Pediatrics, Chap 17, Health Promotion of The Adolescent, (11 - 20 yrs).

The period of adolescence is a period of what ?

- Adolescence is a period of transition between childhood and adulthood.

What are topical retinoids ?

- Preferred treatment for "Acne Vulgaris" - Destroys comedones and prevents new ones. - Has anti-inflammatory activity - [Examples include]: 1. Tretinoin (retin-A), 2. tazarotene 3. adapolene (OTC)

What are four examples of an inflamed lesion ?

1. Papules 2. Pustules 3. Nodules 4. Cysts

The initial appearance of pubic hair on the male adolescent is a characterization of what in regards to the sexual maturation of boys ?

- (Early Puberty) - NOTE: Penile enlargement begins, and testicular enlargement and pubic hair growth continue throughout (mid puberty).

What is the fundamental biologic change occurring during adolescence ?

- (Puberty), predictable sequence of hormonal and physical changes that occur universally over a period of time. (encompasses both sexual, and physical growth). - Event triggered by hormonal influences and are controlled by the anterior pituitary gland In response to a stimulus from the hypothalamus.

Precocious puberty in boys may be a concern if secondary sex characteristics occur before what age ?

- 9 years of age. - Precocious puberty is when a Childs body begins changing into that of an adult (puberty) too soon.

Current research states that adolescence involves a complex interplay of what factors ?

- Adolescence involves a complex interplay of biologic, cognitive, psychologic, and social change, perhaps more so than any other time of life.

In regards to nutrition and exercise what are some recommendations for optimal growth and development during adolescence ?

- All well visits should include a nutritional and exercise screen. - Desirable BMI is between 5th and 84th percentile. - Discuss (exercise) with the adolescent, and its emotional, social and physical benefits. NOTE: - Heart Healthy activity levels include: - 1 hour/day of moderate-to-vigorous activity. - Vigorous activity 3 days/week. -Limit total media time to no more than 1-2 hours /day of quality programming.

When does peak height velocity occur in boys ?

- At about 14 years of age, after the growth of the testicles and penis and appearance of axillary hair.

What are the 5 characteristic of Piagets theory of "Formal Operational Thought" ?

- Begins between 11 - 14 years of age - Abstract Terms - Possibilities - Hypotheses - Future time perspective

During adolescence change occurs on multiple levels, what are some of the levels that change occur on ?

- Biologic Maturation - Cognitive Development - Psychologic Development Change also occurs in the social contexts: 1. Peer Groups 2. Workplaces 3. The Adolescents Family

Concerns about "pubertal delay" are associated with what characteristics of puberty ?

- Boys who exhibit no enlargement of testes or scrotal changes by ages (13 1/2 to 14). - If genital growth is not complete (4 years) after the testicles begin to enlarge.

In regards to the sexual development of the female adolescent, what are some expected changes that occur midpuberty ?

- Breast Enlargement occurs - Pubic hair progresses to adult-type sexual hair covering the mons pubis and Labia Majora. - NOTE: Most girls reach their peak height velocity and peak weight velocity in mid pubescence.

For a female adolescent, what are characteristics of pubertal delay ?

- Breast development has not occurred by age 13 years. - Menarche has not occurred within 2 to 2 2 1/2 years of onset of breast development.

In regards to the sexual maturation of girls what are the earliest most easily visible changes of puberty ?

- Changes in the nipple and areola. - Development of a small bud of breast tissue (thelarche). - - NOTE: The average age of (thelarche) for "Caucasian" girls is 10 years of age with a range of 8 to 12 3/4 years. - NOTE: The average age of thelarache for African American girl is earlier around 9 years with a range of 7 to 11 years. - NOTE; The average age of (thelarche) for Hispanic girls falls somewhere between the two other groups listed above.

What's the number one rule for the application of a retinoid and benzoyl-peroxide ?

- DO NOT apply topical retinoids and benzoyl peroxides at the same time. (unless using a combination product). - Apply topical retinoids at bedtime.

