mid term Flashcards
(64 cards)
1
Q
Describe Integument Expected Findings
A
- Intact Skin
- Appropriate distribution of pigmentation
- Slow, progressive decrease in skin turgor
- Greying and loss of hair
2
Q
Describe expected findings for Head & Neck
A
•Symmetry of scalp, skull & face
3
Q
Describe expected findings for Eyes
A
- Normal accessory organs of vision
- Visual acuity (according to snellen chart)
- Normal pupillary reaction to light and accommodation
- Normal visual fields, & extraocular movements
- Normal retinal structures
4
Q
Describe expected findings for ears:
A
•Normal auditory structures & acuity
5
Q
Describe expected findings for Nose, Sinuses, & throat
A
- Patent nares & intact sinuses, mouth, and pharynx
- Location of trachea is midline
- Nonpalpable lateral thyroid lobes
6
Q
Describe expected findings for Thorax & Lungs
A
- Increased anteroposterior diameter
- Respiratory rate 12-20
- Ratio of respiratory to heart is 1:4
- Normal tactile fremitus, resonance, & breath sounds
7
Q
Describe expected findings for Heart & Vascular System
A
- Normal heart sounds
- Systole: first heart sound loudest at apex
- Diastole: first heart sound loudest at base
- Point of maximal impulse: at 5th intercostal space in midclavicular line & 2cm or less in diameter
- Temp 36.1C- 37.6
- Pulse 60-100 bpm
- BP 130 mm Hg systolic, 85 mm Hg diastolic
- All pulses palpable
8
Q
Describe expected findings for breats:
A
- Decreased size resulting from decreased muscle mass
* Normal nipples
9
Q
Describe expected findings for Abdomen:
A
- No tenderness or organomegaly
* Decreased strength of abdominal muscles
10
Q
Describe expected findings for Female Reproductive System:
A
•Change in menstrual cycle (Hot flashes)
11
Q
Describe expected findings for Male Reproductive System:
A
- Normal penis and scrotum
* Prostate enlargement in some
12
Q
Describe expected findings for Musculoskeletal System
A
- Decreased muscle mass
* Decreased ROM
13
Q
Describe expected findings for Neurological Systems:
A
- Appropriate affect, appearance, and behaviour
- Lucidity & Appropriate level of cognitive ability
- Intact cranial nerves
- Adequate motor response
- Responsive sensory system
14
Q
What are the health risks for a middle aged adult?
A
Lifestyle
•Poor food choices, smoking, stress, substance abuse, inactivity increase risk of illness
Family History
•Increased risk of developing disease (genetics, cardiovascular, renal, endocrine, diabetes
Accidental Death & Injury
•Leading causes of death in young adult- MVA physical assault, suicide
•Predisposing factors- poverty, breakdown of family relations, child abuse, neglect, access to firearms
•Environmental risk factors- social determinants of health
•Assess behaviour patterns, history, education, social support system
Substance Abuse
•Contributes to mortality & morbidity directly or indirectly
•Regular heavy drinking (5 OR MORE)
•Drug dependence- can lead to accidental or intentional OD
15
Q
What should middle aged adults screen for?
A
• Clients should perform monthly skin, breast, or male genital self-examinations.
16
Q
What are the health concerns for a middle aged adult?
A
- Stress and Stress reduction
- Levels of wellness
- Obesity
- Forming positive health habits
- Anxiety
- Depression
17
Q
What are the 10 functional dimensions?
A
oExpressive functioning-10 categories •Emotional communication •Verbal communication •Non-verbal communication •Circular communication •Problem solving •Roles •Influence •Beliefs •Alliance & coalitions
18
Q
What are the Developmental Dimensions
A
oThe development assessment is divided into 3 components
•Stages
•Tasks
•Attachments
o6 stages of family life cycle (based on traditional)
•Between families Unattached Young Adults
•The Joining Of Families Through Marriage
•Families with Young Children
•Families with Adolescents
•Launching Children & Moving On
•Families in Later Life
19
Q
What are the Structural Dimensions?
