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)
Coping-Stress: suicide: adolescent
Recognition of warning signs and prevention essential
Most likely underreported: the shame + the stigma around suicide
Females are more likely to attempt suicide… Males are more likely to be successful
Warning Sign: giving stuff away that you loved, isolation, sudden energy/mood change, risk taking, violence, preoccupation with death,
ASK!!!!!Direct Questions
Have you thought about hurting yourself, do you have a plan
Refer to mental health: may need to go to hospital
Unintentional Injury: adolescent
2/3rds of all unintentional injuries in this group are MVA
Accidents:
MVA 20x more likely than any other age group
contributing factors: not wearing helmets, distractions, impaired while driving
Includes bike, ATV, motorcycles, skiing
Nurses Role: talk, talk, educate, educate, support parents
Substance Abuse; adolescent:
- alcohol, marijuana: causing high anxiety, sniffing
- want to fit in, social anxiety
- Chemical use increasing—use precursor to abuse
- signs that a teen is using:
- stealing
- sudden changes in behavior (academics)
Isolation
Eye drops
Nose bleeds
Ask about in non-judgmental manner (normalizing)
Do you have friends that do drugs?
Leading cause of substance abuse deaths: opioids
Screening Tool- CRAFT: adolescent
C: driven a car while under influence
R: need to take to feel relaxed
A: Do you take drugs alone?
F: do you forget things after?
F:do family or friends tell you to stop
T:have you gotten into trouble
Smoking: adolescent
Caucasian females have higher %
Most start use in adolescence
Focus on preventing nonsmokers from starting; helping smoker to quit
vape and other smokeless tobacco
Most start if parents/ peer smoke
5A’s
Ask , advise to quit, assess, arrange follow up, assist
Infectious Monocleosis:
viral infection transmitted by direct contact
Caused by the Epstein-Barr virus
Sx include: sore throat, lymph node enlargement, lethargy.
enlarged liver and spleen
watch contact sports, do not palapate spleen
Meningitis
caused by bacteria: the one that can kill you + viral
Vaccine for bacterial meningitis: at 11 and then before college (17)
Exchange through exchange of throat and respiratory secretions
Contagious but not as contagious as other viruses
Commonly spread in community setting; college dorms
VACINATION
Causal and Protective Factors:
Insufficient use of condoms
Lower self esteem
Peer pressure
Depression
Sense of invisibility
Protective:
high Self-efficacy
Good parental monitoring
Good parent-child communication
Positive school relationships
Sexual knowledge
Sexually Transmitted Infection: Adolescent
Gonorrhea/Chlaymdia
Herpes
Warts (HPV)
Trichmonas
HIV
Oral Contraceptives: the pill
Many different brands
Key Components:
Estrogen
Progesterone
How does it work?
When taking the pill, body thinks it is making it + suppresses hormones that cause ovulation (no egg = no pregnancy)
Typically, 21 active pills + 7 placebo pills
How to Use:
Take the pill around the same time everyday
When starting use backup methods; for at least first month
How effective?
98% in perfect world
9% of users will get pregnant
Side Effects
Positive:
Helps with cramping
Lightens up the bleeding (decreases risk of anemia)
Decreases risk of ovarian cancer + Uterine Cancer: temporary shutting down of the uterus (no correlation with breast cancer)
Negative:
Headache, nausea, breast tenderness, irregular bleeding
18 states pharmacist can give birth control
Contraindications for the pill:
(related to the estrogen in the pill)
History of blood clots
Strokes
Smokers (over 35 has increased risk)
Breast Cancer
Family History of MI (early age)
High Blood Pressure
Severe liver disease
Warning Signs: (stop medication ASAP, call provider)
Severe leg pain
Abdominal pain
Chest pain
Eye/vision changes
Return to fertility after stopping is easy
Medications:
TB medications (rifampin)
Seizure medication
St John’s Wort
Progesterone Only-Pill
Also called Mini Pill
What it contains?
Contains No Progesterone: not as good as combined pill
How it Works?
Take pill at same time everyday
Suppresses ovulation; thins lining of uterus, thickens cervical mucous
Effective?
