Adolescence diseases

 WHO considers this age group to be 10-
19 year olds, variation of definitions from
11-21 . Different from other pediatrics in
that there is completion of somatic
growth, movement from concrete to
abstract thinking, social, emotional,
cognitive growth, establishment of identity,
and preparation for career or growth.
Clinician needs to be able to relate to the
patient in order to be effective

SCOLIOSIS
Scoliosis is a lateral (sideways)
curvature of the spine. It may
involve all or only a portion of
the spinal column. It may be
functional (a curve caused by a
secondary problem) or
structural (a primary
deformity) (Pilliteri, 2010)

SCOLIOSIS
 Adolescent idiopathic scoliosis is an
abnormal curvature of the spine
that appears in late childhood or
adolescence. Instead of growing
straight, the spine develops a side-
to-side curvature, usually in an
elongated "S" or "C" shape; the
bones of the spine are also slightly
twisted or rotated.

ADOLESCENT IDIOPATHIC SCOLIOSIS
between 10 and 18 years of age is termed
adolescent scoliosis and can be due to many
causes.
the most common type of scoliosis in the
adolescent period is one in which the cause is not
known and is called idiopathic or adolescent
idiopathic scoliosis (AIS).

SCOLOSIS
 Age of onset :
 Early Onset : Before puberty
 Late Onset :After puberty
A spinal deformity characterized by lateral bending and
fixed rotation of the spine in the absence of any cause.
• In general, the younger the age at onset, the more likely the
deformity will progress and require treatment
• The deformity is often familial

ETIOLOGY
Remains unknown
Several studies have suggested :
 - Genetic cause
 - Tissue deficiencies
 -Vertebral growth abnormalities
 - Central nervous system theories

CLASSIFICATION
 Based on Curve Location :
 Cervical Apex : C2-C6
 Cervicothoraxic Apex : C7-T1
 Thoraxic Apex:T2-T12
 Thoracolumbar Apex :T12-L1
 Lumbar Apex : L2-L4
Based on Age at Onset Age
of Onset :
§ Infantile :Age birth to 3
years
§ Juvenile :Age 4 to 10 years
§ Adolescent :Age 11- 17
years (the most common)

CLINICAL FEATURES
 Pain : Not a common complaint
 Discomfort can be a common
feature but not severe pain
 Mild back discomfort and fatigue in
23% of cases.
 If severe pain : Must question
etiology of the idiopathic curve.

Commonest type. Mostly in girls
Primary thoraxic curves are usually convex to
the right , lumbar curves to the left.
Most curves < 20% : either resolve
spontaneously or remain unchanged

Once a curve start progress, it usually goes on
doing throughout growth period.
Progression predictors:
Very young age
Marked curvature
An incomplete Risser sign at presentation

RISSER SIGN
 The Risser sign is an indirect measure
of skeletal maturity, whereby the
ossification stage of the Iliac apophysis
is used to judge the ossification of the
spinal vertebrae
 The earlier the Risser Grade, the
greater the likelihood of a scoliosis
progressing to the point it becomes
clinically significant and requires
intervention.

TREATMENT OPTIONS :THREE O`S
1. OBSERVATION
The aim of observation for Adolescent idiopathic
scoliosis is to identify and document the curve
progression
Curves less than 20° are observed.

 2. ORTHOTIC TREATMENT
 Spinal orthotic is used to prevent curve progression and
generally, does not lead to permanent curve improvement.
 Although bracing is still being used, it is now recognized that
it does not actually improve curve – at best, it just stops it
from getting worse.
 Preference now :Wait for the curve to progress to the stage
where corrective surgery would be justified.

CONTRAINDICATION FOR BRACE TREATMENT
Skeletally mature patients
Curves greater than 40°
Thoracic lordosis ( Bracing potentiates
cardiopulmonary restriction)
Patient unable to cope emotionally with
treatment

BRACES
1.Braces are not curative but may slow the
progression of the curvature to allow skeletal
growth and maturity.
2.Braces usually are prescribed to be worn 16 to
23 hours a day.
3.Inspect the skin for signs of redness or
breakdown.

BRACES
1. Keep the skin clean and dry, and avoid lotions and powders
because these can lead to skin breakdown.
2. Advise the child to wear soft nonirritating clothing under the
brace.
3. Instruct in prescribed exercises (exercises help maintain and
strengthen spinal and abdominal muscles during treatment).
4. Encourage verbalization about body image and other
psychosocial issues.

