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NURS 207: Promoting Pediatric Wellness in the Family & Community

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NURS 207: Promoting Pediatric Wellness in the Family & Community Elizabeth Hartman, MSN, RNC Allan J. V. Cresencia, MSN, RN Christine Limann, BSN, RN – PowerPoint PPT presentation

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Title: NURS 207: Promoting Pediatric Wellness in the Family & Community


1
NURS 207 Promoting Pediatric Wellness in the
Family Community
  • Elizabeth Hartman, MSN, RNC
  • Allan J. V. Cresencia, MSN, RN
  • Christine Limann, BSN, RN
  • West Coast University - Los Angeles

2
Health Promotion of the School-Age Child and
Family
  • Chapter 17

3
Promoting Optimum Growth and Development
  • School age generally defined as
  • 6 to 12 years
  • Physiologically begins with shedding of first
    deciduous teeth and ends at puberty with
    acquisition of final permanent teeth
  • Gradual growth and development
  • Progress with physical and emotional maturity

4
Shedding Deciduous Teeth
5
Maturation of Systems
  • Bladder capacity increases
  • Heart smaller in relation to the rest of body
  • Immune system increasingly effective
  • Bones increase in ossification
  • Physical maturity not necessarily correlated with
    emotional and social maturity

6
Prepubescence
  • Defined as 2 years preceding puberty
  • Typically occurs during preadolescence
  • Varying ages from 9 to 12 (girls about 2 years
    earlier than boys)
  • Average age of puberty is 12 in girls and 14 in
    boys

7
Psychosocial Development
  • Relationships center around same-sex peers
  • Freud described it as latency period of
    psychosexual development

8
EriksonDeveloping a Sense of Industry
  • Eager to develop skills and participate in
    meaningful and socially useful work
  • Acquire sense of personal and interpersonal
    competence
  • Growing sense of independence
  • Peer approval is strong motivator

9
School-Age Children Are Motivated to Complete
Tasks
10
Erikson Inferiority
  • Feelings may derive from self or social
    environment
  • May occur if incapable or unprepared to assume
    the responsibilities associated with developing a
    sense of accomplishment
  • All children feel some degree of inferiority
    regarding skill(s) they cannot master

11
Piaget Cognitive Development
  • Concrete operations
  • Use thought processes to experience events and
    actions
  • Develop understanding of relationships between
    things and ideas
  • Able to make judgments based on reason
    (conceptual thinking)
  • CONSERVATION

12
School-Age Children Are Often Avid Collectors
13
Kohlberg Moral Development
  • Development of conscience and moral standards
  • Age 6 to 7 reward and punishment guide choices
  • Older school age able to judge an act by the
    intentions that prompted it
  • Rules and judgments become more founded on needs
    and desires of others

14
Spiritual Development
  • Children think in very concrete terms
  • Children expect punishment for misbehavior
  • May view illness or injury as punishment for a
    real or imagined misdeed

15
Children Are Comforted by Prayer
16
Language Development
  • Efficient language skills
  • Important linguistic accomplishments
  • Correct syntax, improved grammar, word usage
  • Metalinguistic awareness

17
Social Development
  • Importance of the peer group
  • Identification with peers is a strong influence
    in child gaining independence from parents
  • Sex roles strongly influenced by peer
    relationships

18
Engaging in Activities with a Best Friend
19
9-Year-Olds Club Rules
20
Relationships with Families
  • Parents are primary influence in shaping childs
    personality, behavior, and value system
  • Increasing independence from parents is primary
    goal of middle childhood
  • Children not ready to abandon parental control

21
Developing a Self-Concept
  • Definition a conscious awareness of a variety of
    self-perceptions (abilities, values, appearance,
    etc.)
  • Importance of significant adults in shaping
    childs self-concept
  • Positive self-concept leads to feelings of
    self-respect, self-confidence, and happiness

22
Developing a Body Image
  • Generally children like their physical selves
    less as they grow older
  • Body image is influenced by significant others
  • Increased awareness of differences may
    influence feelings of inferiority

23
Development of Sexuality
  • Normal curiosity of childhood
  • Attitudes toward sex
  • Use of terminology

24
Sex Education
  • Sex play as part of normal curiosity during
    preadolescence
  • Middle childhood is ideal time for formal sex
    education
  • Life span approach
  • Information on sexual maturity and process of
    reproduction
  • Effective communication with parents

25
Nurses Role in Sex Education
  • Treat sex as normal part of growth and
    development
  • Questions and answers
  • Differentiate between sex and sexuality
  • Values, problem-solving skills
  • Open for communication with parents

26
Play
  • Involves physical skill, intellectual ability,
    and fantasy
  • Children form groups, cliques, clubs, secret
    societies
  • Rules and rituals
  • See need for rules in games they play

