COMMON HEALTH PROBLEMS

Adolescence is considered to be a relatively healthy period; however, significant morbidity and mortality do occur. Health promotion is of extreme importance during the adolescent period. There are fewer actual physical health problems during this period, but there is a greater risk for morbidity and mortality from other causes, such as acci­dents, homicide, or suicide.

Several factors contribute to the risk for injury dur­ing adolescence. The adolescent often is unable to recog­nize potentially dangerous situations, possibly because of a discrepancy between physical maturity and cognitive and emotional development. Certain behavioral and de­velopmental characteristics of the adolescent exaggerate this problem. Adolescents typically feel the need to chal­lenge parental or other authority. They also have a strong desire to "fit in" with the peer group. Adolescents exhibit a type of magical thinking and have a need to experiment with potentially dangerous situations or behaviors. They believe that bad things will not happen to them, despite engaging in risky behaviors.

More than 80% of deaths during adolescence are at­tributed to injuries. Leading causes of nonintentional in­juries are automobile accidents (number 1), motorcycle accidents, and drowning (number 2). Other accidental in-

juries include those from falls, striking objects, firearm mishaps (number 3), and sports. Accidental injuries kill more adolescents every year than all other causes of death combined, with males accounting for four of five injury victims. Automobile accidents account for 50% of all deaths of adolescents from ages 16 through 19 years.⁶,³⁴ Drown­ing, which is more common in males than females, de­creases in prevalence after 18 years of age. Most drownings occur on weekends from May through August, are asso­ciated with alcohol use, and occur in fresh water rather than in the ocean. Firearm injuries are the third leading cause of nonintentional mortality in adolescents. Firearm accidents occur much more frequently in males between the ages of 15 and 24 years than in males of any other age.⁶ Many of these accidents occur in the adolescent's home while cleaning or playing with the gun.

Other nonintentional causes of death include poison­ing, skateboard injuries, all-terrain vehicle accidents, and participation in sports. However, most sports injuries are not fatal. Approximately one third to one half of all in­juries occur in school. Falls are the most common cause of injury in high schools, with contusions, abrasions, swell­ing, sprains, strains, and dislocations being the most com­mon injuries.²,²⁶ Cancer is the fourth leading cause of death in adolescents, but it is the leading cause of death from nonviolent sources. There is an increased incidence of certain types of cancer during adolescence, including lymphomas, Hodgkin's disease, and bone and genital tu­mors. Leukemia is the leading cause of cancer mortality in persons between the ages of 15 and 24 years.³⁴

Adolescents also are subject to intentional injuries, such as homicide and suicide. Suicide rates have risen dra­matically for adolescents since the 1950s, to approxi­mately 13 to 14 per 100,000. Most of the increase can be attributed to the greater number of suicides committed by white males. It also is thought that the rate of adolescent suicide may be higher than what is reported because of underreporting on death certificates. Almost 60% of sui­cides involve firearms.³⁴

The increasing prevalence of sexual activity among adolescents has created unique health problems. These in­clude adolescent pregnancy, sexually transmitted diseases, and human immunodeficiency virus (HIV) transmission. Associated problems include substance abuse, such as alco­hol, tobacco, inhalants, and other illicit drugs. Health care providers must not neglect discussing sexual activity with the adolescent. Nonjudgmental, open, factual communi­cation is essential for dealing with an adolescent's sexual practices. Discussion of sexual activity frequently is diffi­cult for the adolescent and the adolescent's family. If a re­lationship exists between the adolescent and the health care provider, this may provide a valuable forum for the adolescent to get accurate information about safe sex, in­cluding contraception and avoidance of high-risk behav­iors for acquiring sexually transmitted diseases or acquired immunodeficiency syndrome (AIDS).³⁴

