Family health – week 1 discussion 2nd reply

Jessica Alper

Components of an annual exam for an adolescent patient

Having an adolescent as a patient may be difficult, as generally, the adolescent is not the one to initiate or agree to have the consultation. While that is true, “delineating signs and symptoms through detailed clinical history and examination help ascertain key areas of concern and presence or absence of a mental health disorder” (Srinath et al., 2019). Because communicating with a teenager may be challenging, a therapeutic alliance between the two parties is crucial. If good rapport is built, facts become more meaningful and become more useful, which will then lead to shared intervention goals. 

Srinath et al. (2019) state that there are five goals in the evaluation of clinical history and examination. The first one is to evaluate the developmental trajectories and attainments of the patient, to present behavioral and emotional problems, to assess the current functioning in different settings, to evaluate the strengths of the adolescent and the family, and to reach the highest level of functioning before the onset of current concerns. These goals are achieved by obtaining a detailed medical history along with a physical examination. Laboratory investigations may be needed in complement to the history and physical examination. Additionally, “a history of similar or other behavioral concerns and history of medical issues must be asked for” (Srinath et al., 2019). Developmental history across different domains may help determine the source of the behavioral concerns along with the pharmacological and psychotherapeutic management. The developmental profile includes information about the age of acquisition of milestones, as well as the current developmental level. Temperamental history should also be assessed as well as schooling history. The child’s interests, skills and talents must also be assessed to get an accurate understanding of the child. 

It is vital for the practitioner to assess the behaviors of the teenagers, as substance abuse use, high-risk sexual behaviors and risky driving may lead to poor health outcomes and high mortality rate. Bright Futures, as part of the American Academy of Pediatrics, has set guidelines on what type of preventative care to perform depending on each age group. For this 14-year-old patient, personal history, all measurements including a blood pressure and BMI should be obtained, and vision and hearing should be examined. As previously stated, developmental surveillance, behavioral/social/emotional screening, tobacco/alcohol/drug assessment, depression and suicide risk screening should be assessed. Immunizations should be kept up-to-date, and anticipatory guidance should be provided. Laboratory findings should be obtained to screen for anemia, tuberculosis, dyslipidemia, sexually transmitted diseases, and HIV as well as fluoride supplementation (Recommendations for Preventive,