Adolescent Health Assessment Chapter 9 PDF

Chapter 9: Adolescents (ages 13-18) - Old enough to tell you exactly what happened and how they feel - More sensitive to opinion of peers and intimidation of parents and body image - Do not delay evaluation if patient is embarrassed: get same sex person or have a witness of same sex...

Chapter 9: Adolescents (ages 13-18) - Old enough to tell you exactly what happened and how they feel - More sensitive to opinion of peers and intimidation of parents and body image - Do not delay evaluation if patient is embarrassed: get same sex person or have a witness of same sex person - Average menarche age- 12.1 - First sign of male puberty- testicular enlargement - Track puberty changes with the Sexual Maturation Scale (SMS) or Tanner Stages - Perform additional workup if testicular enlargement occurs before 9 years or nothing by 14 years. Also, if breast buds appear for girls at age 8 or nothing by age 13 - A distinguishing feature of adolescent thought is abstract reasoning (attained by age 15) - Can understand and create general principles or rules to explain aspects of human experience - Most exasperating to parents is that they can reason well in academic subjects but at the same time exhibit illogical thinking about their own lives (normal to argue, tantrums, dramatic) - Also egocentric, leading to risk-taking behavior - Major task of adolescence: quest for identity Adolescent Health Assessment - Take a comprehensive health history- have parents there for an initial interview to assess family and patient medical, mental health, and surgical history. Discuss family practices (household smoking, rules, meals, and safety). Having a parent at the initial interview allows one to observe their relationship. After asking the parent about their concerns, have them leave the visit to give the adolescent privacy. After the physical assessment, vision, and hearing, use pneumonic HEADSSS FIRST (ask about home environment, education, employment, eating, peer-related activities, drugs, sexuality, suicide, depression, and safety and violence. - Substance abuse- CRAFT - Depression- PHQ 2 and PHQ 9 - Anxiety- GAD 7 - Sexual health- condom use, contraception options, can seek care without parental consent - Physical exam- Prearticipation for sports that includes height, weight, vital signs, BMI - PAP test- begins at age 21, routine STI tests - Precollege visits- immunizations, anticipatory guidance related to contraception, risks and prevention of STIs, responsible sexual behaviors, prevention of sexual assault, cardiovascular health (nutrition, exercise, smoking), injury prevention (car and campus safety), and mental health (stress, substance abuse, eating disorders, campus resources). - Health promotion and adolescents- immunization updating at annual visits - TB screening- if required for college or employment, or close contact with diseased person, person from foreign country where TB is common, medically underserved and low income populations. - MCV at age 11-12 and 16 years - Tdap at age 7-10 years then age 11-12 booster