Exam 4

veggie nutritional recommendations

2.5 to 4 cups per day

fiber, potassium, vit A

fruit nutritional recommendations

1.5 to 2.5 cups per day

vit C

grain nutritional recommendations

at least half being whole grains 

fiber, vit B, minerals 

protein nutritional recommendations

various sources: lean meat, seafood, eggs, diary, beans, peas, lentil, soy

dairy nutritional recommendations

3 cups per day

fat-free or low-fat

calcium, vit D, magnesium, zinc, potassium, vit A, vit B12

Tanner stage 1

breast development (XX): no glandular breast tissue

external genitalia (XY): testicular volume < 4 mL and penile length < 2.5 cm

pubic hair: no hair

Tanner stage 2

breast development (XX): breast bud under areola 

external genitalia (XY): 4-8 mL and 2.5 - 3.3 cm

pubic hair: some hair

Tanner stage 3

breast development (XX): breast tissue palpable beyond areolar margins

external genitalia (XY): 9 - 12 mL and 3.4 - 4 cm

pubic hair: coarse and curly hair

Tanner stage 4

breast development (XX): areola elevates above breast contour “double-scooping”, “mound on mound”

external genitalia (XY): 15 - 20 mL and 4.1 - 4.5 cm

pubic hair: spreads laterally, spares thigh

Tanner stage 5

breast development (XX): areolar mound recedes, areolar hyperpigmentation, papillae, nipple protrusion

external genitalia (XY): >20 mL and >4.5 cm

pubic hair: thigh involvement

emotional changes in early adolescence

individuals are preoccupied by body changes; thinking remains concrete, they are in process of forming identity and they question independence; strong parental controls are typically in place

emotional changes in middle adolescence

there is increase in abstract and future orientation; thoughts are ideal and individuals may experience feelings of being invincible or narcissistic; identity continues to develop; cognition increases, leading to capacity for consent 

emotional changes in late adolescence

individuals become future oriented and achieve emotional independence; they develop capacity for empathy, intimacy and reciprocal relationships; they are also legally able to give consent and vote

psychosocial changes in early adolescence

individuals begin making comparisons between their home culture and culture of other; they increase extracurricular involvement and undergo school transitions, such as moving to middle school; they main good parental relationships and affiliate with peer of same sex

psychosocial changes in middle adolescence

adolescents look for emotional independence; they may experience peer group power conflicts with parental power and show interest in intimate relationships; driving often begins; they go through school transitions. moving to high school and continue with extracurricular activities; conflict between family members may increase

psychosocial changes in late adolescence

parent-adolescent relationship changes; individual relationships become more important; individuals often move out of home and prepare for college/trade education, start careers, marriage, or parenting

physical changes in early adolescence

puberty begins; growth spurt occurs; menarche begins in genotypically XX individuals

physical changes in middle adolescence

ovulation begins in genotypically XX individuals; growth spurt occurs in genotypically XY individuals

physical changes in late adolescence

growth is complete

underweight pediatric BMI

<18.5

healthy weight pediatric BMI

18.5 - 24.9

overweight pediatric BMI

25 - 29.9

obese pediatric BMI

30 - 34.9

severe obesity pediatric BMI

>35

what is the leading cause of mortality for adolescents

unintentional injuries → especially motor vehicle accidents

what is the legal age to consent in Ohio

16 (pre-class ppt says 18 is for medical treatment)

required documentation of informed consent discussion

nature of procedure

risks and benefits of procedure

reasonable alternatives

risks and benefits of alternatives

assessment of pt’s understanding of above elements

exceptions to informed consent

patient incapacitated

life threatening emergences with inadequate time to obtain consent

voluntary waived consent

children cannot provide informed consent

exceptions to confidentiality

suspected child abuse or neglect

sexual abuse

consensual sex depending on age

records of mental health services with parental disclosure

what are the risk factors for substance abuse

individual factors

family factors

social and environmental factors

why are adolescents at high risk for substance abuse

brains still developing, especially frontal lobe

limbic system is more active

what are the “5 Ps” used to take sexual history

partners

practices

protection from STIs

past history of STIs

prevention of pregnancy

when should the first reproductive health visit occur

between 13 and 15

no internal pelvic pelvic exam unless there are symptoms

what is the HEEEADSSS exam

home

eating

education

employment

activities

drugs

sexuality

suicide/depression

safety

who can give consent for treatment of minor

biological parent

legal guardian appointed by court

stepparents must have written permission to provide consent

exceptions allowing minors to consent

legally emancipated

in military

married

self-supporting (determined on case-by-case basis)