 3. OPERATION
 Objectives :
 To halt progression of the deformity
 To straighten the curve
 To arthrodesis the primary curve by bone grafting.
 • Indications:
 Curves greater than 30° that are cosmetically unacceptable esp. in
prepubertal children
 Milder deformity that is deteriorating rapidly

OPERATIVE/SURGERY OPTIONS
 The Harrington System
 The old, original system.
 A rod was applied posteriorly along the concave side
of curve- attached to the rod were movable hooks
that were engaged in the uppermost & lowermost
vertebrae to distract the curve.
 Major Disadvantage: It does not correct the
rotational deformity- rib prominence remains
unchanged.

ROD AND SUBLAMINAR WIRING (LUQUE) -
MODIFIED HARRINGTON SYSTEM

COMPLICATIONS OF SURGERY
Neurological compromise
With modern techniques, the incidence of
permanent paralysis has been reduced to less
<1%

Spinal Decompression
Over correction may produce an unbalanced
spine.
This should be avoided by careful
preoperative planning.

Implant Failure
Hooks may cut out and rods may break. If
this is assoc. a symptomatic
pseudarthrosis, revision surgery will be
needed.

POSTOPERATIVE INTERVENTIONS
1. Maintain proper alignment; avoid twisting movements.
2. Logroll the child when turning to maintain alignment.
3. Assess extremities for adequate neurovascular status.
4. Encourage coughing and deep breathing and the use of
incentive spirometry.
5. Assess pain and administer prescribed analgesics.
6. Monitor for incontinence.

1.Monitor for signs and symptoms of infection.
2.Monitor for superior mesenteric artery syndrome
(caused by mechanical changes in the position of the
child’s abdominal contents during surgery) and notify
the physician if it occurs; symptoms include emesis and
abdominal distention similar to what occurs with
intestinal obstruction or paralytic ileus.
3.Instruct in activity restrictions.

1.Instruct the child how to roll from a side-lying position
to a sitting position, and assist with ambulation.
2.Prepare the child for the use of a molded plastic
orthosis (brace) to provide external stability of the
spine when resuming activities.
3.Address a body image disturbance when formulating a
plan of nursing care.

EARLY ONSET
IDIOPATHIC
SCOLIOSIS
(INFANTILE)
(< 3YEARS)

TREATMEN
T FOR
INFANTILE
ID.
SCOLIOSIS

EARLY ONSET
IDIOPATHIC
SCOLIOSIS
(JUVENILE)
(AGED 4-9
YEARS)

TREATMENT OF JUVENILE ID. SCOLIOSIS
 Juvenile idiopathic scoliosis is treated according to guidelines similar to
those for adolescent idiopathic scoliosis.
 Curve < 20°: Observation with examination and standing
posteroanterior radiographs every 4-6 months.
 Evidence of progression on the radiographs as indicated by a change of
at least 5 to 7 degrees warrants brace treatment. If the curve is not
progressing, observation is continued until skeletal maturity.
 Curve 25° to 50° range : Orthotic treatment
 Curve > 50° : Surgery

Assessment
1. Asymmetry of the ribs and flanks is noted when the child bends forward at the waist and hangs the arms
down toward the feet (Adams’ test).

3. Radiographs are obtained to confirm the diagnosis.

BONE TUMOR
 Tumors derived from connective tissue, such as bone and
cartilage, muscle, blood vessels, or lymphoid tissue, are called
sarcomas.They are the second most frequently occurring
neoplasms in adolescents (only lymphomas occur more often).
Bone tumors may arise during adolescence because rapid
bone growth is occurring at this time. Because girls have a
puberty growth spurt earlier than boys, bone tumors tend to
occur slightly earlier in girls than in boys (13 compared with
14 or 15 years of age) (Pilliteri, 2010)

TYPES OF BONE CELLS
 osteoclast: a large multinuclear
cell associated with the resorption
of bone
 osteocyte: a mature bone cell
involved with the maintenance of
bone
 osteoprogenitor: a stem cell that
is the precursor of an osteoblast
 canaliculus: any of many small
canals or ducts in bone or in some
plants
 periosteum: a membrane
surrounding a bone
 endosteum: a membranous
vascular layer of cells which line
the medullary cavity of a bone
 lacuna: a small opening; a small pit
or depression; a small blank space;
a gap or vacancy; a hiatus
 osteoblast: a mononucleate cell
from which bone develops

BONE TUMORS DEVELOP WHEN CELLS WITHIN A BONE DIVIDE
UNCONTROLLABLY , FORMING A LUMP OR MASS OF ABNORMAL
TISSUE .

