Pediatric Primary Care (37 page)

5.  Are there behavior problems? How have those been addressed?

6.  What is educational/vocational plan?

7.  Has teen dropped out of school?

8.  Is he/she planning to get a GED?

9.  If chronic illness, is there teaching plan in place for missed days?

C.   Peers.

1.  Who are teen's friends?

2.  Is there a best friend?

3.  Is there a trusted adult to talk to?

4.  Does teen prefer to be with friends or alone?

5.  What are interests and activities of peer group?

6.  Does parent know teen's friends?

D.  Interests.

1.  What are teen's activities? Hobbies?

2.  Does teen have a job? How many hours? Safety hazards on job?

3.  Does teen like to read?

4.  Does teen enjoy sports? Exercise?

E.   Dating.

1.  What are house rules about dating?

2.  What advice have parents given about dating?

3.  Is teen thinking about dating?

4.  Does he/she have romantic feelings about anyone?

a.  Is this person male or female?

b.  If these feelings are for same-sex person, does teen feel support from parents? Friends? Community?

F.   Sexual history.

1.  Is teen thinking about sexual relationship or has he/she had sexual relations?

2.  Able to talk with parent about being sexually active?

3.  Aware of risks of sexual activity (emotional, sexually transmitted infections [STIs], pregnancy)?

4.  Vulnerable to these risks?

5.  Reason for being sexually active? Does teen feel pressured?

6.  Specific sexual behaviors (vaginal/anal intercourse or oral-genital sex)?

7.  Teen's age at first intercourse?

8.  Number of lifetime partners?

9.  How old is current partner? Is there more than one partner now?

10.  Are condoms used? Hormonal contraception? Spermacides?

11.  Does teen know how to use male/female condom?

12.  Does teen know about emergency contraception (EC)? Does teen who only uses condoms have prescription for EC?

13.  Any history of or current symptoms of STIs?

14.  Any history of pregnancy? Pregnancy scares? LMP?

15.  History of pregnancy termination? If so, how is teen coping?

16.  For teen parents, what are stresses? Support?

17.  Does teen feel safe in current relationship?

18.  In dating situations, has teen been hit or pushed? What did she/he do?

G.   Substance use.

1.  Does teen know risks of substance use?

2.  Do any friends smoke cigarettes, drink alcohol, use inhalants, marijuana, other drugs?

3.  Does teen smoke cigarettes, drink alcohol, use inhalants, marijuana, other drugs?

4.  If teen does use substances, use screen such as CAGE (Cut down, Annoyed, Guilty, Eye-opener) to obtain more information (have resource available to teen who needs substance abuse treatment):

C.   Do you think you should cut down your use of ____?

A.   Do you get angry or annoyed when people tell you that you should cut down your use of ____?

G.   Do you feel guilty about your use of ____?

E.   Do you use this substance as eye-opener to get going in morning?

5.  Does teen drink alcohol or use other drugs when driving?

6.  Does teen attend parties where alcohol is served?

7.  What plans are there to get home safely? Does teen have to deal with parents for this type of situation?

H.   Antisocial behavior.

1.  Does teen skip school?

2.  Has he/she had trouble with the law?

3.  Does teen belong to or associate with a gang?

VII. IMMUNIZATIONS (SEE
APPENDIX A
)

A.   May not have completed recommended vaccinations.

B.   Immunization status can be reviewed at each visit.

1.  TD: booster usually given between 11 and 12 years but before 16 years, then every 10 years.

2.  MMR: 2 doses needed before school entry.

3.  Hepatitis B: recommended for all adolescents, especially those at risk (sexually active, injection drug abusers, work-related exposure to blood/ body fluids). Routine vaccination of infants began in 1991; may be in need of immunization. Two-dose regimen for 11- to 15-year-olds; 3-dose regimen for others.

4.  Varicella: needed if there is no history of varicella disease. If history is unclear, vaccine is well tolerated, more cost effective than serologic testing in most cases. Two doses given more than 4 weeks apart needed if 13 years of age or older.

5.  Influenza: recommended for teens with chronic illness (i.e., asthma, sickle cell disease, HIV, etc.) or those living with persons with impaired immunity. Can be given to others who want immunity. Cannot be given to individuals with egg allergy.

6.  Hepatitis A: vaccination recommended for those living in high-risk areas; 2 doses needed, at least 6 months apart.

7.  
Neisseria meningitidis:
vaccination recommended in many states for college freshmen living in dormitories.

VIII. SAFETY

A.   Self-protection.

1.  Does teen have any self-defense skills?

2.  Is teen aware of surroundings when in public?

3.  Does teen travel with friends?

4.  Has teen been victim of any attack in past? Any fear of someone threatening harm currently? Are parents/authorities aware?

5.  Does teen feel safe in school?

6.  Can teen walk away from conflict if she/he feels fear/anger?

7.  Does teen get into fights regularly?

8.  Is teen exposed to violence in home, community, media?

9.  Does teen have access to gun? What are rules for gun safety?

10.  Does teen carry a weapon? Why?

B.   Injury prevention.

1.  Does teen wear seat belts?

2.  Does teen wear a helmet?

3.  Does teen plan to take driver's education classes?

4.  Does teen drive at night or with friends?

5.  Does teen use alcohol/other drugs?

6.  Does teen routinely take risks?

7.  Has teen had injuries in past?

8.  Does teen use power tools/lawn equipment?

C.   Suicide prevention.

1.  Does teen or family worry about teen being depressed?

2.  Has teen lost pleasure in usual interests?

3.  Weight loss or gain?

4.  Sleep problem: too much or too little?

5.  Increased/decreased activity level?

6.  Daily fatigue?

7.  Feelings of worthlessness, excessive/inappropriate guilt?

8.  Decreased concentration or ability to make decisions?

9.  Asking teen about mood can be done at every visit and is especially important if teen visits frequently or if physical complaints do not seem to make sense.

10.  Recurrent thoughts of death or suicide? (If teen is suicidal, have resources, such as ability to escort to emergency department for psychiatric evaluation, immediately available.)

IX. ANTICIPATORY GUIDANCE

A.   Many opportunities to give advice exist during history and physical exam.

B.   Giving information in nonjudgmental way allows teen to make up his/her own mind about how to improve his/her health.

C.   Puberty: Acknowledge where individual is regarding pubertal development and how development is likely to proceed.

D.   Health care.

1.  Have yearly physical exam.

2.  See dentist twice/year, practice good dental hygiene.