Pediatric – week 10 discussion

Internal Medicine 14: 18-year-old female for pre-college
physical
User: Elizabeth Hernandez
Email: e[email protected]
Date: May 18, 2021 2:17AM

Learning Objectives

The student should be able to:

Describe and recall the HEEADSS mnemonic approach to adolescent counseling.
Obtain a history that differentiates among etiologies of dysuria.
Differentiate /distinguish signs and symptoms of lower versus upper urinary tract infection.
Recognize /recommend when to order diagnostic and laboratory tests in evaluation of dysuria, including urinalysis, wet prep,
and KOH stain.
Describe current recommendations for cervical cancer screening.
Discuss safe sexual practices and efficacy of common methods of contraception.

Knowledge

HEEADSSS Approach to Adolescent Counseling

The HEEADSSS approach to adolescent counseling addresses the main categories of Home/health, Education/employment, Eating
disorders, Activities, Drugs, Sexuality, Safety/violence, and Suicide/depression. View examples of screening questions for the
HEEADSSS history.
One of the nice qualities about the HEEADSSS approach is that it starts with less threatening issues and proceeds to more
personal questions, so the interviewer has a chance to establish rapport before exploring sensitive, intrusive topics. Be sure to ask
questions in a nonjudgmental way, and avoid questions that can be answered with “OK” or with a “Yes/No” (i.e., “Do you get along
with your mom and dad?”; “How are you doing in school?”; “Do you have any activities outside of school?”; “Do you do drugs?”;
“Are you sexually active?”; “Are you careful about being safe?”).
Remember to avoid making assumptions about a teen’s behaviors. For example, don’t assume that your patient is heterosexual,
sexually active, or even dating.

Adolescent Interview – Safety

Violence

The leading causes of death in older adolescents are violent: suicide, injuries, and homicide. Bullying, family violence, sexual
abuse, date rape, and school violence are all common. In many urban communities, up to one in four students report carrying a
weapon to school. Family violence and dating violence cross all economic and social boundaries.
Injuries

For some teens, school violence and guns are the major risks, and in others, sports injuries and injuries from wheeled vehicles are
more likely. It is important to address the use of seat belts and bike helmets with every adolescent.
Even though you address the safety issues most prevalent in the patient’s community first, do not skip any part of the history
based on assumptions about the patient’s ethnic background or economic status.

Recommended Vaccinations for Adolescents and Teenagers

Haemophilus
influenzae
type b

Haemoph