RISK FACTORS
Genetic Disorders
- Li-Fraumeni syndrome
- Rothmund-Thomson syndrome
Retinoblastoma
Paget Disease
Radiation
Bone marrow transplantation
Injuries

RISK FACTOR
The Li-Fraumeni syndrome makes people much
more likely to develop several types of cancer ,
including breast cancer, brain cancer , osteosarcoma
and other types of sarcoma
Most of those cases are caused by a mutation of
p53 tumor suppressor gene , but some are
caused by mutations in the gene CHEK2

BONE TUMOR
A neoplastic disease that can arise from tissue involved in bone growth
Incidence: less than 5% of all malignant neoplasms; peak ages 15 to 19 years
Bone cancer is when unusual cells grow out of control in your bone.
It destroys normal bone tissue. It may start in your bone or spread
there from other parts of your body (called metastasis).
Bone cancer is rare. Most bone tumors are benign, which means
they aren’t cancer and don’t spread to other areas of your body. But
they may still weaken your bones and lead to broken bones or other
problems.

BONE TUMOR
There are a few common types of benign bone tumors:
 Osteochondroma is the most common. It often happens in people under age 20.
 Giant cell tumor is usually in your leg. In rare cases, these can also be cancerous.
 Osteoid osteoma often happens in long bones, usually in your early 20s.
 Osteoblastoma is a rare tumor that grows in your spine and long bones, mostly in young
adults.
 Enchondroma usually appears in bones of your hands and feet. It often has no symptoms.
It’s the most common type of hand tumor.

OSTEOSARCOMA
 Most frequent bone tumor in children
 Primary tumor sites: upper part of tibia; lower part of femur;
humerus just below the shoulder
 Arises from osteoid tissue
 Osteosarcoma often forms around your knee and upper
arm. Teens and young adults are most likely to get it, but
another form is common in adults who have Paget's disease of
bone.

EWING SARCOMA
 Ewing's sarcoma usually happens in people between the ages
of 5 and 20.Your ribs, pelvis, leg, and upper arm are the most
common sites. It can also start in the soft tissue around your
bones.
 Most frequent sites: shaft of long bones (e.g., femur, tibia, fibula,
humerus, ulna); trunk bones (e.g., vertebra, scapula, ribs, pelvis,
skull)
 Arises from medullary tissue (marrows)

CLINICAL FINDINGS
 Signs and symptoms
 A localized pain in the affected
site
 Limp; voluntary curtailment of
activity
 Inability to hold heavy objects
 Weight loss; frequent
infections
Fevers
Night sweats
Swelling around a bone
Limping
Fatigue

DIAGNOSIS
 X-rays. These show tumors and how big they are.
 CT scans. A computer uses X-rays to make more
detailed pictures.
 MRI scans. These use a strong magnet to show
inside your body.
 PET scans. A technician injects radioactive glucose
(sugar) into your vein.A scanner then spots cancer
cells, which use more glucose than regular cells.

DIAGNOSIS
 Bone scans. A technician injects a different
radioactive material into your vein. It collects in your
bones, where a scanner can see it.
 Radiographic examination; C.T. (bone); MRI;
prosthetic bone replacement
 Bone marrow aspiration
 Surgical Biopsy (Ewing Sarcoma)

THERAPEUTIC INTERVENTIONS
 Osteosarcoma
 Limb salvage procedure: resection of the tumor with prosthetic bone
replacement
 Chemotherapy
 Preoperative: to reduce tumor size
 Pre- and postoperative: DOXOrubicin, cyclophosphamide (cytoxan),
ifosfamide, carboplatin, cisplatin, high-dose methotrexate with
leucovorin; medications singly or in combination
 Amputation (rare)

COMMON TREATMENTS FOR BONE CANCER INCLUDE:
 Limb salvage surgery. Your doctor removes the part
of the bone with cancer but not nearby muscles,
tendons, or other tissues.They put a metallic implant in
place of the bone.
 Amputation . If a tumor is large or reaches your
nerves and blood vessels, your doctor might remove the
limb.You may get a prosthetic limb afterward.

COMMON TREATMENTS FOR BONE CANCER INCLUDE:
 Radiation therapy. This kills cancer cells and shrinks
tumors with strong X-rays. Doctors often use it along with
surgery.
 Chemotherapy . This kills tumor cells with cancer drugs.
Your doctor might use it before surgery, after surgery, or for
metastatic cancer.
 Targeted therapy. This drug treatment targets certain
genetic, protein, or other changes in or around cancer cells.

