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EPISODICAL VARIATIONS

EPISODICAL VARIATIONS. Common physical health problems of adolescence. - Acne. Extremely common skin problem Affects 50% of adolescents Peak years females:16-17 and males:17-18 Males more than females May continue into adulthood Impact self-esteem * don’t underestimate the impact

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EPISODICAL VARIATIONS

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  1. EPISODICAL VARIATIONS • Common physical health problems of adolescence

  2. - Acne • Extremely common skin problem • Affects 50% of adolescents • Peak years females:16-17 and males:17-18 • Males more than females • May continue into adulthood • Impact self-esteem * don’t underestimate the impact • Inflammation = papules, pustules, cysts & scarring in severe cases • Refer p 850

  3. Grade 2 Comedones, papules, few pustules Grade 1 Comedones, few papules Grade 3 Comedones, papules, pustules, few nodules Grade 4 Comedones, papules, pustules, nodules, cysts

  4. Etiology • More than 50% of adolescents affected • 45% males have +ve family hx • Premenstrual flares occur in 70% of females • Adolescents report stress causes acne outbreaks • No known association between diet and development or worsening acne • Pathophysiology • Involves hair follicle and sebaceous glands • Comedogenesis

  5. Acne Therapeutic Management • Medications: • Retin-A • Benzoyl peroxide • Topical antibacterial agents • Systemic antibiotic therapy • Oral contraceptive (OCP) • Accutane • General: • Rest • Exercise • Well-balanced diet • Reduction of emotional stress • Elimination of infection • Hygiene

  6. Acne Therapeutic Management • Nursing Considerations • Assess • Level of distress • Current management • Perceived success of any regimen • Teaching • Medication • Long term consistent use of recommendations • Basic skin care info • Avoiding abrasive cleansing products, scrubbing, • picking, squeezing

  7. Mononucleosis • Acute, self-limiting infectious disease; common in younger than 25-year-olds • Epstein-Barr virus • 10 days to 6 weeks after exposure • Malaise, sore throat, fever, lymphadenopathy, splenomegaly • May have a rash over the trunk • “Monospot” test • No specific treatment

  8. Mononucleosis (con’d) • Complications are uncommon but can be serious • Liver and spleen enlargement can lead to rupture Health teaching! • What would be your main nursing care interventions?

  9. Intracranial Infections • Nervous system susceptible to same organisms that affect other body organs • Laboratory studies needed to identify the causative agent • Inflammation can affect: • Meninges (meningitis) • Brain (encephalitis)

  10. Meningitis • Inflammation of the meninges • Causes: bacterial & viral (or aseptic) • Pathology: bacteria spreads from other infection through bloodstream to meninges  meningeal inflammation purulent exudate can block CSF  cerebral edema, IICP

  11. Diagnosis: LP – CSF cloudy,  WBC,  glucose,  protein Symptoms: fever, vomiting, opisthotonus, headache, altered LOC, nuchal rigidity, Kernig’s sign, Brudzinski sign, petechial rash (meningococcus) Nsg Care: V/S, I&O, neurological assessment, isolate, support Antibiotic Rx – broad spectrum, Rifampin for families Follow-up re: hearing Meningitis (con’d)

  12. Purpura of the Lower Extremities

  13. Encephalitis • Inflammatory process of CNS –bacteria, spirochetes, fungi, protozoa, helminths & viruses • May be direct invasion or postinfection • Mild form lasts few days –full recovery • 50% of cases – cause unknown • Associated with measles, mumps, varicella, rubella, enteroviruses, herpes & West Nile

  14. Encephalitis • S&S – seizures, malaise, fever, h/a, dizziness, apathy, stiffness of neck, N&V, ataxia, tremors, speech difficulties • Dx- LP, CT scan, blood cultures • Rx -symptom relief, decrease ICP, neurologic monitoring

