Week 4 Flashcards
School aged child (6-12) - physical growth (6)
- gain 1.4-2.2kg/year
- grow 4-6cm/year
- loss of baby teeth (brushing = important)
- better metabolism
- fat gives way to muscle
- hit growth spurt between 9-11
School aged child (6-12) - sensory (3)
- can read
- conversion develops
- able to concentrate for longer periods on activities
School aged child (6-12) - motor skills (General)
- finishing touches on school and sport
School aged child (6-12) - fine motor skills
- enjoys craft projects
- cards and board games
School aged child (6-12) - gross motor skills
- two-wheeler (training wheels)
- jump rope
- ice skates
School aged child (6-12) - stages of play
- cooperative play, learning social component of play
- when hospitalized, feel the need for socialization
School aged child (6-12) - Communication
- vocab increases
- cleaning up pronunciations and grammar
- when hospitalized they need simple vocabulary
School aged child (6-12) - sexuality (4)
- need to learn in the factual information for later age group (9-12)
- explanation of inappropriate touch
- need prep for puberty (physical and hormonal) as it starts in late stages of this age group
- needs to be done by family and school
Puberty/physical growth - females (4)
- 8-13 years (lasts for 3 years)
- menses 2.5 years into puberty (mean age of 12.5)
- pubic hair, breasts, fat distribution changes
- girls hit their sprouts (7-25kg, grow 2.5-20cm)
Puberty/physical growth - males (3)
- age 10-15, lasts for 6 years
- pubic hair, penis, testes grow, more muscular, fat distribution change
- growth spurts (7-30kg, grow 11-30 cm)
Adolescence (12-18) - sensory
fully developed
Adolescence (12-18) - motor skills fine
skills well developed
Adolescence (12-18) - gross motor skills
- muscle development continues
- lack of coordination common during growth spurt
12-14 years (early adolescence) - psychosocial development (6)
- preoccupation with body changes and images (self conscious)
- expectations vs self doubt
- peer group influencial
- abstract thinker (sense of right and wrong)
- most interest in present and near future
- test rules and limits
15-17 years (mid adolescence) psychosocial development (8)
- desire for independence
- self conscious
- peer group = life
- less conflict with parents but sadness due to psychological loss of parents
- increased ability to care and share so can devlelop intimate relationships
- improved work habits and sense of right and wrong
- concern about future plans and intellectual interests
- unrealistically high expectations of self alternate with poor self-concept
18-21 (late adolescence) - psychosocial development (6)
- identity more firm, including sense of humour, interests, emotional stability
- able to compromise and develop useful insignt
- adult appearance, clear sexual identity
- setting goals, mutual caring, internal control
- uncertainties about sexuality future relationships and work
- pride in own works
- accepts social institutions and cultural traditions
History taking adolescents (10)
- to be kept strictly confidential
- build rapport - less intrusive to most intrusive
- do not make assumptions - open ended Q
- accentuate positive traits (self esteem)
- write as little as possible (be engaged)
- sensitively explore sexuality, drugs, school, mental health, violence, family (prob will answer but wont be volunteered)
- asking what their peer group is like tends to reflect their individual activities and likes are
- hist is important
- puberty (record of changes, menstruation pain, bleeding, etc)
- diet and exercise (meals away form home, allergies, iron, weight bering exercise etc)
Psychosocial evaluation - HEEADSSS
H = home environment (family structure, dynamics, etc)
E = education (fav classes, difficulties, employment)
E = eating (foods, concerns with over/under weight, ED)
A = activities that are peer related (extra curricular, exercise, peer relationships)
D = drugs
S = sexuality (age of first sexual activity)
S = suicide/depression
S = safety from injury and violence (include bullying and abuse)
Adolescents - sexuality
- 30% teens 15-17 reported having sex (68% 18-19)
- 39% of sexually active males had intercourse with more than one partner (25% of females)
- percent of more than one sexual partner was higher among 15-17 than 20-24
Sexual health - adolescents
- related physical and psychosocial development
- sexual function
- attitudes and behaviours
Importance of scripted verbiage in sexual health
- part of my role is… no right and wrong answer… no judgment
- 3 exceptions (you say you are abused, you might hurt yourself or someone else, if you are diagnosed with disease that needs to be reported
- is it okay to ask you some questions about sexual health?
Sexual health questions (6)
- do you use drugs
- are you currently having sex or have you ever had sex
- have you ever experienced something sexually that you didn’t want to experience
- do you have symptoms that make you think you have an STI
- if female when was first day of your last period? pap test? HPV
- any questions for me?
Safe sex and teens (7)
- condoms for safer sex (don’t prevent viral STI like herpes and HPV)
- pre exposure hepatitis, A, B, HPV
- STI info about transmission, s/s, risk factors, safer sex
- increased STI with use of spermicides
- partner testing
- contraception
- pre-conceptual folic acid
- emergency contraception for females
Sexual health - LGBT
- young gay men are at high risk for HIV
- HIV ans STI testing offered at every visit
- gay + lesbian ahve higher rates of al and drug, depression
Hormonal contraception
- most effective nonsurgical method for preventing pregnancy in adolescents
- 3 months after initiation, 76% teens remain on oral contraceptives after 12 months 50% continue
- family pressure, poor compliance, adverse effects
combined oral contraceptives benefits
- menstrual cycle regulation
- decreased menstrual flow
- decreased dysmenorrhea
- decreased acne
- decreased hirsutism (body hair)
- decreased risk of endometrial and ovarian cancer
Risks of oral contraceptives (6)
- venous thromboembolism
- myocardial infarction
- stroke
- gallbladder disease
- breast cancer
- cervical cancer
.
