CARE of ADOLESCENTS with Idiopathic scoliosis is of unknown cause.

It is
common among adolescents.
HEALTH PROBLEMS
Neuromuscular scoliosis is caused by problems
I.
such as poor muscle control or muscle
Definition of Terms weakness, or paralysis due to diseases such as
cerebral palsy, muscular dystrophy, spina bifida
1. Idiopathic and polio.
- Any disease that is of uncertain or unknown
origin
Tests and Diagnostics
2. Drug tolerance
Physical Exam – forward bending test
- decrease in susceptibility to the effects
of a drug due to its continued administration. Scoliometer screening – measure the curvature
of the spine
Physical Dependence
Spine x-rays – front and side
- substance dependence in which there
is evidence of tolerance, withdrawal, or both. MRI – checks neurologic changes

II. Adam’s forward bend test

Health Problems Common * patient is asked to lean forward with

his or her feet together and bend 90 degrees at
In Adolescents the waist.
Scoliosis * The examiner can view any
is a curving of the spine. asymmetry of the trunk or any abnormal spinal
curvatures.
The spine curves away from the middle or
sideways. Screening hints

Symptoms Shoulders are different heights – one shoulder

blade is more prominent than the other
• shoulder appears to be higher than the
other, or the pelvis appears to be tilted Head is not centered directly above the pelvis