  15. MUSCULOSKELETAL DYSFUNCTION

  16. Sports Injuries, Risks, Mortality • Competitive sports & peer pressure factors • Types of sports (Box 39-10 Pg. 1767) • Injury increases with contact/collision sports • Strenuous ie dancing, swimming, track, gymnastics • See Box 17-4 & 17-5 Pg. 737- • goals & safeguards • Parent response can increase stress and anxiety • Education important

  17. Importance of Physical Activity* muscle tone and development* increased balance* coordination* strength and endurance* positive self-image* increased confidence

  18. PROS:* learn cooperation* self-discipline/perseverance* develop social skills/friendships* enhanced school performance

  19. CONS:* Specializing early in one sport may result in more injuries (i.e. repetitive strain)* Children experience high stress levels (expectations from parents/coaches, lack of personal time)* Parents feel pressure to specialize their children at a very young age (fear they will fall behind their peers)

  20. Sports Injuries • Contusions • Dislocations • Epiphyseal separation • Sprains • Ligament stretched or torn – ie knee • Swelling – inability to use joint • Strains • Painful to touch but able to use

  21. Overuse syndrome • Chronic pain r/t repetitive microtrauma • Frictional – rubbing of one structure against another • Tractional- pulling on ligament or tendon • Cyclic –repetitive loading of impact forces (stress Fx) • Plantar fasciitis • Osgood-Schlater • See table 39-4 p 1772

  22. Sudden Death • High impact sports, high velocity sports • football, hockey, rugby, boxing, riding vehicles • Underlying medical problem • Cardiac abnormalities • Commotio cordis – impact to chest causing VT • Environmental causes • Heatstroke, hypothermia • Recommend external defibrillator

  23. Therapeutic Management • Rest • Ice immediately • Compression • Elevation • Nutrition • Require more calories • Water recommended 120-240 ml q 20 mins • Gatorade if diluted

  24. Nurses role • Preparation& evaluation for activities • Prevention of injuries • Treatment of injuries • Rehabilitation after injury • Counselling of parents • Exposure to variety • Avoid overprogramming

  25. Legg-Calve-Perthes • Aseptic necrosis of femoral head • CPD is of unknown origin. • Bone death occurs in the ball of the hip due to an interruption in blood flow. • As bone death occurs, the ball develops a fracture of the supporting bone. • This fracture signals the beginning of bone reabsorption by the body. • As bone is slowly absorbed, it is replaced by new tissue and bone.

  26. Legg-Calve-Perthes • Affects ages 3-12 yrs; more common in males ages 4-8 • 10-15% cases have bilateral hip involvement • S&S: pain in hip, knee; stiffness,  ROM, limp • Early diagnosis leads to better outcome • Important to keep head of femur in acetabulum until it reforms

  27. Four Stages of LCPD • Femoral head becomes more dense with possible fracture of supporting bone; • Fragmentation and reabsorption of bone; • Reossification when new bone has regrown; and • Healing, when new bone reshapes. • Phase I takes about 6-2 months, Phase 2 takes one year or more, and Phase 3 and 4 may go on for many years.

  28. Therapeutic management • Correction of deformity • Serial casting, rest, traction, active non-weight bearing motion • Maintenance of correction until normal balance regained • Manipulation & recasting until maximum correction – 8-12 weeksBraces, casts, crutches • Promote comfort, mobility • Follow up to avoid recurrence • Surgery at 6 mons to 1 yr if unsuccessful • Teaching care of braces and management • Compliance issues with child/family

  29. Scoliosis

  30. What is Scoliosis? • a lateral (sideways) curvature of the spine • usually develops in preadolescence or during early adolescence. • in most cases the curve is slight, but in severe cases it can resemble either an S or C in shape. The normal spine appears curved when viewed from the side and straight when viewed from behind. In scoliosis, the opposite is true; the spine appears straight when viewed from the side yet curved from behind.

