Transcript Health Problems of Early Childhood

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
Health Promotion of the SchoolAge Child and Family
Chapter 17
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
Shedding Deciduous Teeth
Maturation of Systems
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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
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
Psychosocial Development
• Relationships center around same-sex peers
• Freud described it as “latency” period of
psychosexual development
Erikson:
Developing 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
School-Age Children Are
Motivated to Complete Tasks
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
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
School-Age Children Are Often
Avid Collectors
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
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
Children Are Comforted by Prayer
Language Development
• Efficient language skills
• Important linguistic accomplishments
• Correct syntax, improved grammar, word
usage
• “Metalinguistic awareness”
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
Engaging in Activities with a
“Best Friend”
9-Year-Olds’ Club Rules
Relationships with Families
• Parents are primary influence in shaping
child’s personality, behavior, and value
system
• Increasing independence from parents is
primary goal of middle childhood
• Children not ready to abandon parental
control
Developing a Self-Concept
• Definition: a conscious awareness of a variety
of self-perceptions (abilities, values,
appearance, etc.)
• Importance of significant adults in shaping
child’s self-concept
• Positive self-concept leads to feelings of selfrespect, self-confidence, and happiness
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
Development of Sexuality
• Normal curiosity of childhood
• Attitudes toward sex
• Use of terminology
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
Nurse’s 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
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
Activities Vary by Interest and
Opportunity
Play (cont.)
• Team play
• Quiet games and activities
• Ego mastery
Selecting a Book with an
Adult
Pride in Learning New Skills
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
Coping with Concerns Related to
Normal Growth and
Development (cont.)
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Teachers
Parents
Limit setting and discipline
Dishonest behavior
Stress and fear
Teachers’ Influence on Children
Latch-key Children
Promoting Optimum Health
During the School Years
• Nutrition
• Importance of balanced diet to promote growth
• Quality of diet related to family’s pattern of
eating
• Fast-food concerns
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
Physical Activity
• Exercise essential for development and
function
• Importance of physical fitness for children
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
Music Is a Favorite Form of
Expression
Performing Household Tasks
Dental Health
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Permanent teeth eruption
Good dental hygiene
Prevention of dental caries
Malocclusion
Dental injury
Dental evulsion—replacement or
reattachment
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
Injury Prevention
• Most common cause of severe injury and
death in school-age children is motor vehicle
crashes—pedestrian and passenger
• Bicycle injuries—benefits of bike helmets
• Appropriate safety equipment for all sports
Bicycle Safety
Anticipatory Guidance—
Care of Families
• Parents adjust to child’s increasing
independence
• Parents provide support as unobtrusively as
possible
• Child moves from narrow family relationships
to broader world of relationships
Health Problems of
Middle Childhood
Chapter 18
DISORDERS AFFECTING
THE SKIN
Purposes of the Skin
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Protection
Impermeability
Heat regulation
Sensation
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
Examples of Age-Related
Skin Manifestations
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Infants: birthmarks
Early childhood: atopic dermatitis
School-age children: ringworm
Adolescents: acne
Dermatitis
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Pathophysiology
Diagnostic evaluation
History and symptoms: pruritus, sensation
Objective findings: lesion
Types of Lesions
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Papule
Macule
Vesicle/bulla
Pustule
Cyst
Patch
Plaque
Wheal
Striae
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Scale
Crust
Keloid
Fissure
Ulcer
Petechiae
Purpura
Ecchymosis
Nursing Considerations
• Prevent spread of bacterial infection
• Prevent complications
Viral Skin Infections
• Most communicable diseases of childhood
have characteristic rash
• Examples: verruca, herpes simplex types 1
and 2, varicella zoster, molluscum
contagiosum
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
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
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
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
Systemic Mycotic (Fungal)
Infections
• Invade viscera as well as the skin
• Wide spectrum of disease
• May appear as granulomatous ulcers,
plaques, nodules, and abscesses
Rickettsial Infections
• Intracellular parasites generally transmitted by
infected fleas, ticks, and mites
• Infections widely varied from benign and selflimiting to fatal
Lyme Disease
• Most common tick-borne disorder in United
States
• Clinical stages
• Diagnosis and therapeutic management
• Vaccine against Lyme disease
• Focus on prevention
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
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
