NCM 102

HIGH RISK Children

HIGH RISK ADOLESCENT

COMMON HEALTH PROBLEMS IN ADOLESCENT

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 :
 Structural / Progressive form
 “S” curve of the spine
 usually idiopathic
 does not disappear with position changes needs more aggressive treatment
 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
 Uneven shoulders
 Uneven hips
 Asymmetry of rib cage
 Unequal length of bra strap
 Bump or rib hump on one side of the spine
 Diagnosis
 Forward bend test/ Adam’s bend test
 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
 Management - Depends on the maturity of the skeleton and on the degree of curvature
 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 Harrington rod
 Electrical stimulation
 Use as an alternative for braces
 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
1. Provide care for child with brace
a. Teach the child to wear it constantly, except when bathing
b. wear over a t-shirt to protect the skin
c. report if there is rubbing
 d. encourage exercise as prescribed
2. Provide cast or traction care
. Frequent cleansing on the pin sites
a. Provide diversional activities
b. Monitor for signs of complications
3. Provide preoperative and post operative nursing care
. Deep breathing exercise
a. Use of incentive spirometry
b. Log roll; do not raise the head of the bed
4. Stress correct body mechanics
. Promoting mobility, positive body image and compliance with therapy
a. Preventing injury and
b. Preventing skin irritation

BONE TUMORS
a. Sarcoma – tumors arising from connective tissue, such bones and cartilage, muscle, blood
vessels or lymphoid tissue
b. common neoplasm in adolescent
c. Arise during adolescent because of rapid bone growth
d. Two most frequently occuring types of bone cancer:
a. Osteogenic Sarcoma
 A malignant tumor tumor of long bone involving rapidly growing bone tissue (
mesenchymal matrix forming cells)
 characterized by formation of osteoid (immature bones)
 Common sites of occurrence
a. distal femur – 50%
b. Proximal tibia – 20%
c. Proximal humerus – 10 to 15%
 High incidence in children expose to radiation and with retinoblastoma
 Lungs – common site of metastasis
 Assessment
. pain
a. Swelling, redness
b. Tender mass, warm to touch
c. Limitation of movement
d. Pathologic fracture
 Diagnosis
. Bone Biopsy
a. Ct scan
b. Bone scan
 Management
1. Surgery
a. Limb salvage procedures
b. Bone or skin grafts
c. Amputation
d. Reconstructions
e. Resections of metastases
2. Radiation therapy
3. Chemotherapy
4. Rehabilitation
a. physical and occupational therapy
b. psychosocial adapting
c. prosthesis fitting and training
d.
  Nursing management
a. Provide routine preoperative care
b. Offer support or encouragement and accept client’s response of anger
and grief
c. Discuss to patient and family
a. rehabilatation program and use of prosthesis
b. crutch walking
c. phantom limb sensation as normal recurrence
d. Prevent hip and knee contractures prone position several times a day (unless
otherwise ordered)
e. Provide stump care
b. Ewing’s Sarcoma
 Malignant tumor arising most often in the bone marrow of the diaphysis area
(midshaft) of long bones
 The diaphyses of the femur are the most common sites, followed by the tibia and the
humerus
 Lungs is the most frequent site of metastasis
 Clinical Findings
a. Pain and swelling on affected part
b. Palpable mass
c. Tender and warm to touch
d. 15- 35% of clients have metastasis at time of diagnosis
 Management
. High doses of radiation therapy
a. Chemotherapy
b. Surgery
 Diagnosis
 X-ray
 Bone scan
 Biopsy
 Bone marrow aspiration
 Nursing intervention
 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

 are those disease spread through sexual contact
A. Gonorrhea
 Causative agent Neisseria Gonorrhea
 Signs & symptoms: often asymptomatic in females purulent yellow-green vaginal
discharge
 May cause ophthalmia neonatorum and sepsis to newborn
 Treatment:
a. Penicillin
b. Erythromycin
c. Ceftriaxone
d. Doxycycline

B. Chlamydia
 Chlamydia trachomatis
 Most common STD
 Signs & symptoms:
 i.watery, gray-white vaginal discharge
ii.vulvar itching
 May causes ophthalmia neonatorum, sterility in female or male, tubal pregnancy
 Drug: doxycycline or tetracycline, azithromycin,
C. Syphilis
 Treponema pallidum (spirochete)
 Crosses placenta after 16 week of pregnancy
 Manifestation
.Primary cardinal sign – CHANCRE - a hard red painless lesion @ the point of
infection site disappear without treatment in 4-6 weeks
i.Secondary - rash, malaise, alopecia
ii.Tertiary
iii. effect any organ system – cardiovascular, neurovascular system
 Treatment : penicillin or erythromycin
D. Trichomoniasis
 Trichomonas vaginalis - a single-cell protozoan
 Sign & symptoms: thin, irritating, frothy gray- green discharge, strong odor, itching to
genitalia
 Treatment:
.Metronidazole
i.douche with weak vinegar solution to reduce pruritus
E. Candidiasis
 Candida Albicans - fungus
 Caused by a yeast transmitted from GI tract to vagina
 Sign & symptoms – thick , white cheese-like vaginal discharges, vulvar reddening and
pruritus
 Treatment:
.topical application or suppositories of antifungal drug such as:
 clotrimazole , nystatin, miconazole, diflucan, gentian violet
i.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:
a. limiting food intake
b. excessive exercise
c. binge eating/purging
 Clinical findings and diagnosis(The American Psychiatric Association Criteria for Diagnosis)
 body mass index – less than 85% of expected weight
 intense fear of getting fat or gaining weight even though underweight
 severely distorted body image
 refusal to acknowledge seriousness of weight loss
 amenorrhea
 Manifestation
 Almost skeleton-like appearance
 Sexually immature
 Dry skin, brittle nails
 Presence of lanugo
 Constipation, hypothermia, bradycardia, low blood pressure
 Anemia
 Depression, social withdrawal and poor individual coping
 Management
1. Nutritional therapy
a. Total parenteral nutrition
b. Enteral tube feeding
2. Behavior modification
3. Medication - antidepressant
4. Counselling
. Individual therapy
a. Group therapy
b. Family therapy

