MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca, Cagayan
Telefax No. (078) 304-1010 Website: www.mcnpisap.com
E-mail Address:
[email protected] COLLEGE OF NURSING
Health Problems common in Adolescence
Scoliosis
Refers to an S-shaped curvature of the spine.
During adolescence, scoliosis is more common in girls.
Untreated scoliosis may lead to back pain, fatigue, disability, and heart and lung complication.
2 types
1. Functional Scoliosis- caused by poor posture and not by spinal disease
Flexible and easily correctible
2. Structural- anatomical change in shape of thorax or vertebrae
Hips and shoulders are uneven
Not easily correctible/ may need medical interventions
It may be congenital
Neuromuscular scoliosis- result of muscle weakness or imbalance
Treatment:
1. Milwaukee brace
This apparatus exerts pressure on the chin, pelvis and convex (curved) side the spine.
Worn approximately 23 hours a day and is worn over a t-shirt to protect the skin
Indicated for curves between 20-40 degrees
2. Boston Brace
An underarm modification of the brace
Effective for patients with low curvature
3. Spinal fusion
Indicated for curves more than 40 degrees and for patient with unsuccessful conservative
treatment
Halo traction- used when there is associated weakness or paralysis of the neck and truk
muscle
Note: Curves up to 20 degrees do not require treatment.
Bone Tumor (Osteosarcoma)
It is a primary malignant tumor of the long bones
Risk factors:
Age: 10-15 years old
History of radiation therapy
History of retinoblastoma
Manifestations
1. Pain and swelling in the site (in adolescence, it is sometimes mistaken for growing pains)
2. Pathophysiologic fractures
Treatment and Nursing care
1. Radical resection or amputation surgery
2. Addressing the body image of the adolescents- (Adolescents are very much concern of self-
image)
3. Nurse should anticipate anger, grief or fear if there will be amputation
4. Address problems associated with phantom limb pain- continuous sensation of pain even if the
limb is no longer present
Trauma and Injury
Soft tissue injuries usually accompany traumatic fractures in adolescents involved in sports and
adventurous activities.
Types:
o Contusion- tearing of subcutaneous tissue results in hemorrhage, edema and pain.
Hematoma is evident.
o Sprain- when ligament is torn or stretched away from the bone at the point of trauma.
Swelling, disability and pain are major signs.
o Strain- microscopic tear of the muscle or tendon occurs over time and results in edema
and pain.
Prevention
o Maintain safe environment
o Educate the adolescents on safety precautions
o Wearing of helmets and protective devices when engaging to sports and adventurous
activities
Treatment of soft tissue injuries
o Cold pack and elastic wrap reduces edema and bleeding and relieves pain.
Applied at alternating 30-minutes interval
o Elevate extremities above heart level
o Elastic bandage application
Nursing resp: neurovascular check to ensure adequate tissue perfusion
o RICE
R-est
I-ce
C-ompression
E-levation
Fracture
Break in the bone and is mainly caused by accidents.
Characterized by pain, tenderness and swelling, discoloration, limited movement and numbness
Types
o Simple- bone is broken but skin is intact
o Compound- a wound in the skin accompanies the broken bone
o Greenstick- incomplete fracture in which one side of the bone is broken and the other
side is bent.
Treatment:
o Bryant’s traction- weights and pulleys extend the limbs as in the Buck’s extension;
however the legs are suspended vertically. The weight of the child supplies the
countertraction
o Buck’s Skin Traction- type of skin traction used in fractures of the femur and in hip and
knee contractures.
o Russel Traction- similar to Buck’s traction but a sling is positioned under the knee, whch
suspends the distal thigh above the bed. Skin traction is applied to the lower
extremities.
Nursing consideration for patients with traction
o Neurovascular check to ensure adequate tissue perfusion
Peripheral pulse rate and quality
Color
Capilliary refill time
Warmth
Movement and sensation
pain
o Maintain body alignment
o Skin integrity monitored regularly
o Pain relief as ordered
o Antiembolism stocking or foot pumps in place as ordered
Sexually Transmitted Infections
General name given to infections spread through direct sexual activities.