Substance abuse among adolescents increased rapidly in the 1960s and 1970s but has declined since that time. However, substance abuse still is prevalent in the adoles­cent age group. Health care workers must be knowledgeable

about the symptoms of drug abuse, the consequences of drug abuse, and the appropriate management of adoles­cents with substance abuse problems. Substance abuse among adolescents includes the use of tobacco products, cigarettes, and "smokeless" tobacco (e.g., snuff, chewing to­bacco). Other substances include alcohol, marijuana, stim­ulants, inhalants, cocaine, hallucinogens, tranquilizers, and sedatives. Adolescents are at high risk for succumbing to the peer pressure to participate in substance abuse. They have a strong desire to fit in and be accepted by their peer group. It is difficult for them to "just say no." Magical thinking leads adolescents to believe that they will not get "hooked" or that the bad consequences will not happen to them. Adolescents and the rest of society are constantly bom­barded with the glamorous side of substance use. Television shows, movies, and magazine advertisements are filled with beautiful, healthy, successful, happy, and popular persons who are smoking cigarettes or drinking beer or other alco­holic beverages. Adolescents are trying to achieve the lifestyle depicted in those ads, and it takes tremendous willpower to resist that temptation. It is important that adolescents be provided with "the rest of the story" through education and constant communication.^6,34

Pregnancy has become a major problem of the teen years. Approximately 1 million adolescents in the United States become pregnant annually.² Four of every 10 teen­age females become pregnant before reaching 20 years of age. One fifth of all pregnancies occur within the first month after beginning sexual activity; one half occur within the first 6 months of sexual activity. Of the slightly more than 1 million pregnant adolescents, 47% delivered, 40% had therapeutic abortions, and 13% had spontaneous abortions.⁶

Adolescent pregnancy carries significant risks to the mother and to the fetus or newborn. The topic of adoles­cent pregnancy involves issues related to physical and bi­ologic maturity of the adolescent, growth requirements of the adolescent and fetus, and unique prenatal care re­quirements of the pregnant adolescent. Emotional re­sponses and psychological issues regarding relationships of the adolescent in her family and with the father of the baby, as well as how the pregnancy will affect the adoles­cent's future, must be considered.

In summary, adolescence is a transitional period between childhood and adulthood. It begins with development of sec­ondary sex characteristics (11 to 12 years) and ends with ces­sation of somatic growth (18 to 20 years). This is the period of a major growth spurt, which is more pronounced in males. The endocrine system is of great importance with its numerous hormonal changes and their initiation and continuation of the growth spurt. Psychosocial changes are equally dramatic dur­ing this period and often place tremendous pressure on rela­tionships between adults and the adolescent. Adolescence is a relatively healthy period, but significant morbidity and mor­tality exist as a result of accidents, homicide, and suicide. The increasing prevalence of sexual activity and substance abuse places the adolescent at risk for HIV infection; alcohol, to­bacco, and other drug abuse; and adolescent pregnancy.

The vital signs of a full-term 1-day-old newborn are as follows: temperature, 101.4°F (axillary); pulse, 188 beats/ minute; respirations, 70 breaths/minute; blood pressure, 56/36 mm Hg.

A. What laboratory test or tests should be performed?

B. What information could be obtained from review of
the maternal record that may be helpful in estab­
lishing a differential diagnosis for this infant?

С What other clinical signs should be assessed?

A preterm newborn, approximately 30 weeks' gestation, is admitted to the newborn intensive care unit. The baby exhibits respiratory distress, including tachypnea, retractions, and expiratory grunting.

A. Identify the two most common causes for respira­
tory distress in this baby.

B. Explain the etiology of the two causes identified.

An adolescent male is seen in the health clinic for a rou­tine sports examination. The nurse practitioner notes that the adolescent has a mild to moderate case of facial acne. The nurse practitioner discusses the causes, pre­vention, and treatment of acne with the young man.

A. What physiologic changes contribute to the devel­
opment of acne in adolescents?

B. What other physical changes also occur during
adolescence?

С What are common health problems in adolescents?