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PPC2 Exam 1 > Primary Care of Adolescent and School-Aged (Through AAP Changes) > Flashcards

Primary Care of Adolescent and School-Aged (Through AAP Changes) Flashcards

1
Q

6 Year Old Developmental Tasks (6)

A
  1. Less magical thinking
  2. Can draw triangle
  3. Egocentric (sun comes up so child can play)
  4. Has friends outside home
  5. Think that they cause everything, cause for mom’s illness
  6. Playdates
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2
Q

What age should a child be able to draw certain shapes? (4)

A
  1. O = 3
  2. Cross = 4
  3. Square = 5
  4. Triangle = 6
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3
Q

School-Aged Child 7-10 Erickson’s Developmental Tasks (8)

A

Industry versus inferiority

  1. Need to separate
  2. Develop coping skills
  3. Still like fantasy
  4. Quest for social involvement and socialization
  5. Stress overload causes somatization
  6. Loves books and fantasy
  7. Need social involvement
  8. Overschedule their kids
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4
Q

School-Aged Child General Developmental Tasks (5)

A
  1. Explore school performance
  2. Social skills
  3. Family functioning
  4. Activities
  5. Development of conscience
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5
Q

Tasks of Adolescence (1b, 2d, 3c, 4)

A
  1. Establish autonomy
    a. Peer group primary social support 15-17
    b. 15-17 is peak period for family conflict
  2. Psychosocial and psychosexual development
    a. Acceptance of physical change
    b. Establish of peer relations
    * Same sex peer relationship in early adolescence
    * Dating in later adolescence
    c. Development of responsible behavior
    d. Evolution of personal values (taking sides on social moral issue
  3. Acceptance of physical change
    a. Growth spurt
    b. Growth of pubic and body hair
    c. Growth and maturation of reproductive organs
  4. Develop future plans
    a. Occurs in later adolescence (18-25)
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6
Q

Adolescence Overview (3)

A

a. Period of physical change
b. Period of wanted to be accepted by peers
c. Don’t get involved – counsel parents of 10-13 year olds
* Want them to emerge independent

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7
Q

Hall’s 3 Key Elements of Adolescent Developments

A

“Storm and Stress”

  1. Conflict with parents
  2. Mood disruption
  3. Risky behavior
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8
Q

Erikson Stage of Adolescence

A

Confusion or diffusion of identity versus achieving a stable identity

(Identity vs. Role Confusion)

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9
Q

Adolescent Boys Physical Change (2)

A
  1. Increased muscle mass
    * XXY with less muscle mass = Kleinfelder syndrome
  2. Onset of sperm production
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10
Q

Adolescent Girls Physical Change (3)

A
  1. Development of female body shape, including breast development
  2. Menarche
  3. Gain a little weight
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11
Q

Adolescent Psychosocial Development (4)

A
  1. Emotional separation from parents
    - Parent tries to control child instead of letting them go:” “Helicopter” parents; Sometimes adolescents need to learn from their mistakes
  2. Greater sense of personal identity
  3. Identification with a peer group
  4. Exploration of romantic relationships and a sense of one’s sexuality
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12
Q

Cognitive Changes of Adolescence (7)

A
  1. Increased capacity for abstraction and advanced reasoning
  2. Greater impulse control
  3. More effective assessment of risk versus reward
  4. Improved use and manipulation of working memory
  5. Improved language skills
  6. Increased capacity to self-regulate emotional states
  7. Kids are highly manipulative
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13
Q

Moral Changes of Adolescence (4)

A
  1. Usually a shift from preconventional to conventional level of morality in Kohlberg’s theory
    * Some kids don’t get good morality
  2. Greater ability to take others’ perspectives
  3. Morality less concrete and rule-based, more focused on role obligations and how one is perceived by others
  4. May question values of parents and institutions; Question family values
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14
Q

Neinstein Phases of Adolescence (3)