27
Activities Vary by Interest and Opportunity
28
Play (cont.)
  • Team play
  • Quiet games and activities
  • Ego mastery

29
Selecting a Book with an Adult
30
Pride in Learning New Skills
31
Coping with Concerns Related to Normal Growth and
Development
  • School experience
  • Second only to the family as socializing agent
  • Transmission of values of the society
  • Peer relationships become increasingly important

32
Coping with Concerns Related to Normal Growth and
Development (cont.)
  • Teachers
  • Parents
  • Limit setting and discipline
  • Dishonest behavior
  • Stress and fear

33
Teachers Influence on Children
34
Latch-key Children
35
Promoting Optimum Health During the School Years
  • Nutrition
  • Importance of balanced diet to promote growth
  • Quality of diet related to familys pattern of
    eating
  • Fast-food concerns

36
Sleep and Rest
  • Average 9½ hours/night during school age but
    highly individualized
  • Ages 8 to 11 may resist going to bed
  • 12 years and up generally less resistant to
    bedtimes

37
Physical Activity
  • Exercise essential for development and function
  • Importance of physical fitness for children

38
Exercise and Activity
  • Sports
  • Controversy regarding early participation in
    competitive sports
  • Concerns with physical and emotional maturity in
    competitive environment
  • Acquisition of skills
  • Generally like competition

39
Music Is a Favorite Form of Expression
40
Performing Household Tasks
41
Dental Health
  • Permanent teeth eruption
  • Good dental hygiene
  • Prevention of dental caries
  • Malocclusion
  • Dental injury
  • Dental evulsionreplacement or reattachment

42
School Health
  • Responsibilities of parents, schools, and health
    departments
  • Ongoing assessment, screening, and referrals
  • Routine services, emergency care, and safety and
    infection control instruction
  • Increase knowledge of health and health habits

43
Injury Prevention
  • Most common cause of severe injury and death in
    school-age children is motor vehicle
    crashespedestrian and passenger
  • Bicycle injuriesbenefits of bike helmets
  • Appropriate safety equipment for all sports

44
Bicycle Safety
45
Anticipatory GuidanceCare of Families
  • Parents adjust to childs increasing independence
  • Parents provide support as unobtrusively as
    possible
  • Child moves from narrow family relationships to
    broader world of relationships

46
Health Problems of Middle Childhood
  • Chapter 18

47
DISORDERS AFFECTING THE SKIN
48
Purposes of the Skin
  • Protection
  • Impermeability
  • Heat regulation
  • Sensation

49
Origin of Skin Lesions
  • Contact with injurious agents
  • Hereditary factors
  • External factor that produces a reaction in the
    skin
  • Systemic disease in which lesions are a
    manifestation

50
Examples of Age-Related Skin Manifestations
  • Infants birthmarks
  • Early childhood atopic dermatitis
  • School-age children ringworm
  • Adolescents acne

51
Dermatitis
  • Pathophysiology
  • Diagnostic evaluation
  • History and symptoms pruritus, sensation
  • Objective findings lesion

52
Types of Lesions
  • Papule
  • Macule
  • Vesicle/bulla
  • Pustule
  • Cyst
  • Patch
  • Plaque
  • Wheal
  • Striae
  • Scale
  • Crust
  • Keloid
  • Fissure
  • Ulcer
  • Petechiae
  • Purpura
  • Ecchymosis

53
Nursing Considerations
  • Prevent spread of bacterial infection
  • Prevent complications

54
Viral Skin Infections
  • Most communicable diseases of childhood have
    characteristic rash
  • Examples verruca, herpes simplex types 1 and 2,
    varicella zoster, molluscum contagiosum

55
Fungal Skin Infections
  • Superficial infections that live on the skin
  • Also called dermatophytoses, tinea
  • Transmission person to person or infected animal
    to human
  • Examples tinea capitis, tinea corporis, tinea
    pedis, candidiasis

56
Scabies
  • Inflammation occurs 30 to 60 days after exposure
  • Topical treatment scabicides such as permethrin
    5 or lindane
  • Oral treatment ivermectin if body weight is
    greater than 15 kg

57
Scabies (cont.)
  • Caused by scabies mite as female burrows into the
    epidermis to deposit eggs and feces
  • Inflamed, intense pruritus, excoriation
  • Therapeutic management with scabicide (permethrin
    5 preferred) for 30 to 60 days
  • Treat all contacts
  • Nursing considerations

58
Pediculosis Capitis (Head Lice)
  • Very common, especially in school age
  • Adult louse lives only 48 hours without human
    host female louse has life span of 30 days
  • Females lay eggs (nits) at base of hair shaft
  • Nits hatch in 7 to 10 days
  • Treatment pediculicides and nit removal
  • Preventing spread and recurrence

