ADOLESCENCE - PC
SMR 2-3
SMR where you will see female anatomy attain peak height velocity
Male anatomy - will typically later in SMR 3-4
Screen for preexisting conditions that may be life-threatening and to screen for conditions that may increase risk for injury
What are the primary goals for PPE
HPV, Meningitis A,C,W,Y and Tdap
What are vaccines that an 11-12 year old is eligible for - so have the discussion
Family history of premature death, heart disease in younger relatives, HOCM, Long QT, Marfans, Personal history of a murmur, hypertension, excess fatigue, syncope, chest pain or worsening SOB with exertion
What are the screening questions you MUST ask on PPE as part of the cardiac screening for clearance
Universal -
1. Start at age 12 years old
2. Once between 9-11 years old
What are Universal Screening for Early to Middle Adolescents
1. Depression screener - starting at age 12 y
can be the PHQ-9
2. Lipid profile (once between 9-11 years of age)
Carditis and / or a fever
What are automatic DISQUALIFIERS for sports clearance
Reschedule or work-up this patient - they need to be followed and can be cleared once resolved (if an isolated febrile illness)
Remember: concern for a cardiac issue or a fever - do not clear at this visit
The reason for body odor and faint genital hair
What is adrenal production of DHEAS
Headache that gets worse and doesn't go away, Weakness, numbness, poor coordination, Unequal pupils, seizures, persistent vomiting, Changes in mental status, worsening confusion, irritability, Loss of consciousness
What are signs of a Concussion
Concussion - Is a type of mild traumatic brain injury
Evaluate and follow the Return to Play protocol
social determinants of health, strengths and protective factors, risk reduction, growth and development, mental health, safety
What are priorities for the Adolescent well visit-
Remember your HEEADSSS assessment and to discuss the Anticipatory Guidance for age at each wcc
Structural or acquired cardiac disease
Infectious diarrhea
Infectious Conjunctivitis
What are the conditions/reasons for a qualified NO on a PPE
One of the earliest neuroendocrine changes associated with onset of puberty
Maturation of gonadotropin-releasing hormone
Remember: Under influence of GRH, the pituitary secretes LH and FSH initially in a pulsatile fashion during sleep. LH and FHS stimulate increases in gonadal androgens and estrogens
2. Light aerobic exercise
3. Sport-specific exercise
4. Non-contact training drills
5. Full contact practice
What are the steps for Graduated Return to Play protocol that should be followed as the PNP-PC guides the patient back to their normal activity level
This includes the
A. Rehabilitation stage
B. Functional Exercise at each stage of rehab
C. Objective of each stage
A great resource for you as the PNP-PC and patients and families