Other symptoms: Appearance of a raised, prominent hip

• Low back pain; or Rib cages are at different heights

• Backache Screening hints

• Fatigue • Shoulders are different heights – one

Causes
Congenital (present at birth) scoliosis is due to a
problem with the formation of the spine bones
(vertebrae) or fused ribs during development in
the womb or early in life.
shoulder blade is more prominent than
the other
• Head is not centered directly above the
pelvis
• Appearance of a raised, prominent hip
 • Rib cages are at different heights
• Uneven waist
• Changes in look or texture of skin
overlying the spine (dimples, hairy
patches, color changes)
• Leaning of entire body to one side
Scoliometer
• The patient bends over, arms dangling
and palms pressed together, until a
curve can be observed in the upper
back (thoracic area).
• The Scoliometer is placed on the back
and measures the apex (the highest
point) of the upper back curve.
* The patient continues bending until the curve
can be seen in the lower back (lumbar area).
The apex of this curve is also measured.
Medical Management
Brace Treatment for Scoliosis
• Most common is Boston brace (aka
Thoraco-lumbar-sacral orthosis)
• Braces have 74% success rate at halting
curve progression (while worn)
• Bracing does not correct scoliosis, but
may prevent serious progression
• Of patients with 20º - 29º curves, only
40% of those wearing braces ultimately
required surgery, compared to 68% of
those not wearing back braces
• Length of wearing time correlates with
outcome (At least 16 hrs per day leads
to best chance of preventing curve
progression)
Surgical Treatment for Scoliosis
• Spinal surgery with instrumentation
significantly corrects deformity &
usually stops curve progression
• Surgery is accompanied by spinal cord
monitoring using somato-sensory &
motor-evoked potentials
Complications
• Emotional problems or lowered self-
esteem
• Failure of the bone to join together
• Low back arthritis & pain
• Respiratory problems
• Spinal cord or nerve damage
• Spine infection after surgery
• Spinal cord or nerve damage
• Spine infection after surgery
Prevention
Routine screening among high school students
Dysmenorrhea
Painful menstrual periods are periods in which a
woman experiences crampy lower abdominal
pain, sharp pain that comes and goes, aching
pain, or possibly back pain.
Primary Dysmenorrhea
Results from contractions of the muscle layers
of the uterus which are stimulated by pain-
triggering hormones called prostaglandins.
Causes
Excess weight. Overweight women have
stronger and more persistent menstrual pain.
Smoking. Women smokers are 50% more likely
to suffer from menstrual pain.
Sedentary lifestyle and stress. Stress and lack
of regular physical exercise increase menstrual
pain.
Alcohol consumption. Alcohol consumption
prolongs the duration of pain in women who
suffer from dysmenorrhea.
Secondary Dysmenorrhea
caused by certain disorders of the female
reproductive system
Causes
Endometriosis. The tissue lining the uterus,
called endometrium (responsible for
menstruation), reside outside the uterine cavity
(ovaries, Fallopian tubes, etc.)
• And still acts as it does inside the
uterus.
• This means it responds to hormonal
changes, breaks apart and bleeds. This
is what causes the pain.
Fibromas. These benign tumors form and grow
in the uterus or the ovaries. They cause pain
during the menstrual flow.
Pelvic inflammatory disease (PID). A bacterial
infection of the uterus, fallopian tubes and
ovaries.
Diagnostic Evaluation
Ultrasound. It is used to look for fibroids and
other ovarian abnormalities that may cause
heavy bleeding or cramps.
Endometrial biopsy. Women should take a pain
reliever prior to the procedure, as there may be
some cramping.
Blood, stool and urine tests – to check for levels
of various hormones, blood cells, and other
chemicals.
Dilation and curettage (D&C) – the cervix is
opened and the lining of the uterus scraped for
a tissue sample.
Laparascopy and hysteroscopy: a small camera
is inserted into the woman to view the inside of
the pelvis, abdomen or uterus.
Medical Management
Birth control pills
Prescription anti-inflammatory medicines
Prescription pain relievers (including narcotics
for brief periods)
Therapeutic Management
Apply a heating pad to your lower abdomen
(below your belly button).
Do light circular massage with your fingertips
around your lower abdomen.
Drink warm beverages.
Eat light but frequent meals.
Follow a diet rich in complex carbohydrates
such as whole grains, fruits, and vegetables, but
low in salt, sugar, alcohol, and caffeine.
Keep your legs elevated while lying down, or lie
on your side with your knees bent.
Practice relaxation techniques.
Try over-the-counter anti-inflammatory drugs.
Try vitamin B6, calcium, and magnesium
supplements, especially if your pain is from
PMS.
Take warm showers or baths.
Walk or exercise regularly, including pelvic
rocking exercises.
Lose weight if you are overweight.
Amenorrhea
is the absence of menstruation — one or more Hormonal Imbalance
missed menstrual periods.
* Polycystic Ovarian Syndrome (PCOS) –
Primary Amenorrhea causes relatively high & sustained levels of
hormones
absence of normal menstruation in a patient
without previously established cycles * Thyroid Malfunction – hyper or
hypothyroidism causing amenorrhea
Secondary amenorrhea
* pituitary tumor – interferes with
absence of menses for 3 cycle lengths in
hormonal regulation
oligomenorrhea, or for 6 months after having
regular menses * premature menopause – no menses
at 40
Natural Amenorrhea
Structural Problems
Due to normal reasons as:
* uterine scarring – Asherman’s
• Pregnancy
syndrome right after D&C and CS
• Breast-feeding
* Lack of Reproductive Organs
• menopause
* Structural abnormality of the vagina –
Causes obstruction of the vagina

Contraceptives Risk Factors

* pills Family history

* injected Eating Disorders

* implanted * anorexia or bulimia

Medications Athletic Training

* antipsychotics

* cancer chemotherapy Complications

* antidepressants Infertility

* blood pressure drugs * no ovulation, no menses, no

pregnancy
Lifestyle
Osteoporosis
* stress – affects the hypothalamus, an
area of the brain that controls the hormones * amenorrhea causes low estrogen
that regulate menstrual cycle levels putting a woman at risk of osteoporosis

