Care of Mother and Child at Risk or with

Problems (Acute and Chronic)

LESSON TITLE: CARE OF A FAMILY OF A HIGH-RISK Materials:

ADOLESCENT
Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to:
1. Define the common classifications of high-risk adolescent References:
and describe common illnesses that occur in these
classifications of adolescent. Pilliteri, Adele and Silbert-Flagg, JoAnne
2. Integrate the knowledge of the common classifications of (2018) Maternal and Child Health Nursing, 8th
high-risk adolescent and describe common illnesses that Edition. USA: Lippincott Williams and Wilkins
occur in these classifications of adolescent in formulating
nursing care plan in giving quality maternal and child health
nursing care.

A. LESSON PREVIEW/REVIEW

Instruction: Differentiate Polyarticular and Pauciarticular juvenile arthritis. (Refer to session 23 for answers.)

B. MAIN LESSON
The instructor should discuss the following topics. Instruct students to take down notes.

SCOLIOSIS
DESCRIPTION
⚫ Lateral curvature of the spine ⚫ Electrical stimulation for mild to moderate
⚫ FUNCTIONAL, which occurs as a compensatory curvatures, to cause muscles to contract at
mechanism in children who have unequal leg regular and frequent intervals, possibly helping to
lengths or poor posture straighten the spine
⚫ STRUCTURAL scoliosis is a permanent curvature ⚫ If curvature progresses or is > 40 degrees,
of the spine accompanied by damage to the surgery is warranted for spinal instrumentation;
vertebrae rods, screws & wires are placed next to the
⚫ Structural scoliosis-most often during rapid growth curvature; spine is then fused in correct position;
spurt ( 11 to 14 yrs for females, 13 to 16 yrs for bone from iliac crests may be used to strengthen
males) fusion
⚫ Post-operative care: ROM exercises, log rolling
ETIOLOGY AND PATHOPHYSIOLOGY every 2 hours, deep breathing and use if incentive
⚫ 70%is idiopathic spirometry, NPO, NGT, strict I & O, VS &NVS
⚫ There is a familial predisposition for structural monitoring, BT, pain management, TEDS, and
scoliosis gradual resumption of activity
⚫ It is common in diseases where there is unequal
muscle balance, such as CP, muscular dystrophy MILWAUKEE OR OTHER BRACES
and myelomeningocoele ⚫ Worn 23 hours a day, off to shower, bathe, swim
⚫ T-shirt is worn underneath the brace to protect the
ASSESSMENT skin
⚫ painless and insidious onset ⚫ Exercises (pelvic tilt, lateral strengthening) several
⚫ skirts hang unevenly, or that bra straps are times a day while in brace
adjusted unevenly ⚫ Slight muscle ache noticed when first wearing the
⚫ unequal shoulder heights, waist angles, scapula brace
prominences, rib prominences, and chest
asymmetry DISCHARGE TEACHING

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

⚫ Screening by school nurse begins in 5th grade ⚫ Must not slump on chairs, must not bend or twist
the torso or lift over 10 lbs
PLANNING AND IMPLEMENTATION ⚫ Comply with activity restrictions for 6 to 8 months
⚫ Xray to identify extent of curvature and give
baseline information
⚫ If spinal curve is <15 to 20 degrees, the teen is
monitored every 3 to 6 months; exercises to
improve posture and muscle tone and increase
flexibility of the spine are encouraged
⚫ If curve is >40 degrees, surgery; if >32 degrees,
conservative nonsurgical treatment with bracing
such as a MILWAUKEE brace, made of leather
and plastic and is worn until the growth spurt
stops

BONE TUMORS (OSTEOGENIC SARCOMA)

DESCRIPTION PLANNING AND IMPLEMENTATION
⚫ It is a tumor that arises from a bone cell, probably ⚫ Treatment may include radical resection or
the osteoblast amputation
⚫ Most common bone cancer in children ⚫ Selected clients may have prosthetic replacement
⚫ Frequently affects the metaphysis of long bones ⚫ Thoracotomy for lung metastasis
⚫ Chemotherapy may be administered preop and
ETIOLOGY AND PATHOPHYSIOLOGY postop
⚫ Common in adolescent boys; tumor growth is ⚫ Emotional support of child is important
detected t time of rapid bone growth ⚫ Employ a straightforward approach when
⚫ Frequently affects distal end of femur; also affects amputation is indicated; allow verbalization
humerus, tibia, pelvis, jaw, and phalanges ⚫ Sterile stump care and special bandaging as
⚫ It is a malignant tumor that frequently ordered
metastasizes to the lungs ⚫ Elevate stump for 24 hours if prescribed; avoid
⚫ High incidence in children who had retinoblastoma prolonged elevation
⚫ Maintain body alignment
ASSESSMENT ⚫ Perform ROM exercises to joints above the
⚫ Pain and swelling are the initial symptoms amputation
⚫ Xrays following traumatic injury may be 1st ⚫ Assist with early ambulation and temporary
indication of disease prosthesis use
⚫ CT, or MRI to detect metastasis ⚫ Encourage early interaction with peers