A
  1. Early adolescence: 10-13
  2. Middle adolescence: approximately 14-16
  3. Late adolescence: 17-21years
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15
Q

Early Adolescence (1,2,3d,4b)

A

10-13 Years Old

  1. Also called “tween years”
  2. Transition from childhood to adolescent
  3. Hurried childhood at risk for:
    a. More mental and behavioral problem
    b. Unintentional and sports related injuries
    c. Neighborhood and school violence
    d. Risk behaviors related to early sexual behavior and substance abuse
  4. Puberty begins
    a. Earlier pubertal maturation leads to potential for early sexual intercourse
    b. Early female maturation and late male maturation at risk for poor self esteem
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16
Q

Early Adolescence: Psychological Development (7)

A
  1. Personal fable
    Ex: I won’t get hurt, I won’t develop a problem
  2. Imaginary audience
  3. Tendency to magnify the situation
  4. Egocentricity
  5. Emotionally labile
  6. Unrealistic or idealistic vocational goal
  7. Need for privacy
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17
Q

Early Adolescence: Social Development (2)

A
  1. Beginning separation from family
    a. Increased desire for independence
    b. Increased resistance to parental supervision
    c. Continued reliance on family for structure and support
  2. Peer group increasingly important
    a. Same sex social group
    b. Idealized friendships
    i. Ask about curfew times*
    ii. Developmental stress, oncology regresses patients
    iii. Peer group is increasingly important
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18
Q

Early Adolescence: Cognitive Development (3)

A
  1. Decisions are based on one’s own perception and direct experiences
  2. Cannot plan into the future or conceive long-range implications of actions or decisions
  3. Inability to personalize information that is presented in general terms
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19
Q

Pre-Adolescent Years: 10-13 (12)

A

Tweens are exposed to societal environmental pressures at a younger age

  1. Specialized camps
  2. Empty houses
  3. Family structures have changed
  4. Early exposure to sexual practices
  5. Sports at an earlier age
  6. All socioeconomic class are under increased pressure to engage in high risk behaviors between 10-15

Results in more vague symptoms at a younger age

  1. Stomach pain
  2. Headache
  3. Dizziness
  4. Vague complaints
  5. Time when injurious risk taking behavior –drinking, sex, smoking—can begin at urging of older socially advanced peers
  6. Concept of resiliency: Kids in the worse circumstances = very resilient
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20
Q

Middle Adolescence (14-16): Psychological Development (1d,2,3)

A
  1. Sense of omnipotence and invincibility
    a. I can do it all attitude
    b. Engenders risk taking which can result in positive or negative behaviors
    c. Encourages limit testing
    d. Leads to many “firsts”—job, experimentation
  2. Impulsivity
  3. Self image is defined by perceived opinion of others; influence of peer
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21
Q

Middle Adolescence: Cognitive Development (2)

A
  1. Abstract thinking abilities increase

2. May revert to concrete thinking in stressful or emotional situations

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22
Q

Middle Adolescence: Social Development (3)

A
  1. Intense peer involvement – HALLMARK OF ADOLESCENCE*
    a. Conformity with peer values, code and dress
    b. Peer pressure can be positive or negative
  2. Strive for emancipation from family
    a. Interest and activities out the home and family
    b. Employment allows financial independence
    c. Challenges to parental authority
    d. Peak time of conflict for parents and teens
  3. Contracts
    a. How can you deal with middle adolescents in a civil way?
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23
Q

Middle Adolescence: Sexual Development (6)

A
  1. Exploration of gender roles
  2. Awareness of sexual orientation
  3. Idealistic, romantic fantasies
  4. Testing sexual attractiveness
    * Experimentation with clothes, makeup, and behavior
  5. Sexual experimentation
  6. Relationships are brief and self serving
24
Q

Late Adolescence (17-21): Psychological Development (6)