59
Systemic Mycotic (Fungal) Infections
  • Invade viscera as well as the skin
  • Wide spectrum of disease
  • May appear as granulomatous ulcers, plaques,
    nodules, and abscesses

60
Rickettsial Infections
  • Intracellular parasites generally transmitted by
    infected fleas, ticks, and mites
  • Infections widely varied from benign and
    self-limiting to fatal

61
Lyme Disease
  • Most common tick-borne disorder in United States
  • Clinical stages
  • Diagnosis and therapeutic management
  • Vaccine against Lyme disease
  • Focus on prevention

62
Cat Scratch Disease (CSD)
  • Most common cause of regional lymphadenitis in
    pediatric population
  • Usually follows the scratch or bite of an animal
    (90 cats)
  • Usually benign, self-limiting course lasting 2 to
    4 months
  • Treatment supportive

63
Contact Dermatitis
  • Inflammatory reaction of skin to chemical
  • Initial reaction in the exposed region
  • Characteristic sharp delineation between inflamed
    and normal skin
  • Primary irritant
  • Sensitizing agent
  • Examples diaper dermatitis, reaction to wool,
    reaction to specific chemical

64
Poison Ivy, Oak, and Sumac
  • Produce localized lesions
  • Caused by urushiol from the plants leaves and
    stems
  • Sensitivity may develop after one or two
    exposures and may change over time
  • Therapeutic management

65
Poison Ivy
66
Foreign Bodies
  • Wood splinters
  • Cactus spines
  • May require medical treatment if difficult to see
    or remove

67
Sunburn
  • Ultraviolet A waves
  • Ultraviolet B waves
  • Importance of protection sunscreen

68
Cold Injury Chilblain
  • Redness/swelling especially of hands
  • Vasodilation, edema, bluish patches, itching
  • and burning symptoms continue after
  • rewarming
  • Usually resolve in a few days

69
Cold Injury Frostbite
  • Tissue damage due to ice crystals in tissues
  • Blisters appear 24 to 48 hours after rewarming
  • Treatment of blisters similar to burn treatment

70
Hypothermia
  • Definition less than 35 C
  • Effect of decrease in core temperature
  • Therapeutic management
  • Nursing considerations
  • Prevention

71
Drug Reactions
  • Adverse drug reactions are most often seen in
    skin (rashes most common reaction)
  • May be immediate or delayed following
    administration of the drug
  • Treatment discontinue the drug give
    antihistamines, corticosteroid therapy if severe

72
Erythema Multiforme Exudativum(Stevens-Johnson
Syndrome)
  • Onset with flulike symptoms
  • Balanitis, conjunctivitis, stomatitis
  • Erythematous, papular rash
  • Lesions on all surfaces (even palms and soles of
    feet) except scalp
  • Prognosis

73
Stevens-Johnson Syndrome
74
Toxic Epidermal Necrolysis (TEN)
  • Also called Lyell disease
  • Clinical appearance is same as for staphylococcal
    scalded skin syndrome (SSSS)
  • Protracted illness
  • 25 to 50 mortality
  • Precipitating factors antiseizure medications,
    sulfa, penicillin

75
Neurofibromatosis-1
  • Also called von Recklinghausen disease
  • Autosomal dominant
  • Initial presentation café-au-lait spots,
    pigmented nevi, axillary/inguinal freckling
  • Elephantiasis may occur
  • Nursing considerations

76
BITES AND STINGS
77
Arthropod Bites and Stings
  • May cause mild to moderate discomfort
  • Manage with symptomatic measures and prevention
    of secondary infection
  • Bees stinger penetrates the skin
  • Remove stinger ASAP
  • Sensitization to bee stings may result in
    anaphylaxis

78
Arachnid Bites
  • Most in United States are relatively harmless
  • Scorpions, brown recluse spider, and black widow
    spider inject venom potentially deadly

79
Ticks
  • Partially embed in skin as they feed
  • Remove by grasping tick close to point of
    attachment (with forceps)
  • Preventive measures

80
Mammal Bites
  • Common pediatric problem especially in children
    younger than 5 years old
  • Wound care
  • Prophylactic antibiotics for some types of bites
  • Rabies concern

81
Snakebites
  • Manifestations and morbidity are highly variable,
    based on species, size of snake, size of child,
    location of bite
  • Maintain a calm response to the victim
  • Apply loose tourniquet proximal to the bite DO
    NOT OCCLUDE SYSTEMIC CIRCULATION
  • Suction in appropriate cases