ACCIDENTS
ACCIDENT HEALTH TEACHING MEASURES
MOTOR  Use a seatbelt
VEHICLE  Do not drink alcohol while driving or ride with anyone who
has been drinking
 Wear helmet and long pants when riding a motorcycle
 Accepting dares has no place in safe driving
 Take driving lessons to learn safe driving habits for 2-wheel
or 4-wheel vehicles
FIREARMS  Always consider all guns loaded are potentially lethal
 Learn safe gun handling before attempting to clean a gun
or hunt
DROWNING  Learn how to swim; follow safe water rules such as never
swim alone, no diving into a shallow pool, no swimming
beyond own limit
 Never take dares
SPORTS  Use protective equipment such as hockey mask, football
pads, etc

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

 Do not attempt in participating beyond physical limits

 Training for sports is necessary
SEXUALLY TRANSMITTED INFECTION

Symptoms Common Therapy

Vulvar reddening and pruritus; Nystatin or miconazole (Monistat)

thick, white, cheese-like vaginal suppositories or fluconazole
Candida discharge orally; bathing with dilute
albicans NaHCO3 to relieve pruritus
Thin, irritating, frothy, gray- Metronidazole (Flagyl) orally;
green discharge; strong, putrid douching with weak vinegar to
odor, itching reduce
Pruritus
Gardnerella Edema and reddening of vulva; Metronidazole (Flagyl) or
vaginalis milky-gray discharge, fishy odor clindamycin
Foreign Body Vaginal discharge; odor Removal of foreign body
Herpesvirus Painful, pinpoint vesicles on an Bathing with dilute NaHCO3,
type II erythematous base with watery applying lubricating lotions to
vaginal discharge; voiding may lesions or oral analgesic; topical
be irritating and painful acyclovir helps heal lesions
Chlamydia Watery, gray-white vaginal Tetracycline or doxycycline;
trachomatis discharge, vulvar itching erythromycin during pregnancy
Neisseria Possibly symptomless; profuse Ceftriaxone and doxycycline; oral
gonorrhoeae yellow-green vaginal discharge amoxicillin
Enterobius Rectal pruritus, especially on Oral administration of
vermicularis rising in the morning antihelminthic such as
mebendazole (Vermox)
Treponema Painless ulcer on vulva or Benzathine penicillin,
pallidum vagina administered IM
(Syphilis)
Group B Vaginitis, vulvar itching, edema Antibiotic (Amoxicillin)
Streptococcus and reddening of vulva
⚫ Hepatitis B and C- spread by semen and blood
⚫ Syphilis- IP of 10-90 days then typical painless lesion (CHANCRE) appears
on genitalia, lips, rectum lasting for 6 weeks then fades; 2-4 weeks after, a
generalized, macular, copper-colored rash appears usually on the soles and
palms (VDRL serologic test will be +); next stage is a latency period lasting
from years to decades(+ serologic test); final stage involves major organs
casing blindness, paralysis, crippling neurologic deformities, mental confusion,
slurred speech and lack of coordination
⚫ HIV

AMENORRHEA DYSMENORRHEA
⚫ Absence of menstrual flow; may be due to ⚫ It is painful menstruation caused by the release of
pregnancy, tension, anxiety, fatigue, chronic prostaglandins in response to tissue destruction
illness, extreme dieting and strenuous exercise during the ischemic phase of the menstrual cycle
⚫ Associated with low ratio of body fat to muscle ⚫ Prostaglandins cause the smooth muscles to
which leads to excessive secretion of contract causing pain in the uterus
PROLACTIN causing a decrease in the secretion ⚫ It can be a preliminary symptom of an underlying
of GnRH by the hypothalamus illness such as PID, myoma or endometriosis
⚫ Menstrual cycle usually returns to normal within 3
months after discontinuation of strenuous training ASSESSMENT
⚫ 1st 2 years of menstruation, dysmenorrhea is rare
because early MC’s are anovulatory
⚫ Categorized as mild( no interference with normal

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

activities), moderate(some interference), or

severe(interference with majority of daily activities
⚫ Primary if it occurs in the absence of an organic
disease and secondary if it is a result of organic
disease
⚫ Begins with a bloated feeling and light cramping
24 hours before menstrual flow
⚫ Pain is noticed when the flow begins-
colicky(sharp) pain is superimposed on a dull,
nagging pain across the lower abdomen
accompanied by an aching, pulling sensation of
the vulva and inner thighs
⚫ Some have mild diarrhea with the abdominal
cramping
⚫ Mild breast tenderness, , abdominal distention,
N/V, headache and facial flushing

