Mental health & crisis management 7 APRIL qui z
Perry: Maternal Child Nursing Care in Canada
Chapter 36: The Infant and Family
Case Study 24: Child Abuse
1. Jamie is 6 months old and was brought to the emergency department by her mother. In your assessment of Jamie, you find multiple bruises in different stages of healing and decreased range of motion in the left leg. As the nurse in the emergency department, what should you do? (a) Call the division of family services. (b) Maintain confidentiality of physical data until Jamie's mother signs admission papers. (c) Obtain a thorough patient and family history. (d) Obtain a serum sample for a CBC.
2. Jamie is 6 months old and was brought to the emergency department by her mother. In your assessment of Jamie, you find multiple bruises in different stages of healing and decreased range of motion in the left leg. Jamie has been diagnosed with a fractured femur. During your interview with Jamie's mother on the nature of the fracture, which one of the following statements made by Jamie's mother would cause you to suspect abuse? (a) "Jamie got her leg caught in the crib bars and it twisted." (b) "Jamie hurt herself while crawling." (c) "I can't remember Jamie falling or hurting herself." (d) "Jamie fell out of her car seat because I didn't have it secured properly."
3. Jamie is 6 months old and was brought to the emergency department by her mother. In your assessment of Jamie, you find multiple bruises in different stages of healing and decreased range of motion in the left leg. The criterion that is most important for causing the nurse to suspect child abuse is which one of the following? (a) Appropriate parental concern for the degree of injury. (b) Absence of the parents for questioning about the child's injury. (c) Parental concern about health problems other than the ones associated with the possible abuse. (d) Incompatibility between the history given and the observed injury.
Chapter 36: The Infant and Family
Case Study 25: Infant Growth and Development
1. Elizabeth is a 6-month-old female delivered at 40 weeks of gestation weighing 3400 g. She now weighs 6800 g. You are discussing infant growth and development with Elizabeth's mother. Elizabeth's mother is concerned that her baby is not gaining enough weight. You can assure her and provide anticipatory guidance. Which of the following statements should you make to Elizabeth's mother? (a) Elizabeth is gaining weight well. At 6 months an infant is expected to have doubled her birth weight. At 1 year the weight should triple. (b) Elizabeth is gaining weight well. At 6 months an infant is expected to have tripled her birth weight. At 1 year the weight should quadruple. (c) Elizabeth is gaining weight well. At 6 months an infant is expected to have doubled her birth weight. At 1 year the weight should quadruple. (d) Elizabeth is not gaining weight as expected. At 6 months an infant is expected to have tripled her birth weight. At 1 year the weight should quadruple.
2. Elizabeth's mother says the infant reaches for her food. She asks if it is acceptable to let the baby feed herself. Which is the most appropriate response? (a) Grasping occurs during the first month as a reflex and gradually becomes voluntary. By 4 months, infants can hold their bottle, as well as grasp their feet and pull them to their mouth. (b) Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary. By 6 months, infants can hold their bottle, grasp their feet and pull them to their mouth, and feed themselves a cracker. (c) Grasping occurs during the first 4 to 5 months as a reflex and gradually becomes voluntary. By 7 months, infants can hold their bottle, grasp their feet and pull them to their mouth, and feed themselves a cracker. (d) Grasping occurs during the first 6 to 8 months as a reflex and gradually becomes voluntary. By 9 months, infants can hold their bottle, grasp their feet and pull them to their mouth, and feed themselves a cracker.
3. Elizabeth's mother is aware of the importance of play for children. What games and interactions should you recommend? (a) Encourage the infant to play with push-pull toys. (b) Hang mobiles with black and white designs above the crib. (c) Place an unbreakable mirror where the infant can see herself. (d) Point to body parts and name each one.
Chapter 36: The Infant and Family
Case Study 26: Health Problems of Infants
1. Sara is a formula-fed, 1-month-old infant who weighed 3200 g at birth. She is gaining weight well and appears healthy. Sara's mother looks exhausted and states she is concerned, frustrated, and feels like she is not a good mother. Sara's mother explains that the baby begins to cry early in the evening and continues to cry for hours. The crying started about a week ago. She is worried there is something wrong with the baby; nothing she does seems to help. The nurse recognizes this description of paroxysmal abdominal pain. Which one of the following is the most appropriate response to the mother's concerns? (a) Tell her to ignore the crying for as long as possible before picking the baby up. (b) Provide support to the parent. Stress that despite the crying and obvious pain, the infant is doing well. (c) Encourage the mother to be more responsive to the child in order to prevent the crying episodes. (d) Change the child's formula to a soy-based product.