82
Human Bites
  • Lacerations from teeth of other humans
  • Risk of infection
  • Wound care

83
DENTAL DISORDERS
84
Dental Caries
  • Overall incidence decreased since introduction of
    fluoridation
  • Continues to be principal oral problem in
    pediatric population
  • Greatest vulnerability
  • Ages 4 to 8
  • Ages 12 to 18

85
Pathophysiology of Dental Caries
  • Multifactorial
  • Host
  • Microorganisms
  • Substrate
  • Time

86
Pathophysiology of Dental Caries (cont.)
  • Diagnostic evaluation
  • Therapeutic management
  • Plasticized sealant
  • Removal of carious portions
  • Restoration of involved teeth
  • Nursing considerations
  • Oral hygiene
  • Dietary influences

87
Periodontal Disease
  • Inflammatory and degenerative condition involving
    the gums and supporting tissues
  • Gingivitis
  • Periodontitis
  • Acute necrotizing ulcerative gingivitis (trench
    mouth)
  • Nursing considerations

88
Malocclusion
  • Heredity
  • Habits
  • Thumb sucking
  • Tongue thrusting
  • Orthodontic treatment
  • Nursing considerations

89
Dental Trauma
  • Tooth evulsion
  • Cold milk osmolality to maintain evulsed tooth
  • Reimplantation of teeth
  • Emotional response

90
DISORDERS OF CONTINENCE
91
Enuresis
  • Bed wetting
  • More common in boys
  • Usually ceases between 6 and 8 years of age
  • Diagnosis
  • Developmental age of more than 5 years
  • Two times per week or more for 3 months
  • May have urgency, frequency

92
Enuresis (cont.)
  • Organic causes
  • Structural defects
  • UTI, impaired kidney function, chronic renal
    failure
  • Neurologic deficits, endocrine disorders
    (diabetes)
  • Sickle cell disease
  • Bladder volume of 300 to 350 ml is sufficient to
    hold a nights urine

93
Psychologic Factors
  • Sleep more soundly than other children
  • Emotional factors
  • Familial tendency

94
Treatment for Enuresis
  • Drugs
  • Tofranil
  • Oxybutynin
  • DDAVP
  • Bladder training
  • Fluid restriction in evenings
  • Interruption of sleep to void
  • Conditioned reflex response device

95
Encopresis
  • Repeated voluntary or involuntary passage of
    feces of normal or near normal consistency into
    places not appropriate for that purpose
  • Not caused by any physiologic effect (e.g.,
    laxative) or medical problem
  • Primary encopresis fecal incontinence after age
    4 years
  • Secondary encopresis fecal incontinence in a
    child older than 4 years after period of prior
    established fecal continence

96
Encopresis (cont.)
  • More common in males
  • May follow psychological stress
  • May be secondary to constipation or impaction
  • Therapeutic management
  • Determine cause
  • Dietary intervention, management of constipation
  • Psychotherapeutic interventions

97
DISORDERS WITH BEHAVIORAL COMPONENTS
98
Attention Deficit Hyperactivity Disorder (ADHD)
  • Etiology unknown probably multifactorial
  • Inattention, impulsiveness, and hyperactivity
  • Typical onset before age 7
  • Diagnostic criteria for ADHD

99
Therapeutic Management of ADHD
  • Classroom
  • Family education and counseling
  • Behavioral therapy and/or psychotherapy for child
  • Environmental manipulation
  • Medication

100
Medications for ADHD
  • Not all children benefit from pharmacologic
    therapy
  • Stimulants
  • Dexedrine, Adderall
  • Ritalin
  • Side effects insomnia, anorexia and weight loss,
    hypertension long-term use may suppress growth

101
Learning Disability (LD)
  • Learning disability a heterogeneous group of
    disorders with difficulties in acquisition and
    use of listening, speaking, reading, writing,
    reasoning, math and/or social skills
  • Includes dyslexia, dysgraphia, dyscalculia,
    right/left confusion, and short attention span

102
Battery of Tests for LD and ADHD
  • IQ
  • Hand-eye coordination
  • Visual and auditory perception
  • Comprehension
  • Memory

103
Therapeutic Management of LD
  • Primarily educational interventions
  • Wide variation of diagnostic severity

104
Tic Disorders
  • Definition tic is an involuntary, recurrent,
    random, rapid, highly stereotyped movement or
    vocalization
  • Increases with stress, decreases markedly with
    sleep
  • Most are self-limiting, less than 1 year, usually
    resolve by late childhood or adolescence

105
Tourette Syndrome (TS)
  • Severe, complex form of tic disorder
  • Onset ages 2 to 16 persists throughout life
  • Etiology uncertain
  • Diagnostic criteria
  • Associated problems include ADHD, disruptive
    behavior, learning disabilities