 Ewing Sarcoma
 Intensive irradiation of involved bone
 Surgical removal of the primary tumor
 Chemotherapy: vinCRIstine, cisplatin, DOXOrubicin, ifosfamide,
etosposide
 Amputation: for severe deformity as a result of radiation, if the limb is
useless

PLANNING/IMPLEMENTATION
1. Provide preoperative and postoperative care
a. Offer straightforward, honest explanations
b. Answer questions and clarify misconceptions
c. Avoid overwhelming adolescents or parents with too much in formations
d. Emphasize lack of alternatives if amputation is planned
e. Provide care related to amputations
f. Use a pain rating scale and medicate appropriately during the
postoperative period

1. Provide care related to radiation therapy for Ewing Sarcoma
a. Explain procedure; explain side effects
b. Suggests and/or implement measures to reduce the physical effects of
radiotherapy
1. Select loose-fitting cotton clothing over irradiated areas to decrease irritation
2. Protect the area from sunlight and sudden changes in temperature
3. Avoid ice packs, heating pads
c. Help to cope with side effects of radiotherapy

 3. Support during chemotherapy
 Explain the procedure, stressing the importance of chemotherapy
 Explain probable side effects of antimetabolites (e.g., nausea, hair loss,
stomatitis)
 Administer antiemetics (e.g., ondansetron [Zofran]) to limit the side effects
of chemotherapy
 Use nonpharmacologic means to minimize discomfort from chemotherapy
(e.g., soft, non-irritating foods, a soft-tipped applicator for oral hygiene)
 Encourage hygiene, grooming.And items to enhance appearance (e.g., wig)

 4. Provide emotional support to adolescent and family members
 a. Clarify misconceptions and provide technical information as needed
 b. Provide time and opportunity for grieving
 c. Encourage expression of feelings regarding loss and undesirable effects of
therapy
 d. Allow dependence while encouraging independence
 e. Emphasize the need for continuing regular activities, interactions, and
behaviors

EVALUATIONS/ OUTCOMES
 1. Reports minimal pain
 2. Resumes peer relationships and activities commensurate with abilities
 3.Adolescent and parents
 a. Express feelings and concerns
 b. Demonstrate positive coping skills
 c.Verbalize understanding of therapies and side effects
 d.Adjust to alterations in adolescent’s appearance

ANOREXIA NERVOSA, ALSO CALLED
ANOREXIA, IS A POTENTIALLY LIFE-
THREATENING EATING DISORDER THAT IS
CHARACTERIZED BY SELF-STARVATION
AND EXCESSIVE WEIGHT LOSS. THE
DISORDER IS DIAGNOSED WHEN A
PERSON WEIGHS AT LEAST 15% LESS THAN
THEIR NORMAL/IDEAL BODY WEIGHT.
EXTREME WEIGHT LOSS IN PEOPLE WITH
ANOREXIA NERVOSA CAN LEAD TO
DANGEROUS HEALTH PROBLEMS AND
EVEN DEATH.

A N O R E X I A N E RV O S A I S A D I S O R D E R
CHARACTERIZED BY REFUSAL TO MAINTAIN A
MINIMALLY NORMAL BODY WEIGHT BECAUSE OF
A DISTURBANCE IN PERCEPTION OF THE BODY'S
SIZE OR APPEARANCE (ZANDIAN ET AL., 2007). IT
INCLUDES THREE SEPARATE FEATURES: SELF-
INDUCED STARVATION TO A SIGNIFICANT
DEGREE; A RELENTLESS DRIVE FOR THINNESS, A
MORBID FEAR OF FATNESS, OR BOTH; AND
MEDICAL SIGNS AND SYMPTOMS RESULTING FROM
STARVATION (PILLITERI, 2010).

