COMMON HEALTH PROBLEMS IN
ADOLESCENT - does not disappearwith position changes
Scoliosis
 a lateral curvature of the spine
 five times more common in girls and has
peak incidence at 8 to 15yrs
 Majority (75%) - idiopathic
 has a familial pattern (30% of children with
scoliosis)
 associated with other neuromuscular
disorders
Forms
1. Structural / Progressive form “S” curve of
the spine
- usually, idiopathic
needs more aggressive treatment
2. Functional/ Postural/Non-structural “C”
curve of the spine
- cause by poor posture, muscle spasm due
to trauma, or unequal length of legs
- disappears when child lies down
- can be treated with posture
- exercise
Assessment findings
1. Uneven shoulders
2. Uneven hips
3. Asymmetry of rib cage
4. Unequal length of bra strap
5. bump or rib hump on one side of the spine
 Spinal curve of less 20 degree
- no therapy
- observation until 18years of age
Spinal curve greater than 20 degree
- conservative, nonsurgical approach
- braces
- traction
- Plaster jacket cast
Spinal curve of more than 40 degree
- Surgery
- Spinal fusion with insertion of
Diagnosis Harrington rod

Forward bend test/ Adam’s bend test 23 hours/day for 3 years

- a test used most often in schools and

doctor's offices to screen for scoliosis
Scoliometer – a commercial device used to
document the extent of spinal curve
Radiograph (X-ray)
- assess the angle of the curve and
determine extent of deformity
Cobb angle standard method for assessing the
curvature quantitatively.
Using a Scoliometer
1. Ask the child to slowly bend forward until
the shoulders are level with the hips
2. Adjust the bending position height so the
deformity of the spine is most pronounced.
3. Gently lay the scoliometer across the
deformity at right angles to the body, with
the marking centered over the curve.
Boston brace
General Rule:
Refer to a physician with a scoliometer reading of
seven degrees or greater
Management
Depends on the maturity of the skeleton and on the
degree of curvature
 Traction
- Halo-pelvic traction
- Halo-femoral traction

THE BOSTON BRACE (For Full-time Wearing)

THE CHARLESTON BENDING BRACE (For

Part-time Wearing)
 Two most frequently occuring types of
bone cancer:
Electrical stimulation
- Osteogenic Sarcoma
- Use as an alternative for braces - Ewing’s Sarcoma
- Electrodes are applied to the skin or
surgically implanted
- Electrical stimulation is usually
employed at night, during sleeping hours
- To stimulate muscle to contract to
straighten the spine
Stretching exercises of the spine for non-structural
changes

Nursing intervention
Provide care for child with brace
- Teach the child to wear it constantly,
except when bathing
- wear over a t-shirt to protect the skin
report if there is rubbing
- encourage exercise as prescribed
- Provide cast or traction care
- Frequent cleansing on the pin sites
- Provide diversional activities
- Monitor for signs of complications
Provide preoperative and post operative nursing
care
- Deep breathing exercise
- Use of incentive spirometry
- Log roll; do not raise the head of the bed Osteogenic Sarcoma
- Stress correct body mechanics
- Promoting mobility, positive body image - A malignant tumor of long bone
and compliance with therapy involving rapidly growing bone tissue
- Preventing injury and Preventing skin (mesenchymal matrix forming cells)
irritation - Characterized by formation of osteoid
(immature bones)
Bone tumors
Common sites of occurrence
Sarcoma – tumors arising from connective tissue,
such bones and cartilage, muscle, blood vessels or - distal femur – 50%
lymphoid tissue - Proximal tibia – 20%
- Proximal humerus – 10 to 15%
- common neoplasm in adolescent
- Arise during adolescent because of rapid High incidence in children expose to radiation and
bone growth with retinoblastoma
Lungs – common site of metastasis
 Ewing’s Sarcoma
Assessment - Malignant tumor arising most often in
the bone marrow of the diaphysis area
- Pain
(midshaft) of long bones
- Swelling, redness
- The diaphyses of the femur are the most
- Tender mass, warm to touch
common sites, followed by the tibia and
- Limitation of movement
the humerus
- Pathologic fracture
- Lungs is the most frequent site of
Diagnosis metastasis

- Bone Biopsy
- Ct scan
- Bone scan
Management
Surgery
- Limb salvage procedures
- Bone or skin grafts
- Amputation
- Reconstructions
- Resections of metastases Clinical Findings
- Radiation therapy
- Chemotherapy 1. Pain and swelling on affected part

