Case 15- SAP Flashcards
A family
A married, civil partnered or cohabiting couple with or without children, or a lone parent with at least one child who live at the same address. Children may be dependent or non-dependent.
Nuclear family
Traditional family structure. Two biological parents (or adoptive) and children
Nuclear blended family
After a couple get divorced, the blending of two separate families. It consists of the blending of one biological and one non-biological husband, wife, or spouse and their children from previous marriages or relationships.
Types of family
1) Nuclear
2) Nuclear blended family
3) Same sex family- can be through conception methods
4) Single parent family- normally women
5) Extended family
6) Childless family- two partners living and working together without children
7) Grandparent family- when the grandparents are raising the children, parents are not present in the kids life
Extended family
2 or more adults related by blood or marriage living in the same home. They tend to work towards common goals like raising children. Can include cousins, grandparents etc. Can be due to financial difficulties or when older relatives cant care for themselves.
Age range of young people
10-24
Why do we need to think about young people specifically in healthcare engagement
- Engagement can be difficult yet is crucial for many health issues e.g. STIs + mental health
- Young people frequently drop out of healthcare systems after they leave paediatric care
- Failure to monitor + treat chronic illness can lead to irreversible disease-related complications + more emergency hospital admissions
Give the patient factors that challenge young people engaging in care
- Fear of confidentiality breach
- Parental presence
- Shyness, unfamiliar situation without parent
- Maturity level = affects ability to express themselves + understand given information
- Might not attend follow-up appointment, ongoing care is difficult
- Adolescence is a time of physical, social + psychological changes
- Sensitive issues may be hard to raise i.e. sexually active
- Personal organisation effects concordance with treatment
- Coming to terms with diagnosis may effect identity- may affect concordance
Give the doctor factors that challenge young people engaging in care
1) Lack of awareness
2) Increased time often needed to put the patient at ease
3) Time pressure can make consultations less effective, causing strain and distraction
From what age can a healthcare professional prescribe contraception without parental involvement
- At 16 a young person can be presumed to have the capacity to consent
- Under 16 a young person may have the capacity to consent, depending on their maturity + ability to understand what is involved = if they are assessed as competent + meet Fraser guidelines they can be given contraception
- Under 13 has to be reported to Social services as they can’t legally consent to sex + its a child protection issue
The fraser guildines relevant to prescribing contraception
- The young person understands the professional’s advice
- The young person cannot be persuaded to inform their parents
- The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
- Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
- The young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
How family can affect wellbeing
- Organisation
- Clear rules, expectations + boundaries
- Good generational boundaries, i.e. parental hierarchies
- Good marital relationship
- Good communication
- Modelling healthy habits i.e. diet and exercise
- Can provide proper nutrition and shelter
- Support network
Family stress can increase your risk of illness
Better outcome’s for managing chronic illness within the family
- Good expressive communication
- Routines- but with ability to be flexible
- Balancing needs of person with chronic illness with the needs of the rest of the family
- Emotional stress of conflict within the family can cause physiological responses that may worsen outcomes
Importance of the lay referral system
The decision to act upon symptoms is often due to discussions with a range of people, either immediate members of a persons family or their friends and colleagues
Significance of the lay referral system
People re-interpret medical and social information within a lay framework, conflict between lay and medical ideas can affect the patient/doctor relationship. Lay ideas are an important influence on the experience of health and illness. Its linked to Zola’s triggers and sanctioning
What influences the decision to use or avoid professional healthcare systems
- The extent of ‘close knit social relations’ between the members who make up a person’s lay referral system, and
- The predominant values and attitudes to professional health care within that lay referral system
Primary Amenorrhea
Menses has not started after 13 years if secondary sexual characteristics have not developed or after 15 years if secondary sexual characteristics are present.
