Adolescent Medicine Flashcards
(28 cards)
Adolescence ages defined
11-12-years-old through 18-21 years-old
21% of US population
1, 2 and 3 causes of death in adolescents
1 Cause of Death = Accidents
- 34.6% (MVA, Poisoning, etc.)
- 23.4%
1 cause of death in adolescent girls
Motor vehicle accident
1 cause of death in adolescent boys
Suicide
↑ Risk factors for Poisoning
- ↑ Access
- Mental/medical illness
- Peer group favorable attitudes
toward drug use - Lack of competing reinforcers*
- Lack of strong parental
boundaries/disapproval
↑ Risk for homicide (firearms)
- Physical/cognitive challenges
- E.g., fetal alcohol syndrome,
learning disorders - Impulsive or aggressive tendencies
- Hx of trauma
- Incl. foster care & homelessness
- Exposure to violence
- Involvement with drugs or alcohol
- Parental authoritarian childrearing
- Low parental involvement
- Poor family functioning
- Parental substance abuse or criminal
involvement - Peer involvement in gangs
- Social rejection by peers
Major causes of morbidity during adolescence are psychosocial & often correlate with ______
poverty
“Success Sequence” for influencing
Psychosocial & Poverty-related circumstances
- Goals
1. ↓ reduce poverty
2. Help adolescents & young adults become
self-sufficient adults - Aka “Launch!”
clear themes about what leads to the two
goals of the success sequence:
- Graduate from high school (minimum)
- Full-time work
- Marriage, then children
11-14 Years: normal development
- Physical Growth: see chart, healthy eating
- Onset of puberty & secondary sexual characteristics
- Gross Motor Control: Active for at least an hour/day
- Fine Motor Control: Continued refinement
- Language: Articulate
- Personal-Social
- At least one relationship with a responsible adult
Fast Facts about Puberty
- Weight ~doubles
- Major organs double in size
- Height ↑ ~15%–20%
- Before puberty
- Muscular strength, boys = girls
- Muscle mass & strength
↑ during puberty
- Onset of puberty is marked by _____
disinhibition
of Hypothalamic GnRH
Pituitary gonadotropins released during puberty:
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Early/middle adolescence
Testosterone function during puberty
- ↑ development of male reproductive
system - ↑ development of male secondary
sexual characteristics
Estrogen function during puberty
- ↑ development of female reproductive system
- ↑ development of female breasts &
secondary sexual characteristics
Progesterone function during puberty
- ↑ secretion of “uterine milk”
- Endometrial secretion nourishes embryo
until placenta attachment functions - ↑ development of secretory apparatus of
breasts
ADOLESCENT HEALTH SERVICES guidelines
- Privacy should be respected by
providers & the staff - Offer an opportunity for examination & counseling separate from parents/guardians.
- Encourage the adolescent to involve parents or guardians in healthcare decisions.
- Maintain confidentiality
- Patients should be made aware that certain situations & circumstances create limitations on guaranteed confidentiality
T/F If the adolescent has the legal
right to give consent, confidentiality must be
maintained
T
Approach to the exam: Strengths-based approach
- Identify & build on strengths early
- Look for (+) examples of adaptation &
overcoming difficulty
* Adapting + Overcoming = Resiliency
* Normal function during adversity
* Growth in coping capacity - Praise & encouragement
* Not hollow lip service
* Help them with self-perception
Approach to the exam: Confidentiality
- Not uncommon a patient is brought
to the office against their wishes - Drug & alcohol use
- Parent-child conflict
- School failure
- Depression
- Suspected eating disorder
- Foster a trust & comfort
- Review expectations of
confidentiality - Consider two meetings
- One with only the teen
- One with only the parents
Approach to the exam: Psychosocial History (HEEADSSS)
H ome environment
E ducation
E mployment
E ating
A ctivities (with peers)
D rugs
S exuality
S uicide/depression
S afety (from injury & violence)
Approach to the exam: The Physical Exam
- Pt may be shy & modest
- Address the purpose of the examination directly
Good decision making requires both:
- Socioemotional system
- Cognitive-control system
Medically emancipated (variable by state)
- Process by which minors can attain legal
adulthood before reaching the age of
majority (>18)
1. NOT legal status, but similar to the age of majority
2. Minors who are married or were married
3. Minors who have a child
4. Minors who have reached a specific age (eg, 15 yrs)
5. High school graduates
6. Minors living away from home without parental
permission/financial support
7. Homeless minors & runaways
8. “Mature minors”
