Objectives:by the end of this session you’ll be able to:
define adolescence period & its stages .be familiar with the recommendation of( GAPS).
Understand Adolescence preventive services:
Screening
Laboratory tests.
Immunization.
Recognize HEADSS Assessment .
Be familiar with Safe teens.
Know Anticipatory guidance.
Understand the Consent & confidentiality.
Recognize Sexuality concept .
Definition:
Adolescence is a time of a physical, emotional, mental& psychosocial changes. It also a time for experimentation &risk taking ,its also a time for a relatively good health for most.
Stages of adolescence:
Early adolescence:
Occurs at 11-13 years of age &merges with mid adolescence at14-15 years. charactarized by concrete thinking & body image disruption.
Mid adolescence:
Begins around 14-15 years of age till 17 yr.Issue involve autonomy may lead to parental conflict.
Late adolescence:
from 17-21yr.the upper end is particularly variable & depends on cultural, economic,& educational factors. adolescents begin to think about the future & form stable intimate relationship.
Early adolescence
Mid adolescence
Late adolescence
Characteristics
Secondary sexual characteristics have begun to appear
Secondary sexual characteristics are well advanced
Physically mature, statural and reproductive growth are virtually complete
Growth
Rapidly accelerating, reaches peak velocity
Decelerating, stature reaches 95% of adult height
Guideline of adolescence preventive services:
A series of recommendations regarding the delivery of health services ,promotion of well-being, screening for common conditions ,& provision of immunization for adolescents & young adults between the age of 11-21y it includes:Annual health visits: (3 complete physical examinations, one at each stage).
Counseling for both parents & adolescent.
Screening
Adolescence preventive services:
Routine screening :
For several medical, behavioral,& emotional conditions:
Hypertension (measuring Bp)
Hearing ( conduct objective test at 12-15-18 yr.)
visual acuity (Snellen test)
High risk or symptomatic adolescents( TB. ,anemia ,cholestrol)
eating disorder & obesity (BMI)
Use of tobacco , alcohol & other abusable substances
2)Laboratory test :
Often not necessary .in the asymptomatic teenager , screening lab. Test should be kept at a minimum.
Hb or Hematocrit : anemia screening is recommended at the end of puberty.
S.C.D.
lipid profile.
sexually active adolescents :
males: gonorrhea, Chlamydia , annual syphilis serology, HBV( homosexual).
Female : pap smear starting at age 21 in vulnerable group.
3) Immunization:
Diphtheria, tetanus: a booster of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) is recommended 10 years after the initial series.
meningococcal conjugate vaccine: administer to unvaccinated adolescents at high school entry (15y)
influenza vaccine recommended for adolescents with certain risk factors
hepatitis A and B: if not received during childhood
Pneumococcal vaccine: for adolescents with chronic illnesses (S.C.D., HIV, B-cell immune deficiency) and those with cardiovascular and pulmonary disease.
HPV vaccine: all females 11-12 years of age should receive the 3 dose series
Rubella: unimmunized females.
HEADSS Assessment:
Adolescent psychosocial screening:
Home
Education/ employment
Activities
Drugs
Sexuality
Suicide/ depression screen/ referral
(the area of sex, school performance, family, peer group, identity, and future should all be explored)
Safe teens
Injuries are the most significant health problem of adolescents, providing safety guidelines for teens is thus crucial in decreasing mortality from high risk behavior.
Sexuality: health education regarding contraception, STI, sexual abuse
Accident
Fire arms / Homicide: safely used legal issue with guns
Emotions / suicide
Toxins / drug abuse
Environment (school, home, friends)
Eating
Nutrition
Shots / immunization
Anticipatory guidance:
the goals are:
promote understanding of physical growth and the importance of becoming actively involved in health care decision
Reduce injuries by encouraging the use of helmets, seatbelts and sunscreen
Provide information regarding dietary habits
Provide information about the benefit of fitness and physical activity
Educate adolescents about responsible sexual behavior
Discourage use of elicit substance
Consent and confidentiality
Adolescents may fail to seek or delay seeking of health care for number of reasons like lack of access, finances, and may have concerns about confidentiality.
Adolescents are more likely to seek care about sensitive issues yet they fear that the health provider will not disclose the information to their parents.
Laws about confidentiality vary from country to another.
Issues of confidentiality and consent are best managed in the contest of a long term physician- family relationship.
Sexuality:
Differing family values, cultural values and personal experiences may give rise to varying sexual education needs which may include understanding body functions, exploring personal values and setting sexual limits with partners.
parents and clinicians maybe unprepared to discuss sexually related issues with adolescents.
Teens may be uncomfortable discussing sexual issues with their peers and with adults.
Lack of comprehensive sex education program
All the above put adolescents at increased risk for unwanted or unhealthy consequences of sexual activity.
stage
characteristics
Pre- adolescence
Low investment in sexuality
Information about sexuality comes from friends , school, and family
Physical appearance is pre-pubertal
Early adolescence
Physical maturation begins
Curiosity about one’s own body persists.
Sexual fantasies are common
Masturbation begins
Sexual activities are often non physical (phone calls , emails)
Late adolescence
Full physical maturation
Sexual behavior and thoughts are more expressive
Intimate physical and sharing relationship may develop