PERIODIC PHYSICAL EXAMINATION

FOR ADOLESCENTS
 Screening
1. Height and weight

• Height was measured in meters

• Weight was measured in Kilograms
• BMI was calculated for the person in Kg/m2
• A BMI for age percentile growth chart was used to determine the weight
status of the patient- underweight, normal weight, overweight or obese.
 Screening
1. Height and weight results

• Height- 2.322576 m2
• Weight- 45.3592 Kg
• BMI- 19. 5 Kg/m2
The BMI for age percentile growth chart
was used to determine the patient’s
weight status – normal weight
 Screening
2. Blood pressure

• Blood pressure was measured

and the reading obtained was
110/70 mmHg.
• This suggested that the
patient BP was normal.

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 Counselling
The patient’s guardian was asked to kindly leave the room and the limits of
confidentiality was discussed with the patient. The patient was told, “Anything that is
said here today will be confidential, unless I feel another person is potentially at risk. In
that case, I would need to share some information. I appreciate that some questions
might be difficult to answer- if there’s anything you don’t want to answer right now, we
can come back to it another time. Does this all sound okay?”
The patient was then counselled on the following areas:
I. Nutrition and exercise
II. Alcohol, tobacco and illicit drug intake
III. Sex education
IV. Suicide
 Counselling
1. Nutrition and exercise
Information about the patient’s diet and exercise was gathered by asking questions. Here
are a few examples of some questions asked and the responses obtained:
i. What do you normally eat on a daily basis?
“On a daily basis, I eat rice, roti, fried chips and chicken, nuggets, toast bread, cake,
vegetables such as corilla, bora and drink Coke and water. Rarely I drink milk and I
don’t eat fish .”
ii. Do you think your daily diet is healthy or not? And why?
“No, I don’t think it is because I eat mostly fatty foods and less fruits and
vegetables.”
 Counselling
iii. Do you skip meals? If yes, how often? And why?
“Yes. I don’t eat breakfast everyday because I have late midnight snacks.”
iv. How many meals and snacks do you have per day?
“I have 2 meals and 5 snacks per day.”
v. Do you use any tonics or tablets to open your appetite or help you to study?
“I drink Nutrophos tonic everyday.”
vi. How often do you exercise and for how long?
“I exercise once every 2 months by skipping rope for about ten minutes.”
 Counselling
• The patient was then educated about a balanced diet and dietary diversity and the
disadvantages of skipping meals. Emphasis was placed on the importance of daily
consumption of iron rich foods, calcium, vitamin D, folate and folic acid. She was
also encouraged to use iron supplements.
• The patient was educated about the benefits of regular physical activities and the
consequences of physical inactivity. Emphasis was placed on the fact that exercise
improves physical fitness, strengthens muscle, makes bone stronger, reduces
weight and the risk of developing type II diabetes, high blood pressure, heart
disease, osteoporosis, etc.
 Counselling
• Emphasis was placed on the fact that physical inactivity increases the risk for
becoming overweight or obese; developing type II diabetes, cardiovascular
diseases, breast, colon, endometrial and lung cancer and osteoporosis.
• The importance of physical activity on academic achievement was highlighted.
Emphasis was placed on the fact that physical activity and physical fitness are
associated with improved cognitive performance (e.g. concentration and memory)
among students.
 Counselling
2. Alcohol, tobacco and illicit drug intake
Information about alcohol, tobacco and illicit drug intake was gathered by asking
questions. Here are a few examples of some questions asked and the responses
obtained:
i. Do you smoke cigarettes?
“I smoked cigarette once because I wanted to get a feel of it.”
ii. Do you drink alcohol?
“Yes, I usually drink about 6 tequila shots on holidays with my cousins and
friends.”
 Counselling
iii. Do you use ganja (weed), cocaine or any other illegal drugs?
“Yes, my cousin gave me weed once and my friend and I snorted cocaine
once.”
iv. Why did you use these drugs?
“One of the reason was because I was curious. The other was to relief my
stress and to forget about the problems that would’ve occurred in my life. As
such, I willingly accept them whenever I’m offered.”
 Counselling
The patient was then educated about the negative effects of their use. In addition,
she was advised to use other means to address her underlying issues or triggers for
example: talking to trusted relatives, physical activities, painting, meditating, etc.
 Counselling
3. Sex education
Information about the patient’s sexual history was gathered by asking questions.
Here are a few examples of some questions asked and the responses obtained:
i. Did you ever had sex before? By “sex” I mean vaginal, oral or anal sex.
“Yes, I was engaged in oral sex before.”
ii. How many persons you had oral sex with?
“I had oral sex with 2 persons.”
iii. What is the gender of those persons?
“Both were males.”
 Counselling
iv. How are these persons related to you?
“Both of them are my friends.”
v. Did you use a condom or any other form of protection?
“No, they didn’t use condom while we were engaged in oral sex because
they said it made them feel uncomfortable and that it wasn’t necessary.”
vi. Would you ever consider performing vaginal sex with these persons?
“Yeah definitely. It is something I would really like to try with them.”
 Counselling
vii. What are your thoughts on the use of condoms when engaging in sex?
“I know they’re important to use but personally I won’t use them because I
think they make you feel uncomfortable and I won’t get to experience the
true feeling of sex. Also my friends don’t like using them because they said
they don’t get turned on.”
viii. What are your reasons for engaging in sexual activity?
“I was curious about it and after the first try I felt happy and less stressed so
I wanted to try it again.”
 Counselling
• The patient was educated about sexual and reproductive health.
• She was educated about specific behaviors related to preventing unwanted
pregnancy and sexually transmitted diseases.
• Emphasis was placed on the importance of using condoms and other forms of
contraception when engaging in sexual activity and the pros and cons of each
contraception was highlighted in the process.
 Counselling
4. Suicide

