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Approach to the Adolescent Exam Maj Anisha Abraham, MD, MPH Adolescent Medicine Womack Army Medical Center
OBJECTIVES <ul><li>To identify the stages of psychosocial development in adolescence </li></ul><ul><li>To set the stage fo...
Definition of Adolescence
Overview of the Adolescent Visit  <ul><li>During adolescence- visits to a health care provider may be limited </li></ul><u...
Stages of Psychosocial Development <ul><li>Early adolescence (11-14 yrs) </li></ul><ul><li>Middle adolescence (15-17yrs) <...
Early Adolescence <ul><li>Period of rapid growth and  physical change </li></ul><ul><li>Characteristics-egocentrism, concr...
Middle Adolescence <ul><li>Secondary sexual characteristics develop, growth rate decreases  </li></ul><ul><li>Emancipation...
Late Adolescence <ul><li>Physically mature </li></ul><ul><li>Vocational goals important </li></ul><ul><li>Individual frien...
Setting the Stage
Setting the Stage <ul><li>Make the adolescent the primary historian </li></ul><ul><li>Establish confidentiality </li></ul>...
Obtaining a History <ul><li>Chief Complaint </li></ul><ul><li>Past Medical history </li></ul><ul><li>Family Medical Histor...
Psychosocial History <ul><li>H </li></ul><ul><li>E </li></ul><ul><li>A </li></ul><ul><li>D </li></ul><ul><li>S </li></ul>
Psychosocial History <ul><li>H-Home </li></ul><ul><li>E-Education </li></ul><ul><li>A-Activities </li></ul><ul><li>D-Diet,...
HOME <ul><li>Who lives at home?  </li></ul><ul><li>Who can you talk to?  </li></ul><ul><li>How are things going with your ...
EDUCATION <ul><li>How are your grades? </li></ul><ul><li>Do you enjoy school? </li></ul><ul><li>What are your plans for th...
ACTIVITIES <ul><li>What do you do for fun?  </li></ul><ul><li>Are you involved in sports or extracurricular activities? </...
DIET <ul><li>Do you eat breakfast? Regular meals? </li></ul><ul><li>Are you concerned about your weight? </li></ul><ul><li...
DRUGS <ul><li>Do you or your friends drink alcohol? </li></ul><ul><li>Do you or your friends smoke cigarettes? </li></ul><...
DEPRESSION <ul><li>Have you been feeling sad? </li></ul><ul><li>Have you been crying frequently?  </li></ul><ul><li>Do you...
SEXUALITY <ul><li>Have you ever had  a sexual relationship with anyone? </li></ul><ul><li>Have you been forced to have sex...
SAFETY <ul><li>F-Fights </li></ul><ul><li>I-Injuries </li></ul><ul><li>S-Sexual Violence </li></ul><ul><li>T-Threats </li>...
Physical Exam <ul><li>Ensure privacy </li></ul><ul><li>Do thorough exam </li></ul><ul><li>Document Tanner Staging </li></u...
Screening tests <ul><li>Routine-refer to GAPS guidelines </li></ul><ul><ul><li>CBC,Cholesterol </li></ul></ul><ul><ul><li>...
Wrap up <ul><li>Interpret findings and discuss plans directly </li></ul><ul><li>Identify strengths and weaknesses </li></u...
SUMMARY <ul><li>Set the stage </li></ul><ul><li>Establish confidentiality </li></ul><ul><li>Use HEADS </li></ul><ul><li>Co...
QUESTIONS?
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Intro to Adolescent Medicine

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Intro to Adolescent Medicine