* Low body weight – interrupts Test and Diagnosis

hormonal functions affecting ovulation
Lab tests
* excessive exercise – rigorous training
* pregnancy test
interrupts menses
 * thyroid function test – measure the
TSH in the blood to check if the thyroid is
working
* Ovary function test – measure the FSH
in the blood to check if the ovaries are working
Test and Diagnosis
Ultrasound – a test to see if all organs are
present
Computerized tomography – CT scan; to check
whether organs look normal
Magnetic Resonance Imaging (MRI) – to check
for pituitary tumor
Treatment and Drugs
Treatment depends on the underlying cause:
* Contraceptive pills
* Specific meds – for thyroid & pituitary
disorders
* Surgery – to remove structural
blockage
Obesity
• Body weight much greater than what is
considered healthy
Causes
• Eating more food than your body can
use
• Drinking too much alcohol
• Not getting enough exercise
Risk Groups
• Lower income groups
• Former smokers
• People with chronic mental illness
• People with disabilities
• People with sedentary lifestyle
Tests & Diagnostics
Physical Examination & History Taking
Blood tests – thyroid or endocrine problems
Treatments
Diet – learn new and healthy ways of eating and
make them part of your daily routine
Medications & Herbal Remedies – talk to a
health care provider before starting to take any
meds
Exercise – to burn energy & strengthen bones
Surgery
Laparoscopic gastric banding – a band
is placed around the upper part of the stomach,
creating a small pouch to hold food.
The band limits the amount of food you
can eat by making you feel full after eating small
amounts of food.
Gastric bypass surgery -changing how
the stomach and small intestine handle the
food you eat.
You will not be able to eat as much as
before, and your body will not absorb all the
calories and other nutrients from the food you
eat.
Complications
Diabetes Mellitus
Hypertension
Obstructive sleep apnea & sleep disorders
Certain cancers – breast & colon
Depression
osteoarthritis
Prevention • Poor memory or poor judgment

Monitor fat consumption • Significant weight loss

Keep a detailed food diary Causes

Eating a 3-balanced, moderate portion meals a • Cause is unknown

day – with the main meal at midday
• Factors can be:
Exercise
– Genetic
Encourage healthful habits
– Social attitude toward body
Anorexia Nervosa appearance

• An eating disorder that involves limiting – Conflict within the family

the amount of food a person eats.
Risk Factors
• It results in starvation & an inability to
Accepting society’s attitude about thinness
stay at the minimum body weight
considered healthy for the person's age Being perfectionist
and height
Being female
Noticeable Behaviors
Experiencing childhood anxiety
• Cutting food into small pieces
Feeling increased concern or attention to
• Exercising compulsively weight & shape
• Going to the bathroom right after meals • Having eating & gastrointestinal
problems
• Quickly eating large amount of food
• Having a family history of addictions or
• Using laxatives, enema, diuretics
eating disorders
Symptoms
• Having parents who are concerned
• Yellow skin about weight & weight loss

• Confused or slow thinking • Having a negative self-image

• Dental cavities due to self-induced Treatment

vomiting
• Recognize that the eating behavior is in
• Depression itself a problem
• Behavioral therapy
• Dry mouth
• Supportive care
• Extreme sensitivity to cold • Feedings thru the vein – severe cases

• Fine hair • Having eating & gastrointestinal

problems
• Low blood pressure
• Having a family history of addictions or
• No menstruation eating disorders
 • Having parents who are concerned
about weight & weight loss
• Having a negative self-image
• Recognize that the eating behavior is in
itself a problem
STEP 1
Identify Hazards. Identify hazards to the force.
Consider all aspects of current and future
situations, environment, and known historical
problem areas.

• Behavioral therapy STEP 2

• Supportive care Assess Hazards. Assess hazards to determine

risks. Assess the impact of each hazard in
• Feedings thru the vein – severe cases
terms of potential loss and cost, based on
• Medications probability and severity.

• Antidepressant drugs STEP 3

Complications Develop Controls and Make Risk Decisions.

• Appearance of fine baby-like body hair Develop control measures that eliminate the
(lanugo) hazard or reduce its risk, where benefits
outweigh potential cost.
• Bloating or edema
STEP 4
• Decrease in WBC
Implement Controls.
• Heart arrythmias
Put controls in place that eliminate the
• osteoporosis hazards or reduce their risks.
Severe dehydration – leads to shock STEP 5
Severe malnutrition Supervise & Evaluate.
Seizures – due to fluid loss from diarrhea or Perform to, and enforce standards and
vomiting controls. Evaluate the effectiveness of controls
Thyroid gland problems and adjust/ update as necessary.