• ETIOLOGIC FACTORS
1. DECREASED LEVELS OF NOREPINEPHRINE, SEROTONIN,
AND DOPAMINE
2. COMBINATION OF GENETIC, NEUROCHEMICAL,
DEVELOPMENTAL, PSYCHOLOGIC, SOCIAL, CULTURAL,
AND FAMILIAL FACTORS CITED
3. MORE COMMON IN FEMALES
4. AVOIDANCE OF FOOD MAY RESULT FROM AN EXCESSIVE
CONCERN WITH 5. OBESITY
6. APPARENT FAILURE TO SEPARATE FROM MOTHER AND
BECOME AUTONOMOUS, UNCONSCIOUS FEAR OF
MATURING
7. ONSET USUALLY DURING ADOLESCENCE THROUGH
YOUNG ADULTHOOD; LESS COMMON IN OLDER ADULTS
BUT IS INCREASING IN PERIMENOPAUSAL WOMEN

THE SYMPTOMS OF ANOREXIA OFTEN INCLUDE THE FOLLOWING:
 Rapid weight loss over several weeks or months
 Continuing to diet/limited eating even when thin or when weight is very
low
 Having an unusual interest in food, calories, nutrition, or cooking
 Intense fear of gaining weight
 Strange eating habits or routines, such as eating in secret
 Feeling fat, even if underweight
 Inability to realistically assess one's own body weight
 Striving for perfection and being very self-critical

THE SYMPTOMS OF ANOREXIA OFTEN INCLUDE THE FOLLOWING:
 Undue influence of body weight or shape on self-esteem
 Depression, anxiety, or irritability
 Infrequent or irregular, or even missed menstrual periods in females
 Laxative, diuretic, or diet pill use
 Frequent illness
 Wearing loose clothing to hide weight loss
 Compulsive exercising
 Feeling worthless or hopeless
 Social withdrawal
 Physical symptoms that develop over time, including: low tolerance of cold weather, brittle hair and nails, dry or
yellowing skin, anemia, constipation, swollen joints, tooth decay, and a new growth of thin hair over the body

UNTREATED,ANOREXIA NERVOSA CAN LEAD TO:
 Damaged organs, especially the heart, brain, and kidneys
 Drop in blood pressure, pulse, and breathing rates
 Loss of hair
 Irregular heart beat
 Thinning of bones (osteoporosis)
 Fluid-electrolyte imbalance
 Death from starvation or suicide

WHAT ARETHE HEALTH HARMS OF ANOREXIA
NERVOSA?
 Not getting enough nutrients (malnutrition) and starvation affects
nearly every system of the body.
 Effects on the heart. Slow heart rate (bradycardia), low blood pressure
(hypotension) and orthostatic hypotension are common effects of
starvation. These complications increase the risk of ventricular
arrhythmia and sudden cardiac death.The heart itself can lose some of its
muscle mass, which can lead to mitral valve prolapse.
 Effects on the brain. Starvation affects the brain’s structure – including
decreased brain tissue and brain activity and function. Functions impaired
include decision making, ability to concentrate/focus, memory issues,
emotional control, appetite regulation, mood and reward pathways.

 Effects on the digestive tract. Starvation can cause abdominal discomfort and
pain, bloating, constipation, feelings of being full, as well as lead to fatty liver disease
(steatosis).
 Effects on the body’s hormones. Starvation can cause missed menstrual periods
(amenorrhea) and reduced levels of female hormones, low testosterone levels,
delayed puberty and physical growth, underactive thyroid (hypothyroidism),
euthyroid sick syndrome, and in older individuals, increased the risk of weak bones
(osteopenia), bone loss (osteoporosis) and stress fractures.
 Effects on the body from vomiting (purging). Exposure to stomach acid can
wear down the enamel on teeth and enlarge the salivary glands. Loss of water and
electrolyte/acid-base imbalances can cause a loss of potassium and lead to
rhabdomyolysis (damaged skeletal muscle) and kidney damage.

PSYCHOTHERAPY
 This is a type of individual counseling that focuses on changing the thinking (cognitive
therapy) and behavior (behavioral therapy) of a person with an eating disorder.
Treatment includes practical techniques for developing healthy attitudes toward food
and weight, as well as approaches for changing the way the person responds to
difficult situations.There are several types of psychotherapy including:
 Acceptance and CommitmentTherapy. This therapy’s goal is to develop
motivation to change actions rather than your thoughts and feelings.
 Cognitive BehavioralTherapy (CBT). This therapy’s goal is to address distorted
views and attitudes about weight, shape and appearance and practice behavioral
modification (if “X” happens, I can do “Y” instead of “Z”).
 Cognitive RemediationTherapy. This therapy uses reflection, and guided
supervision to develop the capability of focusing on more than one thing at a time.