A
  1. Firmer sense of self
  2. Development of realistic goals
  3. Ability to plan for future and delay gratification
  4. Ability to compromise
  5. Refine personal values
  6. Development of conscience
    * Get kids back at 17,18,19; Independent and they will talk to you
25
Q

Late Adolescence: Cognitive Development (4)

A
  1. Abstract thought firmly established
  2. Ability to made independent decisions
  3. Awareness of personal limits and limitations
  4. Ability to predict probable outcomes and consequences
    * Understand they have limits
26
Q

Late Adolescence: Social Development (6)

A
  1. Peer group values less important
  2. Friendships are fewer but more selective
  3. Relationships based on mutual interests, values, caring, and reciprocity
  4. Renewed relationship with family
  5. Adult interaction with parents – REAL HELP
  6. Appreciation of family values, experience and advice
27
Q

Late Adolescence: Sexual Development (2)

A
  1. Acceptance of sexual identity

2. Intimate relationship based on giving and sharing, rather than exploration and romanticism

28
Q

Late Adolescence: Moral Development (2)

A
  1. Recognize multiple points of view, complex interrelationships, ambiguity
  2. Decisions based on understanding of both society’s values and rights of individuals
29
Q

Primary Health care for School-age Child and Adolescent (7)

A
  1. History
  2. Physical examination
  3. Screening
  4. Lab studies
  5. Counseling/Toxic stress
  6. Depression Screening
  7. Immunizations
30
Q

Physical Exam Unique to Adolescents (3)

A
  1. Tanner Staging
  2. Scoliosis screening
  3. Blood Pressure screening
31
Q

Male Tanner Stage I

A

Preadolescent and no sexual hair

32
Q

Male Tanner Stage II (3)

A
  1. Enlargement of scrotum and testes
  2. change in texture of scrotum and reddening of scrotum
  3. Sparse, pigmented, long, straight, mainly at base of penis
33
Q

Male Tanner Stage III (3)

A
  1. Enlargement of penis (length first)
  2. Further growth in testes
  3. Darker, coarser, curlier hair hair; spreading over junction of pubes
34
Q

Male Tanner Stage IV (4)

A
  1. Increased size of penis and growth in breadth
  2. Development of glans penis
  3. Darkening of scrotal skin
  4. Adult hair but decreased distribution
35
Q

Male Tanner Stage V (2)

A
  1. Adult genitalia

2. Adult hair in quality and type with spread to medial thighs

36
Q

Female Tanner Stage I

A

Preadolescent, no sexual hair

37
Q

Female Tanner Stage II (2)

A
  1. Sparse, pigmented, long straight hair mainly along labia

2. Breast budding (enlargement of areola, elevation of breast and papilla)

38
Q

Female Tanner Stage III (2)

A
  1. Darker, coarser, curlier hair over junction of pubes

2. Continued enlargement of breast; no separation of the contour of breast and areola

39
Q

Female Tanner Stage IV (2)

A
  1. Adult hair but decreased distribution

2. Areola and papilla form secondary mound above level of breast

40
Q

Female Tanner Stage V (2)

A
  1. Adult hair in quality and type with spread to medial thighs; horizontal distribution
  2. Mature female breasts
41
Q

Scoliosis – presence of body asymmetries (4)

A
  1. Shoulder height (AC joint level)
  2. Scapular prominences
  3. Chest prominences
  4. Unequal line from C7
42
Q

Scoliosis (4)

A
  1. More than 10 degrees of scoliosis is abnormal
  2. Most common pattern is right thoracic and left lumbar**
  3. Use of the scoliometer
    * Angle of more than 7 degrees is associated with 20 degrees of scoliosis
  4. Check for reflexes, muscle strength = want to make sure it’s not showing as a spinal cord tumor
43
Q

Adams Bend Forward Test Positions (3)

A
  1. Thoracic
  2. Thoracolumbar
  3. Lumbar levels of the spine
44
Q

Health Screenings (6)