Less forgiving, Must be good at taking pills on time
88-91% effective
Side Effects
Acne, headache, mood swings, weight gain, irregular bleeding
Cautions:
If nausea or vomiting, or using antibiotics use backup method
Liver disease, breast cancer
Safer for women who have contradictions from the other pill
When stopping fertility goes back: you can get pregnant
Depo-Provera: the shot
Contains only progesterone
Similar to the mini pill
Thickens cervical mucous, thins uterine lining: prevents pregnancy
99% effective in perfect world: real world: only 94%
Every 3 months for an injection
Side Effects: mood swing, acne, weight gain
Can take a while to get fertility back: 9- 12 months
Increased risk of osteoporosis: stop smoking less alcohol, increase calcium
A LOT of irregular bleeding for first 6 months then no bleeding
Implant: nexplanon
Contain only progesterone
Stop ovulation, thicken cervial mucous, thin cervical lining
99% effective
Stays in for 4 years
Acne, mood swings, weight gain
No Nausea from estrogen
Mirerna: IUD (intrauterine device)
Hormone based IUD
Progesterone is released
Good for people who can’t take birth control pills
99% effective
Side effects: moods swings, acne, weight gain
Gets fertility back when taking out
Amenorrhea is not worrisome
No impact on fertility
Less cramping
7 years it can stay in
Check the string
At higher risk for STI: string helps the bacteria move up
Contraindication:: Pelvic inflammatory, Uterine Cancer,
The RIng:
Contain Estrogen and progesterone
99% in perfect, 91% in real world: people put it in wrong, or forget to put it in
In for 3-5 weeks
Contraindication
History of blood clots
Strokes
Smokers (over 35 has increase risk)
Breast cancer
Family history of MI (early age)
High blood pressure
Severe liver disease
Non- Hormonal birth control
Condoms: prevent STD
Latex + Plastic condoms: are good for std protection
Natural Condoms: good at pregnancy protection; not STI
Pinch the tip: no air should be in the condom; more likely to break
Condom can slip off
Water based lubericants should be used: Oil breaks down the latex
98% effective perfect world: 85% in real world
Spermicide:
Should be used with condoms
80% effective if used alone
No protection against STI: can increase risk
Can be used for an hour
Sponge:
Round sponge that has spermicide
Covers the cervixs
Toxic Shock Syndrome
Pulled off the market
76-88% effective
Blocks sperm + spermicide
More effective if you have not had children
Diaphragm:
Round rubber disk: barrier and spermicide: cover the cervix
Perfect world: 94% effective: real world; 88%): human errors lower the efficacy rate
Leave in for 6 hours after
Toxic shock syndrome
UTI can be caused
Cervical Cap
Mini diaphragm: sits on the cervix; acts with suction
Spermicide and barrier
86% effective: more effective in women who have not had children
Can leave in for 2 days
Paraguard: Copper IUD
Does not have hormones in it: no progesterone
Highest satification method
Hostile to sperm : sperm does not like copper
99.9% effective
Good for up to 12 years
Side effects: heavier blood flow and cramping; does not stop cycle
Anyone who does not want hormones, nearing menopause
No impact on fetilirt
Check the string
Other Methods of birth control:
Fertility Awareness: times ovulation, only works for people who have regular cycles, if unreular you should not use as birth control, avoiding sex during ovulation, monitoring cervical mucous, avoid sex for days after ovulation
Withdrawal: male pulls out before ejeculation, 78% effective, sperm can be left behind
Tubal ligation: for females, 99.7% effective, higher risk of tubal pregnancy because tubes are cut, snip the fallopian tubes, eggs get reabsorbed, women still ovulate, if they have a late period make sure to test for pregnancy
Vasectomy: 99.7% effective, for males, prevents sperm from being ejectulated, laser, keeps sperm out of the semen, takes 3 months to have zero sperm
Young Adult: Erikson
Erikson: important to develop a sense of competency and self esteem
Formulation of intimate relationships
Intimacy vs isolation and loneliness
characterized by reciprocal expression of affection and intimacy
requires mutual trust
Young Adult Time frame:
18-35
Marriage, family, milestones
major task: adult responisbilites
nurses need to maximize healthy period
2 prong approach: help continue with healthy lifestyle/behaviors and decrease accidents/injuries/ violence
greater complexity of thinking, further organization of emotional and cognitive thinking and decision making is based on impact on other and future consequences
usually healthiest period
Biology and Genetics: young adult
Full Growth:
women 17, Men 21
optimal strength occurs 25-35
Lonevity:
women have greater longevity-on average 5 years longer
Preventative health care: Young adult
Developing behaviors to promote healthy lifestyles
Decreasing the incidence of accidents, injuries and acts of violence
Maximize good health for as long as possible
