Approaches teen assesment

Teen assessment
The assessment of teenagers and young adult is a crucial aspect of identifying health care
concerns early in life. In approaching the teenager or young adult, the approach should be aimed
to focus on them rather than their problem (Bickley & Szilagyi, 2013). Such an approach
encourages the teenager to open. Assessing adolescents requires the nurse to talk more and
invoke informal communication to ease the teenager (Bickley & Szilagyi, 2013). Topics such as
discussing about school, hobbies and family are essential to establish rapport with the teenager.
During physical examination, the use of summarization and translational statements is crucial. It
is important to encourage the adolescent to ask questions where and if necessary.
Confidentiality is a critical aspect in the assessment of the teen. It is essential to
communicate with clarity that confidentiality will be maintained for the adolescent and explain
situations where confidentiality may be broken such as in case the teenager is I danger
In assessing adolescent’s cultural sensitivity is critical. It is important to ask and put into
consideration the cultural aspects that may influence the assessment of the teen (Douglas et al.,
2014). Issues such as the presence of the parent or family in the assessment of the teen, what and
with whom to share the teen information with and how the teenager communicates may be
influenced by the cultural background of the teenager.
Physical assessment
The physical assessment for teenagers is usually similar to physical assessment of adults
in sequence and content. It is, however, important to note essential issues such as relationships,

high-risk behaviors, puberty, growth and development, sexuality and decision making which are
pertinent to young people and adolescents.
In assessing the adolescent, it is important to assess the adolescent basing it on their stage
of development. The tanner stages of development are a crucial guide to assessment of teenagers.
Tanner staging categorizes the growth and developmental changes identifiable in teenagers
(Bickley & Szilagyi, 2013). The stages through which various parts undergo development such
as genitalia, breasts and other physical changes such as growth of pubic hair and physical growth
are identified. Tanner staging should be utilized to assess the teenager’s growth parameters in
relation to their age noting any abnormalities.
Mental and psychological assessment
In assessing the teenagers mental and psychological status, it is essential to start with the
least sensitive issues as may be for individual teenagers. Ask the teenager about her/his
relationship with peers, his /her hobbies and progress gradually to more sensitive issues such as
sexuality and drug use and abuse. Mental health assessment for teenagers ought to incorporate
tests to test for anxiety, depression drug abuse and learning abilities of the teenager. Other
techniques used may involve use of storytelling, play therapy, drama, photographs among others
to assess the teenager’s perspectives.
In mental and psychological assessment, it is imperative to note an adolescent for signs of
reduced interest, self-reported feelings of hopelessness and sadness which are indicative of
teenage depression. Also of key important are any notable signs of drug use such as falling
grades, teenagers who appear poorly groomed and violent, obsessions with something
Special concerns

The assessment of Tanner stages in adolescents it is essential to note delayed puberty in
boys or precocious puberty which are significant during the assessment as they denote endocrine
and nervous system concerns. In assessing the adolescent genitalia, it is crucial to assess for any
vaginal or penile discharge which is indicative of sexually transmitted infections.
Other special concerns for teenagers include any risks for suicide or self-harm, abuse or
drug use by the teenager. Such concerns when identified should be addressed according to
protocols and may necessitate a break of confidentiality.
Part 2-Cultural sensitivity
The successful communication between healthcare providers and patients from other
cultures depends on the healthcare provider’s understanding of the patient’s culture and practices
and being able to identify its difference and impact on the health seeking behaviors (Douglas et
al., 2014). Employing the correct communication strategies when dealing with individuals from
different cultures is critical to establishing therapeutic relations with the patient.
The Chinese culture is a fast expanding culture due to expansion of the Chinese influence
world over. Communicating effectively with Chinese patients entails understanding fully the
Chinese culture and their health beliefs and practices. The Chinese maintain a culture that
promotes and supports the use of traditional Chines medicine (Culture clues n.d). To establish
culturally sensitive nursing care for the Chine patient, it is essential to first understand the culture
of the patient. Employing an open flexible discussion as a communication strategy with patients
is important in discussing treatment plans to incorporate traditional Chinese medicine.
Incorporating some therapeutic Chinese therapies in treatment can play a key role in encouraging
trust with the patient (Polsa, Fuxiang, Sääksjärvi & Shuyuan, 2013).