Rehabilitation 2. Palpable mass

- physical and occupational therapy 3. Tender and warm to touch

psychosocial adapting 4. 15- 35% of clients have metastasis @ time
- prosthesis fitting and training of diagnosis
Nursing management Management
1. Provide routine preoperative care 1. High doses of radiation therapy
2. Offer support or encouragement and accept 2. Chemotherapy
client’s response of anger and grief
3. Surgery
3. Discuss to patient and family rehabilatation
program and use of prosthesis crutch Diagnosis
walking phantom limb sensation as normal - X-ray
recurrence - Bone scan
4. Prevent hip and knee contractures prone - Biopsy
position several times a day (unless - Bone marrow aspiration
otherwise ordered) Nursing intervention
5. Provide stump care Caution adolescent to continue to be careful and
avoid activities that may cause added stress to
affected limb such as football and weight lifting
Sexually Transmitted Disorders C. Syphilis
- are those disease spread through sexual contact Causative agent: Treponema pallidum (spirochete)
A. Gonorrhea Crosses placenta after 16 week of pregnancy
Causative agent: Neisseria Gonorrhea Manifestation
Signs & symptoms:  Primary
- cardinal sign – CHANCRE - a hard red
- often asymptomatic in females
painless lesion @ the point of infection
- purulent yellow-green vaginal discharge
site
- May cause ophthalmia neonatorum and
- disappear without treatment in 4-6
sepsis to newborn
weeks
Treatment:  Secondary
- rash, malaise, alopecia
- Penicillin
 Tertiary
- Erythromycin
- effect any organ system –
- Ceftriaxone
cardiovascular, neurovascular system
- Doxycycline
Treatment:
all sexual contacts must be treated
penicillin or erythromycin

D. Trichomoniasis
B. Chlamydia
Trichomonas vaginalis - a single-cell protozoan
Causative agent: Chlamydia trachomatis
Sign & symptoms:
- Most common STD
- thin, irritating, frothy, gray- green
Signs & symptoms:
discharge
- watery, gray-white vaginal discharge - strong odor, itching to genitalia
- vulvar itching
Treatment: metronidazole
- May causes ophthalmia neonatorum,
sterility in female or male, tubal douche with weak vinegar solution to reduce
pregnancy pruritus
Drug: doxycycline or tetracycline, azithromycin
E. Candidiasis Clinical findings and diagnosis
Candida Albicans - fungus The American Psychiatric Association Criteria for
Diagnosis
Caused by a yeast transmittedfrom GI tract to
vagina - body mass index – less than 85% of
expected weight intense fear of getting
Sign & symptoms:
fat or gaining weight even though
- thick, white cheese-like vaginal - underweight
discharges - severely distorted body image
- vulvar reddening and pruritus - refusal to acknowledge seriousness of
weight loss
Treatment: - amenorrhea
topical application or suppositories of antifungal Manifestation
drug such as:
- Almost skeleton-like appearance
- clotrimazole, nystatin, miconazole,
diflucan, gentian violet - Sexually immature

Bathing with diluted sodium bicarbonate solution to
reduce pruritus
Anorexia nervosa
- A disorder characterized by refusal to
maintain a minimally normal body
weight because of a disturbance in
perception of the size or appearance of
the body
- an eating disorder characterized by
extremely low body weight, body image
distortion and
- an obsessive fear of gaining weight.
May be manifested as severe weight restriction
controlled by:
 limiting food intake
 excessive exercise
 binge eating/purging
- Dry skin, brittle nails
- Presence of lanugo
- Constipation, hypothermia, bradycardia,
low blood pressure, anemia
- Depression, social withdrawal and poor
individual coping
Management
Nutritional therapy
- Total parenteral nutrition
- Enteral tube feeding
Behavior modification
Medication - antidepressant
Counselling
- Individual therapy
- Group therapy
- Family therapy
Bulimia Nervosa
Bulimia – refers to recurrent and episodes of binge
eating and purging accompanied by an awareness
that eating pattern is abnormal but not being able to
stop
Bulimic person is of normal of weight or slightly
overweight or underweight
may abuse purgative, laxatives and diuretic to aid in Obesity
weight control
- An excessive accumulation of fat that
Clinical manifestation and Diagnosis increases body weight by 20% or more
- Obesity is now among the most
- Dental caries and erosion
widespread medical problems affecting
- Throat irritation
children and adolescents living in the
- Electrolytes imbalance- hypokalemia
United States and other developed
Behavior problem countries.
- Obesity increases the child's risk of of
- drug abuse serious health problems such as heart
- alcoholism disease, DM type 2 and stroke
- stealing
- impulsive activities - It also can create emotional and social
problems
American Psychiatric Association the criteria for
bulimia are: - often feels isolated from the peer group
embarrassed to participate in sports
- Recurrent episodes of binge eating
- A feeling of lack of control over - Adolescents may have difficulty
behavior during binges achieving a sense of identity if they are
- Self-induced purging; use of laxatives, always excluded from group and if they
diuretics, enemas don’t like their image in a mirror
- Average of at least two binge-eating
BMI – most accurate method of assessment
episodes a week during 3 months period
- Obsessiveness regarding body weight - indicates relationship between height
and shape and weight
Management Causes
- Pharmacology – antidepressant - Many different factors contribute to this
- Psychotherapy imbalance between calorie intake and
consumption
Nursing intervention
Genetic factors
- Monitor vital signs
- Obesity tends to run in families
- Monitor intake and output
Dietary habits
- Record food intake
- fast food, processed snack foods, and
- Monitor weight
sugary drinks.
- Encourage client to express feelings
- use food as means of satisfying
- Help client to set realistic goal for self emotional needs

