Ch9 basic nursing pgs170-177 Flashcards
Teaching About Diabetes
The parents and child must understand that diabetes involves dietary changes, weight loss, and exercise. Medications are required if the lifestyle changes are not sufficient to control blood sugar, but they cannot be relied on. You may need to refer the family to a nutritionist or diabetes counselor.
Teaching About Asthma
Teach parents and children about indoor environmental asthma triggers: mold, cockroaches, pets, and nitrogen dioxide (a gas that is a byproduct of indoor fuel-burning appliances such as gas stoves, fireplaces, or wood stoves
Provide and help fill out, as necessary, an asthma action card for the child to carry when away from home. An action plan should include
(1) the child’s asthma triggers,
(2) instructions for asthma medicines,
(3) what to do if the child has an attack,
(4) when to call the doctor, and
(5) emergency telephone numbers.
Teaching About Violence and Risk-Taking Behaviors:
On the community level:
school violence can be addressed through psychological counseling, weapons-screening devices, school-wide educational programs, and policies calling for the suspension or expulsion of students who are caught intimidating other children or participating in fights on school property. The school-age period offers many opportunities to educate children about the hazards of smoking, drinking, and using drugs, which often contribute to violence.
Helping the Hospitalized Child
Help children express their fears and respond to specific needs.
Hospitalized children may fear the unknown, the strange environment, the strange professionals, afraid of tests and treatments (i.e., operations, needles) pain, and dying, miss the comforts of home: their mother’s cooking, their own room, and so on, bothered by separation from family and friends and by loss of control over their personal needs. You can help them in the following ways:
Maximize their contact with outside friends and school.
Minimize the adverse aspects of the hospital environment.
Offer choices, when possible, to restore some sense of control (e.g., whether to have a tub bath or shower, or what they would prefer to eat for meals).
Encourage parents to bring familiar items from home to personalize their space.
Involve parents in their care and provide them accurate information so they can relieve children’s anxieties.
ADOLESCENCE: AGES 12 TO 18 YEARS
Adolescence marks the transition from child to adult. Puberty refers to the beginning of reproductive abilities. In this period of development, the child experiences progressive physical, cognitive, and psychological change.
Physical Development of Adolescents
Physical and hormonal changes are readily apparent during the adolescent years.
The adolescent reaches adult height and about 90% of peak bone density by the end of this period.
Menarche occurs by age 14 in most girls, who develop adult primary and secondary sex characteristics by about age 16.
Boys have developed adult primary and secondary sex characteristics by about age 17 to 19.
Motor development is equal to that of adults.
Maturation of the central nervous system allows formal operational thought processes, logic, and abstract reasoning.
Psychosocial development includes the teen’s increasing reliance on peers, ambivalent feelings toward family, anxiety over and/or preoccupation with sex and sexuality, and determination of sexual orientation.
Growth
Females undergo a growth spurt between 9 and 14 years of age. Height increases 2 to 8 in. (5.1 to 7.6 cm) and weight gain varies from 15 to 55 lb (6.8 to 24.9 kg). By the onset of menstruation, girls have attained 90% of their adult height.
Males undergo a growth spurt between 10 and 16 years. Height increases by 4 to 12 in. (10.2 to 30.5 cm) and weight increases by 15 to 65 lb (6.8 to 29.5 kg). Boys continue to grow until 18 to 20 years of age. Bone mass continues to accumulate until about age 20.
In both males and females, the blood pressure and the size and strength of the heart increase. The pulse rate decreases. By the time of adolescence, blood values are that of the adult. Respiratory rate, volume, and capacity also reach the adult rates. By the end of the adolescent period, all vital organs reach adult size.
Onset of Puberty
The onset of puberty varies widely, but the sequences of these changes are standard
In females:
the time from the first appearance of breast tissue to full sexual maturation is 2 to 6 years. Menarche (first menstruation) occurs approximately 2 years after the beginning of puberty. The average age of menarche is 12 years, depending on racial group and body mass.
In males
the onset of puberty occurs between 9 and 14 years of age. Throughout puberty, boys become more muscular, the voice deepens, and facial hair begins to grow and coarsen. It may take 2 to 5 years for the genitalia to reach adult size.
In both males and females
in both males and females, hormonal changes are accompanied by increased activity of the sweat (apocrine) glands, and heavy perspiration may occur for the first time. For the same reason, the sebaceous glands become active, and the adolescent may experience acne.