  1. 1. Approach to the Adolescent Exam Maj Anisha Abraham, MD, MPH Adolescent Medicine Womack Army Medical Center
  2. 2. OBJECTIVES <ul><li>To identify the stages of psychosocial development in adolescence </li></ul><ul><li>To set the stage for an adolescent interview </li></ul><ul><li>To obtain a complete adolescent history </li></ul>
  3. 3. Definition of Adolescence
  4. 4. Overview of the Adolescent Visit <ul><li>During adolescence- visits to a health care provider may be limited </li></ul><ul><li>Teens may seek care from a variety of providers </li></ul><ul><li>Goal of provider is to complete a thorough physical and psychosocial evaluation </li></ul><ul><li>THINK PREVENTION! </li></ul>
  5. 5. Stages of Psychosocial Development <ul><li>Early adolescence (11-14 yrs) </li></ul><ul><li>Middle adolescence (15-17yrs) </li></ul><ul><li>Late adolescence (18-21 yrs) </li></ul>
  6. 6. Early Adolescence <ul><li>Period of rapid growth and physical change </li></ul><ul><li>Characteristics-egocentrism, concrete thinking </li></ul><ul><li>Relations-same sex friends </li></ul><ul><li>Problems-injuries </li></ul>
  7. 7. Middle Adolescence <ul><li>Secondary sexual characteristics develop, growth rate decreases </li></ul><ul><li>Emancipation from parents </li></ul><ul><li>Abstract thought </li></ul><ul><li>Opposite sex friends </li></ul><ul><li>STD’s,MVA’s </li></ul>
  8. 8. Late Adolescence <ul><li>Physically mature </li></ul><ul><li>Vocational goals important </li></ul><ul><li>Individual friendships over peer group </li></ul><ul><li>Stress induced illness </li></ul>
  9. 9. Setting the Stage
  10. 10. Setting the Stage <ul><li>Make the adolescent the primary historian </li></ul><ul><li>Establish confidentiality </li></ul><ul><li>Use understandable language </li></ul><ul><li>Use open-ended questions </li></ul><ul><li>Be non-judgemental </li></ul><ul><li>Listen to the patient! </li></ul>
  11. 11. Obtaining a History <ul><li>Chief Complaint </li></ul><ul><li>Past Medical history </li></ul><ul><li>Family Medical History </li></ul><ul><li>Psychosocial History </li></ul>
  12. 12. Psychosocial History <ul><li>H </li></ul><ul><li>E </li></ul><ul><li>A </li></ul><ul><li>D </li></ul><ul><li>S </li></ul>
  13. 13. Psychosocial History <ul><li>H-Home </li></ul><ul><li>E-Education </li></ul><ul><li>A-Activities </li></ul><ul><li>D-Diet,Drugs,Depression </li></ul><ul><li>S-Sexuality, Safety </li></ul>
  14. 14. HOME <ul><li>Who lives at home? </li></ul><ul><li>Who can you talk to? </li></ul><ul><li>How are things going with your parents/family members? </li></ul>
  15. 15. EDUCATION <ul><li>How are your grades? </li></ul><ul><li>Do you enjoy school? </li></ul><ul><li>What are your plans for the future? </li></ul>
  16. 16. ACTIVITIES <ul><li>What do you do for fun? </li></ul><ul><li>Are you involved in sports or extracurricular activities? </li></ul><ul><li>How many hrs/day- TV? Computers? Video games? </li></ul>
  17. 17. DIET <ul><li>Do you eat breakfast? Regular meals? </li></ul><ul><li>Are you concerned about your weight? </li></ul><ul><li>Do you drink milk? </li></ul>
  18. 18. DRUGS <ul><li>Do you or your friends drink alcohol? </li></ul><ul><li>Do you or your friends smoke cigarettes? </li></ul><ul><li>Do you or your friends smoke marijuana? Use other drugs? </li></ul>
  19. 19. DEPRESSION <ul><li>Have you been feeling sad? </li></ul><ul><li>Have you been crying frequently? </li></ul><ul><li>Do you feel that life is not worth living? </li></ul><ul><li>Are you sleeping at night? </li></ul><ul><li>Have you gained or lost weight? </li></ul>
  20. 20. SEXUALITY <ul><li>Have you ever had a sexual relationship with anyone? </li></ul><ul><li>Have you been forced to have sex against your will? </li></ul><ul><li>Do you use protection? </li></ul>
  21. 21. SAFETY <ul><li>F-Fights </li></ul><ul><li>I-Injuries </li></ul><ul><li>S-Sexual Violence </li></ul><ul><li>T-Threats </li></ul><ul><li>S-Self defense </li></ul>
  22. 22. Physical Exam <ul><li>Ensure privacy </li></ul><ul><li>Do thorough exam </li></ul><ul><li>Document Tanner Staging </li></ul><ul><li>Consider pelvic exam if sexually active or over 18 yrs </li></ul>
  23. 23. Screening tests <ul><li>Routine-refer to GAPS guidelines </li></ul><ul><ul><li>CBC,Cholesterol </li></ul></ul><ul><ul><li>Document varicella status, Hep B vaccine,tetanus. Consider meningococcal vaccine for college age students </li></ul></ul><ul><ul><li>Recommend annual dental visit </li></ul></ul><ul><li>High Risk </li></ul><ul><ul><li>female-RPR, GC/CH </li></ul></ul><ul><ul><li>male-UA </li></ul></ul>
  24. 24. Wrap up <ul><li>Interpret findings and discuss plans directly </li></ul><ul><li>Identify strengths and weaknesses </li></ul><ul><li>Discuss anticipatory care and PREVENTION </li></ul><ul><li>Provide educational materials </li></ul><ul><li>Encourage patients to return! </li></ul>
  25. 25. SUMMARY <ul><li>Set the stage </li></ul><ul><li>Establish confidentiality </li></ul><ul><li>Use HEADS </li></ul><ul><li>Consider FISTS </li></ul><ul><li>Prevent High-risk Behaviors </li></ul><ul><li>Encourage teens to return </li></ul>
  26. 26. QUESTIONS?

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