A
- Genogram- diagram of family constellations; provides you a picture.
- Ecomap-diagram of the family’s contact with others outside the immediate family
20
Q
Why is preconception education and care important?
A
Preconception care is care you receive before you get pregnant. It involves
finding and taking care of any problems that might affect you and your baby later, like diabetes or high blood pressure. It also involves steps
you can take to reduce the risk of birth defects and other problems.
By taking action on health issues before pregnancy, you can prevent many future problems for yourself and your baby.
21
Q
What is Naegele’s Rule?
A
rule for calculating an expected delivery date; subtract three months from the first day of the last menstrual period
and add seven days to that date
22
Q
What are some of the goals of prenatal care?
A
pregnancies end with a healthy mother and baby and that the foundation is laid for the
newly expanded family to thrive. A variety of other goals fall under the umbrella of this general goal, such as prevention or management of
birth defects, prevention of preterm delivery and low birth weight, prevention of pregnancy loss and intrauterine fetal death, reduction of
traumatic birth injuries, and reduction of maternal, fetal, and neonatal infections.family planning, reducing the incidence of unintended
birth, promoting breastfeeding, promoting good nutrition and healthy behaviors for women and their families, preparing for labor and
delivery and for bringing a new baby into the home, screening for and treating postpartum depression, and screening for domestic violence.
23
Q
List presumptive signs of pregnancy:
A
Presumptive signs of pregnancy are signs and symptoms that may resemble pregnancy signs and
symptoms, may be caused by something else.absence of a period,Nausea or vomiting,Fatigue,Frequent urination and breast tenderness
24
Q
Probable signs of pregnancy
A
Probable signs of pregnancy are signs that indicate pregnancy majority of the time. A positive pregnancy
test,An enlarged abdomen,
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Positive signs of pregnancy
demonstration of seperate fetal heart, fetal movements felt by examiner, visualization of fetus by ultrasound
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stages of fetal development
Cellular Multiplication -Pre-embryonic Period/Intrauterine Development (24 hrs to 2 weeks), Cellular
Multiplication - The Embryo (embryonic stage lasts between 2-8 weeks), Organ Development
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Postpartum maternal psychosocial changes
A major psychological task for the parents is the process of bonding and attachment with
their newborn. This takes place the first three to four days of postpartum.
POSTPARTUM "BLUES"
MATERNAL ADAPTATION FOLLOWING DELIVERY
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PHASES OF THE RESTORATIVE PERIOD OF MATERNAL BEHAVIOR FOLLOWING DELIVERY
Taking-In Phase. During this
phase the mother is oriented primarily to her own needs. She primary focuses on sleeping and eating. She may be quite passive and
dependent.
Taking-Hold Phase. During this phase the mother strives for independence and autonomy, she becomes the "initiator." She is concerned
about her ability to control her bodily functions (that is, bowels, bladder, and if breast-feeding, concerned about adequate amount and
quality of milk). She takes an active part in trying to control these functions. She is concerned about her ability to take care of her newborn.
Letting-Go Phase. Generally, this phase occurs when the mother returns home. The mother must accomplish two separations during this
phase. The separations are to realize and accept the physical separation from the baby and to relinquish her former role of a childless
person. The mother must adjust her life to the relative dependency and helplessness of her child.
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First Trimester (0 to 13 Weeks):
The first trimester is the most crucial to your baby's development. During this period, your baby's body
structure and organ systems develop. Most miscarriages and birth defects occur during this period. Your body also undergoes major changes during the first trimester. These changes often cause a variety of symptoms, including nausea,
fatigue, breast tenderness and frequent urination. Although these are common pregnancy symptoms, every woman has a different
experience. For example, while some may experience an increased energy level during this period, others may feel very tired and emotional.
