Exam 3 Flashcards
What are the ages for Adolescent and how does it begin?
11-13 —-> 18-21 years old
begins with puberty: developmental maturation of the reproductive, endocrine, and structural processes that lead to reproduction
unique opportunites for health promotion and prevention services
What is the Erikson Stage for Adolescent?
identity vs confusion:
may move into “identity crisis”
success/failure in other stages can influence adolesent years
Trying to develop sense of self
Trying new roles
Self-identity emerging
Teenage Pregnancy:
rates coming down, invisibility pregnancy won’t happen to me
Primary prevention: talking about it (healthy communication prevent pregnancy)
High risk pregnancies
Preterm labor; low birth weight; cognitive delays,
High risk in maternal/infant outcomes, educational and economic effects
Anticipatory guidance:
support and services for pregnant adolescents to facilitate positive outcomes; get them back in school; counsel on option; terminated, carry pregnancy or adoption
Disturbing Stats about Adolescent:
5x higher mortality rate of adolescents compared to school age children
2nd leading cause of death: suicide
29% are sexually active: 14% not using birth control
Changes during Adolesence?
Rapid Changes on many levels
Psychosocial
spiritual
physical
moral
cognitve
What are Protective Factors for Adolecent?
positive parenting practices
monitoring and regular communication
parental engagement in the adolescent education
facilitaing postive and mutual “connectedness” both at home and in the community
Growth/ Development during Adolecent:
period of accelerated growth
development of secondary sexual characteristic:
regulated primarily by hormonal regulation (males and females)
Menarche (females) onset of menses (period) usually occurs in late in puberty (avg. 11-15)
if girls do not show signs of period by 18 and boys by 14: referral to endocrinologist
Tanner Stage: (table 21-1)
Stage 1: Male Genital development : Prepubertal: no distiniction between hair over pubic area and hair over abdomen: no female breast developement
Stage 2:
Male Genital Development: initial enlargement of scortum and testes; reddening and texture changes in scrotum:
Pubic Hair: sparse growth of long, straight, downy hair, at base of penis or along labia
Female Breast Development: enlargement of areolar diameter; small area of elevation around papillae (breast bud)
Other changes: usual time for peak height velocity for girls
Stage 3:
Male genital development: initial enlargement of penis, mainly in length; further growth of testes and scrotum
Pubic Hair: hair becomes dark, coarse and curly; spreads sparsely over entire pubic area
Female Breast development: further elevation and enlargement with no seperation of contours
Other changes: usual time of menarche: facial hair begins to grow on upper lip and voice deepens for boys
Stage 4:
Male Genital: further enlargement of penile diameter, testes, scrotum, and glans
Pubic Hair: further spread of hair distrubution; not extending to thighs
Female Breast: areolas and papillae project from breast to from secondary mound
Other changes: usual peak of height velocity for boys; axillary hair begins to grow
Stage 5:
Male: adult in size and contour
Pubic: adult in amount and type; spreads to inner surface of thighs
Female: adult, in projection of papillae only; recession of areolas into general breast contour
Physical changes in adolescent?
may experience increase in body fat
heart continues to grow in size and weight
respiratory rate decreases (15-20 per minute)
sweat and sebaceous glands become more active:
Sweat: axillary, genital, perumbilical area
Sebaceous: face, neck, shoulder, upper back, chest and genital
Acne during Adolescent:
Sebaceous follicles become clogged forming open or closed comedones:whiteheads or Blackheads
Can impact body image…
soap and water 2-3 times a day: helps remove dirt and oil
discourage removing and scrubbing hard: can cause irritation and damage to skin
topical medication: can cause dryness
Sunlight can help avoid prolonged exposure
stress can excerbate acne breakout
diet does not impact acne during this time
treatment does not start immediately; acne can get worse before it gets better
Scoliosis in Adolescent:
a lateral S shaped curvature of the spine
10% of adolescent have mild asymmetry
more common in females
curves greater than 15 degrees are considered abnormal
untreated scoliosis can result in disfigurement, impaired mobility and complication of cardiac system
Screening:
girls: 10-12
boys: 13-14
Treatment: physical therapy, brace, surgery
Health Perception and Health management during adolescence:
generally a healthy time
biggest concern is their own sense of invincibility
adolescent experimentation
risk taking behaviors can result in unhelathy/dangerous outcomes: speeding, not wearing helmet, no seatbelt
peer influence primary: parenral input often rejected
Being seen less in doctors office:
rarely hospitialized
can feel awkward in pediatration office
does not feel important