What are some descriptions of Piagets cognitive development in regards to the adolescent ?

- Emergence of Formal Operational Thought (Piaget) - The shift from childhood to adolescence as a movement from "concrete" to "formal operational thought". - For most children this formation occurs between the ages of 11 and 14 years. - being able to think in abstract terms - think about possibilities - think through hypotheses - the young person becomes able to think about abstractions. - Gain the ability to use of future time perspective

What's Benzoyl peroxide ?

- First line of treatment for "Acne Vulgaris" - Bactericidal - Effective for superficial inflammatory and non-inflammatory lesions - (Not) associated with antibiotic resistance - Teach about bleaching effect on linens and clothes.

In males, what does the Tanner Stages describe in relation to development ?

- In males the Tanner Stages describe pubertal development based on the size and shape of the penis and scrotum and the shape and distribution of pubic hair.

In regards to brain growth, what are the characteristics associated with "adolescence" ?

- Its a time of continued brain growth - The amount of neurons doesn't increase but there is a proliferation of support cells that brace and nourish the neurons, and an increase neural connections. - Developments of these connections in the cortex of the brain continue throughput adolescence, and may not reach adult levels until after the age of 20.

In regards to nutrition and exercise what is the recommended amount of caloric intake for the adolescent ?

- Most need over 2000 calories daily to support growth spurts. Note: (Some boys need > 3000).

What's the number 1 notable characteristic of "Salicylic Acid" Products in the treatment of "Acne Vulgaris" ?

- Not Preferred

In females , what does the Tanner Stages describe in relation to development ?

- Pubertal development based on breast size and the shape and distribution of pubic hair.

In regards to the sexual maturation of the adolescent , what are the main characteristics of the The Pubertal Growth Spurt ?

- Refers to the general increase in growth of the skeleton, muscles and internal organs. -- Which reaches peak rate at about 12 years of age in girls and about 14 years of age in boys. - NOTE: The age of onset, duration, and extent vary among each individual.

What is Isotretinoin (accutane) ?

- Reserved for severe cystic acne not responsive to other Tx. - (Highly Teratogenic) - (accutane) Adverse effects: Dry eyes, Nasal Irritation, are seen with the use of, isotretinoin, 13-cis-retinoic acid (Accutane) - For this to be prescribed the person has to be on 2 forms of birth control & (has to sign form).

In regards to the sexual maturation of adolescent males, what are the first pubescent changes noted in boys ?

- Testicular Enlargement accompanied by thinning, reddening, and increasing looseness of the scrotum. - NOTE: These changes usually occur between (9 1/2 and 14 years of age).

In regards to the sexual maturation of the adolescent female, when is the appearance of public hair expected to show up ?

- The appearance of pubic hair (pubarche) usually follows initial breast development by about 2 to 6 months. - NOTE: In a minority of normally developing girls, pubic hair may precede breast development. - NOTE: Early in puberty there is often an increase in the normal (vaginal discharge) "physiologic leukorrhea" - this associated with uterine development. - This is a sign that the uterus is preparing for menstruation.

What are some changes that occur in "midpuberty" in the male adolescent ?

- The boy undergoes increasing muscularity. - Early voice changes. - Development of Facial Hair. - Axillary Hair develops - Facial Hair extends to cover the anterior neck. - Final voice changes occur secondary to the larynx. - Gynechomastia (breast enlargement) also occurs and is common. (breast enlargement disappears in 2 within 2 years). - Spurts in height and weight occur concurrently towards the end of midpuberty. - Increase in length and width of penis, testicular enlargement continues. (first ejaculation occurs).

What is the hallmark of late puberty ?

- The first menstrual period or menarche... is the hallmark sign of late puberty.

In regards to the psychosocial development of the Adolescent, what are the characteristics of Erikson's Theory (Identity vs. Role Confusion) ?