The occurrence of STI in a prepubertal stage must prompt investigation for possible sexual
abuse
Nursing Interventions
o Review structures of reproductive system
o Review personal hygiene
o Discuss values and decision making, possible sexual behaviors and consequences
o Discuss prevention of pregnancies and STIs
Dysmenorrhea
Painful menses, or cramps
Discomfort in the lower abdomen and may radiate to the lower back or down the egs.
May be accompanied by nausea and vomiting
Types:
o Primary- there is no evidence of pelvic abnormality
Affects 50 % of menstruating females and is the leading cause of short
term recurrent school absenteeism in adolescent girls
o Secondary- pathologic condition is identified
Manifestation
o Onset is shortly aftr menarche with heavy menstrual flow
o Pains starts no more than a few hours before menstruation starts and lasts for no more
than 72 hours
o Pelvic exam results are normal—Primary
o Secondary dysmenorrhea most commonly results from endometriosis
Treatments
o Prostaglandin Inhibitor drugs such as Ibuprofen or Naproxen
o Heat application to the ower abdomen or back
o Oral contraceptives which reduce the aount of endometrium build up each month and
therefore reduce prostaglandin secretions.
o Low fat and vegetarian diet
o Vitamins B and E and high level of omega 3 fatty acids
Obesity
Excessive weight in childhood is related to obesity in adulthood
Can lead to increase cholesterol, orthopedic problems, sleep apnea, high blood pressure and
diabetes
It can lead to social isolation which may lead to depression
BMI- 22-24 in adolescents indicates obesity
Nursing interventions:
o Monitoring of weight regularly
o Counseling on diet and lifestyle
o Encouraging exercise
Anorexia Nervosa
Is a form of self starvation seen mostly in adolescent girls
Characteristics
o Failure to maintain minimum body weight for age and height
o An intense fear of gaining weight
o Excess influence of body weight upon evaluation
o Amenorrhea
Risk factors
o Genetics
o Average to superior intelligence and overachievers usually perfectionist
o Dysfunctional family- controlling, rigid and imposing
o Social standards of weight such as being thinner
Manifestation
o Weight loss
o Dry skin
o Amenorrhea
o Lanugo hair over back and extremities
o Cold intolerance
o Low blood pressre
o Abdominal pain
o Constipation
o Helplessness
o Lack of control
o Low self-esteem
o Depression
o Lack of self- identity
o Although eating less, anorexic patients are preoccupied with food but hunger is denied
o They feel bloated when ingesting even small amount of food
Treatment
o A brief period of hospitalization may be necessary to correct severe malnutrition and
electrolyte imbalance
o Stabilization of patient’s weight
o Individual and family psychotherapy
o Antidepressant medications as ordered
o Provide comfortable and relaxed atmosphere
Bulimia
It is characterized by recurrent episodes of uncontrolled binge eatig followed by self-induced
vomiting and misused of laxative and/ or diuretics
Characteristics
o Dysfunctional family may cause the problem
o Depression and alcoholism in the family
o The binge-purge cycle if thought to be a coping mechanism for dealing with guilt,
depression, and low self-esteem
Manifestations
o Persistent vomiting
o Erosion of tooth enamel and eventual tooth loss
o Electrolyte imbalance due to excess use of laxatives and diuretics
o Muscle weakness
Nursing management
o Educate the adolescent on the condition
o Involve adolescent in meal planning
o Stay with the adolescent while she is eating until 30 minutes after eating to ensure that
there is no vomiting or purging
o Encourage verbalization of feelings
o Maintain nutritional requirements
CONCERNS REGARDING DEPRESSION AND ATTEMPTED SUICIDE
Suicide - deliberate self-injury with the intent to end one’s life
Suicide is more successful in males than in women, although there are more attempts in women
than in male
Most often happens during school year, reflecting school stress, and between the time of 3 PM
and midnight, which reflects depression that increases with the dark.
