Physical Health Problems of Adolescence

Chapter 20

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Slide 1

Acne

More than 50% of adolescents affected Etiology

Familial aspect Hormonal influence Other influences Self-esteem issues

Psychosocial ramifications

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Slide 2

Acne (cont.)

Pathophysiology

Involves hair follicle and sebaceous glands Comedogenesis General measures/overall health Medications Nursing considerations

Therapeutic management

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Slide 3

Vision Changes

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

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Slide 4

Male Reproductive Health Problems

Penile problems

Uncorrected congenital problems HPV Trauma

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Slide 5

Testicular Tumors

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

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Slide 6

Varicocele

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

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Slide 7

Epididymitis

Causes

Infection (bacterial or viral) Chemical irritant Local trauma

Presentation: pain, redness, swelling Treatment: analgesics, antibiotics, supportive care

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Slide 8

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

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Slide 9

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

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Slide 10

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

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Slide 11

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

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Slide 12

Causes of Primary Amenorrhea

Structural abnormality: septum, hymen, female circumcision Unresponsive to hormonal stimulation

Hypothalamic, pituitary, ovarian, uterine origin Thyroid dysfunction, prolonged or severe infections, adrenal hyperplasia, DM, obesity, malnutrition

Systemic disorders

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Slide 13

Causes of Secondary Amenorrhea

Most common cause: pregnancy Stress, chronic illness, polycystic ovarian disease, anorexia, ovarian disturbance, phenothiazines, heroin

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Slide 14

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

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Slide 15

Dysmenorrhea

Primary dysmenorrhea Secondary dysmenorrhea Therapeutic management

NSAIDs Estrogen therapy Oral contraceptives Dietary changes Exercises, comfort measures

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Slide 16

Endometriosis

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

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Slide 17

Premenstrual Syndrome (PMS)

Symptoms Diagnosis Therapeutics

SSRIs Nutrition/nutritional supplements Supportive care

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Slide 18

Dysfunctional Uterine Bleeding (DUB)

Occurs in absence of pregnancy, infection, neoplasms, and known pathology Usually with anovulation Hormonal therapy treatments Surgical treatment (D&C) Nursing considerations

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Slide 19

Vaginitis and Vulvitis

Causes may be physical, chemical, or infectious Diagnosis confirmed by vaginal exam, microscopic evaluation of vaginal secretions Health teaching

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Slide 20

Infections

Candidiasis Trichomoniasis Bacterial vaginosis (BV)

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Slide 21

Health Problems Related to Sexuality

Sexual activity among adolescents Sexual risk-taking behaviors Family influences Peer influences

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Slide 22

Adolescent Pregnancy

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

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Slide 23

Infants of Adolescent Mothers

Higher risk of prematurity Higher incidence of low birth weight Potential for developmental delay Cumulative risk factors for infant

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Slide 24

Social and Economic Effects of Teen Pregnancy

School/education disruption Social relationship deprivation Statistical risk of poverty Emotional effect on infant and parents

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Slide 25

Adolescent Fathers

Changing social expectations Legal rights Emotional effect Parenting skill development Economic effect

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Slide 26

Adolescent Abortion

Roe v. Wade 1973 Counseling Associated risks

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Slide 27

Contraception

Methods

Prescription and nonprescription

Use of contraception Conflict about sexual activity Desire for pregnancy Nursing considerations

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Slide 28

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

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Slide 29

STDs

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

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Slide 30

Gonorrhea

Cause: Neisseria gonorrhoeae Clinical manifestations Diagnosis Therapeutic management Prevention

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Slide 31

Chlamydia

Cause: bacterium Chlamydia trachomatis Clinical manifestations Diagnosis Therapeutic management Prevention

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Slide 32

Human Papillomavirus

Anogenital warts Strong link to cervical carcinoma Clinical manifestations Diagnosis Therapeutic management Prevention

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Slide 33

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
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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

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Slide 35

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

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Slide 36