The correct answer is (b).
Paroxysmal abdominal pain (or colic) is reported in many infants, and despite the stress it causes for parents, results in no long-term health problems for the child. Discuss possible treatments for soothing Sara with her mother, including reviewing her formula type, placing the infant on a hot water bottle, and so on.
2. Sara's mother has heard about a condition called sudden infant death syndrome (SIDS) and asks the nurse how she can protect her baby. The nurse should recommend one of the following: (a) Place Sara to sleep on her back. (b) Place Sara to sleep on her stomach. (c) Recommend the use of a home monitor to assess for apneic episodes. (d) Place Sara to sleep on her side, with soft pillows for support.
The correct answer is (a).
Many studies have linked sleep position with an increased risk of SIDS. For this reason, it is recommended that parents put their baby to sleep on its back. Do not put anything soft, loose, or fluffy in the baby's sleep space (this includes pillows, blankets, comforters, stuffed animals, and other soft items), as these may increase the baby's risk for suffocation.
Key Points
· Biological development of the child encompasses proportional changes; sensory changes, including binocularity, depth perception, and visual preference; maturation of biological systems; fine motor development; and gross motor development.
· Erikson’s theory of psychosocial development (birth to 1 year) is concerned with acquiring a sense of trust while overcoming a sense of mistrust.
· Piaget’s theory of cognitive development, as it applies to the infant, focuses on the sensorimotor phase, which includes the use of reflexes, primary circular reactions, secondary circular reactions, and coordination of secondary schemata and their application to new situations.
· Development of body image begins in infancy; by 1 year of age, infants recognize that they are distinct from their parents.
· Social development of the infant is guided by attachment, language development, personal-social behaviour, and participation in play.
· Temperament influences the type of interaction that occurs between the child and parents and siblings.
· Parents are faced with many concerns, including selecting an appropriate day care, limit-setting and discipline, thumb-sucking and pacifier use, teething, and choice of infant shoes.
· Breast milk provides optimal nutrition for the infant during the first six months; gradual introduction of solid food occurs during the second six months. Commercial iron-fortified infant formula is a safe alternative to human milk. Whole milk is not recommended until after 1 year of age.
· Common sleep problems that develop during infancy—and that are easily prevented—are associated with night crying and feeding. Nurses should instruct the parents, after careful assessment, in strategies to deal with the specific problem.
· Cleaning the teeth regularly in early childhood and appropriate dietary intake promote good dental health.
· Recommended routine immunizations include those for hepatitis B virus, hepatitis A virus, diphtheria, influenza, tetanus, pertussis, polio, measles, mumps, rubella, pneumococcus, meningococcus, chickenpox, and haemophilus influenzae type B.
· Recommended immunizations for selected groups of children are rotavirus and human papillomavirus vaccines.
· Because injuries are a major cause of death during infancy, parents should be alerted to the possibility of aspiration of foreign objects, suffocation, falls, poisoning, burns, motor vehicle injuries, and bodily damage, as well as preventive actions needed to make the environment safe for infants.
· Treatment of colic may involve change in feeding practices, correction of a stressful environment, behaviour modification, and support of the parent.
· Growth failure, or failure to thrive (FTT), may occur in children who have a chronic illness, or it may occur in a family environment in which healthy-infant feeding practices are poorly managed or understood. FTT is not always associated with a pattern of a disturbed maternal–infant relationship.
· Factors that place the infant at high risk for sudden infant death syndrome (SIDS) include prone sleeping position, soft bedding, sleeping in a noninfant bed with an adult or older child, and maternal prenatal smoking.
· Positional plagiocephaly can be easily prevented by allowing the awake infant to have periods of tummy time and by alternating the infant’s head position during sleep.
· The primary nursing responsibility in care associated with sudden infant death is educating the newborn’s family about the risks for SIDS; modelling appropriate behaviours in the hospital, such as placing the infant in a supine sleep position; and providing emotional support of the family that has experienced a SIDS loss.
· Infants with apparently life-threatening events are carefully evaluated for clues to the underlying cause.
· Home apnea or cardiorespiratory monitors do not prevent SIDS.
Questions on Toilet Training
1. Matt is a healthy 2 1/2-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training. Which one of the following should the nurse do first? (a) Ask Matt if he wants to learn to use the toilet. (b) Discuss the signs that indicate Matt is ready to begin toilet training. (c) Encourage Matt's mother to initiate toilet training after the birth of the new baby. (d) Assess the mother to determine why she has waited so long to begin toilet training.