Information about the patient’s suicidal thoughts was gathered by asking questions.
Here are a few examples of some questions asked and the responses obtained:
i. Have you ever had thoughts about killing yourself?
“Yes, I did a few times.”
ii. Why did you have these thoughts?
“I was stressed and overwhelmed with the amount of school work I have to do
and not meeting my parents’ expectations in terms of academic achievement.”
 Counselling
iii. How do you intend on carrying out this act?
“I never really put much thought into it. The only thing that ever crossed my
mind was overdosing on aspirin or drinking bleach.”
iv. What do you do when these thoughts cross your mind?
“I would talk to my best friend and she would normally remind me of my
purpose in life and encourage me to explore other reasons for being alive.
She would also remind me of all the accomplishments I have achieved thus
far in life and give me a feeling of hope of wanting to live.”
 Counselling
v. Do you still have thoughts about killing yourself?
“No, not anymore because I always use the same approach my best friend
would have told me to use- remembering all the accomplishments I have
achieved thus far in life and my purpose for being alive.”
 Counselling
• Nevertheless, the patient doesn’t have suicidal thoughts anymore, reasons and
ways to stay alive were still discussed with her and she was encouraged to focus
on her personal strength.
• The patient was encouraged to continue reaching out to trusted persons such
as her best friend, a family member or she could even return to the health
center to speak with a healthcare provider should she ever have any more
suicidal thoughts.
• She was also advised to keep the bleach and aspirin out of reach.
 Immunization
1. HPV vaccine

• The clinic chart was reviewed to determine the patient’s current

immunization status.
• The patient was fully updated with all her childhood vaccines, however,
she was yet to receive her HPV vaccine.
• The patient was recommended to go to MOH to receive her HPV
vaccine.
 Sexual Maturation

During the examination:

• privacy and confidentiality

were assured

• sexual maturation and

menstrual history were
assessed.
Retrieved from: https://sn.polyu.edu.hk/whocc/youthnet/jobaid/Module%204.pdf
 Sexual Maturation

Results obtained from the examination:

Pubic hair: darker, beginning to curl and increased amount

Breasts and areola: enlarged but no contour separation

Other changes: axillary hair developed

Based on the Tanners Staging Chart, the patient was classified as Stage
III.
 Sexual Maturation
Results obtained for menstrual history:

• Age of menarche- 13 years • No. of pads changed/day- 2

• Cycle length and regularity- 28 days pads

cycle and regular period • Passage of clots- No

• LMP- 11/01/2021
• Days of flow- 5 days
• Associated symptoms- cramps
 References
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[cited 2020Dec31]. Available from: https://www.kaieteurnewsonline.com/2019/02/15/hpv-vaccine-now-being-offered-
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7. Physical Activity Facts [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and
Prevention; 2020 [cited 2020Dec31]. Available from: https://www.cdc.gov/healthyschools/physicalactivity/facts.htm
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