106
Therapeutic Management of TS
  • Symptomatic treatment
  • Family support
  • Pharmacologic interventions
  • Nursing considerations

107
Posttraumatic Stress Disorder (PTSD)
  • Development of characteristic symptoms following
    exposure to extremely traumatic experience or
    catastrophic event
  • May function adequately but have foreboding
    regarding the future

108
PTSD Response to the Event
  • Initial response
  • Intense arousal lasts 1 to 2 hours
  • Fight or flight response
  • Second phase
  • Lasts approximately 2 weeks
  • Denial, period of quiescence
  • Third phase
  • Appears to get worse lasts 2 to 3 months

109
PTSD Symptoms
  • Depression, anxiety, conversion reactions
  • Phobic symptoms, repetitive actions
  • Flashbacks are common
  • Inquiry about what has happened
  • Nursing considerations

110
School Phobia
  • Defined as extreme reluctance to attend school
    for a sustained period as a result of severe
    anxiety or fear of school-related experiences
  • Also called school refusal and school
    avoidance
  • Most common in children older than 10 years

111
School Phobia (cont.)
  • Physical symptoms
  • Symptoms subside after staying at home
  • No symptoms on weekends, holidays, etc.
  • Nursing considerations

112
Recurrent Abdominal Pain (RAP)
  • May have psychogenic origin
  • May have real pain
  • Psychological aspects
  • Nursing considerations

113
Conversion Reactions
  • Also called hysteria, hysterical conversion
    reaction, and childhood hysteria
  • Sudden onset, traced to a precipitating event
  • Symptoms abdominal pain, fainting,
    pseudoseizures, paralysis, headaches, visual
    field restriction
  • Rule out true seizures with EEG

114
Childhood Depression
  • Temporary acute depression precipitated by a
    traumatic event
  • Chronic depression
  • May accompany chronic illness or disability
  • Familial circumstances
  • Nursing considerations

115
Childhood Schizophrenia
  • Severe deviation in ego functioning
  • Psychotic disorder that appears after ages 4 to 5
  • Characterized by gradual onset of neurotic
    symptoms
  • Lack of contact with reality A world of his
    own
  • Nursing considerations

116
Health Promotion of the Adolescent and Family
  • Chapter 19

117
Promoting Optimum Growth and Development
  • Complex interplay of biologic, cognitive,
    psychologic, and social change, perhaps more so
    than at any other time of life
  • Change on multiple levels
  • Biologic maturation
  • Cognitive development
  • Psychologic development

118
Adolescence
  • Early ages 11 to 14
  • Middle ages 15 to 17
  • Late ages 18 to 20

119
Biologic Development
  • Neuroendocrine events of puberty

120
Hormonal Interaction Between Hypothalamus,
Pituitary, and Gonads
121
Changes in Reproductive Hormones
  • Females
  • Menarche
  • Ovulation
  • Males

122
Pubertal Sexual Maturation
  • Tanner stages 1 through 5

123
COGNITIVE DEVELOPMENT
124
Piaget Emergence of Formal Operational Thought
  • Formal operational thinking ages 11 to 14
  • Abstract terms, possibilities, and hypotheses
  • Decision-making abilities increase
  • May not use formal operational thought and
    reasoned decision making all the time choices
  • ADAPTATION

125
Adolescent Conceptions of Self
  • Adolescent egocentrism
  • Self-absorption
  • Health-related beliefs
  • Imaginary audience (everyone is watching)
  • Personal fable (wont happen to me)

126
Changes in Social Cognition
  • Understanding of others thoughts and feelings
  • Mutual role taking
  • Effect on health-related choices

127
Development of Value Autonomy
  • Struggle to clarify values
  • Development of a personal value system
  • Gradual process in late adolescence

128
Moral Development
  • Parallels advances in reasoning and social
    cognition
  • Conventional level of moral reasoning
  • Principled moral reasoning

129
Spiritual Development
  • Religious beliefs may become more abstract during
    adolescence
  • Late adolescents may reexamine and reevaluate
    beliefs and values of their childhood

130
PSYCHOSOCIAL DEVELOPMENT
131
Identity Development
  • Social forces shape sense of self
  • Identity achievement
  • Moratorium
  • Foreclosure
  • Identity diffusion

132
Development of Autonomy
  • Emotional autonomy
  • Behavioral autonomy
  • Value autonomy

133
Achievement
  • Development of motives, capabilities, interests,
    and behaviors
  • Progress toward occupational achievement
  • Relationship between social class and educational
    and occupational achievement

134
Sexuality
  • Hormonal, physical, cognitive, and social changes
    affect sexual development
  • Body image
  • Sexual identity
  • Sexual orientation