 Dialectical BehaviorTherapy (DBT), is CBT plus insight. In other words,
this therapy helps the individual not just develop new skills to handle negative
triggers, but also helps the person develop insight to recognize triggers or
situations where a non-useful behavior might occur. Specific skills include building
mindfulness, improving relationships through interpersonal effectiveness, managing
emotions and tolerating stress.
 Family-basedTreatment (also called the Maudsley Method). This therapy
involves family-based refeeding, which means putting the parents/family in charge of
getting the appropriate nutritional intake consumed by the individual with the
eating disorder. It is the most evidence-based method to physiologically restore
health to an individual with anorexia nervosa who is under 18 years of age.

 Interpersonal Psychotherapy. This therapy is aimed at
resolving an interpersonal problem area. Improving relationships
and communications, and resolving identified problems has been
found to reduce eating disorder symptoms.
 Psychodynamic Psychotherapy. This therapy involves
looking at the root causes of anorexia nervosa – what are the
patient’s true underlying needs and issues -- as the key to
recovery.

MEDICATION
The antipsychotic olanzapine (Zyprexa®) may be
helpful for weight gain.Although there is no clear
evidence that antidepressant medications can help
individuals gain weight, some doctors may
prescribe these drugs to help control anxiety and
depression associated with an eating disorder.

SUBSTANCE
ABUSE
 Substance abuse isn't something you should take lightly. It
occurs when you use alcohol, prescription medicine, and other
legal and illegal substances too much or in the wrong way

SUICIDE IS A DELIBERATE SELF-INJURY WITH THE INTENT
T O E N D O N E ' S L I F E ( P I L L I T E R I , 2 0 1 0 ) .
A. SUCCESSFUL SUICIDE OCCURS MORE FREQUENTLY
IN MALES THAN IN FEMALES,ALTHOUGH MORE FEMALES
ATTEMPT SUICIDE THAN MALES (ABOUT 8:1).
B. ADOLESCENT SUICIDES ARE ATTEMPTED MOST
OFTEN IN THE SPRING OR THE FALL, REFLECTING
SCHOOL STRESS AT THESE TIMES OF THE YEAR, AND
BETWEEN 3 PM AND MI D N I G H T, R E F L E CT I N G
DEPRESSION INCREASES WITH THE DARK. SUICIDE IS SO
COMMON IN ADOLESCENTS THAT IT RANKS THIRD AS A
CAUSE OF DEATH IN THE 15- TO 19-YEAR-OLD GROUP
( C D C , 2 0 0 8 A ) .

SEXUALLY TRANSMITTED DISEASE
Sexually transmitted
infections (STIs) are
diseases that are spread
through sexual contact
with an infected partner.

Kinds of STI’s
Vaginal candidiasis
1. Description
a. Candida albicans is the most common causative organism.
b. Predisposing factors include use of antibiotics, diabetes mellitus,
and obesity.
c. Vaginal candidiasis is diagnosed by identifying spores of Candida
albicans.
2.Assessment
a. Vulvar and vaginal pruritus
b. White, lumpy, cottage cheese–like discharge from vagina
3. Interventions
a. An antifungal vaginal preparation such as miconazole (Monistat)
may be prescribed.
b. For extensive irritation and swelling, sitz baths may be prescribed.
c. Sexual partner may need to be treated

Trichomoniasis
1. Description
a. Trichomoniasis is caused by Trichomonas vaginalis and is
transmitted via sexual contact.
b. A normal saline wet smear of vaginal secretions indicates the
presence of protozoa.
c. Infection is associated with premature rupture of the
membranes and postpartum endometritis
2.Assessment
a. Yellowish to greenish, frothy, mucopurulent, copious, malodorous
vaginal discharge
b. Inflammation of vulva, vagina, or both may occur
3. Interventions
a. Metronidazole (Flagyl) may be prescribed.
b. Sexual partner may need to be treated.

Bacterial vaginosis
1. Description
a. Caused by Haemophilus vaginalis (Gardnerella vaginalis) and
transmitted via sexual contact
b. Associated with premature labor and birth
2.Assessment
a. Client complains of “fishy odor” to vaginal secretions and
increased odor after intercourse.
b. Microscopic examination of vaginal secretions identifies the
infection.
3. Interventions
a. Oral metronidazole (Flagyl) may be prescribed.
b. Sexual partner may need to be treated.