MANAGEMENT
⚫ Analgesics such as aspirin or ibuprofen and
naproxen sodium may be used but most not be
taken on an empty stomach
⚫ Low-dose oral contraceptive to prevent ovulation
⚫ Alternative therapies: imagery, TENS
OBESITY
⚫ Most overweight adolescents have obese parents (environment and inheritance)
⚫ Suicide rate for obese teens is higher than in the non-obese
⚫ Teens generally adhere to a diet closer to 1800 calories a day
⚫ Adolescents who overeat as a reaction to stress need psychological counseling rather than diet counseling
⚫ Obesity causes low self-esteem, body image problems and depression
⚫ Diet and exercise are the main measures

MEASURES TO HELP DECREASE OVEREATING

⚫ Make a detailed log of the amount they eat, the time, and the circumstances and then changing those
circumstances
⚫ Always eat in 1 place instead of while walking or watching TV
⚫ Slow the process of eating by counting mouthfuls and putting the fork down beside the plate between bites, and
being served food on small plates so helpings look larger

ANOREXIA NERVOSA
 characterized by refusal to maintain a ASSESSMENT
minimally normal body weight because of a ⚫ perceive food as revolting or nauseating and
disturbance in perception of the size or refuse to eat or vomit food after eating
⚫ May use IPECAC for vomiting, laxatives, diuretics,
appearance of the body
intensive exercise to lose weight
 Includes 3 separate features: self-induced
⚫ Excessive weight loss, acidosis, dependent
starvation to a significant degree; relentless drive
edema, hypotension, hypothermia, bradycardia,
for thinness, a morbid fear of fatness, or both; and
formation of lanugo
medical signs ad symptoms resulting from
starvation MANAGEMENT
 most often in girls (90%) between 13 and 20 yo ⚫ Oral foods withheld to prevent vomiting; TPN to
 It may be manifested as severe weight restriction supply needed fat, protein and calories
controlled by limiting food intake, excessive ⚫ Establish trust and effective communication
exercise or by BINGE EATING or PURGING ⚫ Antidepressants
⚫ Identification of emotional triggers
SPECIAL CHARACTERISTICS OF A CHILD WITH ⚫ Self-monitoring (awareness training)
ANOREXIA NERVOSA ⚫ Education about normal nutritional needs
⚫ BMI < 17.5 or <85% of expected weight ⚫ Gradual weight gain is recommended
⚫ Intense fear of gaining weight or becoming fat

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 Care of Mother and Child at Risk or with
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even though underweight

⚫ Severely distorted body image
⚫ Refusal to acknowledge seriousness of weight
loss
⚫ Amenorrhea

SUBSTANCE ABUSE
DRUGS SYMPTOMS OF USE DANGERS
Glue  Violence, drunken appearance, Lung, brain or liver
dreamy or blank expression damage; suffocation or
 Glue smears on clothing or choking, anemia
fingers; tubes of glue, paper bags
Heroin, morphine,  Stupor, drowsiness, needle marks, Overdose; liver and
codeine watery eyes, anorexia, bloodstains other infections
on sleeves, runny nose
 Needle or syringe, cotton,
tourniquet, burnt bottle caps or
spoons, glassine envelopes
Hallucinogens (LSD  Severe hallucinations, Suicidal tendencies,
PCP, DMT) detachment, incoherent speech, unpredictable behavior,
cold hands and feet, laughing and neurologic effects
crying, vomiting
 Possession of cube sugar with
discoloration in the center, strong
body odor
Stimulants  Aggressive behavior, giggling, Overdose,
(methamphetamine, silliness, rapid speech, confusion, hallucinations,
cocaine) anorexia, extreme fatigue, black psychosis
caries, dry mouth, shakiness,
insomnia. Pills or capsules in
varying colors, absence of nasal
hair, possession of a glass pipe
Depressants  Drowsiness, stupor, slurred Death or
(barbiturates, speech, drunken appearance, unconsciousness from
alcohol) vomiting overdose; addiction,
seizures from
 Pills or capsules in varying colors,
withdrawal
odor of alcohol on breath
Steroids  Aggressive behavior, increase in Violent actions, possibly
muscle strength and mass tumor growth
ASSESSMENT
⚫ Failure to complete assignments in school
⚫ Demonstration of poor reasoning ability
⚫ Decreased school attendance
⚫ Frequent mood swings
⚫ Deteriorating physical appearance
⚫ Recent change in peer group
⚫ Expressed negative perceptions of parents
TEEN SUICIDE
DESCRIPTION SUICIDE WARNING SIGNS
⚫ It is deliberate self-injury with the intent to end ⚫ Giving away prized possessions
one’s life ⚫ Organ donation questions