1. The correct answer is (b).
(a) "Negativism," the persistent negative response to requests, is a characteristic of toddlers in their quest for autonomy. Asking a toddler a "yes or no" question will often result in a "no" response. Therefore, asking Matt if he wants to learn to use the toilet is not the most accurate way to assess his readiness.
(b) Both physical ability and complex psychophysiological factors are required for toilet training readiness. One of the most important responsibilities of nurses is to help parents identify the readiness signs in their child. According to the Canadian Paediatric Society, 5 markers signal a child's readiness to toilet train: motor, language, social milestones, demeanour, and relationship with the parents. According to some experts, physiological and psychological readiness is not complete until age 22 to 30 months.
(c) The addition of a new baby to the family often involves changes that are resented by the toddler. The first few weeks at home with a newborn and toddler can be challenging enough for the parents and should not be complicated with the task of toilet training.
(d) This is a normal time to consider toilet training. The mother is requesting advice on toilet training at an appropriate age for her toddler.
2. Matt's mother tells the nurse that she can't afford to buy a potty chair. She explains that they are saving money because they will soon have the added expense of another child. What is the most appropriate response for the nurse to make? (a) Suggest ways to toilet train Matt without a potty chair. (b) Refer the family to social services for financial assistance. (c) Recommend postponing toilet training until they can afford a potty chair. (d) Have Matt sit on a regular toilet to assess whether his feet will touch the floor.
2. The correct answer is (a).
If a potty chair is not available, many other methods can be used to assist the child in toilet training. Having the child sit facing the toilet tank, or placing a small bench under the child's feet can provide added support when his feet do not touch the floor.
3. Matt is brought to the clinic 4 1/2 months later because he has an ear infection. The nurse asks about his toilet training. His mother says, "He has done real well, except since the baby came he has wanted to wear diapers instead of underpants. I have been letting him wear diapers. He takes them on and off to use the toilet. I hope that is okay." What is the most appropriate response from the nurse? (a) Assess why the mother decided to let Matt wear diapers. (b) Recommend that the mother put Matt back into underpants immediately. (c) Reassure the mother that regression such as this is common in toddlers after the birth of a sibling. (d) Explain to the mother that negativism like this is common in toddlers who are toilet trained before they are ready.
3. The correct answer is (c).
(a) Sibling rivalry may cause a toddler to revert to more infantile forms of behaviour. The mother is demonstrating an understanding of this response in her toddler, and allowing him to express his feelings. The nurse should support the mother's actions rather than assessing further.
(b) The toddler's regression is a common sign of his feelings and will pass as he learns to accept the changes in his lifestyle. This expression should not be suppressed by making the child wear his underpants.
(c) Reassure the parent that the period of regression will pass when the toddler learns to accept the changes in his lifestyle.
(d) The regression demonstrated by the toddler is a common form of communicating angry feelings following the addition of a newborn to the family. This should not be interpreted as a lack of toilet training readiness.
· The toddler stage, extending from 12 to 36 months, is a period of intense exploration of the environment.
· Biological development during the toddler years is characterized by the acquisition of fine and gross motor skills that allow children to master a wide range of activities.
· Although most of the physiological systems are mature by the end of toddlerhood, development of certain areas of the brain is still occurring, allowing for greater intellectual capacity.
· Locomotion is the major gross motor skill acquired during toddlerhood, followed by increased eye–hand coordination.
· Specific tasks in the psychosocial development of a toddler include differentiating self from others, tolerating separation from parent, coping with delayed gratification, controlling bodily functions, acquiring socially acceptable behaviour, communicating verbally, and interacting with others in a less egocentric manner.
· According to Erikson, the major developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame.
· In Piaget’s sensorimotor and preconceptual phases of development, the toddler experiments by incorporating the old learning of secondary circular reactions with new skills and applies this knowledge to new situations. There is the beginning of rational judgement, an understanding of causal relationships, and discovery of objects as objects.
· Preconceptual thought is characterized by egocentrism, centration, global organization of thought processes, animism, and irreversibility.
· Language is the major cognitive achievement in toddlerhood.
· The most striking characteristic of language development during early childhood is the increasing level of comprehension.
· Development of body image occurs with increasing motor ability, at which point toddlers recognize the importance and capacity of body parts.