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Second Trimester (14 to 26 Weeks):
The second trimester of pregnancy is often called the "golden period" because many of the unpleasant
effects of early pregnancy diappear. During the second trimester, you're likely to experience decreased nausea, better sleep patterns and an
increased energy level. However, you may experience a whole new set of symptoms, such as back pain, abdominal pain, leg cramps,
constipation and heartburn.
Somewhere between 16 weeks and 20 weeks, you may feel your baby's first fluttering movements.
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Third Trimester (27 to 40 Weeks):
You have now reached your final stretch of pregnancy and are probably very excited and anxious for the
birth of your baby. Some of the physical symptoms you may experience during this period include shortness of breath, hemorrhoids, urinary
incontinence, varicose veins and sleeping problems. Many of these symptoms arise from the increase in the size of your uterus, which
expands from approximately 2 ounces before pregnancy to 2.5 pounds at the time of birth.
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postpartum blues:
New mothers often experience conflicting feelings of joy and emotional letdown during the first few weeks after birth.
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postpartum depression:
strong feelings of sadness, resentment, and despair that may appear shortly after childbirth and can linger for
months.
older adult and conception..
Study online at quizlet.com/_bq24o
34
postpartum psychosis:
a rare and severe form of depression that occurs in women just after giving birth and includes delusional thinking
and hallucinations
35
social isolation:
caused by loss of work role, relocation to unfamiliar surroundings, reduced mobility and independence, or withdraw due to
ageism
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interventions for social isolation:
The most common type of program aimed at reducing social isolation and loneliness found in the
literature was a type of peer (volunteer) helping/ visiting outreach model. Several examples of
these types of programs are presented as well as others that involve peer support groups and
programs that recruit seniors to volunteer with other populations such as children. The literature
does caution that when planning interventions for socially isolated and lonely seniors a good
understanding of the target group, or of an individual's need for acceptance and social support is
necessary before employing commonly recommended interventions. Also, it may be possible
that feeling supported is in fact exclusively an outcome of caring interpersonal transactions
among individuals who trust each other and not an intervention that can be implemented.
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Physiological Changes With Aging Integument:
Loss of skin elasticity (resulting inwrinkles, sagging, dryness, easily tears)
Pigmentation changes, glandular atrophy (oil, moisture, sweat glands)
Thinning hair (facial hair: decreased in men, increased in women)
Slower nail growth, atrophy of epidermal
arterioles
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Physiological Changes With Aging Respiratory in aging
Decreased cough reflex
Decreased removal of mucus, dust, irritants from airways (decreased cilia)
Decreased vital capacity (increased
anterior-posterior chest diameter)
Increased chest wall rigidity
Fewer alveoli, increased airway resistance
Increased risk of respiratory infections
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Physiological Changes With Aging Cardiovascular:
```
Thickening of blood vessel walls
Narrowing of vessel lumen
Loss of vessel elasticity
Lower cardiac output
Decreased number of heart muscle fibres
Decreased elasticity and calcification of heart valves
Decreased baroreceptor sensitivity
Decreased efficiency of venous valves
Increased pulmonary vascular tension
Increased systolic blood pressure
Decreased peripheral circulation
```
40
Physiological Changes With Aging Gastrointestinal:
Periodontal disease
Loss of teeth
Decrease in saliva, gastric secretions, and pancreatic enzymes
Changes in smooth muscle, with decreased esophageal peristalsis and small intestinal motility
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Physiological Changes With Aging Musculoskeletal:
```
Decreased muscle mass and strength
Decalcification of bones
Degenerative joint changes
Dehydration of intervertebral disks
(decreased height)
```
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Physiological Changes With Aging Eyes:
Decreased ability to focus on near objects (presbyopia)
Difficulty adjusting to changes from light to dark
Yellowing of the lens
Altered perception of colours
Increased sensitivity to glare
Smaller pupils
43
Physiological Changes With Aging Ears:
Loss of ability to hear high-frequency tones (presbycusis)
Thickening of tympanic membrane
Sclerosis of inner ear
Possible buildup of cerumen (earwax)
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Reproductive changes in older adult
```
Female Decreased estrogen production
Degeneration of ovaries
Atrophy of vagina, uterus, breasts
Male Diminished sperm count
Smaller testes
Less firm and slower erections
```
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Endocrine changes in older adult:
General-Alteration in hormone production with decreased ability to respond to stress
Thyroid- Decreased secretion
Thymus- Involution of thymus gland
Cortisols, glucocorticoids- Increased levels of anti-inflammatory
hormones
Pancreas -Increased fibrosis, decreased secretion of enzymes and hormones
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Delirium:
a usually brief state of excitement and mental confusion often accompanied by hallucinations
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dementia:
a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by
personality changes
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depression
a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity
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Health concerns myths of ageing;
Older adults are sometimes stereotyped as ill and disabled.