Poison Ivy, Oak, and Sumac
• Produce localized lesions
• Caused by urushiol from the plant’s leaves
and stems
• Sensitivity may develop after one or two
exposures and may change over time
• Therapeutic management
Poison Ivy
Foreign Bodies
• Wood splinters
• Cactus spines
• May require medical treatment if difficult to
see or remove
Sunburn
• Ultraviolet A waves
• Ultraviolet B waves
• Importance of protection: sunscreen
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
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
Hypothermia
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Definition: less than 35° C
Effect of decrease in core temperature
Therapeutic management
Nursing considerations
Prevention
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
Stevens-Johnson Syndrome
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
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
BITES AND STINGS
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
Arachnid Bites
• Most in United States are relatively harmless
• Scorpions, brown recluse spider, and black
widow spider inject venom: potentially deadly
Ticks
• Partially embed in skin as they feed
• Remove by grasping tick close to point of
attachment (with forceps)
• Preventive measures
Mammal Bites
• Common pediatric problem especially in
children younger than 5 years old
• Wound care
• Prophylactic antibiotics for some types of
bites
• Rabies concern
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
Human Bites
• Lacerations from teeth of other humans
• Risk of infection
• Wound care
DENTAL DISORDERS
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
Pathophysiology of Dental Caries
• Multifactorial
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Host
Microorganisms
Substrate
Time
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
Periodontal Disease
• Inflammatory and degenerative condition
involving the gums and supporting tissues
• Gingivitis
• Periodontitis
• Acute necrotizing ulcerative gingivitis
(“trench mouth”)
• Nursing considerations
Malocclusion
• Heredity
• Habits
• Thumb sucking
• Tongue thrusting
• Orthodontic treatment
• Nursing considerations
Dental Trauma
• Tooth evulsion
• Cold milk = osmolality to maintain evulsed tooth
• Reimplantation of teeth
• Emotional response
DISORDERS OF
CONTINENCE
Enuresis
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“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
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 night’s urine
Psychologic Factors
• “Sleep more soundly than other children”
• Emotional factors
• Familial tendency
Treatment for Enuresis
• Drugs
• Tofranil
• Oxybutynin
• DDAVP
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Bladder training
Fluid restriction in evenings
Interruption of sleep to void
Conditioned reflex response device
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
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
DISORDERS WITH
BEHAVIORAL
COMPONENTS
Attention Deficit Hyperactivity
Disorder (ADHD)
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Etiology unknown; probably multifactorial
Inattention, impulsiveness, and hyperactivity
Typical onset before age 7
Diagnostic criteria for ADHD
Therapeutic Management of
ADHD
• Classroom
• Family education and counseling
• Behavioral therapy and/or psychotherapy for
child
• Environmental manipulation
• Medication
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
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
Battery of Tests for LD
and ADHD
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IQ
Hand-eye coordination
Visual and auditory perception
Comprehension
Memory
Therapeutic Management of LD
• Primarily educational interventions
• Wide variation of diagnostic severity
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
Tourette Syndrome (TS)
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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
Therapeutic Management of TS
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Symptomatic treatment
Family support
Pharmacologic interventions
Nursing considerations
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
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
PTSD Symptoms
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Depression, anxiety, conversion reactions
Phobic symptoms, repetitive actions
Flashbacks are common
Inquiry about what has happened
Nursing considerations
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
School Phobia (cont.)
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Physical symptoms
Symptoms subside after staying at home
No symptoms on weekends, holidays, etc.
Nursing considerations
Recurrent Abdominal Pain
(RAP)
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May have psychogenic origin
May have real pain
Psychological aspects
Nursing considerations
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
Childhood Depression
• Temporary: acute depression precipitated by a
traumatic event
• Chronic depression
• May accompany chronic illness or disability
• Familial circumstances
• Nursing considerations
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
Health Promotion of the
Adolescent and Family
Chapter 19
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
Adolescence
• Early: ages 11 to 14
• Middle: ages 15 to 17
• Late: ages 18 to 20
Biologic Development
• Neuroendocrine events of puberty
Hormonal Interaction Between
Hypothalamus, Pituitary, and
Gonads
Changes in Reproductive
Hormones
• Females
• Menarche
• Ovulation
• Males
Pubertal Sexual Maturation
• Tanner stages 1 through 5
COGNITIVE DEVELOPMENT
Piaget: Emergence of Formal
Operational Thought
