Week 4 Flashcards

(55 cards)

1
Q

School aged child (6-12) - physical growth (6)

A
  • 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
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2
Q

School aged child (6-12) - sensory (3)

A
  • can read
  • conversion develops
  • able to concentrate for longer periods on activities
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3
Q

School aged child (6-12) - motor skills (General)

A
  • finishing touches on school and sport
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4
Q

School aged child (6-12) - fine motor skills

A
  • enjoys craft projects
  • cards and board games
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5
Q

School aged child (6-12) - gross motor skills

A
  • two-wheeler (training wheels)
  • jump rope
  • ice skates
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6
Q

School aged child (6-12) - stages of play

A
  • cooperative play, learning social component of play
  • when hospitalized, feel the need for socialization
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7
Q

School aged child (6-12) - Communication

A
  • vocab increases
  • cleaning up pronunciations and grammar
  • when hospitalized they need simple vocabulary
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8
Q

School aged child (6-12) - sexuality (4)

A
  • 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
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9
Q

Puberty/physical growth - females (4)

A
  • 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)
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10
Q

Puberty/physical growth - males (3)

A
  • 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)
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11
Q

Adolescence (12-18) - sensory

A

fully developed

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12
Q

Adolescence (12-18) - motor skills fine

A

skills well developed

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13
Q

Adolescence (12-18) - gross motor skills

A
  • muscle development continues
  • lack of coordination common during growth spurt
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14
Q

12-14 years (early adolescence) - psychosocial development (6)

A
  • 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
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15
Q

15-17 years (mid adolescence) psychosocial development (8)

A
  • 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
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16
Q

18-21 (late adolescence) - psychosocial development (6)

A
  • 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
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17
Q

History taking adolescents (10)

A
  • 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)
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18
Q

Psychosocial evaluation - HEEADSSS

A

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)

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19
Q

Adolescents - sexuality

A
  • 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
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20
Q

Sexual health - adolescents

A
  • related physical and psychosocial development
  • sexual function
  • attitudes and behaviours
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21
Q

Importance of scripted verbiage in sexual health

A
  • 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?
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22
Q

Sexual health questions (6)

A
  • 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?
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23
Q

Safe sex and teens (7)

A
  • 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
24
Q

Sexual health - LGBT

A
  • 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
25
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
26
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
27
Risks of oral contraceptives (6)
- venous thromboembolism - myocardial infarction - stroke - gallbladder disease - breast cancer - cervical cancer . slim risks, but it does happen
28
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)
29
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
30
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
31
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)
32
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
33
Follow up - teen pregnancy
- keep in contact with all individuals who were pregnant (edu and guidance) - assessment and counselling for drug and alc abuse
34
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
35
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
36
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
37
Vaccinations and STIs
- all adolescents should be considered to be given hepatitis B virus and human papillomavirus vaccines (HPV)
38
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
39
Screening for substance use
- any friends use tobacco, alcohol, others - ever fell pressured to use any of these in social situations?
40
Assess substance
crafft mnemonic
41
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
42
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
43
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
44
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
45
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
46
Complications of obesity - psychological and social (3)
- discrimination - low self esteem - bullying and victimization
47
Obesity treatment (6)
- diet - physical activity - behaviour modification (focus social and behavioural aspects of food) - family involvement - drugs (orlistat) - PREVENTION
48
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
49
Acne - mild
non-inflammatory comedones (no colour)
50
acne - moderate
- inflammatory papules, pustules, comedones - mild disease on chest and back
51
acne - moderately severe
- inflammatory, numerous papules, localized cysts or nodules, - face, chest, back
52
acne - severe
- nodular and cystic acne on face back chest - numerous cystic lesions that may connect - pustules may be present
53
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)
54
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
55