is a pea-sized mass below the nipple, often tender
-Not unusual for one breast to grow before the other/more rapidly, resulting in asymmetry
-Reassure that after full maturation, asymmetry will be less obvious
-Fibroadenomas/cysts are most common breast masses in young women (US is imaging study of choice)
-Gynecomastia in Boys
-Breast enlargement is common (50-60%) and usually benign/self-limiting
-Findings: Round, 1-3 cm, freely mobile, often tender, firm mass beneath the areola during sexual maturity
-Large, hard, fixed enlargements/nipple discharge warrant further investigation
eating disorders: anorexia
-1.5% in teenage girls, F:M ratio 20:1, familial pattern
-Cause: Unknown; involves complex interaction between social, environmental, psychologic, and biologic events
-Dx Criteria:
-Restriction of energy intake relative to requirements leading to low wt in context of age, sex, physical health, and developmental trajectory
-Strong fear of gaining wt or becoming fat, even though underweight
-Disturbance in body wt or shape is experienced, undue influence of body wt or shape on self-evaluation, or denial of seriousness of low body wt
-1st event - behavioral change in eating or exercise
-Wearing oversized or excessively tight clothing, fine hair on face and trunk, rough/scaly skin, bradycardia, hypothermia, decreased BMI, erosion of tooth enamel (if emetic episodes with the binge-purge type versus restricting type), and acrocyanosis of hand/feet
-Tx and Prognosis:
-Multi-disciplinary approach with family-based therapy
-Feeding through voluntary intake of regular foods, nutritional formula orally, or NG tube
-When 80% of normal body wt achieved -> pt given freedom to gain wt at personal pace
-Prognosis includes 3-5% mortality, development of bulimic symptoms (30%), and persistent anorexia nervosa syndrome (20%)
bulimia
-5% in female college students (overwt, history of dieting), F:M ratio 10:1
-Dx Criteria:
-Recurrent episodes of binge-eating, characterized by both:
-Eating a larger amount of food than most people would eat in a discrete period of time
-lack of control during the episode
-Recurrent inappropriate compensatory behavior to prevent weight gain (self-induced vomiting; misuse of laxatives, diuretics, or other products; excessive exercise; fasting)
-Binge eating and inappropriate behaviors occur at least 1x week for 3 months
-Complications: Metabolic disturbances may occur from excessive vomiting
-Treatment and Prognosis:
-Nutritional, educational, and self-monitoring techniques are used to increase awareness of the maladaptive behavior, followed by efforts to change the eating behavior
-May respond to anti-depressants
-Attempted suicide and completed suicide (5%)
substance abuse
-Age at which street drugs are first used is decreasing (< 12 years), female use rising
-History of drug use should be taken in a nonjudgmental and supportive manner; include type, frequency, timing, circumstances, and outcomes of substance use
-CRAFFT: Car, Relax, Alone, Forgetting, Family/Friends, Trouble
-Acute Overdose: Alcohol, amphetamines, opiates, and cocaine can result in a toxicologic emergency, often with first-time use
-Management focuses on supportive treatment with follow-up counseling
acute and chronic effects of substance abuse
-Alcohol: Acute gastritis, acute pancreatitis
-IV drug use: Hepatitis B, bacterial endocarditis, osteomyelitis, septic pulmonary embolism, infection, AIDS
-Chronic marijuana or tobacco use: Bronchoconstriction/bronchitis
-Compulsive drug or alcohol use: Inability to navigate away from consequences of habituation
-Treatment: Because of the highly addictive (physical/psychologic) nature of many substances, residential drug treatment facilities are suggested