135
Romantic Relationships Are Important During
Adolescence
136
Intimacy
  • Intimate relationship begins to emerge in
    adolescence
  • Developmental course of intimacy
  • Self-focused
  • Role focused
  • Individual connected

137
Social Environments
  • Ecological model
  • Microsystems
  • Mesosystems
  • Exosystems
  • Macrosystems

138
Families
  • Changes in family structure and parent employment
  • Parenting styles
  • Socioeconomic influences

139
Peer Groups
  • Significance in socialization
  • Significance in development
  • Value placed on peer relationships

140
The Peer Group Influences Adolescent Development
141
Schools
  • Play increasingly important role in preparation
    for adulthood
  • Parental involvement in schools
  • Effect of academic success or failure on
    self-esteem

142
Work
  • Workplace as fourth microsystem
  • Positive or negative
  • May encourage development of intellectual and
    social skills, autonomy
  • May result in decreased interest in school, fewer
    extracurricular activities, and poorer grades

143
Community and Society
  • Media influences
  • Communitys economic resources play role in
    health and well-being of young people
  • Resources for health promotion

144
Promoting Optimum Health During Adolescence
  • Empowering individuals, families, and communities
  • Power, authority, and opportunities to make
    healthy choices
  • Risk reduction in areas of mental health,
    substance use, sexual behavior, violence,
    unintentional injury, nutrition, physical
    activity and fitness, and oral health

145
Adolescents Perspectives on Health
  • Factors promoting adolescent health and
    well-being
  • Contexts for adolescent health promotion
  • School-based and school-linked health services
  • Adolescent health screening
  • Safe times method for screening interviews
    with teens

146
Health Concerns of Adolescence
  • Parenting and family adjustment
  • Psychosocial adjustment
  • Intentional and unintentional injury
  • Dietary habits, eating disorders, and obesity
  • Physical fitness

147
Snacking on Empty Calories Is Common Among
Adolescents
148
Adolescent Physical Fitness
149
Health Concerns of Adolescence (cont.)
  • Sexual behavior, STDs, and unintended pregnancy
  • Use of tobacco, alcohol, and other substances
  • Depression and suicide
  • Physical, sexual, and emotional abuse

150
Coping with Stress
151
Health Concerns of Adolescence(cont.)
  • School and learning problems
  • Hypertension
  • Hyperlipidemia
  • Infectious diseases/immunizations

152
Health Promotion Among Special Groups of
Adolescents
  • Adolescents of color
  • Gay, lesbian, and bisexual adolescents
  • Rural adolescents

153
Physical Health Problems of Adolescence
  • Chapter 20

154
Acne
  • More than 50 of adolescents affected
  • Etiology
  • Familial aspect
  • Hormonal influence
  • Other influences
  • Psychosocial ramifications
  • Self-esteem issues

155
Acne (cont.)
  • Pathophysiology
  • Involves hair follicle and sebaceous glands
  • Comedogenesis
  • Therapeutic management
  • General measures/overall health
  • Medications
  • Nursing considerations

156
Vision Changes
  • Refractory errors peak in adolescence due to
    growth spurts
  • Vision screening
  • Myopia most common

157
Male Reproductive Health Problems
  • Penile problems
  • Uncorrected congenital problems
  • HPV
  • Trauma

158
Testicular Tumors
  • Usually malignant
  • Testicular CA is most common solid tumor in males
    ages 15 to 34
  • Testicular self-examination (TSE)

159
Varicocele
  • Usually asymptomatic scrotal mass or aching
    sensation
  • Occurs in about 15 of males
  • Varicocelectomy controversial in adolescence

160
Epididymitis
  • Causes
  • Infection (bacterial or viral)
  • Chemical irritant
  • Local trauma
  • Presentation pain, redness, swelling
  • Treatment analgesics, antibiotics, supportive
    care

161
Testicular Torsion
  • Partial or complete venous occlusion with
    rotation of testicle
  • Occurrence 1 in 4000 males
  • Peak onset age 13
  • Surgical emergency to prevent necrosis
  • Nursing considerations

162
Gynecomastia
  • Normal if transient (less than 1 years duration)
    and during puberty
  • Prepubescent or Tanner stage 5 need evaluation
    for adrenal or gonadal tumors, liver disease, or
    Klinefelter syndrome
  • Drug induced Ca channel blockers, H2 blockers,
    ketoconazoles, possibly marijuana

163
Female Reproductive Health Problems
  • Gynecologic examination indicated
  • Menstrual disorders
  • Undiagnosed abdominal pain or pelvic mass
  • Sexually active and/or request contraception
  • Rape
  • Virginal, 18 years old
  • Requested by patient