Chlamydia
1. Description
a. Sexually transmitted pathogen associated with an increased
risk for premature birth, stillbirth, neonatal conjunctivitis,
and newborn chlamydial pneumonia
b. Can cause salpingitis, pelvic abscesses, ectopic pregnancy,
chronic pelvic pain, and infertility c. Diagnostic test is culture
forChlamydia trachomatis
2. Assessment
a. Usually asymptomatic
b. Bleeding between periods or after coitus
c. Mucoid or purulent cervical discharge
d. Dysuria and pelvic pain

Interventions
a.Screen the client to determine whether she is high
risk; a vaginal culture is indicated for all pregnant
clients if the client is in a high-risk group or if
infants from previous pregnancies have developed
neonatal conjunctivitis or pneumonia.
b.Instruct the client in the importance of rescreening
because reinfection can occur as the client nears
term.
c.Ensure that the sexual partner is treated.

Condyloma acuminatum (human papillomavirus)
1. Description
a. Condyloma acuminatum is caused by human papillomavirus.
b. Infection affects the cervix, urethra, anus, penis, and scrotum.
c. A culture is indicated for clients with a positive history or with active lesions, and weekly
cultures may be done at week 35 or 36 of pregnancy until delivery; the test is performed to
determine the route of delivery.
d. Human papillomavirus is transmitted through sexual contact.
2.Assessment
a. Infection produces small to large wart-like growths on the genitals.
. Cervical cell changes may be noted because human papillomavirus is associated with cervical
malignancies.
3. Interventions
a. Lesions are removed by the use of cytotoxic agents, cryotherapy, electrocautery, and laser.
b. Encourage annual Papanicolaou smear.
c. Sexual contact should be avoided until lesions are healed (condoms reduce transmission).

Herpes Genitalis (Herpes Simplex Type 2)
-Genital herpes is caused by herpesvirus hominis type 2
Assessment
1. On the first contact, extensive primary lesions originate as a group of pinpoint vesicles on an erythematous base.
2. Within a few days, the vesicles ulcerate and become moist, painful, draining open lesions.
3. An adolescent may have accompanying flulike symptoms with increased temperature; vaginal lesions may
cause a profuse discharge.
4. Pain is intense in contact with clothing or acidic urine.
5. After the primary stage that lasts approximately 1 week, lesions heal, but the virus lingers in a latent form,
affecting the sensory nerve ganglia.
6. The condition will flare up and become an active infection during illness, just before menstruation, fever,
overexposure to sunlight, or Stress.
7. A secondary response usually produces only local lesions rather than systemic symptoms.

Treatment:
1. Acyclovir (Zovirax) is an example of an antiviral that controls
the virus by interfering with deoxyribonucleic acid
reproduction and decreasing symptoms (Watkins, 2008).
2. Sitz baths three times a day may be helpful to reduce
discomfort.
3. An emollient (A&D Ointment) can also reduce discomfort, but
its moisture tends to prolong the lesions' active period.
4. Topical imiquimod (Aldara) or Foscarnet (Foscavir) may be
prescribed for resistant lesions.
5. Condoms (male or female) help prevent the spread of herpes
among sexual partners.
6. Valacyclovir (Valtrex) may be prescribed as a preventive
measure to help limit the disease spread.

Gonorrhea
1. Description
a. Gonorrhea is an infection caused by Neisseria
gonorrhoeae that causes inflammation of the mucous
membranes of the genital and urinary tracts.
b. . Transmission of the organism is by sexual intercourse.
c. Infection may be transmitted to the newborn’s eyes
during delivery, causing blindness (ophthalmia
neonatorum).
2. Assessment: Usually asymptomatic; vaginal discharge,
urinary frequency, and lower abdominal pain possible
3. Interventions
a. Obtain a vaginal culture during the initial prenatal
examination to screen for gonorrhea; the culture may be
repeated during the third trimester in high-risk clients.
b. Instruct the client that treatment of her partner is
necessary if infection is pres

HEPATITIS
AN ACUTE INFLAMMATORY DISEASE OF THE LIVER
RESULTING IN CELLULAR DAMAGE FROM DEGENERATION
AND NECROSIS

CA: HepatitisVirus- HAV, HBV, HCV, HDV,
HEV
General S/S: inflammation of liver, loss of
appetite, abdominal pain, clay-colored stools,
dark urine, enlarged liver, jaundice

HEPATITIS
 Hepa A – fecal oral route
 Hepa B – body fluids
 Hepa C – non A non B, BT, body fluids
 Hepa D – hypodermic, body fluids
 Hepa E – fecal oral route, fatal and common among
pregnant women
 Hepa G – BT, parenteral

HEPATITIS A
 (infectious hepatitis)
 Caused by HAV, RNA, Hepa A virus
 Transmitted via oral-fecal route, contamination associated with
flood waters or contaminated food
 Incubation pd: 15-50 days
 Confers immunity to individual