Guidelines and Recommendations: Young Adult
Age 18: full health exam and then every 2 years
many young adults do not follow this recommendation
Key areas to assess in History: Young adult
Socio-Demographic:
ex: organization, hobbies, military
Marital status, relationships, family/friend support
Environmental:
ex: living situation, education
work status, risks, stress
Biophysical:
smoking, alcohol, drugs, seatbelt, exercise, weight, helmets, nutrition
Preventative Health Monitoring: young adult
smoking
obesity
alcohol
drug use
accidental injury
family planning
activity levels
Immunization: DPT, Hep B, flu
BP
diabetes
Cholesterol
Paps
STI screening
BSE/TSE
Chronic Disease: Young Adult
Top 3: asthma, Arthritis, HTN
Others
cancer
diabetes
Heart disease
Metabolic Syndrome: Young adult
group of cardiovascular risk factors associated with overweight and obesity
High lipid levels
insulin resistance
hypertension
prominent sign is central or waist center obesity
at greater risk of coronary artery disease
Interventions include:
lifestyle changes- increased activity, diet changes
if those dont work medication
Diabetes: young adult
7th leading cause of death in us
minority populations disproportionally affected
diabetes (type 2) and related consequences (cardiovascular disease, blindness, lower limb amputations, kidney disease) are on the rise in us
can lower the life expectancy by 15 years- early detection and management in young adulthood is important in decreasing progression of complication
Nursing Role: young adult
Assessment:
BMI
waist circumference
BP
cholesterol
Teaching:
increased activity, low fat, more fruits/vegetables, limit proportion
apps and activity monitors are promising
motivational interviewing
Consideration: females
Folic Acid
Calcium: decreases risk of osteoporosis
1000-1500m/ day
Iron
Exercise Recommendations:
Aerobic exercise of moderate intensity for 30 minutes, 5 days a week
optimum heart rate calculation
HR: 220 minus age of person x 65-85% (.75)
MHR:
young adult MHR approximately 150 plus bpm
muscle strengthening important as well
barriers: lack of time, access to facilites, safe enviroment
Sun Exposure:
sun/radiation exposure
avoid excessive UV- highest risk time 10-2
use of sun blocks, unprotective clothin, avoid tanning, sunbathing
SPF: sunscreen protective factor
a calculation of effectiveness of various preparation
rated by FDA
rating of 30 means the sunscreen provides 30 times more protection than unprotected skin
should use sunscreen that blocks UV A and UVB
apply 15-30 min before exposure
need to reapply often- after exercse and swimming
Sports and accidental injuries: young adult
high cause of death in young adults
head injuries are leading cause of death involving bike and motorcycle
must encourage helmet
drowning, boating accident
hang glide, mtn climbing, skiiing
Role-relationship pattern: Young adult
maturing relationships and roles
development of enduring friendships
formation of intimate relationship
decisions about life/career directions
formation of family units
intimate partner violence
Infertility: young adult
affects 10-15% of couples in US; increased diagnosis 25 years
40% male factor. 40% female factor. 20% unknown
assistive reproductive technologies
can be stressful, expensive
encourage women to avoid alcohol, smoking, and drug use
Unintented Pregnancy: young adult
unintended pregnancy: half of all pregnancies
Teen birth rate down 30% in the past decade – result of more involvement in school activities, contracts between unmarried couples, birth control, pregnancy prevention programs and increased job opportunities
Half of unplanned pregnancies are caused by contraceptive failure
Can be related to delayed prenatal care, depression and relationship problems
STI: young adult
HPV- warts, viral, cauliflower-like bumps. Skin to skin, Treat- acid, OTC cream
Gonorrhea and/or Chlamydia- Bacterial, easily spread, treated with antibiotics.
Women may not show sx early, men w/ dysuria. Important to screen..
PID risk in women
Trichomonas- Protozoa, women with vag discharge, odor. Treat with abx
Herpes- Viral, no cure. Painful vesicular lesions, outbreaks come and go. Anti-viral meds
Can help reduce transmission
Bacterial vaginosis- overgrowth of abnmlbact in women, fishy odor, abx to treat
Yeast- clumpy d/c, bad vaginal itch. Treat with antifungals
Stress: young adult
Stress
Assess for stress-related complaints
Fatigue, anxiety, depression, marital problems, increased work demands, children
Assess for signs of achievement stress
Long work hours, skipped meals, loss of sleep, burn out, exhaustion, workaholics
Listen, offer support; referrals as needed
Exercise, relaxation techniques, counseling
Suicide and depression: young adult
Suicide: Leading cause of death
Cause: Unable to cope with stressful circumstances or events
More women attempt suicide; more men succeed
Assess for depression and suicidal ideation – need to ask outright
“Have you had thoughts of wanting to hurt yourself?”