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 Care of Mother and Child at Risk or with
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⚫ More frequent in males although more attempts ⚫ Sudden, unexplained elevation of mood
are made by females ⚫ Accident proneness, carelessness, and death
⚫ Frequent during spring or fall, reflecting school wishes
stress and between 3pm and midnight, reflecting ⚫ “This is the last time you will see me.”
depression that increases with the dark ⚫ Decrease in verbal communication
⚫ 3rd cause of death in the 15 to 19-year old group ⚫ Withdrawal from peer activities or previously-
⚫ Some degree of depression is present in enjoyed events
adolescents because they are not only losing their ⚫ Previous attempt (80% f completed suicides have
parents and also their carefree childhood been preceded by a failed attempt)
⚫ Recent increase in interpersonal conflict with
ASSESSMENT significant others
⚫ Signs of depression: anorexia, insomnia, ⚫ Running away from home
excessive fatigue, or weight loss ⚫ Recent experience of a friend or a famous person
⚫ In younger adolescents: disobedience, tantrums, committing suicide
truancy and running away from home ⚫ Inquiring about the hereafter
⚫ Self-destructive behavior, difficulties in school, ⚫ Asking for information (supposedly for a friend)
acting out with chemicals, alcohol, or sexual about suicide prevention and intervention
promiscuity; or trouble with legal authorities ⚫ Almost any sustained deviation from the normal
pattern of behavior

CHECK FOR UNDERSTANDING

The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

1. A 15-year-old has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until
surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot.
Which action should the nurse take?
A. Administer an analgesic.
B. Release the skin traction.
C. Apply ice to the extremity.
D. Notify the primary health care provider.
2. A 16-year-old is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and
should include which intervention?
A. Ensure that all ropes are outside the pulleys.
B. Ensure that the weights are resting lightly on the floor.
C. Restrict diversional and play activities until the child is out of traction.
D. Check the primary health care provider’s (PHCP’s) prescriptions for the amount of weight to be applied.
3. A 14-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm
and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child’s cast. Which
statement by the parents indicates a need for further instruction?
A. “The cast may feel warm as the cast dries.”
B. “I can use lotion or powder around the cast edges to relieve itching.”
C. “A small amount of white shoe polish can touch up a soiled white cast.”
D. “If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast.”

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 Care of Mother and Child at Risk or with
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4. A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes
of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these
findings, the nurse should take which action?
A. Administer an antiemetic.
B. Increase the intravenous fluids.
C. Place the child in a Sims’ position.
D. Notify the primary health care provider.

5. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement
by the parents indicates a need for further instruction?
A. “I will encourage my child to perform prescribed exercises.”
B. “I will have my child wear soft fabric clothing under the brace.”
C. “I should apply lotion under the brace to prevent skin breakdown.”
D. “I should avoid the use of powder because it will cake under the brace.”

6. The nurse is planning care for an assigned client. The nurse should include information in the plan of care about
prevention of human immunodeficiency virus (HIV) for which individuals specifically at risk?
A. Lesbian persons
B. Men-who-have-sex-with-men (MSM)
C. Women-who-have-sex-with-women (WSW) D. Female-to-male (FTM) transgender persons

7. Which of the following methods should the nurse use to provide the most accurate assessment of an adolescent’s
status regarding obesity?
A. A food intake diary for 1 week.
B. Body mass index.
C. A 4-hour dietary history.
D. Skinfold thickness measurements.

8. When counseling an obese adolescent, the nurse should advise the client that which complication is the most
common?
A. Lifelong obesity.
B. Gastrointestinal problems.
C. Orthopedic problems.
D. Psychosocial problems.

9. When assessing a 17-year-old male client with depression for suicide risk, which of the following questions is best?
A. “What movies about death have you watched lately?”
B. “Can you tell me what you think about suicide?”
C. “Has anyone in your family ever committed suicide?”
D. “Are you thinking about killing yourself?”

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 Care of Mother and Child at Risk or with
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10. Assessment of suicidal risk in children and adolescents requires the nurse to know which of the
following?
A. Children rarely commit suicide unless one of their parents has already committed suicide, especially in the past year.
B. The risk of suicide increases during adolescence, with those who have recently suffered a loss, abuse, or family
discord being most at risk.
C. Children do have a suicidal risk that coincides with some significant event such as a recent gun purchase in the family.
D. Adolescents typically don’t choose suicide unless they live in certain geographical regions.

C. LESSON WRAP-UP

AL Activity: Formative Assessment

Formative assessment (assessment FOR learning) is the collection of information prior to or during instruction, that can be
used by the instructors to make instructional decisions and in-flight adjustments. This can improve student learning,
especially those who are struggling. This activity focuses on the assessment after a lesson. The student must answer the
following questions:
1. What specific part of the Main Lesson for this session do you find the most confusing?
2. What makes your answer in #1 confusing? What is the question in your mind?
3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?

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