Adolesecence Flashcards
Goals of guidelines
deter from participating in behaviors that jeopardize health, detect physical, emotional and behavioral problems early and intervence promptly. reinforce and encourage behaviors that promote healthful living, provide immunization against infectious disease.
11-21 have
annual routine health visits
Physical examination includes
complete physical exam: vital signs, Skin, spine, Breast, Genitalia,
motivational interviewing
effective for tobacco use, substance use, control of T1DM, consling style that guids patients toward behavior change by helping resovle ambivalance
1st step of MI
assess readiness for change, 0-10 how important is change, what can make this number higher
what to avoid in MI
asking why it not important as this puts patient in position to become defensive
Other components of MI
roll with resistance and righting reflex, provider must focus on the patients own individual goals and reflect on patients challenges
Guiding principles of MI
express empathy, meet the patient where they are in the process,
LISTEN REFLECTIVELY, AVOID CONFRONTATIONS, ROLL WITH RESISTANCE
Process of MI
seeks to progress through stages of changes- precontemplative, contemplative, preparation, action
Situations of medial/psychiatric instability
MI is NOT an option
Puberty
activation of hypothalamic-pituitary-gonadal axis in late childhood- before puberty pituitary-gonadal hormone is low
50% of pubertal timing
genetics/ethnicity
Onset of puberty
inhibition of gonadotropin-releasing hormone is hypothalamus is removed- pulsatile production/release of gonadotropins, LH FSH
Early to middle adolescence
pulse frequency and amplitude of LH/FSH secretion increase- stimulates gonads to produce estrogen/testosterone
Female
FSH- Ovarian maturation, granulosa cell function & estradiol secretions. LH: ovulation, corpus luteum formation and progesterone secretion; estradiol levels progressively increase- maturation of female genital tract and breast development.
Males
LH- interstitial cells of testes- testosterone; FSH- production of spermatocytes; testes produce inhibin- during puberty, testosterone levels increase more than 20-fold- correlates with physical stages of puberty and degrees of skeletal maturation
Teens weight
almost doubles in adolescences
Height
increases by 15-20%
Major organs
double in size expect lymphoid tissue
Pubertal growth spurt
begins 2 years earlier in girls than boys and last 2-4 yrs, continues longer than boys
Peak height for girls
11.5-12 yr
Peaks hight for boys
between 13.5-14yr, muscle mass double bwt 10-17yr
83-89 if ultimate height attained by
11yr- girl and 12 yr- boy
sexual orientation
awareness of gender identity happens in early childhood, by age 3yr children identify themselves as boy or girl, by age 4 gender is stable.
Early adolescence- 10-13yr
rapid growth and development of secondary sex characteristics, body image, self concept, self esteems fluctuate, generally feel more comfortable with members of the same sex, peer relationships are increasingly more important, think concretely, cannot easily conceptualize future, vague and unrealistic professional goals.
Middle adolescence- 14-16yr
rapid pubertal development subsides, teens are more comfortable with their new bodies, intense emotions and wide mood swings are typical. formal operations and abstract thinking, new sense of omnipotence, and belief world can be changed by merely thinking about it, sexually active teens, think they don’t need protection, self centered. relationships with peers and others are narcissistic, experimenting with new images is common, begin dating and experimenting with sex, peers determine standard for identification
Late Adolescence- 17 and older
less self centered, more caring of others, social relationships shift from peer group to individual. dating is more intimate, abstract thinking allow more realistic thinking about plans for the future, period of idealism, more rigid concepts of right and wrong.
early cognitive development
growing capacity for abstract thought, interested in present, limited thought to future, intellectual interest expand, deeper moral thinking,
early social emotional development
struggle with sense of identity, worries about being normal, feels awkward about self and body, realize parents aren’t perfect, increased conflicts with patents, desire independence, tendency to return to childish behavior especially when stressed, moodiness, rule and limit resting, greater interest in privacy
middle adolescence cognitive development
cont growth of capacity for abstract thought, greater capacity for setting goals, interest in moral reasoning, thinking about the meaning of life
middle adolescence social emotional development
intense self involvement, con adjustment to changing bodies and worries about being normal, distance from patents, drive for independence, peers gain importance, feeling of love and passion
late adolescence cognitive development
ability to think idea through, ability to delay gratification, examination of inner experience, increased concern for future, cont interest in moral reasoning
late adolescence social-emotional development
firmer sense of identity, increased emotional stability, increased concern for others, increased independence and self reliance, peer relationships remain important, development of more serious relationships.
Chronological age
bad predictor of physiologic/psychosocial development-
skeletal maturation
correlates well with growth and pubertal development
Menarche
average age 12.53 years, may be delayed until 16 or as early as 10
1st measurable sign of puberty- girls
beginning of height spurt, 1st conspicuous sign- breast buds bwt 8-11 yr, spurt ends by 14 yr, height spurt correlates with breast development stages vs pubic hair stage
1st measurable sign of puberty in boys
scrotal and testicular growth, public hair 10-15 yr, 1st ejaculation- 1 year after initiation of testicular growth, height spurt by age 11, development not completed untill age 18,
Gynecomastia
common in younger teen makes and disappears within 2 years
normal menstration
11-14 yrs, normal menstrual cycle 21-45 days and lasting 7 days
Breast stage 1
no breast development
breast stage 2
breast budding, some palpable breast tissue under nipple and areola is somewhat enlarged
breast stage 3
breast is more distinct, no separation btw contours of two breast
breast stage 4
breast is further enlarged and greater contour distinction, nipple including the areola forms a secondary mound on breast
breast stage 5
size may vary in mature stage, breast is fully developed, contours distinct, areola has receded into general contour of breast
Pubic hair stage 1
no pubic hair
pubic hair stage 2
small amount of long pubic hair
pubic hair stage 3
hair is darker, coarser, curlier and spreads sparsely over
pubic hair stage 4
hair is not adult in type, the area covered is smaller than most adults, no pubic hair on the inside of thighs
pubic hair stage 5
inverted triangle
Penis and scrotum stage 1
infantile state that persists from birth until puberty begins, during this time the genitalia increase slightly in overall size but theres little change in general appearance
Penis and scrotum stage 2
the scrotum beings to enlarge and there is some reddening and change in texture of the scrotal skin
Penis and scrotum stage 3
penis has increased length, there is a smaller increase in breadth, there has been further growth of the scrotum
Penis and scrotum stage 4
the length and breadth of the penis have increased further and the glans have developed. the scrotum is further enlarged and the scrotal skin as become darker
Penis and scrotum stage 5
the genitalia are adult in size and shape,.
Male Pubic Hair stage 1
there is no true pubic hair,
Male Pubic Hair stage 2
sparse growth of lightly pigmented hair, usually straight and only slightly curly and usually begins at either side of base of penis
Male Pubic Hair stage 3
hair spreads over pubic symphysis and is considerably darker and course more curly
Male Pubic Hair stage 4
hair is now adult in character cover an areas considerably smaller than most adults. there is no spread to medial surface of thighs
Male Pubic Hair stage 5
hair is distributed in inverse triangle, spread to top of medical thigh but not above the base of the triangle