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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
Adolescent Conceptions of Self
• Adolescent egocentrism
• Self-absorption
• Health-related beliefs:
• Imaginary audience (everyone is watching)
• Personal fable (won’t happen to me)
Changes in Social Cognition
• Understanding of others’ thoughts and
feelings
• Mutual role taking
• Effect on health-related choices
Development of Value
Autonomy
• Struggle to clarify values
• Development of a personal value system
• Gradual process in late adolescence
Moral Development
• Parallels advances in reasoning and social
cognition
• Conventional level of moral reasoning
• Principled moral reasoning
Spiritual Development
• Religious beliefs may become more abstract
during adolescence
• Late adolescents may reexamine and
reevaluate beliefs and values of their
childhood
PSYCHOSOCIAL
DEVELOPMENT
Identity Development
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Social forces shape sense of self
Identity achievement
“Moratorium”
“Foreclosure”
“Identity diffusion”
Development of Autonomy
• Emotional autonomy
• Behavioral autonomy
• Value autonomy
Achievement
• Development of motives, capabilities,
interests, and behaviors
• Progress toward occupational achievement
• Relationship between social class and
educational and occupational achievement
Sexuality
• Hormonal, physical, cognitive, and social
changes affect sexual development
• Body image
• Sexual identity
• Sexual orientation
Romantic Relationships Are
Important During Adolescence
Intimacy
• Intimate relationship begins to emerge in
adolescence
• Developmental course of intimacy
• Self-focused
• Role focused
• Individual connected
Social Environments
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Ecological model
Microsystems
Mesosystems
Exosystems
Macrosystems
Families
• Changes in family structure and parent
employment
• Parenting styles
• Socioeconomic influences
Peer Groups
• Significance in socialization
• Significance in development
• Value placed on peer relationships
The Peer Group Influences
Adolescent Development
Schools
• Play increasingly important role in
preparation for adulthood
• Parental involvement in schools
• Effect of academic success or failure on selfesteem
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
Community and Society
• Media influences
• Community’s economic resources play role in
health and well-being of young people
• Resources for health promotion
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
Adolescents’ Perspectives on
Health
• Factors promoting adolescent health and wellbeing
• Contexts for adolescent health promotion
• School-based and school-linked health
services
• Adolescent health screening
• “Safe times”: method for screening interviews
with teens
Health Concerns of Adolescence
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Parenting and family adjustment
Psychosocial adjustment
Intentional and unintentional injury
Dietary habits, eating disorders, and obesity
Physical fitness
Snacking on Empty Calories Is
Common Among Adolescents
Adolescent Physical Fitness
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
Coping with Stress
Health Concerns of Adolescence
(cont.)
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School and learning problems
Hypertension
Hyperlipidemia
Infectious diseases/immunizations
Health Promotion Among
Special Groups of Adolescents
• Adolescents of color
• Gay, lesbian, and bisexual adolescents
• Rural adolescents
Physical Health Problems of
Adolescence
Chapter 20
Acne
• More than 50% of adolescents affected
• Etiology
• Familial aspect
• Hormonal influence
• Other influences
• Psychosocial ramifications
• Self-esteem issues
Acne (cont.)
• Pathophysiology
• Involves hair follicle and sebaceous glands
• Comedogenesis
• Therapeutic management
• General measures/overall health
• Medications
• Nursing considerations
Vision Changes
• Refractory errors peak in adolescence due to
growth spurts
• Vision screening
• Myopia most common
Male Reproductive
Health Problems
• Penile problems
• Uncorrected congenital problems
• HPV
• Trauma
Testicular Tumors
• Usually malignant
• Testicular CA is most common solid tumor in
males ages 15 to 34
• Testicular self-examination (TSE)
Varicocele
• Usually asymptomatic scrotal mass or aching
sensation
• Occurs in about 15% of males
• Varicocelectomy controversial in adolescence
Epididymitis
• Causes
• Infection (bacterial or viral)
• Chemical irritant
• Local trauma
• Presentation: pain, redness, swelling
• Treatment: analgesics, antibiotics, supportive
care
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
Gynecomastia
• Normal if transient (less than 1 year’s
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
Female Reproductive
Health Problems
• Gynecologic examination indicated
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Menstrual disorders
Undiagnosed abdominal pain or pelvic mass
Sexually active and/or request contraception
Rape
Virginal, 18 years old
Requested by patient
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
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
Causes of Secondary
Amenorrhea
• Most common cause: pregnancy
• Stress, chronic illness, polycystic ovarian
disease, anorexia, ovarian disturbance,
phenothiazines, heroin
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
Dysmenorrhea
• Primary dysmenorrhea
• Secondary dysmenorrhea
• Therapeutic management
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NSAIDs
Estrogen therapy
Oral contraceptives
Dietary changes
Exercises, comfort measures
Endometriosis
• Definition: presence of endometrial glands
and stroma outside of the normal intrauterine
endometrial cavity
• Etiology unclear
• Treatment: medical, surgical, pharmacologic
suppression
