Promoting Health in School-age and adolescents Flashcards
Maturation - Physiological
Puberty = body changes
- Pre-pubescent
- Pubescent
- Post-pubescent
Maturation - Psychological
Adolescence = adjustments in personality
- Early
- Middle
- Late
Fears in school aged children: age 6
-Supernatural events; hidden people; being left or lost; death of a loved one
Fears: age 7
Ideas suggested by TV
Fears: 8-9
School failure; ridicule by peers
Fears: 10-11
Parental anger; older kids; catastrophes; school failure
Fears: 12-17
Physical changes; sexual fears; world events
Greatest risk for harm in school age
Accidental! (preventable)
- Drowning
- Traffic injury
- Poisonings
- Unintentional
Health promotion activities
- School settings
- Social clubs/organizations
- Primary care offices (until 5th grade)
- Social Media
- Peers (increases with age)
Social media
Reflects individualism and community for adolescents
-Young people who feel connected to their school are less likely to engage in many risk behaviors, including early sexual initiation, alcohol, tobacco, and other drug use, and violence and gang involvement
Physical Growth and Dev Considerations
- Wide variation in initiation, rate of growth, completion of development
- Impacted by genetic, environmental and SDH factors
- Females mature earlier
SDH
-born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems
Adolescent development
-Adolescence is often at least one “difficult” stage of transition
-Consists of three distinct stages of development
-Developmental goals:
-Separate from parents
-Connect with peers
-Develop positive self
image
HEADDSSS: the quick assessment for adolescence
Home Education and Employment Activities Drugs Diet Sexuality Suicide and Depression Safety and Violence
Assessing Home
- Open ended questions
- Developmentally appropiate question examples:
1. Tell me bout your mom & dad
2. Where do you live? Who lives with you?
3. What are rules like at home?
Assessing Education and Employment
- How are you doing in school? What are you good at? What’s difficult for you?
- Future plans?
- How do you get along with peers? (bullying inquiry)
Assessing Activities
- What do you do for fun?
- Which activities are you involved in?
- Have you ever been involved with the police?
Assessing Drugs
When you go out with friends or to a party, do most of them drink alcohol or smoke?
- How much and how often?
- How do you pay for drugs/etoh?
- Do you do them regularly?
Assessing Diet
- Tell me about the exercise you do?
- What do you typically eat on a given day?
- SCOFF questionnaire
SCOFF QUESTIONNAIRE
Do you make yourself Sick because you feel uncomfortably full?
Do you worry that you have lost control over how much you eat?
Have you recently lost more than one stone (14 pounds) in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?
Sexuality assessment
Are you in a relationship? Have you ever been? Orientation? Contraception # of partners Concerns of STIs LMP
Suicide and Depression
Have you ever felt stressed or anxious?
- What things make you anxious?
- PHQ19
- SI/SH
- Psychosomatic symptoms
- Isolation
Safety / Violence Assessment
- Have you ever been seriously injured? How?
- How do you decide if a situation/person is safe?
- Seat belt safety
- Have you ever rode in a car with someone who was drinking?
- Guns
Prevention is KEY to teen health: health promotion in school age and adolescents
- Anemia (always tired)
- Behavioral (school and social issues)
- Skin (acne)
- Growth issues/injuries to musculoskeletal system
- Safety
- Relationships
- Promotion of growth/development for all (despite chronic illness)
Top 3 causes of mortality in teens
Accidents (car), homicide, suicide
Promotion of Health for Teens
- Continue annual exams and immunizations
- Enforce health habits that reduce risks
- Address the positives found in “HEADDSSS” assessment
- Praise for success
- Plan for questions teens may have and offer confidentiality
- Ensure adequate sleep and nutrition
- ensure adequate sleep and nutrition
- Support systems, peers, coping mechanisms
- Promote on-going transition in healthcare
Early Adolescence
- Concrete thinkers: “immediate experience” cant think past NOW
- Self focused
- Concerned w appearance / acceptance
- Short attention span
- Might be the last opportunity to have health exam!
Early Adolescence (age 10-14)
Address
- peer and family relationships
- body image issues
- safety
- School success
- Correcting myths
Early Adolescent signs
- Being to separate from parents and family
- Increased importance on same sex peer relationships
- concrete thinkers
- preoccupied with their own bodies
- develop “crushes”
- May initiate sexual activity
Family Support
- Adolescents who perceive that they have good communication and are bonded with an adult are less likely to engage in risky behaviors
- Parents who provide supervision and are involved with their adolescents activities are promoting a safe environment in which to explore opportunities
Bullying
Sexual orientation is a big risk
1. schools can help by implementing anti discrimination and anti harassment policies
Impact of tech
- education benefits vs risks
2. nursing role
Middle Adolescence (ages 14-17)
- Safety (MVC major cause of death in teens)
- Promotion of healthy relationships
- Sleep (need 8.5-9.5)
- Diet and hydration (can cause headache, fatigue, nausea, weakness, crankiness and poor concentration)
- mental health issues
Late Adolescence (17+)
- Promoting Transitions
- PCP, self report of concerns and health history, management of meds - Safety focus continues
- Prevention of long term health issues
Health promotion for young adults
- Complete, confidential physical before leaving high school
- update immunizations
- Start woman’s routine screening and plan for contraception (if not already complete) (pap guidelines >21 if not SA and chlamydia screeing > 16 if SA or suspecting
- Discuss strategies for “adult” health maintenance, revisit any chronic concerns
- Praise for successful transition
- Plans for beyond school
- Address any chronic health conditions
REITERATE SAFETY
Ensure Confidentiality
- talk to teen alone (gentle parentectomy)
- Discuss privacy at the start of the interview
- Normalize teen being independent for care
- Know what MUST be reported (abuse, sexual relationships, STD’s, suicide ideology, self harm, serious health concerns)
NC and family planning clinics
- Minor may consent to contraceptive services (outside of public school clinics)
- Minor may consent to testing and treatment for STD (HPV vaccine is included in this)
- parental consent required before abortion (unless judge allows bypass)
- Teens <18 are not emancipated as parents in NC
Promoting Health
- Developmentally appropriate
- Written
- Discussion
- Repeated messages
- Social Media
- Reliable resources for information and care
Considerations
- Culturally sensitive
- With he parent/caregiver?
- Memorable?
- Use of resources
Approach to teens
- Consider the clinical situation (goal to be patient focused and family sensitive)
- Know the law: patients >16 years old have a right to confidential care unless they are at risk for harm
- Motivational interviewing: be mindful of the developmental stage (prescribing meds, negotiating procedures, discussing sleep, activities, risk factors and diet)
- Discharge/health promotion teaching (verbal and written instructions for both teen and parent)