· The two phases of differentiation of self from significant others are separation and individuation.
· Parental concerns during the toddler years include toilet training; coping with sibling rivalry; limit-setting and discipline; and dealing with temper tantrums, negativism, and regression.
· Effective discipline techniques for toddlers include reward, ignoring, and time-out.
· Nutrition is important during the toddler stage because eating habits established in this period have lasting effects in subsequent years.
· Regular dental examinations, fluoride supplementation, removal of plaque, and provision of a low-sucrose diet promote optimum dental health.
· Because of increased locomotion, toddlers are at high risk for sustaining injuries. Fatal injuries are primarily a result of motor vehicle accidents, drowning, and burns.
Answers to Questions
Amanda is a healthy 4-year-old child who presents for her yearly well child visit. Amanda's mother is concerned because the toddler has trouble going to sleep.
1. What is an appropriate reply for the nurse to initially make regarding Amanda's mother's concern? (a) Some children have trouble going to sleep. (b) Bring the child into your bed to make it easier for her. (c) Allow the child to stay awake beyond her usual bedtime. (d) Try eliminating naps so she is more tired at bedtime.
Sleep disturbances are common during the preschool years, and may be due to a variety of factors. Recommendations for handling sleep disturbances should be offered only after a thorough assessment of the problem.
2. Her mother continues to explain that about 1 to 4 hours after Amanda is asleep, she hears Amanda screaming and thrashing in her bed, but the toddler does not wake up. What does this behaviour best describe? (a) Nightmares (b) Sleep terrors (c) Restlessness (d) Convulsions
Sleep terrors usually happen during non-REM sleep, about 2-3 hours after the child initially falls asleep when sleep transitions from the deepest stage of non-REM sleep to lighter REM sleep, a stage where dreams occur.
3. The appropriate intervention for this sleep disturbance is which one of the following? (a) Sit with the child and offer comfort and protection. (b) Observe the child without interfering and provide safety. (c) Bring the child into your bed. (d) Try to wake the child.
The best way to handle a sleep terror is to wait it out patiently and ensure that the child doesn't get hurt while he or she is moving around. Most children experiencing sleep terrors will settle down and return to sleep on their own in a few minutes. It's best not to try to wake a child during a sleep terror, because these attempts often don't work, or if they do, can cause confusion and disorientation for the child, and may make it more difficult to settle the child down and go back to sleep.
Answers
1. What is an effect of childhood abuse?
a) Anxiety
b) Low self esteem
c) Difficulty trusting people
d) Depression
e) All the above
2. The most common type of childhood abuse is:
a) Physical
b) Neglect
c) Psychological
d) Sexual
e) They are all about equal
3. What is psychological (emotional) abuse?
a) A child looking for support from his or her parents
b) Any behaviour inflicted that could cause bodily harm
c) Any behaviour inflicted for the sexual gratification of the offender.
d) Any behaviour inflicted on a child that causes mental or emotional anguish or deficits
4. In which of the following cases would you suspect Munchhausen by proxy?
a) Child is repeatedly brought in for medical care for alleged problems that cannot be documented
b) Sudden infant death syndrome
c) There are other explanations for the child's symptoms.
d) The parent fails to try to resuscitate child and blames this behavior on shock.
5. Risk factors of neglectful parents include all of the following EXCEPT
a) Poverty
b) Substance abuse
c) Prior referrals
d) Caregiver absence
6. Child neglect has a specific definition so it can be easily identified, intervened upon, and when necessary, prosecuted?
a) True
b) False
7. Which is known as the most basic and destructive element of all forms of child abuse?
a) Physical abuse
b) Psychological maltreatment
c) Sexual abuse
d) Neglect
Chapter 37: The Preschooler and Family
Key Points
· The preschool years consist of the period from 3 to 5 years of age, a time considered critical for emotional and psychological development.
· Biological development in the preschool period is characterized by mature body systems and refinement in gross and fine motor behaviour, as evidenced by activities such as running, riding a tricycle, and drawing.
· According to Erikson, acquiring a sense of initiative is the chief psychosocial task of the preschooler. Development of the superego occurs during this period, as conscience begins to emerge.
· According to Piaget, the preschool age is characterized by intuitive (or prelogical) thinking and a move toward logical thought processes through advanced, complex learning; language; and understanding of causality.
· The seeds of moral development are planted during the preschool period. According to Kohlberg, these children are in the stage of naive instrumental orientation, in which they are concerned with satisfying their own needs and, less frequently, the needs of others.