164
Menstrual Disorders
  • Primary amenorrhea no menses by age 17
  • Secondary amenorrhea no menses for
  • 6 months in previously menstruating female
  • Irregular menses common in adolescence

165
Causes of Primary Amenorrhea
  • Structural abnormality septum, hymen, female
    circumcision
  • Unresponsive to hormonal stimulation
  • Hypothalamic, pituitary, ovarian, uterine origin
  • Systemic disorders
  • Thyroid dysfunction, prolonged or severe
    infections, adrenal hyperplasia, DM, obesity,
    malnutrition

166
Causes of Secondary Amenorrhea
  • Most common cause pregnancy
  • Stress, chronic illness, polycystic ovarian
    disease, anorexia, ovarian disturbance,
    phenothiazines, heroin

167
Menstrual Irregularities in the Female Athlete
  • Delayed menarche
  • Anovulation with dysfunctional bleeding
  • Oligomenorrhea or amenorrhea with hypoestrogenic
    states
  • Treatment options trial of decreased exercise,
    oral contraceptives

168
Dysmenorrhea
  • Primary dysmenorrhea
  • Secondary dysmenorrhea
  • Therapeutic management
  • NSAIDs
  • Estrogen therapy
  • Oral contraceptives
  • Dietary changes
  • Exercises, comfort measures

169
Endometriosis
  • Definition presence of endometrial glands and
    stroma outside of the normal intrauterine
    endometrial cavity
  • Etiology unclear
  • Treatment medical, surgical, pharmacologic
    suppression
  • Nursing considerations

170
Premenstrual Syndrome (PMS)
  • Symptoms
  • Diagnosis
  • Therapeutics
  • SSRIs
  • Nutrition/nutritional supplements
  • Supportive care

171
Dysfunctional Uterine Bleeding (DUB)
  • Occurs in absence of pregnancy, infection,
    neoplasms, and known pathology
  • Usually with anovulation
  • Hormonal therapy treatments
  • Surgical treatment (DC)
  • Nursing considerations

172
Vaginitis and Vulvitis
  • Causes may be physical, chemical, or infectious
  • Diagnosis confirmed by vaginal exam, microscopic
    evaluation of vaginal secretions
  • Health teaching

173
Infections
  • Candidiasis
  • Trichomoniasis
  • Bacterial vaginosis (BV)

174
Health Problems Related to Sexuality
  • Sexual activity among adolescents
  • Sexual risk-taking behaviors
  • Family influences
  • Peer influences

175
Adolescent Pregnancy
  • Rates of teen pregnancy in United States
  • Physiologic aspects
  • Pregnancy risks associated with teen pregnancy
  • Nutritional needs

176
Infants of Adolescent Mothers
  • Higher risk of prematurity
  • Higher incidence of low birth weight
  • Potential for developmental delay
  • Cumulative risk factors for infant

177
Social and Economic Effects of Teen Pregnancy
  • School/education disruption
  • Social relationship deprivation
  • Statistical risk of poverty
  • Emotional effect on infant and parents

178
Adolescent Fathers
  • Changing social expectations
  • Legal rights
  • Emotional effect
  • Parenting skill development
  • Economic effect

179
Adolescent Abortion
  • Roe v. Wade 1973
  • Counseling
  • Associated risks

180
Contraception
  • Methods
  • Prescription and nonprescription
  • Use of contraception
  • Conflict about sexual activity
  • Desire for pregnancy
  • Nursing considerations

181
Rape
  • SANEsexual assault nurse examiners
  • Diagnostic evaluation
  • Obtain account of incident
  • Sensitivity to victims emotional status
  • Physical evidence
  • Vaginal secretions for evidence of sperm, blood,
    DNA
  • GC culture to rule out preexisting condition
  • HIV testing, other STD testing initially and at
    appropriate intervals

182
STDs
  • Major cause of morbidity during adolescence and
    young adulthood
  • Strong relationship between STDs and infertility
  • Transmission and follow-up of contacts

183
Gonorrhea
  • Cause Neisseria gonorrhoeae
  • Clinical manifestations
  • Diagnosis
  • Therapeutic management
  • Prevention

184
Chlamydia
  • Cause bacterium Chlamydia trachomatis
  • Clinical manifestations
  • Diagnosis
  • Therapeutic management
  • Prevention

185
Human Papillomavirus
  • Anogenital warts
  • Strong link to cervical carcinoma
  • Clinical manifestations
  • Diagnosis
  • Therapeutic management
  • Prevention

186
Pelvic Inflammatory Disease (PID)
  • Infection of upper genital tract
  • Tubo-ovarian abcess
  • Salpingitis
  • Long-term effects infertility due to tubal
    scarring
  • Symptoms
  • Therapeutics
  • Nursing considerations

