Ch 20: Care of the Adolescent

Perception of one's own body with regard to looks and sexual appeal

Body image

A condition of painful uterine cramps that occurs before the onset of menses

Dysmenorrhea

One's personal experience of gender, which may or may not match one's biological sex

Gender identity

The process of physiological changes through which a child's body develops into that of an adult

Puberty

Recurrent use of alcohol or illicit drugs that consistently interferes with one's daily life; classified as mild, moderate, or severe

Substance use disorder (SUD)

The use of an electronic cigarette, which simulates the feeling of smoking

Vaping

What are the 3 stages of the adolescent period, and what ages define them?

Early 10-13 y

Middle 14-17 y

Late 18-21

T/F: Once adolescents begin to drive, they may be at health promotion appointments without a caregiver.

T

T/F: Caregivers should not be asked to leave during health promotion appointments for adolescents?

F: Adolescents are less likely to give honest answers regarding substance use, smoking, or sexual activity with the caregiver present.

T/F: HIPPA protects an adolescent's right to privacy from their caregiver.

F: What adolescents say is confidential unless they reveal an intention to hurt either themselves or someone else.

The limbic system, which is responsible for processing emotions, memories, and basic survival drives, is the last part of the brain to develop.

F: The limbic system reaches maturity during early adolescence. The frontal lobe is the last part of the brain to develop.

What is the prefrontal cortex primarily responsible for (state 3)?

Impulse control

Consideration of the consequences of actions

Evaluaton of risk vs reward

The respiratory rate decreases to that of an adult or about _____________ breaths/min.

12 - 20

T/F: By the end of adolescence, the size and strength of the heart reach those of an adult.

T

Blood pressure increases to ______________ mm Hg systolic and ____________ mm Hg diastolic.

110 to 120; 64 to 80

Normal resting heart rate in an adolescent is _____________ beats/min (bpm), although an athlete's may be lower.

60 to 100

T/F: It is not important to monitor cholesterol and triglyceride levels during adolescence because they are apt to change with growth.

F: Continue to monitor these levels during adolescence.

T/F: The spleen is palpable in adolescents.

F: The spleen should not be palpable.

T/F: Only the tip of the liver should be palpable in the adolescent.

T

Which hormone stimulates the onset of puberty?

Gonadotropin-releasing hormone (GnRH)

Summarize the hormone axis responsible for developing secondary sex characteristics (hallmarks of puberty).

The release of GnRH stimulates the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH stimulate the release of androgens and estrogens.

T/F: Delayed puberty is normal for some adolescents.

F: Adolescents in whom the onset of puberty is delayed need further evaluation to determine the reason for the delay. If there is no previously known condition causing pubertal delay, refer the adolescent to an endocrinologist.

T/F: Nocturnal emissions (commonly referred to as "wet dreams") are very uncommon, despite being widely reported.

F: Sometime in middle-to-late adolescence, male adolescents experience their first involuntary ejaculation, usually occurring at night. Let the patient know this is a normal part of development.

The term for the developemnt of breast buds

Thelarche

The term for onset of a female's menstrual period

Menarche

Menarche occurs around ____ years after the development of breast buds or thelarche.

2

In females, growth plates tend to close ___________________ after menarche.

2 to 2.5 years

T/F: Growth plates close around the same time for males as for females.

F: In males, growth plates close later in adolescence.

T/F: Skin becomes thicker during adolescence.

T

Which kind of sweat glands are located around hair follicles, such as in the axilla and groin regions, whose activity increases and leads to sweating in response to stress?

Apocrine sweat glands

T/F: Physical growth is genetically determined and there is little that a person can do to impact it.

F: Physical growth is genetically determined but is also affected by nutrition, environment, and physical activity.

A healthy BMI is in the _______ to less than the _______ percentile.

5th; 85th

T/F: Peak growth rates (inches gained per year) are approximately the same for males and females, and their growth spurts happen at about the same stage in adolescent development.

F: During adolescence, the greatest period of growth is during the growth spurt. For females, the peak growth rate is approximately 3 to 3.5 in/year (7.6-8.8 cm), which occurs about 6 months before menarche. Growth slows after menarche and continues for 2 to 2½ years, at which time the female adolescent has reached her adult height.

The peak growth rate for males is 3.5 to 4 in/y (8.8-10.2 cm), which occurs when the adolescent reaches Tanner stage 3 or 4, typically about 2 years after the female growth spurt. Males continue to grow 2 to 3 years after females stop growing.