However, although many experience chronic conditions or have at
least one disability that limits their performance of activities of
daily living (ADLs), only 23% of older adults describe their health
as poor or fair.
Some people believe that older adults are forgetful, confused,
rigid, bored, and unfriendly and that they are unable to understand and learn new information. However, centenarians, the oldest of the
old, are described as having an optimistic outlook on life, good memories, broad social contacts and interests, and tolerance for others
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elder abuse:
Signs
Physical signs of abuse, Isolation from others, Withdrawal,Feeling of the victim, that he or she is to blame,Verbalized threats against the
victim
Action Required
Assess the presence of physical danger,Take legal action, Support the victim's decision to leave the situation or to stay in it
Develop a workable safety plan, Provide specific information about places of safety
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medications in the elderly:
Older adults take more prescription and over-thecounter
drugs than do people of any other age group. Older adults
account for 12% of the population but use as much as 40% of prescription medications.
The medications most commonly used are cardiovascular
drugs, anti-hypertensives, analgesics, sedatives, tranquilizers, laxatives, and antacids.
a periodic and thorough review of all medications
being used is important in helping the client use the fewest necessary medications.
they are at an increased risk of having reactions to medications that do not mix
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CFAM
The CFAM is based on various theories: systems theory, communications theory, cybernetics and change theory (Neabel et al. 2000).
Systems theory defines the individual as a system and as a sub-system of the family unit, which in-turn is part of a larger system. A
disturbance in one family member will affect the family as a whole and how they respond to the change. By observing both verbal and nonverbal
interactions, this model uses communications theory; which seeks to assess the inter-professional and intra-professional attributes
of family members. Cybernetics strives to understand the control of situations that affect the family. It is mainly used to examine the
'feedback loops' within a family, where an action of one member is influenced by the behaviour of others.
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attributes of a healthy family:
Communication
Learning to be open with one another is the first beginning step to a healthy family. Communicating your needs and caring for the needs of
one another is a major undertaking but not impossible. Sharing is a healthy part of friendship. There are many great strategies for
communicating with one another. If your family is having problems communicating consider rephrasing and asking questions to clarify
what someone means or to get a better understanding of the situation.
Honesty
Honesty follows communication in that if a family is honest with one another there is no need for secrecy and lies. Families that are honest
are much closer and tend to spend more time together than families that build their foundation on lies and deceit.
Fun
Having fun together is a great way to build the family relationship. The family that plays together stays together. Spending time playing
with the kids and having fun will build a strong foundation for the family unit. Whether you're spending time outside or inside quality fun
time is a must for a healthy family relationship.
Commitment
If we can't depend on family who can we depend upon? Family should be able to count on one another through hard times and fun times as
well. Just as a married couple should be committed to one another, so should family. The feeling of trust, belonging and unity will go far in
helping a family cope with day to day issues in life.
Appreciation
Family members all want to feel appreciated. Just like you want your spouse to appreciate you, the children also need to feel appreciated.
When our daughter was about two years of age, I would tell her, "Thank you, I appreciate it". It sounded so cute when she started repeating
it back to us. She learned the value of appreciation and that she is appreciated.
