IntroToAdol - Approach to the Adolescent Approach to the...

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Unformatted text preview: Approach to the Adolescent Approach to the Adolescent Exam Maj Anisha Abraham, MD, MPH Adolescent Medicine Womack Army Medical Center OBJECTIVES OBJECTIVES To identify the stages of psychosocial development in adolescence s To set the stage for an adolescent interview s To obtain a complete adolescent history s Definition of Adolescence Definition of Adolescence Overview of the Adolescent Overview of the Adolescent Visit During adolescence­ visits to a health care provider may be limited s Teens may seek care from a variety of providers s Goal of provider is to complete a thorough physical and psychosocial evaluation s THINK PREVENTION! s Stages of Psychosocial Stages of Psychosocial Development s Early adolescence (11­14 yrs) s Middle adolescence (15­17yrs) s Late adolescence (18­21 yrs) Early Adolescence Early Adolescence s s s s Period of rapid growth and physical change Characteristics­ egocentrism, concrete thinking Relations­same sex friends Problems­injuries Middle Adolescence Middle Adolescence s s s s s Secondary sexual characteristics develop, growth rate decreases Emancipation from parents Abstract thought Opposite sex friends STD’s,MVA’s Late Adolescence Late Adolescence s s s s Physically mature Vocational goals important Individual friendships over peer group Stress induced illness Setting the Stage Setting the Stage Setting the Stage Setting the Stage s s s Make the adolescent the primary historian Establish confidentiality Use understandable language s s s Use open­ended questions Be non­ judgemental Listen to the patient! Obtaining a History Obtaining a History Chief Complaint s Past Medical history s Family Medical History s Psychosocial History s Psychosocial History Psychosocial History H sE sA sD sS s Psychosocial History Psychosocial History H­Home s E­Education s A­Activities s D­Diet,Drugs,Depression s S­Sexuality, Safety s HOME HOME s s s Who lives at home? Who can you talk to? How are things going with your parents/family members? EDUCATION EDUCATION s s s How are your grades? Do you enjoy school? What are your plans for the future? ACTIVITIES ACTIVITIES s s s What do you do for fun? Are you involved in sports or extracurricular activities? How many hrs/day­ TV? Computers? Video games? DIET DIET s s s Do you eat breakfast? Regular meals? Are you concerned about your weight? Do you drink milk? DRUGS DRUGS s s s Do you or your friends drink alcohol? Do you or your friends smoke cigarettes? Do you or your friends smoke marijuana? Use other drugs? DEPRESSION DEPRESSION s s s Have you been feeling sad? Have you been crying frequently? Do you feel that life is not worth living? s s Are you sleeping at night? Have you gained or lost weight? SEXUALITY SEXUALITY s s s Have you ever had a sexual relationship with anyone? Have you been forced to have sex against your will? Do you use protection? SAFETY SAFETY s s s s s F­Fights I­Injuries S­Sexual Violence T­Threats S­Self defense Physical Exam Physical Exam Ensure privacy s Do thorough exam s Document Tanner Staging s Consider pelvic exam if sexually active or over 18 yrs s Screening tests Screening tests s Routine­refer to GAPS guidelines – CBC,Cholesterol – Document varicella status, Hep B vaccine,tetanus. Consider meningococcal vaccine for college age students – Recommend annual dental visit s High Risk – female­RPR, GC/CH – male­UA Wrap up Wrap up s s Interpret findings and discuss plans directly Identify strengths and weaknesses s s s Discuss anticipatory care and PREVENTION Provide educational materials Encourage patients to return! SUMMARY SUMMARY s s s s s s Set the stage Establish confidentiality Use HEADS Consider FISTS Prevent High­risk Behaviors Encourage teens to return QUESTIONS? QUESTIONS? ...
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