Secondary amenorrhea
Absence of menses for 3-6 consecutive months
Causes of primary amenorrhea
• Idiopathic/constitutional delay in growth and puberty (diagnosis of exclusion)
• Impaired HPO axis i.e. Kallman’s syndrome
• Chronic illness i.e. Crohn’s
• Malnutrition i.e. Coeliac
• Excessive exercise
• Stress
Malnutrition, excessive exercise and stress are linked to an eating disorder
Stress and the menstrual cycle
• Increased stress may stimulate the HPA (Hypothalamic-pituitary-adrenal) axis
• This causes an increase in cortisol releasing hormone (CRH)
• CRH increase causes an increase in adrenal production of cortisol
• Activation of the HPA axis has an inhibitory effect on the Hypothalamic-pituitary-ovarian axis (HPO axis)
Could be what causes Amenorrhea in eating disorders
Functional Hypothalamic Amenorrhea
A form of chronic anovulation, not due to an identifiable organic cause but is associated with stress, weight loss and exercise
• The ovary is functional but stressors are impeding its function
• Linked with HPA axis, i.e. adrenal release of cortisol
• Linked to metabolic components i.e. leptin, insulin, ghrelin
• Causes reduced GnRH release which may be linked to kisspeptin release
Age range for adolescent
12-20
Drivers of adolescent psychosocial development
- Biological- weight (weight stigmatisation), Height (especially for men), growth rate, secondary sexual characteristics
- Psychological- Personality (Introverted/extroverted), health behaviour (exercise), academic ability (exams), self-esteem, emotion and action regulation, reward dependence
- Social- Housing, finances, Nutrition (undernourished may enter puberty later), culture (cultural norms for different genders), socialisation (peers, parents, media), Healthcare, Social support
The challenges of adolescence
- Adjusting to a sexually maturing body/feelings- may receive unwanted attention
- Emerging sense of personal identity
- Develop stable/productive peer relationships
- Adjust to new physical self (including body image)- self confidence
- Increasingly demanding roles and responsibilities
- Develop personal value system
- Renegotiate relationship with parents
- Develop abstract thinking skills
Diathesis stress hypothesis
Mental health disorders are due to genetic risk, environmental stressors and a lack of protective factors
The changes that occur in the adolescent brain
- Brain is fundamentally re-organised during adolescence
- Subcortical brain areas (e.g. limbic & reward system) mature earlier
- Asymmetry with prefrontal cortex (drives self-regulation of emotion & behaviour), which continues to develop into early adulthood, might explain increase in risk behaviour
- Adolescent brain highly plastic - environment heavily influences cortical circuitry. Allows for rapid intellectual development but opens door to harmful influences (e.g. addiction) too. More likely to be damaged by negative influences like alcohol.
Why do adolescents engage in more risky behaviour?
1) As good as adults as evaluating risk
2) Brain is more sensitive to the rewards of peer relationships and distress when excluded from peers
3) Benefits- independence, trying out adult behaviour, learning from mistakes, accomplishing key development tasks
Adolescents- change in relationships
Peer relationships become the primary mode of self-expression and intimate disclosure. Disclosure to parents decrease. The rate and intimacy of romantic relationships increase with age.
Cultural socialisation
The transmission of cultural values, beliefs, customs and behaviours and the reciprocal internalisation of these messages
Positives in social media in adolescents
- Access to health advice
- Real-world relationships
- Awareness of people’s health
- Community building
- Emotional support
- Self-identity
- Self-expression
Negatives of social media use in adolescents
- Sleep
- Fear of missing out
- Bullying
- Body image dissatisfaction- Negative subjective evaluation of ones physical body
- Anxiety
- Depression
- Loneliness
Why is puberty a risky time for body image
1) Social media use
2) Body fat percentage rises
3) People go through puberty at different times, women who develop secondary sexual characteristics earlier are at a higher risk of eating disorders
4) Begining of the objectivation of bodies, which can be disempowering
Why do people with body image vulnerabilities seem particularly affected by the ideal body image?