HEPATITIS A
 Caused by Poor sanitation
 Worldwide distribution
 Mortality 1%, with full recovery
 Active Immunity (Havrix)
 Passive Immunity (HAIg)
IP: 3-5 weeks
MOT: Fecal oral route, Spread from person-person, Food handlers,
contaminated water
* Enteric precautions

 Symptoms usually last less than 2 months, although some people can be ill for
as long as 6 months:
 Fatigue
 Fever
 Abdominal pain
 Nausea
 Appetite loss
 Jaundice, a yellowing of the skin or whites of the eyes
 Bile is removed from blood stream and excreted in urine, giving it a dark amber colour
 Clay-coloured feces

DIAGNOSTIC FINDINGS
HEPATITIS A
Anti-HAV: antibody usually apparent once
symptoms appear and lasts up to 12
months
IgM anti-HAV: antibody indicates recent
infection

Dx:Anti HAV IgM – active infection
Anti HAV IgG – old infection; no active
disease
Mgmt: supportive

TREATMENT
 Anti viral therapy (e.g. Ribavirin)
 Corticosteroids
 Vitamin K
 Anti Emetics
 Symptomatic Treatment like:
 a. Paracetamol/Antipyretic
 b. Calamine lotion

PREVENTION
Proper handling of food
Sanitation
Proper nutrition
Vaccine

NURSING CARE
 Bed rest
 Isolation
 Decrease fat, high calorie and CHON
 Calamine lotion
 Clean and cut nails
 No blood donation

HEPATITIS B
 DNA( genetic), Hepa B virus
 Serum hepa
 Worldwide distribution
 Main cause of liver cirrhosis and liver cancer
 It is spread through contact with the blood and body fluids of an
infected person. Blood recipients, hemodialysis, IV drug users,
sexually active homosexual, tattoing and health care workers (high
risk)
 Active Immunity (hevac-B)
 Passive Immunity (HBIg)
 Carrier state
IP: 2-5 months

HEPATITIS B
 You may get hepatitis B if you:
 Have sex with an infected person without using a condom.
 Share needles (used for injecting drugs) with an infected person.
 Get a tattoo or piercing with tools that were not cleaned well.
 Share personal items like razors or toothbrushes with an
infected person.
 A mother who has the virus can pass it to her baby during
delivery

 Symptoms develop within 30-180 days of exposure to the virus.The symptoms are often
compared to flu. Most people think they have flu and never think about having HBV infection.
 Appetite loss
 Feeling tired (fatigue)
 Nausea and vomiting
 Itching all over the body
 Pain over the liver (on the right side of the abdomen, under the lower rib cage)
 Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
 Urine becomes dark in color (like cola or tea).
 Stools are pale in color (grayish or clay colored).

MOT: Blood and other
body fluids route,
percutaneous, perinatal

MANIFESTATIONS
Stage I pre-icteric for 1-21 days
Anorexia, nausea and vomiting, LBM, weight loss
RUQ pain, fatty food intolerance, fever, chills and
headache
Stage II icteric for 2-6 weeks Jaundice, pruritus,
weight gain, ascites, dark-tea colored urine
(urobilirubin), S/sx of ADEK deficiency

MANIFESTATIONS
Stage III pre coma
NH3 level increases with decreasing LOC,
Flapping tremors or asterixis
Stage IV recovery (lifetime carrier) or death

DX:
Elevated AST or SGPT (specific) and ALT or SGOT
Increased IgM during acute phase
(+) or REACTIVE HBsAg = INFECTED, may be
acute, chronic or carrier
(+) HBeAg = highly infectious

 HBcAg = found only in the liver cells
(+) Anti-HBc = acute infection
(+) Anti-HBe = reduced infectiousness
(+) Anti-HBs = with antibodies (FROM
vaccine or disease)
Blood Chem.Analysis (to monitor progression)
Liver biopsy (to detect progression to CA)

Mgmt:
 Prevention of spread – Immunization and Health Education
 Enteric and Universal precautions
 Assess LOC
 Bed rest
 ADEK deficiency intervention
 High CHO, Moderate CHON, Low fat
 FVE prevention

COMPLICATIONS
1. Fulminant Hepatitis – s/sx of encephalopathy
2. Chronic Hepatitis - lack of complete
resolution of clinical sx and persistence of
hepatomegaly
3. HBsAg carrier

Adolescence diseases

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