A
  1. Blood Pressure to rule out hypertension
  2. PPD / IGRA for TB
  3. Assessment of risk
  4. Screen for mental health disorders
  5. Screen for substance Abuse from 11-21 using CRAFFT questionnaire
    * CRAFFT and depression should be used at each visit!
    * GAPS
    * Guidelines for preventative medicine
  6. Screen for risk, not as much blood/lead screening for a 6 year old or up
45
Q

AAP Changes to Vision Screening (3)

A
  1. The routine screening at age 18 has been changed to a risk assessment.
  2. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3 year olds.
  3. Instrument based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age.
46
Q

AAP Changes to Developmental/Behavioral Assessment

A

Alcohol and Drug Use Assessment; Information regarding a recommended screening tool –> (CRAFFT) was added.

47
Q

AAP Changes to Depression Screening (2)

A
  1. Screening for depression at ages 11 through 21 has been added, along with suggested screening tools.
  2. Mood and feeling questionnaire, Patient Health Questionnaire (PHQ-2, PHQ-9), the PHQ for Adolescents (PHQ-A), and the Beck Depression Inventory–Primary Care Version, Center for Epidemiological Studies Depression Scale for Children (CESDC)
48
Q

AAP Changes to Dyslipidemia Screening (2)

A
  1. An additional screening between 9 and 11 years of age has been added**
    ~Added at age 10
  2. Should do it again at 16
49
Q

AAP Changes to Hct and Hgb Screening

A

A risk assessment has been added at 15 and 30 months

50
Q

AAP Changes to HIV Screening (4)

A
  1. A screen for HIV has been added between 16 and 18 years.
  2. CDC says should be done every year
  3. Starting at onset of adolescent you should screen for HIV every year no matter what the history is
  4. Most frequent for HIV = 15-24 years old
    * Should be doing it every year!!!
51
Q

AAP Changes to STI Screening (3)

A
  1. All sexually active adolescents should be screened for chlamydia and gonorrhea annually
  2. Use of highly sensitive nucleic acid amplification tests (NAATs) to test urine, urethral, vaginal (provider or patient colledcted cervical, and liquid cytology specimens
  3. Not approved for oral or rectal swab specimens unless approved the Cliniical Laboratory Improvement Amendment)
52
Q

AAP Changes to Cervical Dysplasia Screening (3)

A
  1. Adolescents should no longer be routinely screened for cervical dysplasia until age 21.
  2. If immunocompromised or immunosuppressed, yearly PAP tests should begin with onset of sexual activity
  3. Most resolves during adolescence
53
Q

AAP Recommendations for Trichomonas Screening (4)

A
  1. No routine trichomonas (most common protozoa, not a bacteria) vaginalis screening unless at high risk

High risk:

  1. New or multiple partners
  2. History of STI
    - NAAT for T vaginalis
    - Point of care tests
    - DNA probe
    - Culture
    - Microscopic is less sensitive (51% to 65% in females and less sensitive in males
  3. THEN YOU WANT TO SCREEN – if multiple partners or history of STI
54
Q

AAP Recommendations for Syphilis Screening

A

Routine syphilis evaluation is not recommended unless MSM annually or every 3-6 months if high risk or behaviors that put them at high risk (ex: men w/ men)

55
Q

Indications for pelvic exams prior to age 21 (10)

A
  1. Persistent vaginal discharge
  2. Dysuria or urinary tract symptoms in a sexually active female
  3. Dysmenorrhea unresponsive to nonsteroidal anti-inflammatory drugs
  4. Amenorrhea
  5. Abnormal vaginal bleeding
  6. Lower abdominal pain
  7. Contraceptive counseling for an intrauterine device or diaphragm
  8. Perform Pap test** ACOG no longer asks for pap smear screening
  9. Suspected/reported rape or sexual abuse
  10. Pregnancy

PPC2 Exam 1 (13 decks)

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