According to Erikson's psychosocial development theory, the task of adolescence is _______________________.

development of identity

What stage of Piaget's cognitive theory of development are adolescents in?

Formal operational

What stage of Freud's psychosexual theory of development are adolescents in?

Genital

What stage of Kohlberg's moral theory of development are adolescents in?

Postconventional

What are the most common types of self-rating pain scales used with adolescents?

Visual Analog Scale (VAS)

Numeric Rating Scale (NRS)

T/F: Nonpharmacological pain management techniques are rarely effective for adolescents to manage pain.

F: Behavioral interventions include preparation for procedures and positive reinforcement. Cognitive interventions include distraction and guided imagery. Music, acupuncture, and craniosacral therapy are complementary therapies that work well with adolescents. Additional interventions include virtual reality distraction.

How is the Clinically Aligned Pain Assessment (CAPA) tool different from the other pain rating scales?

Whereas the most commonly used pain scales are one-dimensional, the CAPA tool engages the patient in a conversation about different aspects of the pain experience. Research showed that this pain rating scale increased patient and nurse satisfaction, and allowed for more accurate pain management which led to earlier discharge.

T/F: An adolescent's growth spurt is marked by the development of new skills and a steady increase in coordination and flexibility.

F: Rather than continually developing new skills, adolescents refine the skills they already have. During growth spurts, adolescents may lose some coordination or flexibility. This loss may have an effect on activities, such as sports, during this time. Once the growth spurt is complete, any lost coordination or flexibility returns.

T/F: By the end of adolescence, language use is at the level of an adult.

T

T/F: The ill effects of social media use (increased anxiety, emotional distress, and depressed mood) are, in general, worse for girls than boys.

T

T/F: Adolescents aged 12 to 19 years report that their peers have a greater influence on sexual decision making than their caregivers.

F: Adolescents aged 12 to 19 years report that caregivers have a greater influence on sexual decision making than do peers.

What are the 3 most common causes of injuries during the adolescent period (2017)?

Motor vehicle accidents

Substance use

Firearms

How many hours of sleep each night does an adolescent need?

At least 7-8

How many minutes of physical activity should adolescents get each day?

60

_____________________________ encompasses organizational skills, time management, planning, the ability to see different points of view, and emotional regulation.

Executive functioning

What is the CRAFT screening tool used for?

The CRAFFT screening tool is a six-item questionnaire recommended by the American Academy of Pediatrics to be used with all adolescents to identify those at risk for alcohol or other drug use disorders.

What are the 6 questions on the CRAFFT screening tool?

C—Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?

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

A—Do you ever use alcohol or drugs while you are by yourself, ALONE?

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

F—Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

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

T/F: Adolescents should continue to visit the dentist every year.

F: Adolescents should continue to visit the dentist every 6 months.

T/F: Health practitioners can wait until early adulthood to teach about reproductive cancers, since they are so rare in adolescents.

F: Teach adolescents about the different types of reproductive cancers and how to screen for them (e.g. breast self-exams, testicular self-exams).

What is the most commonly reported illicit drug that adolescents report using?

Marijuana

What causes infectious mononucleosis?

the Epstein-Barr virus (EBV)

How is infectious mononucleosis transmitted?

The virus is spread through oral secretions and is therefore commonly referred to as the "kissing disease."

How long is a person diagnosed with enfectious mononucleosis possibly contageous?

The virus is shed in oral secretions up to 6 months after acute infection.

How is infectious mononucleosis treated?

Treatment of mononucleosis includes supportive therapy such as rest and fluids. Treat symptoms such as headache, fever, and sore throat with antipyretics and analgesics.

Why would the nurse instruct the adolescent to avoid participating in contact sports for 2 to 3 weeks after contracting infectious mononucleosis?

Because of the risk of splenic rupture

How long do acute symptoms of infectious mononucleosis last?

2 to 4 weeks

How long after contracting infectious mononucleosis might an adolescent experience fatigue?

Fatigue may last up to 6 months.

T/F: Diet can affect acne outbreaks.

Diet generally does not affect acne outbreaks.

What are the 4 types of lesions associated with acne vulgaris?

Open and closed comedones

Papules

Pustules

Nodular cysts

What is dysmenorrhea?

Painful uterine cramps before the onset of menses

What are 3 acne treatments?

Daily cleansing regimen

Antibiotics

Retinoids

Dysmenorrhea occurs in _____% of adolescent females.

93

What are some treatments for dysmenorrhea?

NSAIDs to decrease prostaglandin production

Hormone therapy via oral contraceptives

Nonpharmacological, incuding heat, massage, acupunture, and yoga