187
HIV and AIDS
  • Time lag between infection with HIV and
    development of clinical AIDS
  • Transmission
  • Follow-up of sexual contacts
  • Adolescent perception of risk of AIDS

188
Hepatitis B Virus (HBV)
  • Transmission via body fluids
  • Effects on liver
  • Maternal-infant transmission
  • Immunization
  • Series begun at birth
  • Series of three IM injections
  • Goal to target children before onset of high-risk
    behaviors

189
Behavioral Health Problems of Adolescence
  • Chapter 21

190
Obesity
  • Defined as increase in body weight due to
    accumulation of excessive body fat relative to
    lean body mass
  • Obese generally considered when weight more than
    95th percentile for age, gender, and height
  • Overweight generally considered when more than
    90th percentile
  • 25 to 30 of children are obese

191
Complex Relationships in Adolescent Obesity
192
Effect of Childhood Obesity
  • Increase in type 2 diabetes
  • Risk of adult obesity
  • Hypertension, hyperlipidemia, cardiovascular
    disease
  • Social isolation, low self-esteem, depression

193
Causes of Childhood Obesity
  • 5 due to underlying disease (hypothyroidism,
    other metabolic disease, CNS disorders)
  • Role of heredity
  • Inactivity
  • Patterns of eating behaviors

194
Diagnostic Evaluation
  • Skinfold measurements
  • Body mass index (BMI) calculations
  • Body fat measurements
  • Diagnostics to rule out metabolic and endocrine
    disorders

195
Nursing Considerations
  • Assessment, planning, implementation
  • Diet, exercise, behavioral and group therapy
  • Prevention, evaluation
  • Medical therapies
  • Pharmacologic generally not recommended in
    children
  • Surgical hazardous in children

196
Anorexia Nervosa (AN)
  • Eating disorder refusal to maintain normal body
    weight
  • Primarily in adolescent and young adult females
  • Mean age of onset 13.75 years, ranging from 10 to
    25 years or more
  • LIFE THREATENING!

197
Etiology/Pathophysiology of AN
  • Etiology unclear
  • Distinct psychological component
  • Diagnosis based on psychological and behavioral
    criteria
  • Relentless pursuit of thinness
  • Distorted body image
  • Media influence
  • Concept of control

198
Clinical Manifestations of AN
  • Severe weight loss
  • Altered metabolic activity
  • Amenorrhea
  • Bradycardia, decreased BP
  • Hypothermia, cold intolerance
  • Dry skin, brittle hair and nails
  • Appearance of lanugo

199
Therapeutic Management of AN
  • Treat life-threatening malnutrition
  • IV, tube feedings
  • Monitor CV status
  • Behavior modification
  • Long-term (lifelong?) treatment and management

200
Bulimia
  • Eating disorder characterized by binge eating
  • May be followed by purging behaviors
  • Laxative abuse
  • Self-induced vomiting
  • Diuretic abuse
  • Rigorous exercise regimens
  • Up to eight or more cycles per day

201
Bulimia (cont.)
  • Weight may be normal or slightly above
  • Weight may be low bulimarexia
  • Tooth erosion, esophageal damage, other GI
    concerns
  • Psychologic issues
  • Self-deprecating thoughts, depressed mood
  • History of unsuccessful dieting, overweight in
    childhood
  • Low impulse control

202
Therapeutic Management
  • Similar to anorexia management
  • Hospitalization to treat potassium depletion,
    esophageal damage
  • Cardiac monitoring indicated
  • Behavioral management

203
Fear of Fat Syndrome
  • Differs from AN
  • Worry that being overweight will make them
    physically unattractive, jeopardize their health,
    and shorten life span
  • Diets lacking in iron, calcium, zinc
  • May stop growing and have delayed puberty

204
Substance Abuse
  • Drug abuse, misuse, and addiction
  • Voluntary behaviors
  • Culturally defined
  • Use of drugs for other than acceptable medical
    purpose
  • Drug tolerance and physical dependence
  • Involuntary physical responses

205
Types of Drugs Abused
  • Tobacco
  • Alcohol
  • Cocaine
  • Narcotics
  • CNS depressants
  • CNS stimulants
  • Hallucinogens
  • Inhalants

206
Nursing Considerations
  • Acute care
  • Long-term management
  • Family needs/family support
  • Prevention

207
Suicide
  • Third leading cause of death in teens
  • Suicide
  • Suicidal ideation
  • Suicide attempt/parasuicide

208
Suicide (cont.)
  • Etiology
  • Methods
  • Motivation
  • Diagnostic evaluation/therapeutic management
  • Nursing considerations
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