Togetherness
Spending time together is important to build a strong family relationship. How many people do you know that have no contact with their
family whatsoever? It's so sad to think that so many people will grow old alone and not have any family around them in the end.
Strategies to deal with stress
Dealing with stress can be a huge challenge. Remember to stay calm, stay flexible and have a sense of humor. Things will change form day
to day but family is forever. Stress is never easy but as a family we can learn to help each other through stressful times.
Wellness
Wellness can be broken down into physical, spiritual and emotional. A healthy family will have an even balance of wellness. Sharing a
healthy diet, belief system and goals. Spiritual wellness is the ability to learn to look outside of oneself to share similar values and a similar
belief system. When these work together well there is an emotional nurturing of the spirit that develops the mind and body and family unit.
Positive Attitude
Keeping a positive attitude about life and it's happenings will help to establish and overall sense of well being in a family.
Resilience
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Newborn (first month)
| Physical Changes
* Average newborn weighs 3400g, 50cm long, and 35cm head circumference
* Up to 10% of birth weight is lost in the first few days, primarily because of fluid loss by respiration, urination, defecation, and low fluid intake
* Birth weight is usually regained by the second week
* Heart rate: 120-160 beats/minute
* Respirations: 30-60 breaths/minute
* Temperature 36-37.5C
* BP: 85/54
* Lanugo on the skin of back is present, cyanosis of the hands and feet for 24hours & a soft, protuberant abdomen
* Skin colour varies depending on genetic heritage, and changes as the child ages
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Neurological Function of a newborn
* Observe newborn’s level of activity, alertness, irritability, responsiveness to stimuli and reflexes
* Normal reflexed include: sucking, rooting, grasping, yawning, coughing, sneezing, hiccupping, blinking in response to bright lights, startling (pulling arms and legs inward) in response to sudden noises
* Absence of these reflexes indicate prematurity, possible trauma, or central nervous system complications
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Developmental Milestones
| Birth to 4 Months
* Involuntary reflexes such as crawling, startle
* Infant may roll over
* Eye-hand coordination improves & the involuntary grasp reflex increases
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Developmental Milestones
| 5 to 7 Months
* Rolls over
* Sits momentarily
* Grasp & manipulates small objects
* Picks up dropped object
* Well-developed eye-hand coordination
* Can focus on & locate very small objects
* Tendency to put objects in mouth
* Can push up on hands & knees
* Crawls backwards
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Developmental Milestones
| 8 to 12 months
```
•Crawls & creeps
•Stands, holding on to furniture
•Stands alone
•Cruises around furniture
•Walks
•Climbs
•Pulls on objects
Throws objects
•Can pick up small objects & has pincer grasp
•Explores objects by putting in mouth
•Dislikes being restrained
•Explores away from parents
•Understanding of simple commands & phrases increase
```
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Neurofuction (Cognitive Development)
* Learns by experiencing and manipulating the environment
* Developing motor skills and increasing mobility expand and infant’s environment, and, with developing visual and auditory skills, enhance cognitive development
* Piaget named the first stage of cognitive development that extends until the infant’s 3rd birthday – Sensorimotor Period
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Preschoolers (3 - 6 years)
| Language
* Vocabulary increase rapidly
* By age 5 kids know more than 2100 words and construct sentences with 5-6 words
* Language is more social, and questions expand to “why” and “how come”
* Phonetically similar words may cause confusion (ex. Dye and die)
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Preschoolers (3 - 6 years)
* Become more social, shift from parallel to associative play
* Children playing together engage in similar activities
* Preschoolers demonstrate awareness of social context
* Sex role identification is strengthening & children most often assume roles of their own sex
* Frequently repeat or mimic social experiences (significant in hospitalized children)
* Provides a healthy outlet for frustration especially when a child has been subjected to painful or restrictive experiences against their will