slim risks, but it does happen
Emergency contraception
- progestin only - plan B
- low incidence of side effects, pelvic exam not required
- if an adolescent has had unprotected sex within 5 days
- sooner better (95% first 24, 85% 24-48, etc)
Teenage pregnancy (2)
- 4 times higher for indigenous Canadian youth, 18 time higher for those aged under 15 times living on reserves
- teen pregnancy is an important public health concern for aboriginal communities because an adolescent’s lack of readiness for pregnancy and parenthood
When to suspect pregnancy in a teen (7)
- irregular menses
- unusual vaginal bleeding
- acute or chronic abdominal pain
- unreliable menstrual history
- amenorrhea
- nausea/vomiting
- fatigue
If pregnancy is diagnosed (4)
- ask patients knowledge of options and their feelings about them
- enquire about family, cultural, community concerns and partner’s role
- determine extent of support system (who told, how they reacted)
- assess for other health concerns or complications (ex bleeding)
Teenage pregnancy - more assessment (5)
- current substance use
- enquire where she lives
- enquire about personal goals
- ask about school
- ask if she is taking multivitamin with folic acid and iron
Follow up - teen pregnancy
- keep in contact with all individuals who were pregnant (edu and guidance)
- assessment and counselling for drug and alc abuse
teenage pregnancy - risk to infant (14)
- poor prenatal care
- poor nutrition (intrauterine growth retardation)
- smoking
- use of alcohol
- use of illicit drugs
- associated STIs
- anemia
- pregnancy-induced hypertension
- prematurity
- poor parenting
- separation from child’s father
- low income
- low educational attainment
- unemployment
Sexually transmitted diseases
- females = 49% increase in chlamydia, 75% increase in honorrhea
- males = 94% increase in chlamydia, 80% increase gonnorhea
15-19 have highest risk of contracting chlamydia or gonorrhoea of any age group
Behaviours increasing STI risk (17)
- sexual activity with a person with known STI
- sexually active and age under 25
- a new sexual partner or more than 2 partners in last year
- no contraception
- no use of barrier contraception
- serial one-partner relationships
- substance use (esp with sexual contact under influence)
- injection drug use
- sex with blood exchange
- sharing sex toys
- sex workers and their clients
- sex for food money shelter drugs
- homeless, impoverished, etc
- partnering with anonymous individuals
- sexual abuse or assault victims
- previous STI
- men who have sex with men
- travel
Vaccinations and STIs
- all adolescents should be considered to be given hepatitis B virus and human papillomavirus vaccines (HPV)
Substance abuse
- 3/5% grade 7-12 have used ecstasy one/more times, 2.6% using cocaine
- increased number of hallucinogens, cannabis, cocaine, stimulants
- FNMI = more likely
- linked to increasing availability and changing attitudes twd drug use
Screening for substance use
- any friends use tobacco, alcohol, others
- ever fell pressured to use any of these in social situations?
Assess substance
crafft mnemonic
CRAFFT mneumonic
C - ever rode in a Car driven by someone using drugs or alc
R - ever use drugs or alc to Relax, increase self-esteem, fit in with peers
A - ever use drugs or alcohol when Alone
F - Forget activities done while using drugs or alc
F - Family or Friends ever tell you to cut down on alc or drug use
T - ever been in Trouble while using drugs or alc
Goals of treatment - substance abuse
- client tells their parent about their substance abuse
- behaviour change (ex facilitate treatment prevent relapse)
- assess for and treat co-morbid conditions including medical and mental health
Non-pharmacologic interventions (even if they do not use substances) (6)
- explain how substances can affect things important to teens (ex body image)
- explain risks and consequences of using substances, that everyone can develop a drug use problem
- help them plan to handle scenarios when peer pressure may take place
- counsel about tobacco use, under age drinking, drug use
- advise teens to avoid binge drinking and smoking
- support adult role models and provide age appropriate guidance about supervision
Obesity (2)
- obese children are more likely to become obese adults (associated health and social consequences)
- age and gender-specific BMI at or above 95th percentile for children of same age and sex
Complications of obesity - physical (4)
- insulin resistance and type 2 diabetes
- fatty liver disease
- pulmonary complications (sleep apnea, exercise intolerance, asthma)
- musculoskeletal and abnormal growth acceleration
Complications of obesity - psychological and social (3)
- discrimination
- low self esteem
- bullying and victimization
Obesity treatment (6)
- diet
- physical activity
- behaviour modification (focus social and behavioural aspects of food)
- family involvement
- drugs (orlistat)
- PREVENTION
Acne
- chronic inflammatory disorder of hair follicles on face and trunk
- most common skin disorder
- 85% population 12-25
- 1:1 female to male, more severe in males
- 20% of neonates
- response to maternal androgen hormones
- develops in first month
- resolves spontaneously
Acne - mild
non-inflammatory comedones (no colour)
acne - moderate
- inflammatory papules, pustules, comedones
- mild disease on chest and back
acne - moderately severe
- inflammatory, numerous papules, localized cysts or nodules,
- face, chest, back
acne - severe
- nodular and cystic acne on face back chest
- numerous cystic lesions that may connect
- pustules may be present
Treatment of acne
- treatment = suppress lesions until condition is outgrown (prevent scaring, minimize psychological distress)
- maintenance with topical retinoids-
- isotretinoin (Acutane) for severe acne not responsive to other therapies (4-6 months, severe birth defects)
Pandemic teens -
- July 2020 # girls admitted to ED for suspected suicide attempts has increased 26.2% over a year
- February 2021 has increased to 50%
- boys increased to 3.7%
- second leading cause of death youth aged 10-17
- tele-health
- COVID took away coping strategies = neg impact on depression, anxiety
- remote learning provided some protection for teens against bullying