Tooth erosion & decay Head & Brain Trauma

Prevention Risk Groups

• Encourage healthy, realistic attitude on • Highest: Males 15-24 yrs of age

weight & diet • Very young children: 6 mos to 2 yrs of
• Counseling age

Risk Management • Young school age children

the process of identifying and controlling • Elderly

hazards to protect the force. Mechanisms of Injury
Risk Management Process Motor Vehicle Crashes
 • most common cause of head trauma Basilar Skull Fracture
and subdural hematoma
• Difficult to detect on x-ray
Sports Injuries
• Signs & Symptoms depend on amount
• Acute trauma or repetitive stress of damage
associated with athletic activities
• Do NOT pack ears
Falls
• Let drain
• common in elderly and in presence of
• Do NOT suction fluid
alcohol
• Do NOT instrument nose
Penetrating Trauma
Open Skull Fracture
• When an object pierces the skin &
enters a tissue of the body • Cranial contents exposed
Mechanisms of Injury • Protect exposed tissue with moist, clean
dressing (if possible)
Head Injury
• Neurologic signs & Symptoms evident
• Traumatic insult to the head resulting in
injury to soft tissue, brain, bony Brain Injuries
structures
Injury to Cerebral Parenchyma
Blunt Trauma
Laceration
fractures, focal brain injury
Concussion
Penetrating Trauma
Contusion
GSW most common
Laceration
fractures, focal brain injury
Penetrating wounds
Head Injuries
GSW
Linear Fracture
Stab
• Usually NOT identified in field
Depressed Fracture
• 80% of all skull fractures
Severe blunt trauma
• Usually NOT emergency
Sudden acceleration/deceleration
• Temporal region = ~Epidural hematoma
Concussion
Depressed Skull Fracture
Transient loss of consciousness
• Segment pushed inward
Retrograde amnesia, confusion
• Pressure on brain causes brain injury
Resolves spontaneously without deficit
• Neurologic signs and symptoms evident
Usually due to blunt head trauma bridging veins between cortex & dura

Post-concussion syndrome Causes increased intracranial pressure

Headaches

Depression Subdural Hematoma

Personality changes Slower onset

Contusion Increased ICP

– a bruise in the brain tissue Headache, decreased LOC, unequal pupils

Common characteristics Increased BP, decreased pulse

confusion, sleepiness, dizziness, loss of Hemiparesis, hemiplegia

consciousness, nausea, vomiting, seizures,
Intracerebral Hematoma
difficulty with coordination and movement;
difficulty with memory, vision, speech, hearing, Usually due to laceration of brain
managing emotions and thinking
Bleeding into cerebral substance
Brain Injuries
Neuro deficits depend on region involved and
Epidural Hematoma size
Blood between skull and dura repetitive w/frontal lobe
Usually arterial tear Increased ICP
middle meningeal artery Bone Tumor
Causes increase in intracranial pressure • An abnormal growth of cells within the
bone that may be noncancerous
Epidural Hematoma
(benign) or cancerous (malignant)
Unconsciousness followed by lucid interval
Symptoms
Rapid deterioration
• Bone fracture
Decreased LOC, headache, nausea, vomiting
• Bone pain
Hemiparesis, hemiplegia
• Presence of mass or swelling
Unequal pupils (dilated on side of clot)
Causes
Increase BP, decreased pulse (Cushing’s reflex)
Possible Causes:
Subdural Hematoma
• Inherited genetic mutations
Between dura mater and arachnoid
• Radiation
More common
• trauma
Usually venous
Prognosis
Depends on the type of tumor Marijuana – (THC) tetrahydrocannabinol is the
ingredient associated with intoxication
Outcome is expected to be good for BENIGN
type Cocaine – known as crack, coke, snow, rock

For MALIGNANT type – cure rate depends on Club drugs- Ecstasy – to improve mood &
the type of cancer, location, size, other factors maintain energy

– LSD

Exams and Tests Heroin – known as smack, horse

• Bone biopsy Methamphetamines – known as meth, crank,

ice, speed, crystal; this is a powerful stimulant
• Bone scan
Causes of Substance Abuse
• MRI of the bone
• Family factors
Treatment
– Chaotic home environment
Chemotherapy
– Ineffective parenting
Radiotherapy – used locally to prevent fractures
or relieve pain – Lack of nurturing & parental
attachment
Surgical Treatment
• Socialization factors
Combination of chemotherapy & surgery
– Inappropriate aggressive or shy
Complications
behavior
• Pain
– Poor social coping skills
• Reduced function
– Poor school performance
• Side effect of chemotherapy
– Association with a deviant
• Spread of cancer to nearby tissues group