Cognitive Development of Adolescents
Piaget refers to adolescence as the period of formal operations. The adolescent develops the ability to think abstractly and is receptive to more detailed information. This opens the door to scientific reasoning and logic. She can now imagine what may occur in the future as well as the consequences of her own decisions. Although the adolescent has more refined cognitive abilities, adolescents may still lack judgment and common sense. These develop later through life experience.
Psychosocial Development of Adolescents
The major psychosocial task of the adolescent is to develop a personal identity.
Teenagers shift their emotional attachment away from their parents and create close bonds among their peers (Fig. 9-9). This helps the teenager to further characterize the differences between himself and his parents. The adolescent often takes on a new style of dress, dance, music, or hairstyle; develops personal values; and begins to make choices about career and further education.
Group Acceptance
One of the strongest needs for teens is to feel accepted within a group of their own choosing. Acceptance on a sports team, into a club, or into a clique or gang increases the teen’s sense of self-esteem. In contrast, unpopular teens feel alienated, resentful, and antagonistic and may react with violence directed at themselves or others
Tattoos and Piercings
Adolescents may engage in the trend of body art and piercings for a number of reasons, including a desire for social bonding, to look like their peers, and to commemorate a friend or loved one. In the 10-year period after the mid-1990s, the number of teens who had tattoos increased from 4.5% to 14%. The average age at time of tattooing is around 17 years. Body piercings, likewise, are not unusual. Both tattoos and piercings can cause skin infections and bloodborne diseases such as HIV and hepatitis. Some studies have reported a significant relationship between piercing and substance abuse, leading some to speculate that body piercing may serve as a marker of an at risk teen
Emerging Sexual Orientation
Most adolescents have a sense of their emerging sexual orientation. Approximately 1.9% of people between 18 and 44 years of age identify themselves as homosexual and 1.1% as bisexual (CDC, 2014c). A higher percentage report having had same-sex intercourse at least once, but consider themselves heterosexual. Some youth are bisexual—that is, attracted somewhat equally to both males and females.
Common Health Problems of Adolescents
In the United States, 72% of all deaths among young people aged 10 through 24 years result from four causes: motor vehicle crashes (26%), other unintentional injuries (13%), homicide (15%), and suicide (16%). Many adolescents engage in behaviors that increase their likelihood of death of injury from these four causes: distracted driving (e.g., texting, eating), driving under the influence of alcohol or drugs, carrying a weapon, and using alcohol or other drugs. In a recent year, 25% of high school students reported having been in a physical fight (CDC, 2014b). Illnesses are responsible for less than one-fourth of deaths; cancer and heart disease are the most common.
Example Problem: Substance Abuse
Substance abuse is a major concern because it is widespread and because of the physical, mental, and spiritual toll it takes on teens, families, and communities.
Definition
Regular use of drugs or other substances for purposes other than medical use that causes physical or psychological harm to the person.
Incidence
- In 2013, 36% of high-school seniors said they had used marijuana in the past year, compared with 30% in 2006.
- It is illegal to sell tobacco to minors, yet 9.5% of middle school students and 25.6% of high school students currently use some form of tobacco. Over 54% say they have tried a cigarette.
- Prescription and over-the-counter medications account for most of the top drugs abused by 12th graders in 2013.
- Abuse of prescription drugs is highest among young adults aged 18 to 25, with 5.9% reporting nonmedical use in the past month.
Possible Consequences
- Violence, sexual assault, rape, and alcohol/drug overdose
- Associated with risk-taking behaviors resulting in injury and death (e.g., automobile accidents, falls, drowning, suicide)
- Increased risks of cancer, high blood pressure, cirrhosis, epilepsy, and homicide
- Persons diagnosed with drug disorders are roughly twice as likely to have mood or anxiety disorders.
- Every year, 599,000 people are unintentionally injured while under the influence.
- And more than 1,700 die.
Depression
Depression affects up to 8.5% of adolescents in the United States compared with 11% of the adult population.
A government survey identifies an even higher percentage: During the 12 months preceding the survey, 28% of students nationwide had felt so sad or hopeless almost every day for more than 2 weeks in a row that they stopped doing some usual activities
Risk factors for depression
family history of depression, cigarette smoking, stress, loss of a loved one, breakup of a romantic relationship, learning disorders, attention or behavioral disorders, chronic illnesses (e.g., diabetes), abuse, neglect, or other trauma such as natural disasters.
Suicide
Suicide is the third leading cause of death in teenagers. The CDC (2014b) estimates that 8% of high school students have attempted suicide. Twice as many adolescent girls as boys attempt suicide, but because boys tend to use more lethal methods, such as guns and hanging, they are more likely to die from the attempt. Risk factors include problems at school or in romantic or family relationships, low self-esteem, social isolation, substance abuse, and depression.
