HEALTH PROBLEMS

COMMON IN ADOLESCENTS
• It is common in diseases
where there is unequal
1. SCOLIOSIS
muscle balance, such as
CP, muscular dystrophy
and myelomeningocoele

ASSESSMENT

• Painless and insidious onset

• skirts hang unevenly, or
that bra straps are
adjusted unevenly
DESCRIPTION • unequal shoulder heights,
waist angles, scapula
• Lateral curvature of the
prominences, rib
spine
prominences, and chest
• FUNCTIONAL, which occurs
asymmetry
as a compensatory
• Screening by school nurse
mechanism in children who
begins in 5th grade
have unequal leg lengths or
poor posture
• STRUCTURAL scoliosis is a
permanent curvature of the
spine accompanied by
damage to the vertebrae
• Structural scoliosis-most
often during rapid growth
spurt (11 to 14 years for
females, 13 to 16 years for
males)

ETIOLOGY & PATHOPHYSIOLOGY

• 70%is idiopathic
• There is a familial
predisposition for structural
scoliosis

OB LECTURE 1
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
PLANNING & IMPLEMENTATION intervals, possibly helping
to straighten the spine
• Xray to identify extent of
curvature and give baseline
information
• If spinal curve is <15 to 20
degrees, the teen is
monitored every 3 to 6
months; exercises to
improve posture and
muscle tone and increase
flexibility of the spine are
encouraged
• If curve is >40 degrees,
surgery; if >32 degrees,
conservative nonsurgical
treatment with bracing
such as a MILWAUKEE
brace, made of leather and
plastic and is worn until the
growth spurt stops

• If curvature progresses or is
>40 degrees, surgery is
warranted for spinal
instrumentation: rods,
screws, and wires are
placed next to the
curvature; spine is then
fused in correct position;
bone from iliac crests may
be used to strengthen
• Electrical stimulation for
fusion
mild to moderate
curvatures, to cause
muscles to contract at
regular and frequent

OB LECTURE 2
HEALTH PROBLEMS
COMMON IN ADOLESCENTS

POST-OPERATIVE CARE

• ROM exercises, log rolling

every 2 hours, deep
breathing and use if
incentive spirometry, NPO,
NGT, strict I & O, VS &NVS
DISCHARGE TEACHINGS
monitoring, BT, pain
management, TEDS, and • Must not slump on chairs,
gradual resumption of must not bend, or twist the
activity torso or lift over 10 lbs.
MILWAUKEE or other braces • Comply with activity
restrictions for 6 to 8
months

• Worn 23 hours a day, off to

shower, bathe, swim
•
• T-shirt is worn underneath
the brace to protect the skin
• Exercises (pelvic tilt, lateral
strengthening) several
times a day while in brace
• Slight muscle ache noticed
when first wearing the
brace

OB LECTURE 3
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
frequently metastasizes to
the lungs
2. BONE TUMORS
• High incidence in children
(Osteogenic Sarcoma)
who had retinoblastoma

ASSESSMENT

• Pain and swelling are the

initial symptoms
• X-rays following traumatic
injury may be 1st indication
of disease
• CT, or MRI to detect
metastasis

PLANNING & IMPLEMENTATION

DESCRIPTION
• Treatment may include
• It is a tumor that arises radical resection or
from a bone cell, probably amputation
the osteoblast
• Most common bone cancer
in children
• Frequently affects the
metaphysis of long bones

ETIOLOGY & PATHOPHYSIOLOGY

• Selected clients may have
• Common in adolescent prosthetic replacement
boys; tumor growth is
detected t time of rapid
bone
• Frequently affects distal
end of femur; also affects
humerus, tibia, pelvis, jaw,
and phalanges
• It is a malignant tumor that

OB LECTURE 4
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
3. ACCIDENTS
MEASURES TO PREVENT
• Thoracotomy for lung ACCIDENTS IN ADOLESCENTS
metastasis
• Chemotherapy may be
administered preop and
postop ACCIDENT HEALTH
• Emotional support of child TEACHING
is important MEASURE
• Employ a straightforward
Motor vehicle Use a seatbelt
approach when
amputation is indicated;
Do not drink
allow verbalization alcohol while
• Sterile stump care and driving or ride
special bandaging as with anyone who
has been drinking
ordered
• Elevate stump for 24 hours Wear helmet and
if prescribed; avoid long pants when
prolonged elevation riding a
• Maintain body alignment motorcycle

• Perform ROM exercises to

Take driving
joints above the lessons to learn
amputation safe driving habits
• Assist with early
ambulation and temporary for 2-wheel or 4-
wheel vehicles
prosthesis use
• Encourage early interaction
Accepting dares
with peers has no place in
safe driving

Firearms Always consider

all guns loaded
and potentially
lethal

OB LECTURE 5
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
4. SEXUALLY TRANSMITTED
INFECTIONS
ACCIDENT HEALTH
TEACHING
MEASURE