• Nursing considerations
Premenstrual Syndrome (PMS)
• Symptoms
• Diagnosis
• Therapeutics
• SSRIs
• Nutrition/nutritional supplements
• Supportive care
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
Vaginitis and Vulvitis
• Causes may be physical, chemical, or
infectious
• Diagnosis confirmed by vaginal exam,
microscopic evaluation of vaginal secretions
• Health teaching
Infections
• Candidiasis
• Trichomoniasis
• Bacterial vaginosis (BV)
Health Problems
Related to Sexuality
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Sexual activity among adolescents
Sexual risk-taking behaviors
Family influences
Peer influences
Adolescent Pregnancy
• Rates of teen pregnancy in United States
• Physiologic aspects
• Pregnancy risks associated with teen
pregnancy
• Nutritional needs
Infants of Adolescent Mothers
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Higher risk of prematurity
Higher incidence of low birth weight
Potential for developmental delay
Cumulative risk factors for infant
Social and Economic Effects of
Teen Pregnancy
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School/education disruption
Social relationship deprivation
Statistical risk of poverty
Emotional effect on infant and parents
Adolescent Fathers
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Changing social expectations
Legal rights
Emotional effect
Parenting skill development
Economic effect
Adolescent Abortion
• Roe v. Wade 1973
• Counseling
• Associated risks
Contraception
• Methods
• Prescription and nonprescription
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Use of contraception
Conflict about sexual activity
Desire for pregnancy
Nursing considerations
Rape
• SANE—sexual assault nurse examiners
• Diagnostic evaluation
• Obtain account of incident
• Sensitivity to victim’s 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
STDs
• Major cause of morbidity during adolescence
and young adulthood
• Strong relationship between STDs and
infertility
• Transmission and follow-up of contacts
Gonorrhea
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Cause: Neisseria gonorrhoeae
Clinical manifestations
Diagnosis
Therapeutic management
Prevention
Chlamydia
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Cause: bacterium Chlamydia trachomatis
Clinical manifestations
Diagnosis
Therapeutic management
Prevention
Human Papillomavirus
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Anogenital warts
Strong link to cervical carcinoma
Clinical manifestations
Diagnosis
Therapeutic management
Prevention
Pelvic Inflammatory Disease
(PID)
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Infection of upper genital tract
Tubo-ovarian abcess
Salpingitis
Long-term effects: infertility due to tubal
scarring
• Symptoms
• Therapeutics
• Nursing considerations
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
Hepatitis B Virus (HBV)
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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
Behavioral Health Problems of
Adolescence
Chapter 21
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
Complex
Relationships in
Adolescent Obesity
Effect of Childhood Obesity
• Increase in type 2 diabetes
• Risk of adult obesity
• Hypertension, hyperlipidemia, cardiovascular
disease
• Social isolation, low self-esteem, depression
Causes of Childhood Obesity
• 5% due to underlying disease
(hypothyroidism, other metabolic disease,
CNS disorders)
• Role of heredity
• Inactivity
• Patterns of eating behaviors
Diagnostic Evaluation
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Skinfold measurements
Body mass index (BMI) calculations
Body fat measurements
Diagnostics to rule out metabolic and
endocrine disorders
Nursing Considerations
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Assessment, planning, implementation
Diet, exercise, behavioral and group therapy
Prevention, evaluation
Medical therapies
• Pharmacologic: generally not recommended in
children
• Surgical: hazardous in children
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!
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”
Clinical Manifestations of AN
• Severe weight loss
• Altered metabolic activity
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Amenorrhea
Bradycardia, decreased BP
Hypothermia, cold intolerance
Dry skin, brittle hair and nails
Appearance of lanugo
Therapeutic Management of AN
• Treat life-threatening malnutrition
• IV, tube feedings
• Monitor CV status
• Behavior modification
• Long-term (lifelong?) treatment and
management
Bulimia
• Eating disorder characterized by binge eating
• May be followed by purging behaviors
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Laxative abuse
Self-induced vomiting
Diuretic abuse
Rigorous exercise regimens
• Up to eight or more cycles per day
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
Therapeutic Management
• Similar to anorexia management
• Hospitalization to treat potassium depletion,
esophageal damage
• Cardiac monitoring indicated
• Behavioral management
“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
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
Types of Drugs Abused
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Tobacco
Alcohol
Cocaine
Narcotics
CNS depressants
CNS stimulants
Hallucinogens
Inhalants
Nursing Considerations
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Acute care
Long-term management
Family needs/family support
Prevention
Suicide
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Third leading cause of death in teens
Suicide
Suicidal ideation
Suicide attempt/parasuicide
Suicide (cont.)
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Etiology
Methods
Motivation
Diagnostic evaluation/therapeutic
management
• Nursing considerations