Eating disorders
Although anorexia and bulimia create nutritional problems and manifest as eating disorders, they are psychiatric disorders that require medical and psychiatric intervention.
Anorexia Nervosa
A person with anorexia nervosa dramatically restricts food intake and may exercise excessively in an attempt to lose weight. Anorexia is characterized by a distorted body image; often the person sees herself as fat in spite of being markedly thin.
It is the third most common chronic illness among adolescents.
It occurs predominately in, but is not limited to, high-achieving adolescent females from upper-middle-class backgrounds. Physical consequences include amenorrhea, bradycardia, low white blood cell count, anemia, infertility, and bone loss.
Eating disorders have the highest mortality of any mental illness: 5% to 10% of patients die within 10 years of developing anorexia nervosa. One in five dies by committing suicide
Bulimia
Bulimia is another eating disorder seen in adolescent girls as well as in boys who participate in sports that require them to maintain a specific weight. Bulimia is characterized by binge eating followed by inappropriate mechanisms to remove the food that was consumed (usually inducing vomiting, using laxatives, or engaging in excessive exercise). Binge eating may occur every few days or as often as several times a day. People with bulimia frequently experience electrolyte imbalances, decayed teeth (from gastric acid exposure), or abdominal pain (from gastric overload or laxative use).
Overweight and Obesity
Overweight and obesity continue to be a concern during adolescence, partly because the incidence is so high. Moreover, overweight children are more likely to be overweight adults. Consider the following facts:
Today, about one in three American teens is overweight or obese, nearly triple the rate in 1963
Causes of teen obesity are similar to those of childhood obesity: sedentary lifestyles, eating larger portions, eating fast foods, and substituting high-calorie, nutrient-poor snacks for balanced meals. Even school vending machines contain so-called junk foods such as soda, snack cakes, candy, and chips,
One-third of American children aged 4 to 19 years eat fast food daily. The percentage is undoubtedly higher for adolescents, who eat fewer meals at home and have more freedom to choose their own foods. Food preferences are influenced by television and marketing strategies in other media; on children’s television shows, most of the advertising is for foods of poor nutritional value.
Type 2 DM, hypertension, high cholesterol, and heart disease are occurring with increasing frequency in adolescents, now that so many are affected by obesity. These diseases were previously seen mostly in adults.
Risky Sexual Behaviors
Sexual activity is common among teenagers. By age 13, 4% of girls and 10% of boys have had sexual intercourse. This tends to increase with age, with 35% of students (grades 9 through 12) being sexually active. About 15% of students have had sexual intercourse with four or more persons
Condom use
lmost two-thirds of sexually active high school students report having used a condom at most recent sexual intercourse. Child Trends (2013) reports that males are more likely to use condoms than are females, and black males are more likely to use condoms than are Hispanic males.
Oral Sex
Many adolescents engage in sexual behaviors other than vaginal intercourse. Between 2007 and 2010, 49% of males and 48% of females aged 15 to 19 years reported that they had engaged in oral sex with an opposite sex partner. This often occurs prior to initiating sexual intercourse. KEY POINT: Oral sex does not put adolescents at risk of pregnancy; however, unless barrier precautions are taken, it can put them at increased risk of STIs
Social media
Social media may have a significant impact on the social and sexual well-being of adolescents. In many adolescents, self-regulation and judgment skills are not yet fully mature. This often leads to risky behaviors, especially on social network sites.
Social media
Online disinhibition effect. This means that people more readily release personal and private information into the public domain than they would in face-to-face interactions. Adolescents can fall easy prey to this effect because of the anonymity social network sites provide.
Social network sites provide an attractive outlet for adolescents during a time in development in which self-expression and validation are important. This expression may then translate into risky social and sexual behaviors.
“Sexting.” Adolescents may not directly reference sexual behavior but may partake in a practice known as “sexting”: sending, receiving, or forwarding sexually explicit messages, photographs, images, or videos via the Internet, a cell phone, or another digital device. One survey found that 20% of adolescents between 13 and 19 years old have sent or posted a nude or semi-nude photo or video of themselves to another adolescent.
Risky behaviors and sexual wellness. We now believe that social media may be increasing risky sexual behaviors and decreasing overall social and sexual wellness in adolescents. They are the group at highest risk for contracting an STI because they are more likely to have concurrent sexual partners, multiple sexual partners, and a lack of consistent condom use.
Sexually transmitted infections
Approximately one in four U.S. teens has an STI. STIs, including HIV/AIDS, are a major health consequence associated with sexual activity and especially with unprotected sexual activity.