SYMPTOMS COMMON THERAPY

Drowning Learn how to
swim; follow safe Candida Vulvar Nystatin or Miconazole
water rules such albicans reddening (Monistat) suppositories
as never and pruritus; or fluconazole orally,
thick, white, bathing with dilute
swimming alone,
cheese like NaHCO3 to relieve
no diving into a vaginal pruritus
shallow pool, no discharge
swimming beyond
own limit Thin, Metronidazole (Flagyl)
irritating, orally.
frothy,
Never take dares
douching with weak
gray green vinegar to
Sports Use protective discharge.

equipment such reduce

strong, putrid
as hockey mask,
odor, itching
football pads, etc. Pruritus

Gardnerella Edema and Metronidazole (Flagyl)

Do not attempt reddening of or
participation
vaginalis
beyond physical vulva; milky clindamycin
limits gray

discharge,
fishy odor

Foreign Body Vaginal Removal of foreign body

discharge;
odor

Candidiasis

OB LECTURE 6
HEALTH PROBLEMS
COMMON IN ADOLESCENTS

CAUSATIVE SYMPTOMS COMMON Enterobius Rectal pruritus, Oral

AGENT THERAPY especially on administration
vermicularis rising in the of
Herpesvirus Painful, Bathing with morning anthelminthic
type II pinpoint dilute such as
vesicles on NaHCO3, mebendazole
an applying (Vermox)
erythematou lubricating
s base with lotions to Treponema Painless ulcer Benzathine
watery lesions or pallidum on vulva or penicillin,
vaginal oral vagina administered
discharge; analgesic. (Syphilis) IM
voiding may topical
be irritating acyclovir
Group B Vaginitis, vulvar Antibiotic
and painful helps heal
itching, edema (Amoxicillin)
lesions
Streptococcus and reddening
of vulva
Chlamydia Watery, Tetracycline
gray, white or
trachomatis vaginal doxycycline;
discharge, erythromyci
vulvar itching n during
pregnancy

Neisseria Possibly Ceftriaxone

symptomless and
gonorrhoea . Profuse doxycycline;
e yellow-green oral
vaginal amoxicillin
discharge

OB LECTURE 7
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
HEPATITIS B & C body fat to muscle which
leads to excessive secretion
• spread by semen and blood of PROLACTIN causing a
decrease in the secretion of
SYPHILIS
GnRH by the hypothalamus
• Menstrual cycle usually
• IP of 10-90 days then
returns to normal within 3
typical painless lesion
months after
(CHANCRE) appears on
discontinuation of
genitalia, lips, rectum
strenuous training
lasting for 6 weeks then
6. DYSMENORRHEA
fades; 2-4 weeks after, a
generalized, macular, DESCRIPTION
copper-colored rash
• It is painful menstruation
appears usually on the
caused by the release of
soles and palms (VDRL
prostaglandins in response
serologic test will be +); next
to tissue destruction during
stage is a latency period
the ischemic phase of the
lasting from years to
menstrual cycle
decades (+ serologic test);
• Prostaglandins cause the
final stage involves major
smooth muscles to contract
organs casing blindness,
causing pain in the uterus
paralysis, crippling
• It can be a preliminary
neurologic deformities,
symptom of an underlying
mental confusion, slurred
illness such as PID, myoma
speech, and lack of
or endometriosis
coordination
5. AMMENORHEA ASSESSMENT

• Absence of menstrual flow; • 1st 2 years of menstruation,

may be due to pregnancy, dysmenorrhea is rare
tension, anxiety, fatigue, because early MCs are
chronic illness, extreme anovulatory
dieting, and strenuous • Categorized as mild (no
exercise interference with normal
• Associated with low ratio of activities), moderate (some

OB LECTURE 8
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
interference), or severe ovulation
(interference with majority • Alternative therapies:
of daily activities imagery, TENS
• Primary if it occurs in the 7. OBESITY
absence of an organic
disease and secondary if it • Most overweight
is a result of organic disease adolescents have obese
• Begins with a bloated parents (environment and
feeling and light cramping inheritance)
24 hours before menstrual • Suicide rate for obese teens
flow is higher than in the non-
• Pain is noticed when the obese
flow begins- colicky (sharp) • Teens generally adhere to a
pain is superimposed on a diet closer to 1800 calories
dull, nagging pain across a day
the lower abdomen • Adolescents who overeat
accompanied by an aching, as a reaction to stress need
pulling sensation of the psychological counseling
vulva and inner thighs rather than diet counseling
• Some have mild diarrhea • Obesity causes low self-
with the abdominal esteem, body image
cramping problems and depression
• Mild breast tenderness, • Diet and exercise are the
abdominal distention, N/V, main measures
headache, and facial
MEASURES to help decrease
flushing
overeating
MANAGEMENT
• Make a detailed log of the
• Analgesics such as aspirin amount they eat, the time,
or ibuprofen and naproxen and the circumstances and
sodium may be used but then changing those
most not be taken on an circumstances
empty stomach • Always eat in 1 place
• Low-dose oral instead of while walking or
contraceptive to prevent watching TV

