Session 3-Adolescent health

In the sports pre-participation physical, what is included?

-Heart-cardiac murmurs -Lungs-wheezing -MS screening-2 minute exam -Neuro-head injuries or concussions -Risk factors for sudden CV deaths during sports-history of dizziness or palpitations, prior episodes of syncope (esp. with exercise), FH of sudden death in young or middle aged relatives

At every WCC, adolescents should have their physical development assessed. What are these developments? (5 items)

-Ht, wt, BMI, BP -Tanner staging -Varicocele, gynecomastia may develop in males -Onset of menses -Ask about attitudes related to physical growth and development

What is included in patient education when a concussion has occurred?

-Rest (physical and mental) until symptoms resolve -No alcohol -No NSAIDS, ASA, sleeping pills -No head injury for 6 weeks to avoid second-impact syndrome

What immunizations are administered at 11-12 years old?

-Tdap -Meningococcal -HPV -Annual influenza (optional)

What are red flags in concussion injuries?

-Vomiting -Dizziness -Worsening HA -Double vision -Excessive drowsiness -Change in behavior -Weakness, numbness, imbalance, slurred speech

HEEADSSS: What questions would you ask in H?

-Who lives at home? -How are relationships with siblings, parents, relatives? -Who do you go to for advice? -What are the rules like at home? -Have you ever been homeless or in shelter care? -Have you ever been in foster care or a group home?

What are barriers to care for adolescent care?

-lack of confidentiality -poor communication -insensitive attitudes money, insurance, transportation -services

What age range does early adolescence cover?

11-14 years old

What age range does middle adolescence cover?

15-17 years old

What age range does late adolescence cover?

18-21 years old

How many positives must be answered in the acronym CRAFFT to require further follow-up?

2+ positive answers require further follow-up

CRAFFT: What does A stand for?

A: Do you ever use alcohol/drugs while you are by yourself, ALONE?

HEEADSSS: What questions would you ask in A?

Activities: -How do you like to spend your free time? -Hobbies, clubs, religious activities? -Do you play any sports? -How many hours of television/computer/video games per day/week?

What are the CDC guidelines for screening of sexually active female teens?

All sexually active females less than 25 years old should be screen annually for GC/CT

What are the CDC guidelines for screening of sexually active young males?

All sexually active young males should be screened annually for GC/CT

How often do you screen for syphilis in at-risk individuals?

Annually

In HIV-infected individuals, how often do you screen for all STDs?

At least annually for all STDs

Define puberty.

Biological process leading to fertility

CRAFFT: What does C stand for?

C: Have you ever ridden in a CAR driven by someone who was "high" or using alcohol/drugs?

What acronym is used for substance abuse in adolescents?

CRAFFT It is the gold standard set by the AAP

According to CDC, USPSTF, ACOG, and ACS, what are the cervical cancer screening guidelines?

Cervical cancer screening begins at 21 years old regardless of sexual activity

What are some don'ts when asking about sexuality?

Do not: Ask "are you sexually active"? Use gender-based pronouns when referring to sexual partners Use judgmental language Use slang unless patient offers it first

What are some do's when asking about sexuality?

Do: -Assure confidentiality -Explain why you are asking sensitive questions -Ask patient to describe specific sexual behaviors -Add "second tier" questions to assess comfort with behaviors

HEEADSSS: What questions would you ask in D?

Drugs: -Do you use any illicit drugs? -Have you ever done anything you regretted while high? -Context of use: socially, alone; how often? -Attitudes toward cutting back and/or quitting? -Have you ever received drug treatment or counseling? -How is your drug use supported? -Have you ever had any arrests?

Of the three stages of adolescence, which one is the hardest to transition?

Early adolescence

Which adolescence stage am I: -body conscious (eg, body changes leading to anxiety, comparing self to others -sexual feelings emerge -daydreaming common (eg, develop value system, change life goals)

Early adolescence

When is vision screening done for adolescents?

Early, middle, and late adolescence

HEEADSSS: What questions would you ask in the 1st E?

Education: -Where do you go to school and what grade are you in? -What kind of student are you? -Do you like school, your teachers? -Do you have friends at school? -How many days have you missed in the past year and what was the reason? -Have you ever had any educational setbacks and why? -Have there been any recent school changes? Employment: -Do you work after school? -What type of work do you do? -How many hours a week? -Do you help to pay for things at home? -What are your future career interests? -Do you have any home chores?

HEEADSSS: What questions would you ask in 2nd E?

Exercise/Eating: -Body image -What is your ideal weight? -What do you like about yourself? -Calcium, iron, fiber in diet? -How many meals do you eat per day? -Bowel movement pattern and problems? -Thin: do you exercise, have you ever vomited/used diuretics/laxatives? -Overweight: do you drink soda/juice, whole milk? Watch TV? Exercise?

CRAFFT: What does the 1st F stand for?

F: Do you ever FORGET things while using alcohol or drugs?

CRAFFT: What does the 2nd F stand for?

F: Do your family or FRIENDS ever tell you you should cut down?

What does each letter for the mnemonic HEEADSSS stand for?

H-home E-education/employment E-exercise/eating A-activities D-drugs S-sexuality S-suicidality/mental health S-safety

What is the mnemonic for the foundation of adolescent history in the review of systems?

H-home E-education/employment E-exercise/eating A-activities D-drugs S-sexuality S-suicidality/mental health S-safety

Which adolescence stage am i: -family relationships re-emerge -sexuality-responsible behaviors, pregnancy, STIs -completing academic work -new challenges-work, school or vocational training; transition into adult healthcare

Late adolescence

Which adolescence stage am I: -spend more than twice amount of time with peers than parents -parental conflict peaks -less concern about body changes, more concern about looking attractive -Explore ability to attract partner, dating and sexual experimentation -Feelings of omnipotence, invulnerability, immorality—leads to risk-taking behavior (sex, drugs, alcohol) -Often physical changes precede emotional maturity

Middle adolescence

When are lipids screened for adolescents?

Once in late adolescence, as needed based on risk

When do you screen for anemia and TB for adolescents?

Only if risk factors

CRAFFT: What does R stand for?

R: Do you ever use alcohol/drugs to RELAX, feel better about yourself, to fit in?

HEEADSSS: What questions would you ask in the 3rd S?

Safety: -Child abuse -Domestic/partner violence -School, peer, community violence -Sexual harrassment -Hate crime, bullying -Seat belts, drinking and driving -Helmets -Guns in the home

HEEADSSS: What questions would you ask in the 1st S?

Sexuality: -Are you romantically interested in men, women or both? -Are you dating/going out with someone? -There are many ways of being intimate or sexual—have you had any of these experiences? Which ones? With boys, girls or both? -Have you ever had sex with someone of your same gender? -For younger teens: when you imagine yourself in a relationship in the future, is it with a man, woman or both? -How do you protect yourself?

HEEADSSS: What questions would you ask in the 2nd S?

Suicide/depression/self-image: -What is your usual mood? Happy, sad, both? -What do you do to cope with or relive stress? -Have you ever received counseling and/or therapy? -Have you ever been in an psychiatric hospital? -What was the reason? -How long did you stay? -Have you ever thought of hurting yourself? -Have you ever tried to hurt or kill yourself? -Whom did you tell?

CRAFFT: What does the T stand for?

T: Have you ever gotten into TROUBLE while you were using alcohol or drugs?

If a patient comes in complaining of late menses or amenorrhea and admits to sexual activity without contraception, what lab would you do?

Urine HCG