Discussion Questions

You are a Family Nurse Practitioner working in a community health center. You are seeing a 14-year-old adolescent patent for an annual visit. The patient’s mother is also present during the visit and notes that the patient’s grades in school have been declining. Her son is also hanging out with a group of kids that she has concerns about. The mother has concerns for what is going on with her son. Answer the following questions using course resources (texts) and two other evidence-based sources (current guidelines and/or scholarly articles that are within a 3-5 year time frame).

1. What are the components of an annual exam for an adolescent patient?
2. Is the mother required to be present during your exam?
3. Describe 1 health promotion idea that you would discuss with your middle adolescence patient. Why is this idea important?
4. What are some screening tools that might be of importance in this situation? (hint: do you suspect drug or alcohol abuse here?)

ADDITIONAL DETAILS 

Components of an annual exam for an adolescent patient

Introduction

This is the most important task in any doctor’s office: evaluating your child’s health. With this annual exam, you can catch any problems early and develop a treatment plan that will keep your child safe and healthy.

General physical exam

The general physical exam is an important part of the health care process and should be completed by all patients. It’s also important to perform a complete exam on all patients, even if they don’t have any symptoms or complaints. The general physical exam may include:

• Examine the patient’s general appearance, including skin and hair texture, color, texture and moisture;

• Look for signs of disease such as jaundice, swelling or rashes (check under your fingernails);

• Check weight; height/body mass index (BMI) charts are available online or through health care providers’ offices so you can easily check this information yourself without having someone else do it for you! If a patient seems overweight in relation to their age then it would be appropriate for him/her to get checked out by his doctor who will possibly refer him/her back home with instructions on how best improve his habits before returning again next year!

Breast exam

The breast exam is a vital part of the annual exam. The health care provider should examine your breasts, paying attention to any abnormalities or lumps that may be present.

The nurse or doctor will also perform a self-exam, which means you should check yourself for any abnormalities or lumps on your body.

Auscultation of the heart and lungs

• Auscultation of the heart and lungs. The examiner uses a stethoscope to listen to your heart and lungs.

• Palpation of the chest wall. The examiner palpates your chest wall to check for tenderness or masses, such as lymphadenopathy (swollen glands).

• Focused abdominal examination. Your abdomen will be examined using gentle pressure on parts of it through light touch, including feeling for masses or tenderness in its lining (peritoneum). It may also be examined with an instrument called a rectal probe that has a handle for holding onto it but does not have an end; this type is used when examining younger children because it allows them to feel more comfortable by giving them control over what comes out from their anus instead of having someone else do so for them (or vice versa).

Abdominal examination

The abdominal examination can be performed using the same techniques as those used in adults. In general, however, you should be more careful about palpating the abdomen because of their age and size. The following are some signs of possible injury:

• Swelling or masses in the stomach or liver

• Tenderness to palpation at any point on either side of your patient’s abdomen (except for their back)

• Bowel sounds that do not sound normal (white-noisy stools may indicate a blockage)

Neurologic assessment

Neurologic assessment

• Check for any abnormal muscle tone.

• Check for any weakness in the arms or legs.

• Check for any abnormal reflexes.

• Check for any abnormal sensation (e.g., pain, temperature).

• Check for any abnormal tone in the face (e.g., grimacing)

Extremities exam, including joints and tendons

• Extremities exam: The extremities are the upper and lower limbs, including hands, wrists and ankles.

• Fingers, toes, knees and elbows: Check for swelling in the joints. Are they stiff or tender to touch? Is there deformity (such as clubbing of fingers)? Do they hurt when you move them? How well can they bend at the wrist or ankle?

• Range of motion exercises: For example you may want to examine the range of motion in your child’s wrists or ankles by asking him/her to perform specific movements such as touching their nose with their index finger or bending their knees so far forward that both feet touch together (Figures 1-3).

Conclusion

This exam is an important part of your role as a pediatrician, and I hope that you feel confident in your ability to perform it. Remember that the most important thing is to listen carefully and respectfully to your patient’s concerns. If you have any questions about what should be included in an annual exam for an adolescent patient, please don’t hesitate to ask!