- Across development, patterns of thinking about one’s body are learned based on experiences. These patterns are called called body schemata
- Body schemata are ‘lenses’ through which we filter information about our body
- Individuals with negative body schemata habitually make unfavourable comparisons with media images (vs their own body) and are more likely to engage in unhealthy weight control behaviours
Factors which shape body schemata
- Cultural socialisation- perceived benefit of looking a certain way
- Interpersonal experiences- peer relationships, comparison between peers
- Physical characteristics- adolescents who are obese are more likely to have a negative body image
- Personality attributes- perfectionism, low self esteem
The key lifestyle factrs that influence health
Poor diet, excessive alcohol consumption, inactive lifestyle and smoking
Risk factors for obesity
Lack of exercise, poor diet, excessive alcohol consumption
What comorbidities is obesity associated with
1) Type 2 diabetes
2) Cardiovascular disease
3) Several cancers
4) Joint disease
5) Premature ageing
The risk factors for type 2 diabetes
Family history, unhealthy eating, lack of exercise, obesity
The cancers driven by obesity
Oesophagus, breast, kidney, bowel, ovarian, liver
Age related diseases linked to obesity
Insulin resistance, type 2 diabetes, atherosclerosis, Alzheimers disease, Dementia, Huntingtons disease, Parkinson disease, Cancer. This is because obesity leads to chronic systemic inflammation which affect the immune cells and brain cells and cause a systemic and local increase in cytokine concentration leading to cancer.
How is increased alcohol consumption dangerous
Increased alcohol consumption increases mortality risk. Alcohol consumption is linked to the following cancer- mouth, pharynx and larynx, oesophagus, liver, colorectum and breast.
Dangers of processed meat
Processed meat (salami, bacon, sausages) have a high risk of causing cancer, red meat is a probable cause.
Dementia prevention
Reduced obesity, stop smoking, exercise, rich social network, reduced brain inflammation, cognitive training, preserved hearing.
Mechanistic changes with obesity
- Metabolic dysfunction- increased insulin and leptin
- Immune impairements
- Adipose inflammation- increased macrophages and cytokines
Causes of oral mamifestations of eating disorders
Malnutrition, Modified nutritional habits, Vomiting, Personal hygiene/care, Drugs
Oral symptoms of anorexia
Can lead to deficiencies in the B group, are associated with a decrease in epithelial cell turnover. Causes mucosal atrophy, Glossitis and recurrent aphthous ulcers. Purging can cause aphthorous
Glossitis
Erythema and atrophy of the filiform and fungiform of the tongue. Caused by decreased nutritional intake and anaemia
Causes of glossitis- decreased vitamins, decreased nutritional intake, anaemia.
Causes of recurrent apthous ulcers
In anorexia it is due to vitamin deficiencies and stress
How saliva protects the oral and peri-oral tissue
- Lubrication
- Dilution of sugars after food + drink intake
- Antimicrobial + cleansing activity = degrades bacterial cell walls + inhibits growth
- Buffering acid production + controlling plaque pH with bicarbonate
- Remineralisation of enamel with calcium + phosphates
- Tissue repair
How does saliva fascilitate eating and speech
- Food prep = enhancing chewing, clearing of food residues + swallowing
- Digestion = food breakdown with enzymes
- Enhancing taste
- Enabling speech by lubricating moving oral tissues
The effects of eating disorders on saliva
Hyposalivation- due to dehydration from vomiting, diuretics, laxatives and excessive exercise
Xerostomia= linked to ani-depressants, dry mouth
Enamel
96% mineral (Calcium Hydroxypapatitie), 3% organic (proteins) and 1% water. The Hydroxypapatitie crystallites form prims separated by the inter prismatic region. Any damage to enamel is irreversible.
Enamel erosion
The chemical dissolution of dental hard tissue from acid that does not originate from bacteria. Irreversible tooth surface loss
The source of acid that can cause erosion
- Intrinsic- GORD, frequent vomiting
* Extrinsic- carbonated drinks, fruit juice, pickles, chewable vitamin C tablets, fruit, tomatoe and chilli based food
How acid causes erosion of the enamel
The H+ ions disassociate from the acid and interact with the Hydroxypaptite crystals causing dissolution as it combines with the carbon or phosphate ion. Causes irreversible surface damage. Surface erosion can happen when purging occurs. The pulp is exposed causing immence pain and can cause dental absecces
Dental caries
Dissolution of dental hard tissue mediated by plaque (biofilm). Pathogenic bacteria in the biofilm ferment sugar to produce acid. This causes the plaque pH to drop below the critical level and the Hydroxypaptite crystals start to demineralise.
The risk factors for enamel erosion
- Increased acidic drinks
- Increased fruit intake
- 4+ dietary acids per day
- Consuming fruit between meals
- Spending > 10mins eating fruit/drinking acidic drinks in one sitting