Substance Abuse – Perception of approval of drug

use behavior
• Also known as drug abuse
Symptoms of Substance Abuse
• refers to a maladaptive pattern of use
of a substance (drug) that is not • declining grades
considered dependent
• Giving up past activities
Types of Substance Abuse
• Aggressiveness & irritability
Tobacco – nicotine is the addicting substance
• Disappearing money or valuables
Alcohol - decrease muscle control &
• Feeling hopeless/depressed
coordination
• Not caring & selfish
 • Getting drunk or high US in 2000, and the 3rd leading cause of
death between the ages 15 & 24.
• Telling a lie
Factors
• Taking risks including sexual risks
• Biological vulnerabilities
• Getting in trouble with the law
• Life history
• Drinking & driving
• Occupation
• Suspension from school
• Present social circumstances
• Avoiding friends or family
• Availability of means for committing
• Hiding alcohol
suicide
• Frequent hangovers
Risk Factors
Treatment
• A family history
Prevent relapse – for persistent cravings
• History of previous attempts
Behavioral treatment – to cope with drug
• History of abuse
cravings
• Recent stressful events:
Medications – to control withdrawal symptoms
separation/divorce/death, job loss,
& drug cravings
medical diagnosis
counseling
• Employment/high stress occupation
Prevention
• Alcohol and substance abuse
• Health teaching in schools & the
• Presence of psychiatric illness
community
Diagnosis
• Increase communication between
parents & children Physicians assessment will be based on the ff:

• Create a conducive atmosphere Patients history

• Teach: Clinical interview

– Resistance skills A suicide note

– Correct misperceptions about Information from significant others

cigarettes, alcohol, & drugs
Psychiatric tests
Suicide
Treatment
• the intentional taking of one's own life.
Psychiatric evaluation
• According to the National Institute of
Labs: urine & blood tests – for alcohol or drug
Mental Health (NIMH), suicide was the
use
eleventh leading cause of death in the
Hospitalization is based on the severity of: Viral (incurable)

Depression  Genital herpes

Availability of support groups  Genital warts

Presence of risk factors  Hepatitis B

Alternative Treatment  AIDS

Prevent or relieve depression How Is HIV Transmitted

Meditation practice or religious faith  Through blood, semen, vaginal

secretions & breast milk.
Social group – support system
 Through sexual intercourse with an HIV
Prevention
carrier.
• Make sure that someone is with them
 Through sharing of hypodermic
at all times; do not leave them alone
needles.
even for a short period of time
 Rarely through a transfusion of blood.
• Persuade them to call their family
doctor or the nearest hospital HIV: What is Safe?
emergency room
Safe
• Keep the person away from firearms,
 Casual contact.
drugs, etc.
 Hugging.
Sexually Transmitted Disease
 Eating after.
 One in two sexually active people will
acquire an STD by age 24.  Massage.
 More sexual partners increases risk.  Masturbation.
 Alcohol and drug use increases risk.  Insects.
 Risk is determined by your behavior, Unsafe
not your age or sexual orientation.
 Vaginal sex.
 Risk can be reduced or eliminated
through long-term monogamy or  Anal sex.
abstinence.  Oral sex.
Curable and Incurable STDs  Deep kissing.
Bacterial (curable)  Multiple partners.
 Chlamydia  Sharing needles.
 Gonorrhea Should I Be Tested?
 Syphilis You should be tested if:
  You have had any STD.
 Shared drug needles.
 Had sex with a prostitute.
 Had sex with a man who had sex with
another man.
 Had unprotected sex with three or
more partners.
Remember that the test looks for HIV
antibodies.
• It could take 3 to 6 months before
antibodies appear in the blood.
• A person should have 6 months with no
risk behavior before a test can be
accurate.
Chlamydia: (bacteria) Chlamydia trachomatis
Transmission
Passed during direct sexual contact and hand to
eye.
Incubation
Poorly defined, probably 7-14 days or longer.
Typical Symptoms
Up to 80% of women and 50% of men have no
symptoms.
Diagnosis
Culture tests of discharge collected from around
the cervix and in the urethra. Reliable and
affordable.
Treatment
Curable with certain antibiotics (not penicillin).
Danger
If untreated, can cause Pelvic Inflammatory
Disease.
Genital Herpes: Herpes Simplex Virus (HSV)
Transmission
Direct contact with infectious blisters or sores
usually on genitals, anus, or mouth.
Incubation
2-12 days
Typical Symptoms
Painful blisters or sores form, break, crust over,
and heal in 2 to 4 weeks. Sores may reappear
throughout life, but heal faster, are less painful
and occur less frequently.
Diagnosis
Visual examination and tissue culture.
Treatment
No cure at present time. Medications
(acyclovir) used to relieve pain, shorten
outbreak, or prevent infection in open sore.
Danger
Can be fatal to infants who acquire the disease.
Genital Warts: Human Papilloma Virus (HPV)
Transmission
Direct contact with warts in genital area. May
be transmitted without visible warts.
Incubation
Range from 1-8 months.
Typical Symptoms
Flat or round bumps with cauliflower like
appearance occurring on moist areas of genitals
and anus.
Diagnosis
Visual examination, tissue cultures. Pap smears
can detect warts not visible.
Treatment
Freezing, laser, chemical prep, and surgery.  Most have none or mild flu-like
May not “cure” the infection. feelings, itching, & joint pain.
Eventually leads to liver
Danger
enlargements & failure.
HPV causes cervical cancer. Pap smears are
Diagnosis
important
 Through a blood test.
Gonorrhea: bacteria
Treatment
Transmission
 A vaccine is available.
Direct contact between mucous membranes.
Contaminated fingers and objects. Dangers