- The task if to develop a stable, coherent picture of oneself that includes integrating ones past and present experiences with a sense of where one is headed in the future. - Ability to maintain a commitment to choices under all conditions. (sexual identity is apart of this).

What is the task of identity formation in Erikson's psychosocial developmental theory for the adolescent ?

- The task of identity formation is to develop a stable, coherent picture of oneself that includes integrating ones past and present experiences with a sense of where one is headed in the future.

In regards to nutrition and exercise what are some characteristics associated with this stage of development in the adolescent ?

- They are preparing most of their own foods, and eating with friends. - Need four servings of dairy during growth spurt. - Many teens have been found to be vitamin D deficient. - 17% of 12 - 19 yo. are obese: BMI is greater than or equal to the 95th percentile. CDC

What are the characteristics of the initial menstrual periods ?

- They are usually scanty, and irregular and may not be accompanied by ovulation.

When does ovulation and regular menstrual periods begin in the adolescent female ?

- They usually begin 6 to 14 months after menarche. - Menarche usually occurs about 2 years after the appearance of breast buds, approx. 9 months after the attainment of peak height velocity, and 3 months after the attainment peak weight velocity.

During "adolescence" how does the development of secondary sexual characteristics occur ?

- This process occurs in a predictable sequence - and the sequence is divided into. (five stages) termed the "Tanner Stages". - NOTE: Although the sequence of sexual development is predictable, the ages at which these changes occur, and the rate at which they occur vary considerably among individuals.

When does peak height velocity occur in girls ?

- at about 12 year of age. - around 6 - 12 months before menarche. - NOTE: Cessation of growth in height occurs about 2 to 2 1/2 years after menarche in girls.

What are the characteristics of a "topical antibacterial agent" ?

- indicated for inflammatory lesions (Acne Vulgaris). - Examples Include: 1. Erythromycin, 2. Clindamycin, 3. Tetracycline, and others. - Combination Tx. Include: abx/retinoid or abx/benzoyl alcohol together. - Oral antibiotics

What are the "six general measures" for prevention, and control of Acne Vulgaris ?

1. Adequate Rest 2. Moderate Exercise 3. Well Balanced Diet 4. Reduction of Emotional Stress 5. Eliminating Foci of Infection 6. Developing a good skin care regimen

What are eight considerations you should consider in regards to health promotion of the adolescent and, "Acne Vulgaris" ?

1. Assess, do not underestimate psychosocial effects. 2. Encourage early medical treatment if needed 3. Stress to avoid sun/use sunscreen for retinoids and tetracyclines. 4. Instruct not to pick or squeeze lesions. 5. Explain gentle cleansing with mild soap. 6. Length of time to expect improvement. 7. Encourage compliance and return appointments 8. Contraception

What are the "three categories" of topical treatment for Acne Vulgaris ?

1. Benzoyl Peroxide 2. Salicylic Acid 3. Topical Retinoids

Acne vulgaris is the common form of acne seen during adolescence, what are two examples of Non-Inflamed lesions ?

1. Closed comedones (white head) 2. Open comedones (black head)

What are the 3 categories of skin care for Acne Vulgaris ?

1. [Cleansing] - Mild Cleanser 2 times a day (Dove, Cerave) 2. [Moisturizing] - noncomedogenic, non-acnegenic. 3. [Protection] - UVA protection (noncomedogenic, non-acengenic) to avoid post-inflammatory hyperpigmentation.

What are the "three distinct" sub-phases of adolescence ?

1. [Early Adolescence]: - (ages 11 to 14 yrs). - Characterized primarily by the changes of puberty and responses to those changes. 2. [Middle Adolescence]: - (ages 15 to 17 yrs). - Characterized by transition to a dominant peer orientation, with all the stereotypic adolescent preoccupations of music, technology, dress and appearance, language and behavior 3. [Late Adolescence]: - (ages 18 to 20 yrs). - Involves the transition into adulthood, including taking on adult work roles and developing adult relationships.