Promoting Health in School-age and adolescents

Question 1

Maturation - Physiological

Answer 1

Puberty = body changes

• Pre-pubescent
• Pubescent
• Post-pubescent

Question 2

Maturation - Psychological

Answer 2

Adolescence = adjustments in personality

• Early
• Middle
• Late

Question 3

Fears in school aged children: age 6

Answer 3

-Supernatural events; hidden people; being left or lost; death of a loved one

Question 4

Fears: age 7

Answer 4

Ideas suggested by TV

Question 5

Fears: 8-9

Answer 5

School failure; ridicule by peers

Question 6

Fears: 10-11

Answer 6

Parental anger; older kids; catastrophes; school failure

Question 7

Fears: 12-17

Answer 7

Physical changes; sexual fears; world events

Question 8

Greatest risk for harm in school age

Answer 8

Accidental! (preventable)

• Drowning
• Traffic injury
• Poisonings
• Unintentional

Question 9

Health promotion activities

Answer 9

• School settings
• Social clubs/organizations
• Primary care offices (until 5th grade)
• Social Media
• Peers (increases with age)

Question 10

Social media

Answer 10

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

Question 11

Physical Growth and Dev Considerations

Answer 11

• Wide variation in initiation, rate of growth, completion of development
• Impacted by genetic, environmental and SDH factors
• Females mature earlier

Question 12

SDH

Answer 12

-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

Question 13

Adolescent development

Answer 13

-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

Question 14

HEADDSSS: the quick assessment for adolescence

Answer 14

Home
Education and Employment
Activities
Drugs
Diet
Sexuality
Suicide and Depression
Safety and Violence

Question 15

Assessing Home

Answer 15

• 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?

Question 16

Assessing Education and Employment

Answer 16

1. How are you doing in school? What are you good at? What’s difficult for you?
2. Future plans?
3. How do you get along with peers? (bullying inquiry)

Question 17

Assessing Activities

Answer 17

1. What do you do for fun?
2. Which activities are you involved in?
3. Have you ever been involved with the police?

Question 18

Assessing Drugs

Answer 18

When you go out with friends or to a party, do most of them drink alcohol or smoke?

1. How much and how often?
2. How do you pay for drugs/etoh?
3. Do you do them regularly?

Question 19

Assessing Diet

Answer 19

1. Tell me about the exercise you do?
2. What do you typically eat on a given day?
3. SCOFF questionnaire

Question 20

SCOFF QUESTIONNAIRE

Answer 20

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?

Question 21

Sexuality assessment

Answer 21

Are you in a relationship? Have you ever been?
Orientation?
Contraception
# of partners
Concerns of STIs
LMP

Question 22

Suicide and Depression

Answer 22

Have you ever felt stressed or anxious?

1. What things make you anxious?
2. PHQ19
3. SI/SH
4. Psychosomatic symptoms
5. Isolation

Question 23

Safety / Violence Assessment

Answer 23

1. Have you ever been seriously injured? How?
2. How do you decide if a situation/person is safe?
3. Seat belt safety
4. Have you ever rode in a car with someone who was drinking?
5. Guns

Question 24

Prevention is KEY to teen health: health promotion in school age and adolescents

Answer 24

1. Anemia (always tired)
2. Behavioral (school and social issues)
3. Skin (acne)
4. Growth issues/injuries to musculoskeletal system
5. Safety
6. Relationships
7. Promotion of growth/development for all (despite chronic illness)

Question 25

Top 3 causes of mortality in teens

Answer 25

Accidents (car), homicide, suicide

Question 26

Promotion of Health for Teens

Answer 26

1. Continue annual exams and immunizations 2. Enforce health habits that reduce risks 3. Address the positives found in "HEADDSSS" assessment 4. Praise for success 5. Plan for questions teens may have and offer confidentiality 6. Ensure adequate sleep and nutrition 7. ensure adequate sleep and nutrition 8. Support systems, peers, coping mechanisms 9. Promote on-going transition in healthcare

Question 27

Early Adolescence

Answer 27

1. Concrete thinkers: "immediate experience" cant think past NOW 2. Self focused 3. Concerned w appearance / acceptance 4. Short attention span 5. Might be the last opportunity to have health exam!

Question 28

Early Adolescence (age 10-14)

Answer 28

Address 1. peer and family relationships 2. body image issues 3. safety 4. School success 5. Correcting myths

Question 29

Early Adolescent signs

Answer 29

1. Being to separate from parents and family 2. Increased importance on same sex peer relationships 3. concrete thinkers 4. preoccupied with their own bodies 5. develop "crushes" 6. May initiate sexual activity

Question 30

Family Support

Answer 30

1. Adolescents who perceive that they have good communication and are bonded with an adult are less likely to engage in risky behaviors 2. Parents who provide supervision and are involved with their adolescents activities are promoting a safe environment in which to explore opportunities

Question 31

Bullying

Answer 31

Sexual orientation is a big risk | 1. schools can help by implementing anti discrimination and anti harassment policies

Question 32

Impact of tech

Answer 32

1. education benefits vs risks | 2. nursing role

Question 33

Middle Adolescence (ages 14-17)

Answer 33

1. Safety (MVC major cause of death in teens) 2. Promotion of healthy relationships 3. Sleep (need 8.5-9.5) 4. Diet and hydration (can cause headache, fatigue, nausea, weakness, crankiness and poor concentration) 5. mental health issues

Question 34

Late Adolescence (17+)

Answer 34

1. Promoting Transitions - PCP, self report of concerns and health history, management of meds 2. Safety focus continues 3. Prevention of long term health issues

Question 35

Health promotion for young adults

Answer 35

1. Complete, confidential physical before leaving high school 2. update immunizations 3. 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 4. Discuss strategies for "adult" health maintenance, revisit any chronic concerns 5. Praise for successful transition 6. Plans for beyond school 7. Address any chronic health conditions REITERATE SAFETY

Question 36

Ensure Confidentiality

Answer 36

1. talk to teen alone (gentle parentectomy) 2. Discuss privacy at the start of the interview 3. Normalize teen being independent for care 4. Know what MUST be reported (abuse, sexual relationships, STD's, suicide ideology, self harm, serious health concerns)

Question 37

NC and family planning clinics

Answer 37

1. Minor may consent to contraceptive services (outside of public school clinics) 2. Minor may consent to testing and treatment for STD (HPV vaccine is included in this) 3. parental consent required before abortion (unless judge allows bypass) 4. Teens <18 are not emancipated as parents in NC

Question 38

Promoting Health

Answer 38

1. Developmentally appropriate 2. Written 3. Discussion 4. Repeated messages 5. Social Media 6. Reliable resources for information and care

Question 39

Considerations

Answer 39

1. Culturally sensitive 2. With he parent/caregiver? 3. Memorable? 4. Use of resources

Question 40

Approach to teens

Answer 40

1. Consider the clinical situation (goal to be patient focused and family sensitive) 2. Know the law: patients >16 years old have a right to confidential care unless they are at risk for harm 3. Motivational interviewing: be mindful of the developmental stage (prescribing meds, negotiating procedures, discussing sleep, activities, risk factors and diet) 4. Discharge/health promotion teaching (verbal and written instructions for both teen and parent)