Ranks third as cause of death in the age group of 15 years old to 19 years old.
Causes of Depression:
Anger
Manipulation (psychological black mail)
Loss of a parent
Loss of a girlfriend or a boyfriend
Loss of a community
Loss of self-esteem
ASSESSMENT
Adolescents need to have thorough physical examinations at health maintenance visits to assure
them they are in good physical health.Assess (signs of depression):
o Anorexia
o Insomnia
o Excessive fatigue
o Weight loss
In younger adults, depression can be manifested by behavioral problems
Disobedience
Temper tantrums
Truancy
Running away from home
Self-destructive behavior
Accident proneness
Difficulty in school
Acting out with chemicals, alcohol, or sexual promiscuity
trouble with legal authorities
Occasionally, depressed adolescents find it so hard to be alone they seek constant activity as a
means of escape. Others may withdraw from contact with other persons and become
completely isolated
Adolescents who attempt suicide fall into many categories:
1. Loners and those who have difficulty expressing their feelings to others, therefore, do not receive
emotional support from friends.
2. Students who are trying to continually become an achiever.
3. Gay and lesbian youths.
4. Adolescents who have a family member or close friend who committed suicide.
5. An adolescent who have a school mate who committed suicide.6. Students who have internet
contacts who arranged a group suicide.
Suicide warning signs:
• Giving away prized possessions
• Organ donation questions, such as “How do you leave your body to a medical school?”
• Sudden, unexplained elevation of mood. Mood elevation may indicate that the individual has reached
a decision about the suicide and feels relief.
• Accident proneness, carelessness, and death wishes
• A statement such as, “This is the last time you will see me.”
• Decrease in verbal communication
• Withdrawal from peer activities or previously enjoyed events
• Previous attempt (80% of all completed suicides have been preceded by a failed attempt)
• Preference for art, music, and literature with themes of death
• Recent increase in interpersonal conflict with significant others
• Running away from home
• Recent experience of a friend or famous person committing suicide
• Inquiring about the hereafter
• Asking for information (supposedly for a friend) about suicide prevention and intervention
• Almost any sustained deviation from the normal pattern of behavior
NURSING DIAGNOSIS AND RELATED INTERVENTIONS:
Nursing Diagnosis: Risk for violence, self-directed, related to symptoms of depression or expressed
desire to hurt oneself
Outcome Evaluation:
1. Client expresses feelings of depression to health care providers or other adults, saying she will
contact support person should the desire to commit suicide become overwhelming
2. Intervention for adolescents who are contemplating suicide includes trying to alleviate their pain and
depression and counseling them to help them change their perspective on the value of life.
3. Try to find out the things in the child’s life that are still viewed as important.
4. Since adolescent resort to suicide as a method of solving their problems, helping them in this area can
be an intervention strategy.
5. Help adolescents speak honestly about thoughts of suicide and the problems that have led them to
think that death is a solution.
6. A period of observation in a hospital setting is desirable after a suicide attempt to prevent the
adolescent from inflicting personal injury again and to allow assessment in a neutral setting, away from
the stress that precipitated the attempt.
7. Antidepressant medicine alone, may be of little value in treating depressed adolescents.
8. Continuing evaluation by both history taking and physical examination is necessary, because the
young person who has attempted suicide may attempt it again if support people and better problem-
solving ability are not available at another time
I. CONCERNS OF THE ADOLESCENT AND FAMILY WITH UNIQUE NEEDS
Achieving a sense of identity may be difficult for adolescents who have a chronic illness or other
challenge.
It is important, for such individuals to learn to look past their particular condition to their real
selves.
Some of the biggest problems of chronically ill adolescents are likely to be:
o difficulties in being as independent as they would like to be
o achieving in school
o establishing intimate relationships
The loss of many hours of school because of illness or frequent hospitalization may result in the
inability to pursue a desired career, at least without a delay
Chronic hospitalization or the realization they will never be free of symptoms can cause
depression in adolescents, placing them at high risk for substance abuse or suicide.