BULIMIA NERVOSA
 Bulimia – refers to recurrent and episodes 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 weight control
 Clinical manifestation and Diagnosis
 Dental caries and erosion
 Throat irritation
 Electrolytes imbalance- hypokalemia
 Behavior problem
 drug abuse
 alcoholism
 stealing
 impulsive activities
 American Psychiatric Association the criteria for bulimia are:
 Recurrent episodes of binge eating
 A feeling of lack of control over behavior during binges
 Self-induced purging; use of laxatives, diuretics, enemas
 Average of at least two binge-eating episodes a week during 3 months period
 Obsessiveness regarding body weight and shape
 Management
 Pharmacology – antidepressant
 Psychotherapy
 Nursing intervention
1. Monitor vital signs
2. Monitor intake and output
3. Record food intake
4. Monitor weight
5. Encourage client to express feelings
6. Help client to set realistic goal for self
7. Help client identify interest and positive aspect of self

OBESITY
 An excessive accumulation of fat that increases body weight by 20% or more
 Obesity is now among the most widespread medical problems affecting children and adolescents
living in the United States and other developed countries.
 Obesity increases the child's risk of of serious health problems such as heart disease, DM type 2
and stroke
 Causes
 Many different factors contribute to this imbalance between calorie intake and
consumption
 Genetic factors- Obesity tends to run in families
 Dietary habits
  fast food, processed snack foods, and sugary drinks
 use food as means of satisfying emotional needs
 Indulging in late – night eating
 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 as 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 O STAGE 1 STAGE 2 STAGE 3 STAGE 4
Pre abuse or Experimental Stage Early Regular Late Regular Use End Stage or “Burn
Curiosity (Learning the Use (Seeking the (Preoccupation Out”
Stage Euphoria) Euphoria) with the Euphoria)

Describes the Adolescents have The adolescent Dependent on Adolescent needs

adolescent with already made a now actively substance abuse drugs just to feel
an increased decision to “try” seeks the drug- normal and to
potential for drugs and begun induced mood Deterioration of avoid the profound
substance learning the drug swing behavior such as and nearly constant
abuse induced mood fighting, lying, dysphoria.
swing or euphoria. Use drugs to stealing,
Need for peer seeks relief from Prostitution often Depression,guilt,
acceptance; Drug use is everyday stress depressed, shame, and other
anger and confined to social suicidal ideation, remorse may be
boredom situations Changes in self-destructive overwhelming, and
There are few dress, decline in and risk-taking suicidal ideation
behavioral changes personal behavior becomes more
other than “lying” hygiene, common
deterioration in
school Paranoia, angry
outbursts, and
 Performance, aggression are
loss of previous common
interest in extra
curricular
activities

Adolescent
exhibits more
mood swings,
engages in
regular lying

 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
1. Prevention is the most effective and least expensive treatment for substance abuse
2. Medication, -nicotine patches and methadone
3. Rehabilatation, 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
1. Previous suicide attempts
2. Close family member who has committed suicide.
3. Past psychiatric hospitalization
4. Recent losses: death of a relative, a family divorce or a breakup with a girlfriend
5. Social isolation
6. Drug or alcohol abuse
7. Exposure to violence in the home or the social environment
 Warning Signs for Suicide
1. Suicidal talk
2. Preoccupation with death and dying
3. Signs of depression
4. Behavioral changes
5. Giving away special possessions and making arrangements to take care of unfinished
business
6. Difficulty with appetite and sleep
7. Taking excessive risks
8. Increased drug use
9. Loss of interest in usual activities
 Tips for Parents
1. Know the warning signs!
2. Do not be afraid to talk to your child- The message is, “Suicide is not an option, help is
available."
3. Suicide-proof your home- Make the knives, pills and firearms inaccessible.
 4. Utilize school and community resources- school psychologist, crisis intervention
personnel
5. Take immediate action. If your child indicatescontemplating suicide
6. Do not leave your child alone
7. Seek professional
8. Listen to your child’s friends. They may give hints.
9. 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.