CPS adolescent Flashcards
obesity complications
depression, low esteem
bullying
major anxiety, depressiove
eating disorders
protective obestity
adequate sleep regular family meals siblings parental limits supervision
sleep screen
BEARS B = bedtime issues E = excessive somnolence A = awakenings R -= regularity S = snoring/OSA
sleep recommendations
sleep hygiene (no caffeine, bedroom, regular schedule avoid hunger/eating prior to sleep
alcohol, nicotine
avoid TV< screen time
encourage reading prior
melatonin - short term use for > 2 year old
only after trial of sleep hygiene intervention. lack of long term studies
two most common sleep problems
- delayed sleep phase type
- initiation of sleep significantly later than desired bedtime (ie sleep latency > 30mins) - behavioural insomnia of childhood
- sleep onset association type (specific conditions)
- limit setting type (stalls, refuses to go)
top 3 leading causes of injury-related deaths
MCV
drowning
threats to breathing
principles of injury prevention
Education
enforcement/legislation
engineering
indications for genital exam
routine periodic exam
endocrine concerns
sexual assault
request by parents
advise when touch. neve ruse force.
suicide risk factors
previous attempt substance use impulsitivity precipitating factors family factors lack of social support
Suicidal intent assessment
Columbia suicide severity scale - ideation - frequency, intent, quality - passive/active intent plan attempt itself - impulsive/planned, lethality, anticipated outcome
nutrition for athletes
CHO (1g=4kcal) 50% calories for 4-18year old
protein( 1g = 4kcal) 25% calories
fats - needed for VIt ADEK, essential fatty acids, protect organs. 1g=9kcal (< 10%)
micronutrients
Ca (1000mg/day) , vitamin D (600IU), iron
fluids
500mL prior to exercise
consume 200mL q20mins
if > 60min event, consider sport drink
dieting recommendations
healthy and overweight - canadian food guide
if overweight - refer multidD
screen diet part of HEADS
screen mental health/eating
promote active living
risk of emesis, laxative, diuretics, diet pills, etc.
emergency contraception C/I
known pregnancy
anaphylaxis
Emergency contraception options
Plan B (99%) - ideally < 72hrs, up to 5 days Yupze regime (97%) ideally < 72hrs, up to 5 days copper IUD - 120hrs up to 7 days
s/e GI upset, fatigue, headache, dizziness.
tanning facilities
UV radiation - dmange DNA and induce mutations
can be carcinogenic without causing sun burn
WHO - class 1 of physical carcinogens
cutaneous malignant melanoma - accounts for 75% deaths although not most common
others: basal cell carcinoma, squamous cell caricnomas
risk factors for cutaneous malignant melanoma
light skin color, freckles, moles, personal history 1st degree family history large number of nevi red or blonde hair immuno suppression
smoking dangers
cancer - lung bladder colorectal, esophgea, kidney, larynx, mouth, throat
resp infections
diabetes
coronary artery disease
hair loss, skin wrinkling, risk of erectile dysfunction
smoking prevention
counseling guidance for families school based programs Government - Tobacco act 2008. restrict sales smoke free places, high tax etc.
smoking on specific diseases
asthma & CF - inc severity and freq of attacks, CF dec lung function
JIA - greater disease severity, CV disease, exacerbate osteopenia
cancer - resp infections, exacerbated mucositis
SSD - riskof ACS and stroke
DM - accelerated comorbidities. increases M&M in type 1 by 50%
Risk factors smoking initiation
low SES peer and family influence misinformation to smoking easy acess previous experimentation poor school performance depression and mental health substance abuse family member with substance abuse parental divorce
factors helping success of teems to quit smoking
older teenager male teen pregnancy & parenthood scholastic success peer and family support CYP2A6 slow nicotine metabolizer
smoking cessation approach
individual counselling
motivational interview
CBT
contigency management - alternatives, adaptive
5 A's ask advise assess - 30 days - preparation - next 6 months - contemplative - beyond 6 mo -precontemplative assist arrange
smoking cessation pharmacology
Nicotine replacement for reg use age 12 - 18
nicotine gums, transdermal patches common
(inhaler not recommended)
s/e mouth & skin irritability, inc HR, BP
Bupriopion
C/I seizures, eating disorders
- reduces seizure threshold, causes weight loss
Varenicline
s/e neuropsychiatric and cardivasculr
C/I unstable psych (SI, agression, depression) and active Coronary artery disease
e cigarettes - NOT recommended
e-cigarettes controversies
battery attached to chamber containing liquid that may or may not have nicotine
variable concentrations
1. product perception - still a nicotine delivery device. Not harmless. Unproven as smokign cessation/harm reduction
- emissions/exposure - concentration variable. potential for large boluses with acute cardiac affects. risk battery explosion
- public uptake - expanding industry
- aggressive marking, weak regulation
5 accessible to youth, celebrity indorsement
LGQT risks
higher use of tobacco, alcohol, substance use
club drugs
suicide intent
higher risk STI - more likely to have had sex, more partners, non-consensual
Rx
test gonorrhea, chlamydia, VDR, O&P, HIV testing, etc
contraceptive options +EC
HPV vcacinations
adolescent pregnancy
50% end in induced abortion if < 17, more likely unplanned urine bhcg as early as 10-14 after ovulation options - continue pregnancy and keep - adoption - medial abortion (t1) MTX and misopristol - surgical - early T1 to T2
teenage pregnancy management
prenatal care ASAP
refer to resources - maternal homes, drop in centers, etc
encourage continued education.
contraceptive counseling (35% 2nd bay within 2 years)
medical abortion - bleed, fever, cramps, abnormal d/c, psych
adolescent parents implications
higher rates of mental health, repeat pregnancy, substance, DV
lower SES, education attainment
higher risk substance abuse, smoking, STI
lower prenatal care
risk of depression, PTSD, stress disorder, anxiety
babies LBW, prematurity developmental accidenta injury and neglect as adolescent - substance, early sexual activity
adolescent mother’s basic health needs
growth and development - Greig health records, BMI immunization food security lactation psychosocial assessment sexual health, contraception STI screening
sexual abuse - risk factors
dependency - lack of control
education - lack of sexual education
disability specific - ie communicaton impairment, cognitive impairment to give consent
sexual abuse prevention in chronic disease
institution - screen/monitor employees
chaperones of physical exams
promote patient privacy
proedures to report
sexting
describe send and reciving sexually explicit messages, or ndue/seminude photograms electronically
40% teens
management - parental awareness
reinforce discussions online NOT private
HCP advocate as public health issue & screen
inhalant abuse
volatile substance abuse, solvent abuse, huffing, to achieve altered state
gasoline > air fresheners> propane/butane
effects inhalant abuse
sniffing/snorting - direct inhalation
stimulation then disinhibition, the euphoria,
hallucination
slurred speech, disturbed gait
resp arrest, aspiration
leading cause of death –> cardiac arrhythmias
risky behaviours
substance abuse screen
2 or more is potential substance abuse problem
C - car driven by someone intoxicated
R - relax - drugs to relax or feel better
A - alone - use alone
F - forget - forget things while intoxicated
F - family or friends tell you to cut back
T - trouble
medical cannibis
may be benefician for refractory eplipepsy, but need to be evaluated long term
smoking often mode of delievery and inappropriate in children
combustion - also by products and tar carcinogenic effects
case- by case only
at risk for dependence & withdrawal (headaches, sleep disturbance, irritabilty, anxiety)
gambling
activity that implies element of risk and money or something valuable could be won/lost by participants
higher rates in adolescent than adults worldwide
