LA DISCUSSION

You are a Family Nurse Practitioner working in a community health center. You

are seeing a 14-year-old adolescent patent for an annual visit. The patient’s

mother is also present during the visit and notes that the patient’s grades in

school have been declining. Her son is also hanging out with a group of kids that

she has concerns about. The mother has concerns for what is going on with her

son. Answer the following questions using course resources (texts) and two other

evidence-based sources (current guidelines and/or scholarly articles that are

within a 3-5 year time frame).

What are the components of an annual exam for an adolescent patient?

The adolescent is the time frame noted prior to transitioning into adulthood.

Monitoring baseline medical history from patient and family, social history, drug

alcohol use and discussions regarding sexual activity will begin as in adult

assessments. (Burns, Dunn, Brady, Starr & Blosser, 2016). HEEADSSS

assessment should be performed here at this time. Head to toe exam should

occur with the questions being directed towards the patient as well as the

responses. (Graff, Szczerbik, Kalinowska, Jaworski & Syczewska, 2020). At this

time discussion regarding sexual patterns, testing if sexually active and

immunizations should take place as well. Discussions regarding mental health,

coping skills, safety issues and concerns, driving, seatbelts, illegal substances

and tobacco usage should be addressed.

Is the mother required to be present during your exam?

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No. The areas I have been participating in clinical at ask the child over 12 years

of age if they want the parent to be present during the exam. I was told this week

that Children’s Hospital discusses this with the child, makes them sign a form and

establish an emergency contact. The internal medicine office will ask the child at

the visit if they would like to be alone or with a parent. This week we had a 14

year old who requested to be examined without his mother but asked that his

mother returned once the exam portion was over.

Describe 1 health promotion idea that you would discuss with your middle

adolescence patient. Why is this idea important?

One health promotion discussion would be high risk behaviors such as drugs,

alcohol, tobacco, sexual activity and mental health concerns. Beginning the

discussion early allows the adolescent to feel a little more comfortable in

admitting or discussing these hard topics. The article suggested that the more

these topics were discussed, the more the adolescents opened up to the

practitioner. The goal was to provide preventative measures, discuss concerns

about what could happen, discuss treatment options and open the forum for

further discussions as questions arise. (Dalstrom, Parizek & Doughty, 2020).

What are some screening tools that might be of importance in this

situation? (hint: do you suspect drug or alcohol abuse here?)

The CRAFFT is a tool that is used in the office that I have been working at for clinical

hours. This tool asks the adolescents about alcohol and drug usage and discusses this

in depth. It asks the patient if they use when they are alone or only with their friends, do

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they use to relax, while driving or in a car. Have they ever been in trouble or has anyone

that they care about mentioned that they should cut down the usage of whatever

substance they are using. (CRAFFT, 2017). Depression screening can assist with

finding out if the adolescent is experiencing difficult times and cannot verbalize this to

an adult. At times depression causes the adolescent to seek substances to allow them

not feel sad. Screening will allow the signs and symptoms to be discussed and allow the

practitioner to discuss measures to assist with their feelings. (Callahan, Gordon, Rickert,

Katzman, Neinstein et.al, 2016).

Graff, K., Szczerbik, E., Kalinowska, M., Jaworski, M., & Syczewska, M. (2020). Balance

assessment in healthy children and adolescents aged 6-18 years based on six

tests collected on AMTI AccuSway force platform. Acta of Bioengineering and

Biomechanics, 22(2), 121–130.

Dalstrom, M., Parizek, R., & Doughty, A. (2020). Nurse Practitioners and Adolescents:

Productive Discussions About High-Risk Behaviors. The Journal for Nurse

Practitioners, 16(2), 143–145. https://doi-

org.su.idm.oclc.org/10.1016/j.nurpra.2019.11.021

Callahan, T., Gordon, C., Rickert, V., Katzman, D., Neinstein, L., & Joffe, A.

(2016). Neinstein’s Adolescent and Young Adult Health Care (6th ed.).

Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN:

9781451190083.

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Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C. (2016). Pediatric Primary

Care (6th ed.). St. Louis, MO: Elsevier. ISBN: 9780323243384.

CRAFFT. (2017). CRAFFT Screening Tool for Adolescent Substance Abuse.

Retrieved from https://med.dartmouth-hitchcock.org/documents/CRAFFT-

adolescent-substance-use-screen.pdf

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