NURS 207: Promoting Pediatric Wellness in the Family

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

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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

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Shedding Deciduous Teeth
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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

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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

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School-Age Children Are Motivated to Complete
Tasks
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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

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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

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School-Age Children Are Often Avid Collectors
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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

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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

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Children Are Comforted by Prayer
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Language Development

• Efficient language skills
• Important linguistic accomplishments
• Correct syntax, improved grammar, word usage
• Metalinguistic awareness

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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

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Engaging in Activities with a Best Friend
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9-Year-Olds Club Rules
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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

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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

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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

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Development of Sexuality

• Normal curiosity of childhood
• Attitudes toward sex
• Use of terminology

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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

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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

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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

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Activities Vary by Interest and Opportunity
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Play (cont.)

• Team play
• Quiet games and activities
• Ego mastery

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Selecting a Book with an Adult
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Pride in Learning New Skills
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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

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Coping with Concerns Related to Normal Growth and
Development (cont.)

• Teachers
• Parents
• Limit setting and discipline
• Dishonest behavior
• Stress and fear

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Teachers Influence on Children
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Latch-key Children
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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

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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

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Physical Activity

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

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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

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Music Is a Favorite Form of Expression
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Performing Household Tasks
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Dental Health

• Permanent teeth eruption
• Good dental hygiene
• Prevention of dental caries
• Malocclusion
• Dental injury
• Dental evulsionreplacement or reattachment

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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

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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

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Bicycle Safety
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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

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Health Problems of Middle Childhood

• Chapter 18

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DISORDERS AFFECTING THE SKIN
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Purposes of the Skin

• Protection
• Impermeability
• Heat regulation
• Sensation

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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

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Examples of Age-Related Skin Manifestations

• Infants birthmarks
• Early childhood atopic dermatitis
• School-age children ringworm
• Adolescents acne

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Dermatitis

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

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Types of Lesions

• Papule
• Macule
• Vesicle/bulla
• Pustule
• Cyst
• Patch
• Plaque
• Wheal
• Striae

• Scale
• Crust
• Keloid
• Fissure
• Ulcer
• Petechiae
• Purpura
• Ecchymosis

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Nursing Considerations

• Prevent spread of bacterial infection
• Prevent complications

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Viral Skin Infections

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

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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

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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

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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

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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

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Systemic Mycotic (Fungal) Infections

• Invade viscera as well as the skin
• Wide spectrum of disease
• May appear as granulomatous ulcers, plaques,
  nodules, and abscesses

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Rickettsial Infections

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

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Lyme Disease

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

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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

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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

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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

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Poison Ivy
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Foreign Bodies

• Wood splinters
• Cactus spines
• May require medical treatment if difficult to see
  or remove

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Sunburn

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

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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

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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

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Hypothermia

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

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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

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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

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Stevens-Johnson Syndrome
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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

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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

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BITES AND STINGS
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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

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Arachnid Bites

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

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Ticks

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

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Mammal Bites

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

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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

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Human Bites

• Lacerations from teeth of other humans
• Risk of infection
• Wound care

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DENTAL DISORDERS
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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

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Pathophysiology of Dental Caries

• Multifactorial
• Host
• Microorganisms
• Substrate
• Time

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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

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Periodontal Disease

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

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Malocclusion

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

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Dental Trauma

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

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DISORDERS OF CONTINENCE
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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

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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

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Psychologic Factors

• Sleep more soundly than other children
• Emotional factors
• Familial tendency

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Treatment for Enuresis

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

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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

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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

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DISORDERS WITH BEHAVIORAL COMPONENTS
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Attention Deficit Hyperactivity Disorder (ADHD)

• Etiology unknown probably multifactorial
• Inattention, impulsiveness, and hyperactivity
• Typical onset before age 7
• Diagnostic criteria for ADHD

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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

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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

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Battery of Tests for LD and ADHD

• IQ
• Hand-eye coordination
• Visual and auditory perception
• Comprehension
• Memory

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Therapeutic Management of LD

• Primarily educational interventions
• Wide variation of diagnostic severity

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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

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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

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Therapeutic Management of TS

• Symptomatic treatment
• Family support
• Pharmacologic interventions
• Nursing considerations

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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

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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

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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

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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

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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

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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

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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