  31. Most common spinal deformity Congenital OR dev’p during infancy, childhood OR most commonly during growth spurt of early adolescence Detected: parents notice clothes do not “hang right” One shoulder higher than other One shoulder blade is higher & more noticeable One hip is more noticeable Unequal distance between arms & body Female – one breast may be more prominent Standing radiographs to determine degree of curvature How is it detected? http://www.sickkids.ca/SpineKids/section

  32. Scoliosis -Therapeutic ManagementBracing & exercise • A BRACE USUALLY DOES NOT CORRECT A CURVE. AT BEST IT WILL STOP IT FROM WORSENING. • are numerous anecdotes where curves straighten both spontaneously and while using a brace. • The inset shows such an exceptionof a teenager in a brace for 18 months. • left is an X-ray of the person before starting brace treatment. • right is the same person 18 months after wearing a brace 23 hours per day.

  33. How does scoliosis impact an adolescent? • Treatment is over the majority of period of growth • Treatment involves a modified lifestyle .˙. is “different” from peers • During forming of physical & psychological identify

  34. Scoliosis -Therapeutic Management • Early detection & treatment essential to successful management • Nursing considerations: • Adolescent needs continual positive reinforcement, encouragement, & as much independence as ability allows • Encourage socialization with peers • Support & encourage so teen feels attractive & worthwhile • Assist adolescent to learn how to deal with reaction of others

  35. Lordosis • Accentuation of the cervical or lumbar curvature beyond physiologic limits • May be secondary complication of trauma or idiopathic • May occur with flexion contractures of hip, congenital dislocated hip • In obese children abdominal fat alters center of gravity, causing lordosis

  36. Kyphosis • Abnormally increased convex angulation in the curvature of the thoracic spine • Most common form is “postural” • Can result from TB, arthritis, osteodystrophy, or compression fracture

  37. Endocrine Disorders • Hypopituitarirm • Growth retardation • Affects other endocrine functioning • Pituitary Hyperfunction • acromegaly, precocious puberty, diabetes insipidus

  38. Hypothyroidism • Congenital • Deficiency of thyroid hormones at birth • Increased risk if Down’s syndrome • Associated with other congenital abnormalities • May be permanent or transient • Signs & Symptoms • Poor feeding, lethargy, prolonged jaundice, respiratory difficulty, cyanosis, constipation, hoarse cry, large fontanels, bradycardia shortly after birth • May be post term, heavy birth weight • Characteristic facial features • Severe mental retardation

  39. Nursing Considerations • Early identification through screening • Lifelong treatment with medication • Inadequate treatment – fatigue, sleepiness, decreased appetite, constipation

  40. Hyperthyroidism • Most cases occur between 6 – 15 years of age, peaks at 12 – 14 years • Graves disease – enlarged thyroid gland • Appears more often in girls • Exophthalmos is classic sign

  41. Goiter – may be present at birth • If so, emergency management of airway

  42. Hyperthyroidism • Signs & Symptoms May develop gradually Excessive motion – irritability Tremors, insomnia Growth & bone age accelerated • Therapeutic Management Goal: reduce secretion of hormone through drug therapy, surgery, radioiodine therapy

  43. Hypo Intolerance to cold  metabolic rate  appetite with wt gain Fatigue Weight gain Constipation TX: replacement of missing hormone Hyper Intolerance to heat  metabolic rate  appetite with no weight gain Fatigue with insomnia Weight loss Diarrhea TX: surgery, meds Comparison: Hypo vs. Hyper

  44. Diabetes

  45. What is diabetes? • Most common metabolic disorder • Partial or complete deficiency of hormone – insulin • peak incidence 10-15 years • 75% diagnosed before 18 years of age • Incidence in boys is slightly higher than in girls

  46. Statistics • More prominent in whites, 20 per 100,000 • Incidence in African-Americans 11 per 100,000 • Incidence in Hespanics is 15.2 per 100,000 • Incidence in Cubans 2.6 per 100,000 • (Hockenberry 2003) • Ontario study http://www.ices.on.ca/file/DM_Chapter12.pdf • using data for fiscal years 1994 to 1997 showed an annual incidence of 27/100,000 for children aged 0–19 years (To, Teresa., Curtis, Jacqueline R., & Daneman,Denis.) retrieved February 1, 2006

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