· Social development includes further separation–individuation; more sophisticated language; greater independence; and more complex, imaginative forms of play.
· Areas of special concern to parents during the preschool period are the preschool and kindergarten experience, sex education, fears, stress, and speech problems.
· In selecting an early learning program, parents should inquire about daily activities, teacher qualifications, accreditation, student–staff ratio, safety, meals, fees, and health practices.
· Two rules that govern how parents answer questions about sex and other sensitive issues are to find out what the children know and to be honest.
· Fears constitute a great part of the preschool period; fear of objects or potential annihilation and parent-induced fears are common.
· Preschool aggression may result from frustration, modeling behaviour, and reinforcement.
· Hesitancy or dysfluency in speech patterns is a normal characteristic of language development. Speech problems can occur when parents express excessive concern over this pattern.
· Health promotion continues to be directed toward proper nutrition, adequate sleep, proper dental care, and injury prevention.
· Child maltreatment may take the form of physical abuse or neglect, emotional abuse or neglect, or sexual abuse.
· Parental, child, and environmental characteristics are criteria that may predispose children to maltreatment.
· Identification of abuse entails securing evidence of maltreatment, taking a history pertaining to the incident, and assessing parental and child behaviours.
· The reported incidence of sexual abuse has increased in the past decade; common forms are incest, molestation, rape, exhibitionism, child pornography, child prostitution, and pedophilia.
Questions & Answers on School Age Injury Prevention
1. Patrick is an active 7-year-old who lives with his parents and 2 younger siblings in a house in the suburbs of a small city. He enjoys being outside and riding his bike.
What is the most common cause of severe injury and death in the school-age child? (a) Burns (b) Drowning (c) Motor vehicle accidents (d) Cancer
See your textbook for recommendations on how to help reduce the incidence of these injuries in the school-age child.
2. What is the most effective way to support accident prevention? (a) Purchase new equipment. (b) Supervise all activities. (c) Educate the child and family. (d) Hang posters in the school.
The most effective means of injury prevention is education of the child and family about the hazards of risk taking and the improper use of equipment.
3. Patrick always asks his mother why he can't ride in the front seat of the car beside her. At what age can a child be allowed to ride in the front passenger seat of cars with airbags? (a) 11 years (b) 12 years (c) 5 years (d) 16 years
The Canadian Pediatric Society's (2008) position statement on motor vehicle safety advises that the rear vehicle seat is the safest place for children under the age of 13 years. Children should use specially designed care restraints until they are 145 cm in height or are 8 to 12 years old, and they should not sit in the front seat until they are 12 years of age.
Questions and Answers on Interviewing Adolescents
A father brings his 15-year-old son, John, to the clinic for his sports physical examination. This is the first time you have met the family. According to his chart, John has not had a health assessment in 4 years. There have been a lot of changes in the household. The father reports that he is now the primary care provider since he lost his job over 1 year ago. The mother lives with the family, but works long hours and is unavailable for child care issues.
John seems nervous to answer questions when his father is present. When performing a health history on an adolescent what is the best action for you to take?
John should be offered the opportunity to have the history and assessment done in privacy without the presence of his father. Frequently adolescents are more willing to discuss their concerns with an adult outside the family, and they often welcome the opportunity to interact with a nurse. Confidentiality is of great importance and an adolescent's disclosures do not have to be shared unless they indicate a need for intervention.
During the family assessment interview, John states that the changes at home have not affected him. However, with his father out of the room, John reports that his father has taken control of his life. He is not allowed to spend time with his peers outside of sports activities; he feels his father is very controlling. Which of the following is not helpful in assessing the family function?
A. Observation of the father's and John's responses toward each other.
B. Assessment of the role John has in decision making.
C. Examination of only John's specific concerns and reactions.
D. Evaluation of family communication patterns.
Assessment of family function is concerned with how the family members behave toward one another and with the quality of the relationships. Assessment includes observation of all family members' responses to each other; inquiry into individual member's control over others in the family; clarity of boundaries of power between parents and children; assessment of communication patterns; and acknowledgment of expression of feelings and individuality.
Questions on Teen Smoking
Danielle is a 17-year-old female in Grade 12. She and her friends started smoking 2 years ago, at age 15. Danielle is aware of the risks associated with smoking, but she and her friends think it is cool to smoke, and "besides, everybody is doing it."