A majority of adolescents mistakenly believe that condoms are a foolproof method of preventing STIs and HIV/AIDS. Trichomonal and monilial infections and human papillomavirus (HPV) are common. Those and other STIs occur in both males and females and can have serious complications.
AIDS is a major cause of death worldwide, reaching epidemic proportions in some countries. It is transmitted primarily through genital, oral, or anal sexual activities but can also be transmitted in other ways (e.g., by sharing needles with an infected person). In 2010, the greatest number of new HIV infections (4,800) among men occurred in young black/African American males aged 13 to 24 years who have sex with males (MSM). Young black MSM accounted for 45% of new HIV infections among black MSM and 55% of new HIV infections among young MSM overall
Adolescent Pregnancy
The birth rate for women in this age-group is 26.5 per 1,000 females. This is a record low for U.S. teens in this age-group, and a drop of 10% from 2012. Birth rates fell 13% for females aged 15 to 17 years and 8% for females aged 18 to 19 years.
Still, the teen pregnancy rate in the United States is substantially higher than it is in other Western industrialized nations (CDC, 2015b). A similar percentage of teens are sexually active in the United States; however, consistency and effectiveness of condom use are lower.
Adolescents who become pregnant face physiological risks, such as bone density loss and iron-deficiency anemia, the interruption of progress in their own developmental tasks, and loss of educational opportunities. Teen mothers are less likely to complete high school and more likely to live in poverty than are other teens. They are less likely to be married, to receive prenatal care, and to gain appropriate weight, and more likely to smoke than are older mothers. This puts them and their babies at higher risk for complications of pregnancy and low-birth-weight infants.
Abuse, Neglect, and Violence
There is no age limit on abuse and neglect. One study of children aged 13 to adulthood reported that more than 9% of the nearly 1,000 subjects had substantiated maltreatment. Maltreatment included sexual abuse, physical abuse, emotional abuse, and neglect. Abuse may be linked to later violent crimes and illicit drug use. See the Example Problem: Abuse, Neglect, and Violence.
Assessment Adolescent-pg 174
*General health exam every 2 years
–need to resis authority
-hesitant to share info with adults
-establish rapport-ensure you will maintain confidentiality
-assess for common problems of adolescence including abuse and neglect
-
Obtain a thorough medical history
Medications and other drugs.
Psychosocial profile. Obtain a psychosocial profile focusing on health practices and behaviors. Assess the adolescent’s ability to cope with stressors
-change in academic performance or lack of interest in school may indiate a problem like depression
-difficulty identifying or describing mood states
-instead of saying how they feel may act out, act grouchy or negative, feel misunderstood, get into trouble
-Psychosocial profile. Obtain psychosocial profile focus on health practices/behaviors. –Assess the adolescent’s ability to cope with stressors
-Nutrition and body image.-ask q’s about body image related to nutritional status(over or undereating-protein, iron, calcium, vit D.
-Tattoos and . piercings. ask -may be concealed.
discuss risks
-Activity and exercise patterns- ask about use of protective equipment–if doesnt exericse educate on benefits
-Sleep patterns-teens often get little sleep on school days and sleep late on weekends-ask if feels refreshed.
-ask if wears seat belt, driving distractions,
-Sexual activity-determine if sexually active-ask about condom use
-review all body systems-keep in mind mind changes or problems specific to adolescence.
Complete a general survey after you have gathered the subjective data.
-Vital signs, weight, height, follow with head to toe.
-if issues identified-include adolescent and parent in plan of care.
-Calculate BMI using BMI calculator and BMI for age percentiles for children and teens.
-less than 5th percentile-underweight
-5th to 85th-healthy weight
-85th to less than 95th-at risk for overweight
95th and above overweight
Interventions
-with adolescents-goal is to help the adolescent make informed decisions.
-Avoid scare tactics and encourage open discussion.
-Often a teenager will feel more comfortable asking a nurse or other health professional about sensitive topics than asking a parent.
KEY POINT: Reassure-that you will maintain confidentiality. -
if there is concern about suicide, explain that you are required to share this information with others. Provide mental health referrals immediately when an adolescent contemplates suicide.
Focus your age-specific interventions on educating the teenager about common health problems and avoidance of injury and disease. Include the following topics:
Preventing and treating obesity
help make small but permanent changes in eating and exercise
- gradual weight loss is healthiest approach
- parental involvment important-model healthy eating and activity
Calorie Intake
Reducing calorie intake is usually the easiest change to make.
As a rule, avoid highly restrictive diets that forbid favorite foods.