- Help client identify interest and positive - Indulging in late – night eating
aspect of self
Physical inactivity
- The popularity of television, computers,
and video games results into an
increasingly sedentary lifestyle
Management
Lifestyle modification, Physical activity,
Nutrition education
Ways to manage obesity in children and
adolescents include:
1. Start a weight-management program
2. Change eating habits (eat slowly, develop a
routine)
3. Plan meals and make better food selections
4. Increase physical activity and have a
more active lifestyle
5. Know what your child eats at school
6. Do not use food as a reward
7. Limit snacks
8. Attend a support group (e.g., Overeaters
Anonymous)
Substance Abuse
- is the misuse of an addictive substance
that changes the user’s mental state
- refers to the use of chemicals to improve
a mental state or induce euphoria
Commonly abuse substance – alcohol, tobacco and
illicit drugs
Cause/Reasons: a means of relieving the tension and
pressure of their lives
Adolescent
- a desire to feel more confident and
mature due to peer pressure
- a form of rebellion
Children at greatest risk
1. have family in which alcohol or drug abuse
is present
2. suffer from abuse, neglect
3. have behavior problems – aggressiveness
and excessively rebelious
4. slow learners
5. have problems with depression and low-self
esteem
Stages of substance abuse
Stage 0: Preabuse or Curiosity Stage
- describes the adolescent with an
increased potential for substance abuse
- need for peer acceptance; anger and
boredom
Stage 1: Experimental Stage (Learning the
Euphoria)
- Adolescents have already made a
decision to “try”drugs and begun
learning the drug induced mood swing
oreuphoria.
- drug use is confined to social situations
- there are few behavioral changes other
than “lying”
Stage 2, Early Regular Use (Seeking the
Euphoria)
- the adolescent now actively seeks the
drug-induced mood swing
- use drugs to seeks relief from everyday
stress
- changes in dress, decline in personal
hygiene, deterioration in school
performance, loss of previous interest in
extracurricular activities adolescent
exhibits more mood swings, engages in
regular lying
Stage 3 Late Regular Use (Preoccupation with
the Euphoria)
- dependent on substance abuse
Dependence - compulsive need to use a substance
for its satisfying effect
- deterioration of behavior such as
fighting, lying, stealing, Prostitution
often depressed, suicidal ideation, self-
destructive and risk-taking behavior
Stage 4 End Stage or “Burn Out”
- Adolescent needs drugs just to feel
normal and to avoid the profound and
nearly constant dysphoria.
- Depression, guilt, shame, and other
remorse may be overwhelming, and
suicidal ideation becomes more common
- Paranoia, angry outbursts, and
aggression are common
Common Assessment findings
1. Failure to complete assignments in school
2. Demonstration of poor reasoning ability
3. Decreased school attendance
4. Frequent mood swings
5. Deteriorating physical appearance
6. Recent change in peer group
7. Expressed negative perceptions of parents
Treatment
- Prevention is the most effective and least
expensive treatment for substance abuse
- Medication, -nicotine patches and
methadone
- Rehabilitation, counseling, social
support, family support
Suicide
- Is a deliberate self- injury with the intent
to end one’s life.
- successful suicide occurs more
frequently in male than females
- third cause of cause of death between 15
– 19 years of age
- Suicide as viable solution to life
problems
Risk Factors
- Previous suicide attempts
- Close family member who has
committed suicide.
- Past psychiatric hospitalization
- Recent losses: death of a relative, a
family divorce or a breakup with a
girlfriend
- Social isolation
- Drug or alcohol abuse
- Exposure to violence in the home or the
social environment
Warning Signs for Suicide
- Suicidal talk
- Preoccupation with death and dying
- Signs of depression
- Behavioral changes
- Giving away special possessions and
making arrangements to take care of
unfinished business
- Difficulty with appetite and sleep
- Taking excessive risks
- Increased drug use
- Loss of interest in usual activities
Tips for Parents
- Know the warning signs!
Do not be afraid to talk to your child.
- The message is, “Suicide is not an
option, help is available."
Suicide-proof your home.
- Make the knives, pills and firearms
inaccessible.
Utilize school and community resources.
- school psychologist, crisis intervention
personnel
Take immediate action.
- If your child indicates
- contemplating suicide
Do not leave your child alone
- Seek professional
Listen to your child’s friends.
- They may give hints about your
- Be open. Ask questions.
Three steps teens can take
1. Take your friend's actions seriously
2. Encourage your friend to seek professional
help, accompany if necessary
3. Talk to an adult you trust. Don't be alone in
helping your friend.