Incubation  Progressive destruction of liver

cells, cirrhosis, or liver cancer.
Usually 2-14 days.
Syphilis: (bacteria) Treponema pallidum
Typical Symptoms
Transmission
Symptoms include discharge, burning and
itching, painful urination, or a mild sore throat. Direct contact with infectious sore.

Diagnosis Incubation

Microscopic observation of discharge. Culture 1 to 12 weeks before primary stage.

from site.
Diagnosis
Treatment
Physical examination, microscopic test from
Curable with antibiotics. But some strains are sore, blood tests.
resistant.
Treatment
Danger
Cured with antibiotics.
Can cause PID and sterility in men and women.
Typical Symptoms
Hepatitis B: virus
Primary: painless chancre sore at site of entry of
Transmission germ and lasts 1–5 weeks.

 Vaginal, anal and oral sex,
sharing needles, and mother to
baby.
Incubation
 1 – 9 months but people can
carry the virus with no active
infection (and spread to others)
Typical Symptoms
Secondary: 2 weeks to 6 months after chancre.
Rash, flu-like symptoms, patchy hair loss.
Secondary will go away without treatment, but
will lead to latent syphilis.
Latent: no longer infectious to carry bacteria
and lead to tertiary.
Tertiary Stage: 3 to 40 years later, damage to
body organs such as the brain and heart,
paralysis & death.
Other STI’s * Choose well your sex partner

Trichomonas– treatable parasite * Use condoms

Vaginosis – inbalance in bacteria * Wash genital area after sex

Chancroid– curable genital sore * Urinate after sex

Pubic lice– treatable parasite * If you think you might have an STD -
see a Doctor
Scabies– treatable parasite
Coping with Unwanted Sexual Pressure and
Prevention of STDs
Avoiding Assault
Abstinence
• Attend parties with friends you can
Avoid sexual intercourse with infected persons. trust.

Stay Faithful • Avoid isolation.

Maintain a long-term trusted relationship with • Communicate your limits clearly.

one uninfected partner (monogamy).
• Listen closely to what a person is saying.
Choose Lower Risk Behaviors Ask for clarification.

No fluid exchange • Make sure your actions agree with what

you are saying.
Take Precautions
• Be aware of what is happening.
Limit the number of sex partners; use a latex
condom during the entire sex act • Speak up if you believe someone is at
risk.
Avoid Drug Use
• Stay sober!
Mind-altering drugs, including alcohol, reduce
our ability to reason, which can lead to risky • No means No.
behavior & risky sex.
• Don’t make assumptions about a
If you are sexually active person’s behavior.

Observe your partners for sores, discharge or • Don’t assume that silence is consent for
needle tracts, and get an STD exam every 6 sex.
months.

How to Avoid an STD

The only 100% guaranteed way to avoid getting

an STD:

**DON’T HAVE SEXUAL CONTACT**

If you make a well thought out decision

to have sexual contact:

* Stay with 1 sexual partner