It is important to encourage strong support from parents and others involved in buying and preparing food and to teach the teen how to choose highly nutritious foods at school to replace junk foods and to limit fruit juices and sodas.
Physical Activity
Stress the importance of regular physical activity-may be able to walk to school instead of driving or taking bus
-If this is not practical, involve the family in planning regular physical activities—for example, a long walk after dinner. Even mild exercise, such as shooting hoops or swimming, provides more activity than watching television or playing computer games. You might start with the following goals:
Limit television, phone, and video game use to 1 or 2 hours a day. Discourage use before school, during homework, and late at night. Keep the television and other media off during family mealtimes.
Engage in 30 minutes of outdoor activity every day. Some activity is better than none. Work up to an hour a day of more strenuous exercise.
Preventing Pregnancy and STIs
- Abstinence is the only 100% effective way to prevent pregnancy and STIs. -if the adolescent is sexually active, explain that using condoms can greatly reduce, although do not eliminate, those risks.
- Be sure teens understand that STIs can be transmitted orally and anally, as well as vaginally, so it is important that they use a condom, regardless of the type of sexual activity.
- AAP (2013) recommends that schools make condoms available for adolescents and, with community involvement, develop a comprehensive sequential sexuality education as a part of a K–12 health education program. Some parents may worry that sex education and condom availability encourage teenage sex but data show that making condoms available does not increase the rate of sexual activity.
Breast Self-Awareness
There is a trend toward promoting breast self-awareness, which educates patients about the normal feel and appearance of their breasts. For many patients, breast self-awareness also may include performing breast self-examinations. Breast self-exam (BSE) is a step-by-step approach that a woman can use to look at and feel her breasts. However, many guidelines no longer recommend BSE as a screening tool for breast cancer. Although it seemed promising when it was first introduced, studies have shown BSE does not offer the early detection and survival benefits of other screening tests (U.S. Preventive Services Task Force, 2015a). However, they both have the potential to alert the patient to changes in her breast and may lead to earlier detection of breast cancer.
Testicular Self-Exam (TSE)
Guidelines are not consistent regarding testicular self-exam (TSE).
The U.S. Preventive Services Task Force (USPSTF) (2015b) recommends against routine screening of asymptomatic patients, stating that outcomes are not sufficiently improved to merit routine TSE.
The American Cancer Society (ACS) recommends a testicular exam by a doctor as part of a routine cancer-related checkup but does not have a recommendation about regular testicular self-exams.
Nevertheless, some doctors recommend that all men examine their testicles monthly after puberty. If your patient chooses to perform TSE, advise him to perform the exam after a warm bath or shower (heat relaxes the scrotum, making it easier to find abnormalities).
Immunizations
For adolescents aged 13 to 17, none of the Healthy People 2010 objectives for vaccinations were met. Fewer than half have current tetanus, diphtheria, and pertussis immunization. About double that number have been vaccinated for hepatitis B, measles, mumps, and rubella.
Recently, human papillomavirus (HPV) vaccine has been recommended for both males and females at age 11 to 12 years (Advisory Committee on Immunization Practices, 2014) so they are protected before ever being exposed to the virus. HPV is a common virus; nearly 80 million people—about one in four—are currently infected in the United States. About 14 million people, including teens, become infected with HPV each year. HPV infection can cause cervical, vaginal, and vulvar cancers in women; penile cancer in men; and anal cancer and mouth/throat (oropharyngeal) cancer, as well as genital warts in both men and women.
Other Health Promotion Activities
Rest. Explain the importance of adequate rest. Teens need 8 hours of sleep a night for maximum performance in academics and sports.
Nutrition. Stress the importance of adequate nutrition, including intake of 1,300 mg of calcium and 400 IU of vitamin D daily to reach maximum bone density during this critical period of rapid increase in growth and bone mass. Teach teens how to choose foods that include fruits, vegetables, cereal and grains, lean meats, chicken, fish, and low-fat dairy products and to avoid foods and drinks that are high in sugar, fat, or caffeine.
Dental hygiene. Advise parents that the adolescent should have a preventive dental care visit at least once a year. Teach the teen to brush twice a day with a soft toothbrush and to floss daily.
Safety
Safety. Remind teens to wear a seat belt when riding in the car and avoid distractions while driving (talking or texting on a cell phone, changing a radio station). Ask them never to drive under the influence of alcohol or drugs. Remind them to wear a helmet and protective gear for activities such as bicycling, in-line skating, and skateboarding. Teach the importance of sun safety (e.g., applying a sunscreen of at least SPF 15, avoiding tanning beds, wearing sunglasses when in the sun).