Screenings for Adolescent:
Ht/Wt/BMI
Blood pressure
scoliosis
vision/hearing
tanner
anemia
hyperlipidemia
eating disorders
depression
substance abuse
HIV
STI
anxiety
cardiovascular disease
concussion
MONO: check spleen
Nutrition: adolescent
“ideal body: altered body image, junk food, alcohol, peer pressure
experiment with different food options
increase in activity/sports
need to fit in
asserting autonomy
Calories:
females: 1600-1800
Male: 1800-3200
Activity and Exercise: adolescent:
time of increased strength and endurance
many participate in organized sports
require sports examination: area of concern:
previous trauma/concussion
cardiovascular disease
high blood pressure
asthma
enlarged spleen
Sleep and Rest: adolescent:
need atleast 9 hours of sleep
at risk for sleep deprivation due to busy schedule and school demands
texting at night can interfere with sleep
forced to wake up before completing sleep cycle
increase irritability
to little sleep can interfere with concentation- may be dangerous if driving fatigued
Primary vs secondary sexual characteristic:
Primary: involves the organ necessary for reproduction- vagina and uterus in girls. Penis and testes in boys
Secondary:
external features that are not essential for reproduction: breast development, facial and pubic hair growth, lowering voice
Tanner staging: used to assess and monitor degree of maturation in both
Sexuality- Reproductive: Adolesence:
sexual experimentation very common- esp with the emergence of the secondary sexual characterisitc
become sexually active for several reason: affection: to feel close, peer pressure, experimentation, at time-without consent
social media increased availability of contact with others and potenitally unsafe encounters
Self Breast/ Testicular Exam:
Breast:
Monthly
best in front of a mirror but many prefer in the shower
should also check lying down
looking for unusual lumps or masses under skin
best days after period
Testicular:
monthly
best during or right after warm shower
looking for swelling or hard lump
Roles- Relationship: adolescent:
increases independence and reliance on peer groups
sharing of thoughts and feeling with peers very important
stressful time for family/parents
want independence but often financially dependent on parents
Peer Groups/ gang signs: adolescent:
moving child in family to member of group
strong influence on adolescent
can be positive or negative
gangs: symbolic clothing, body art, dropping grades, substance abuse
Anorexia Nervosa:
typically female that tends to be perfectionist: father and daughter issues may play a part
want to be skinny
relentless pursuit of thiness
self-starving with weight loss
lack of menstration
compulsive physical activity
preoccupation with food
distorted body image
Physical Manifestation:
brittle dry hair and nails
growth of fine hair all over body (protective factor)
constipation and mild anemia
muscle weakness
complaints of feeling cold
can become dangerously malnourished and in some cases death
Bulimia Nervosa
affect female more than male
binge on huge quantities of high caloric foods then purge by vomiting or use of laxative
result is dramatic flutuation in weight
often try and hide signs of vomiting
can result in dehydration, electolyte imbalance and teeth erosion
Overweight and obesity: adolesent
most become obese adults
depression is one of the strongst predictors
severe impact on self esteem and social developement
strong correlation between video games, computers
Nurses Role: adolescent: Teen Pregnancy
provide information in all 3 options in non judgemental way
provide support with decisions and throughout pregnancy, birth and parenting
reinforce reproductive health education
Piercing and Tattoo: Adolescent
aspect of adolescence identity formation
How they expressed identity/style
Parental/child: conflict can arise
Health related risk:
Blood borne pathogens: hep c, HIV
Infection
Keloid
Swollen tongue, blockage of the throat
Bleeding
Nerve damage
Education:
Licensed for piercing: that is well run
Making sure that it is sterile
Meticulous handwashing
Proper cleaning and care
Educate about signs and symptoms of infection
Avoid the sun while healing
Coping- Stress: depression: adolescent
11% of teens have depression disorder by age 18
girls more likely to experience
Major Depression (depressive disorder): depressed or irritable mood, disabling, diminished interest or pleasure in usual activites
Symptoms: changes in weight, insomnia, decreased energy, diffuculty concentrating, preoccupation in death
Has to last more than 2 weeks
Rates increase with age
Lots of stressors: get good grades, friendship troubles, technology, lack of social interaction, cyberbullying
Limit screen time, no access to technology at bedtime
Assessing for signs of depression: adolescent
Changes in weight, appetite, insomnia, low motivation, trouble concentrating, thinking about death (can be passive)
Listen to the adolescent: language cues: tired, flat affective, hopeless:
Start with PHQ: 2
PHQ:9 (if PHQ 2 is positive)