* Imaginary play (child’s memory of things they have seen and heard) involving other children occupies about 1/3 of a 5-year-old child’s time
* Pretending allows children to understand others’ point of view, develop skills in solving social problems and become more creative
* Imaginary playmates are a sign of creativity and healthy development
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Child Proofing for Toddlers and Preschoolers
Potential threats: motor vehicles, drowning, burns, poisoning, falls, choking and suffocation, and bodily damage
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```
School Age (6 - 12 years)
Physical Development
```
* Slower than at anytime but continues steadily (may vary depending on the child)
* School aged children appears slimmer than preschoolers as a result of changes in fat distribution
* Growth accelerates at different times for different children
* Many children double their height during these middle childhood years
* Boys are slightly taller and heavier than girls during these early school years
* About 2 years before puberty, children experience a rapid acceleration in skeletal growth
* Girls generally reach puberty first
* Puberty occurs between the ages of 9 and 13 years in girls, and 11 and 14 years in boys
* Cardiovascular functioning is refined and stabilized
* Heart rate: 75-100 beats/minute
* BP normalizes to approx.: 110/65
* Respiratory rate stabilizes 20-30 breaths/minute. Lung growth is minimal and respirations become slower, deeper and more regular
* Heart has generally reached its adult size, 6 times the size at birth
* Large muscle coordination improves and strength doubles (more graceful)
* Playing (running, jumping, throwing balls, catching, balancing, etc…) results in refinement of neuromuscular function and skills
* Fine motor skills are improved and as control is gained over fingers and wrists children become proficient in a wide range of activities
* Most 6 year olds can hold a pencil adeptly and print letters and words. By age 12, they can make detailed drawings and write sentences in script
* Improve refine motor skills by playing computer games, painting, drawing, making models
* Allow child to participate in care as much as possible. They have developed their own way of caring for themselves
* Steady skeletal growth in the trunk and extremities occur. Dental growth is prominent during school years. First permanent tooth can erupt at 6. Begins with 6 year molars, and follow same order as primary teeth. By 12 years primary teeth have been shed &majority of permanent teeth have erupted.
* Small and long bone ossification is present but incomplete
* Body appearance and posture changes due to skeletal growth. Earlier stoop-shouldered, slight lordosis and prominent abdomen changes to a more erect posture. Girls over 12should be evaluated for scoliosis
* Eye shape alters because of skeletal growth, this improves visual acuity
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Adolescent (12 - 19 years)
| Suicide Risk
HISTORY – Previous attempts? Attempts by family or friends? Child maltreatment? Past psychiatric hospitalization? Death of parent when child was young?
INDIVIDUAL FACTORS – hopelessness; marked, persistent depression; alcohol or drug abuse; impulsiveness; difficulty tolerating frustration; feelings of self hatred, excessive guilt, or humiliation; thinking disorder; physical problem or problems with body image; gender identity concerns; being gay or lesbian in unsupportive environment; seeing self as totally helpless, a victim of fate; and needing to do things perfectly.
FAMILY FACTORS – Difficult home situation, hostile parents, overt rejection by one or both parents, divorce or separation of parents, recent or impending move, family break up or loss of parent, stress of unrealistically high parental expectations, parental indifference with very low expectations.
SOCIAL & ENVIRONMENT FACTORS – firearms in the home; incarceration; lack of effective social support system; isolation; suicide of someone known; few social, vocational, or educational opportunities.
Health Risks
Injuries – self inflicted injuries, motor vehicle accidents & poisoning are the leading causes of death in adolescents
Suicide – increased cause of death between adolescents between 15-19
Substance Abuse – those who have dysfunctional families are more at risk
Eating Disorders – number of eating disorders is on the rise in adolescents, particularly girls
Obesity & Physical Inactivity – becoming serious public health concerns. Rates of overweight have doubled and obesity tripled since the 1990s.
Sexual Experimentation – Sexually Transmitted Infections (STI), increasing in adolescents & Pregnancy