OB LECTURE 9
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
• Slow the process of eating appearance of the body
by counting mouthfuls and • Includes 3 separate
putting the fork down features: self-induced
beside the plate between starvation to a significant
bites, and being served degree; relentless drive for
food on small plates so thinness, a morbid fear of
helpings look larger fatness, or both; and
8. ANOREXIA NERVOSA medical signs and
symptoms resulting from
starvation
• most often in girls (90%)
between 13 and 20 yo It
may be manifested as
severe weight restriction
controlled by limiting food
intake, excessive exercise
or by BINGE EATING or
PURGING

SPECIAL CHARACTERISTICS of a
child with AN

• BMI <17.5 or <85% of

expected weight
• Intense fear of gaining
weight or becoming fat
even though underweight
• Severely distorted body
image
• Refusal to acknowledge
DESCRIPTION
seriousness of weight loss
• Amenorrhea
• characterized by refusal to
maintain a minimally
normal body weight
because of a disturbance in
perception of the size or

OB LECTURE 10
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
9. SUBSTANCE ABUSE

ASSESSMENT

• Perceive food as revolting

or nauseating and refuse to DRUGS SYMPTOMS OF DANGERS
USE
eat or vomit food after
eating Glue Violence, Lung, brain
• May use IPECAC for drunken or liver
vomiting, laxatives, appearance, damage;
diuretics, intensive exercise dreamy or suffocation
blank or choking,
to lose weight
expression anemia
• Excessive weight loss, Glue smears on
acidosis, dependent clothing or
fingers; tubes of
edema, hypotension,
glue, paper
hypothermia, bradycardia, bags
formation of lanugo
Heroin, Stupor, Overdose;
MANAGEMENT morphine, drowsiness, liver and
codeine needle marks,
• Oral foods withheld to watery eyes, other
anorexia, infections
prevent vomiting; TPN to bloodstains on
supply needed fat, protein, sleeves, runny
and calories nose
• Establish trust and effective
communication Needle or
syringe, cotton,
• Antidepressants tourniquet,
• Identification of emotional
triggers burnt bottle
• Self-monitoring (awareness caps or spoons,
glassine
training)
• Education about normal
nutritional needs
• Gradual weight gain is
recommended

OB LECTURE 11
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
behavior, actions,
Marijuana Sleepiness, Psychologi increase in possibly tumor
wandering mind, cal muscle growth
enlarged pupils, dependen strength
lack of ce.
coordination testicular
cancer
ASSESSMENT
Hallucinog Severe Suicidal
ens (LSD hallucinations, tendencies
PCP, detachment, , • Failure to complete
incoherent, unpredicta assignments in school
DMT) speech, cold ble
hands, and feet, behavior,
• Demonstration of poor
laughing and neurologic reasoning ability
crying, vomiting effects • Decreased school
attendance
Possession of cube
sugar with • Frequent mood swings
discoloration in the • Deteriorating physical
center, strong
body odor
appearance
• Recent change in peer
Stimulant Aggressive Overdose, group
(methamp behavior, giggling, hallucinati
hetamin silliness, rapid ons,
• Expressed negative
speech, confusion, psychosis perceptions of parents
10. SUICIDE
DESCRIPTION

Depressan Drowsiness, Death or • It is deliberate self-injury

ts stupor, slurred unconsciousne with the intent to end one’s
speech, ss from
drunken overdose;
life
(barbiturat
es, appearance, addiction, • More frequent in males
seizures from although more attempts
vomiting withdrawal
alcohol) are made by females
• Frequent during spring or
Pills or
capsules in fall, reflecting school stress
varying colors, and between 3pm and
odor of alcohol
on breath
midnight, reflecting
depression that increases
Steroids Aggressive Violent with the dark

OB LECTURE 12
HEALTH PROBLEMS
COMMON IN ADOLESCENTS
• 3rd cause of death in the 15 • Decrease in verbal
to 19-yearold group communication
• Some degree of depression • Withdrawal from peer
is present in adolescents activities or previously
because they are not only enjoyed events
losing their parents but also • Previous attempt (80% f
their carefree childhood completed suicides have
been preceded by a failed
ASSESSMENT
attempt)
• Recent increase in
• Signs of depression:
interpersonal conflict with
anorexia, insomnia,
significant others
excessive fatigue, or weight
• Running away from home
loss
• Recent experience of a
• In younger adolescents:
friend or a famous person
disobedience, tantrums,
committing suicide
truancy and running away
• Inquiring about the
from home
hereafter
• Self-destructive behavior,
• Asking for information
difficulties in school, acting
(supposedly for a friend)
out with chemicals, alcohol,
about suicide prevention
or sexual promiscuity; or
and intervention
trouble with legal
• Almost any sustained
authorities
deviation from the normal
SUICIDE WARNINGS pattern of behavior

• Giving away prized

possessions
• Organ donation questions
• Sudden, unexplained
elevation of mood
• Accident proneness,
carelessness, and death
wishes
• “This is the last time you will
see me.”

OB LECTURE 13