Which of the following is the most appropriate nursing intervention to discourage teen smoking? (a) Ignore the issue because teens never listen to adults. (b) Lecture on the effects of smoking on growth and development. (c) Promote programs that include peers, parents, mass media, and community organizations. (d) Provide models of smoke-filled lungs to the schools.
Identify the most common reason that teenagers start smoking. (a) Peer pressure (b) Relaxation (c) Curiosity (d) Family history
Chapter 38: The School-Age Child and Family
Key Points
· Middle childhood, also known as the school years, is the period of life that extends from 6 to 12 years of age.
· Although growth is slower than in previous years, there is a steady gain in height and weight, with maturation of body systems; primary teeth are lost and replaced by permanent teeth.
· A major task during the middle school years is developing a sense of industry or accomplishment (Erikson).
· Piaget’s period of concrete operations refers to the school-age period, when children are able to use their thought processes to experience events and actions, and to make judgements based on reasoning.
· The child develops a conscience and is able to understand and adhere to rules and standards set by others.
· Entertaining different points of view, becoming sensitive to cultural norms, and forming peer friendships are important features of social development during the school years.
· Co-operative play, team activities, and the acquisition of skills are prime elements of play during the school years; rules and rituals assume greater importance.
· Parental concerns during middle childhood include lying, cheating, stealing, bullying, and school achievement.
· The availability of junk foods, irregular family meals, and schedules of working parents often interfere with optimal nutrition and may lead to obesity.
· Activities involving physical movement should be encouraged; sedentary activities, such as watching television or playing video games for long periods of time, are contributing to health problems in this age group.
· Dental care is important during this time; potential dental problems include caries, periodontal disease, malocclusion, and dental injury.
· Increased socialization and media exposure make the school years an ideal time for sex education.
· Ideally, school health programs include health appraisal, emergency care, safety education, lifestyle support, recommended immunizations, communicable-disease control, counselling, guidance, and health education with adjustment to individual student needs.
· Injury prevention is directed toward safety education, provision of safe play areas and equipment, and supervision of sports activities.
· Alterations in growth and maturation may be manifested as short or tall stature, or delayed sexual development.
· Behaviour problems in middle childhood can result from attention deficit hyperactivity disorder, enuresis, school phobia, recurrent abdominal pain, childhood depression, conversion reaction, and childhood schizophrenia.
· Eating disorders are being seen in younger children; an index of suspicion is important to diagnosis.
· Education related to appropriate uses of social media is important.
Perry: Maternal Child Nursing Care in Canada
Chapter 39: The Adolescent and Family
Key Points
· The pubescent growth spurt that begins around age 10 in girls and age 12 in boys signals the beginning of adolescence.
· Biological development during puberty is characterized by increased activity of the pituitary gland, which results in sexual maturity and the appearance of secondary sex characteristics.
· Development of body image is closely tied to body changes and social interactions.
· According to Erikson, the major developmental crisis of adolescence is establishing a sense of identity.
· Cognitive development in adolescence includes abstract thought, thinking beyond the present, logical reasoning, and a sense of idealism.
· According to Kohlberg’s theory of moral development, adolescents begin to question existing moral values and learn to make their own choices.
· Spiritual development is characterized by the questioning of one’s family’s values and ideals and a move toward more philosophical thinking.
· Adolescent relationships with parents may be strained; the influence of the peer group increases, and intimate relationships assume importance.
· Teenagers demonstrate a wide variety of interests, and their increased physical and cognitive skills allow them to engage in increasingly difficult and complex activities.
· Adolescents’ emotions fluctuate.
· Nutritional needs may not be met by teenagers’ eating habits, such as snacking and irregular mealtimes.
· Motor vehicle injuries are the primary cause of death from injury in the adolescent years.
· The rapid changes, growth, and stress accompanying the transition to adulthood may predispose adolescents to faulty problem solving.
· The most common health problems related to the female reproductive system during adolescence involve menstrual dysfunction.
· Eating disorders observed in middle and late childhood are obesity, anorexia nervosa, and bulemia nervosa.
· Tobacco smoking is a widespread problem among teenagers.
· Reasons for smoking include social pressure and mass-media influence.
· The substances used by children and adolescents are alcohol, marijuana, narcotics, central nervous system depressants, central nervous system stimulants, hydrocarbons and fluorocarbons, and mind-altering drugs.
· Suicide, the deliberate act of self-injury with the intent to kill, may occur because of difficulties coping with stress, disturbed family environment, substance use or dependency, or mental health disorder.
· No threat of suicide by an adolescent should be ignored or challenged.