tender point location for levator scapulae

superior medial border of scapula

tender point location for psoas

2/3 distance from ASIS to midline

tender point for quadratus lumborum

12th rib lumbar TPs superior iliac crest

tender point location for iliacus

1/3 distance from ASIS to midline

tender point location for piriformis

midpoint between greater trochanter and ILA

treatment for levator scapulae

extension

palm scapula and glide superiorly and medially

treatment for psoas major

flex patients’ hips

side bend lumbar spine toward tender point

treatment for iliacus

flex patients’ hips

cross ankles so both hips externally rotate

treatment for quadratus lumborum

prone: hip/thigh extension, ABduction, external rotation

treatment for piriformis

flexion, ABduction, external rotation

strain counterstrain (SCS)

indirect, passive

facilitated positional release (FPR)

indirect, passive

mechanism of SCS

reduces gamma gain by sustained position of ease

mechanism of FPR

adds compression/torsion to enhance proprioceptive reset

A/P

anterior/posterior

F/E

flexion/extension

Sr/Sl

side-bend R/L

Rr/Rl

rotation R/L

IR/ER

internal/external rotation

ABD/ADD

ABduction/ADduction

SUP/PRO

supination/pronation

T (t) /A (a)

toward/away

SP/TP

spinous/transverse process

absolute contraindications for FPR

absence of somatic dysfunction

lack of patient consent and/or cooperation

unstable fracture affected by treatment positioning

severe joint instability

treatment positioning exacerbates neurologic and/or life-threatening symptoms

relative contraindication/precautions for FPR

mild to moderate joint instability

herniated disc where positioning could exacerbate condition

moderate to severe intervertebral foraminal stenosis

severe sprains and strains where positioning may exacerbate injury

vertebrobasilar insufficiency and/or carotid pathology

absolute contraindications for SCS

absence of somatic dysfunction

lack of patient consent and/or cooperation

acute trauma

severe illness in which strict positional restrictions preclude treatment

instability of area being positioned

vascular or neurologic syndroms

severe degenerative spondylosis

relative contraindications for SCS

patients who cannot voluntarily relax so that proper positioning is difficult

stoic patients who can’t discern level of pain

patients who can’t understand instructions and questions of physician

patients with connective tissue/rheumatologic disorders

iliohypogastric nerve (L1)

motor: internal oblique and transversus abdominis

sensory: skin over lower abdomen and upper buttock

ilioinguinal nerve (L1)

motor: internal oblique and transversus abdominis

sensory: upper medial thigh, root of penis/scrotum or mons pubis/labia majora

genitofemoral nerve (L1-2)

divides into genital branch (cremaster muscle, scrotum/labia) and femoral branch (upper anterior thigh skin)

lateral femoral cutaneous nerve (L2-3)

sensory: lateral thigh

femoral nerve (L2-4)

motor: anterior thigh muscles

sensory: anterior and medial thigh, medial leg via saphenous nerve

obturator nerve (L2-4)

motor: ADductor muscles of thigh

sensory: medial thigh

lumbosacral trunk (L4-5)

joins sacral plexus

superior gluteal nerve (L4-S1)

motor: gluteus medius, gluetus minimus, tensor fascialatae

inferior gluteal nerve (L5-S2)

motor: gluteus maximus

sciatic nerve (L4-S3)

largest branch; divides into tibial and common fibular nerves; motor and sensory to posterior thigh, leg, and foot

posterior femoral cutaneous nerve (S1-3)

sensory: posterior thigh and perineum

nerve to quadratus femoris (L4-S1)

motor: quadratus femoris and inferior gemellus

nerve to obturator interus (L5-S2)

motor: obturatur interus and superior gemellus

pudendal nerve (S2-4)

motor and sensory: perineum, external urethral and anal sphincters

pelvic splanchnic nerves (S2-4)

parasympathetic to pelvic viscera

nerve to piriformis (S1-2)

motor: piriformis muscle

superficial branches of femoral artery

superficial epigastric artery

superficial circumflex iliac artery

superficial external pudendal artery

deep external pudendal artery

deep branches of femoral artery

medial circumflex femoral artery

lateral circumflex femoral artery

perforating arteries

primary prevention of STI

preventing someone from acquiring infection