When building a bridge between the traditional and western medicines in care of the
Chinese patient, it is critical to establish the harm, usefulness or how neutral a traditional therapy
is to the patient (Polsa, Fuxiang, Sääksjärvi & Shuyuan, 2013). Incorporating the useful and
neutral therapies is important to preserve trust with the patient and promote patient participation
in care. Initial assessment of the patient ought to include such questions on their use of herbs to
remedy their conditions, their perceptions on the causes of the illness and their perception of the
illness to them (Culture clues n.d).
In providing culturally sensitive care, it is critical to understand the Chinese
understanding of health and illness and its impact on care. The Chinese perceive illness as part of
the normal process of life and death with health viewed as a complementary of forces such as
cold and hot (yin and yang). This perception hence influences the Chinese patient’s choice for
hot drinks as initial remedies to cure. The perception of health also leads to the preference for
traditional Chinese interventions such as acupuncture.
In ensuring efficient communication with the Chinese patient avoidance of yes/no
answers is essential. Asking the Chinese patient open ended questions and encouraging them to
ask questions is essential to gauge their understanding. The Chinese patient may fail to ask any
questions in fear of creating some disharmony with the nurse. Asking them to repeat what they
understand is essential in establishing their understanding of health concepts as explained.
The Chinese culture has a strong emphasis on group consensus on health issues and a
strong family centered-structure. A strategy that allows the patient time to consult family
members on key health decisions is critical is establishing trust and encouraging openness with
the patient. A beneficial strategy would be to identify the family members with the most
influence in decision making. Where possible it is critical to involve the family in discussions. In

disclosing bad health news, it is essential to be conversant of the Chinese strong belief in Karma
(That what is talked about is likely to happen) The family may shield bad medical information
such as diagnosis from the patient or vice versa (Polsa, Fuxiang, Sääksjärvi & Shuyuan, 2013).

Bickley, L.S., Szilagyi, P.G. (2013). Bates’ guide to physical examination and history taking,11th
ed. Philadelphia,

PA: Lippincott,

William & Wilkins. ISBN: 978-1-60913-

Douglas, M., Rosenkoetter, M., Pacquiao, D., Callister, L., Hattar-Pollara, M., & Lauderdale, J.
et al. (2014). Guidelines for Implementing Culturally Competent Nursing Care. Journal
of Transcultural Nursing, 25(2), 109-121.
Polsa, P., Fuxiang, W., Sääksjärvi, M., & Shuyuan, P. (2013). Cultural values and health service
quality in China. International Journal of Health Care Quality Assurance, 26(1), 55-73.

Genitals (male)

Illustration of the Tanner scale for males.
Tanner I
Penis-Preadolescent—same size and proportions as in childhood.
Testis and scrotum -Preadolescent—same size and proportions as in childhood

Pubic hair Preadolescent—no pubic hair except for vellus hair that on the abdomen
Tanner II
The testicular volume is larger than in stage one; the skin on scrotum thins and enlarged
with reddening accompanied by roughening texture. The penis length remains unchanged
or may slightly enlarge. Sparse growth of long, slightly pigmented, downy hair, straight or only
slightly curled, chiefly at the base of the penis

Tanner III
Testicular size further enlarges with the penis enlarging further in size more so the length.
Darker, coarser, curlier hair spreading sparsely over the pubic symphysis
Tanner IV

Coarse and curly hair, as in the adult; area covered greater than in stage 3 but not as great
as in the adult and not yet including thighs. The testicular volume is further enlarged with
scrotum darkened. Penis is lengthened further and width also grows with the formation of
the glans penis.
Tanner V
Adult sized penis and scrotum with pubic hair adult in quantity and quality, spread to the
medial surfaces of the thighs but not up over the abdomen
Breasts (female)

Illustration of the Tanner scale for females.
Tanner I
Elevation of the nipple, still in preadolescent period.

Tanner II

Breast bud stage. Elevation of breast and nipple as a small mound; enlargement of areolar
Tanner III
Breast begins to become more elevated, and extends beyond the borders of the areola,
which continues to widen but remains in contour with surrounding breast.
Tanner IV
There is notable increase in breast size and elevation; areola and papilla form a secondary
mound projecting from the contour of the surrounding breast
Tanner V
Breast reaches final adult size; areola returns to contour of the surrounding breast, with a
projecting central papilla.
Pubic hair female
Tanner I
No pubic hair at all in pre-adolescent stage
Tanner II
Sparse growth of long, slightly pig-mented, downy hair, straight or only slightly curled,
chiefly along the labia
Tanner III
Hair becomes more coarse and curly, and begins to extend laterally over the pubic
Tanner IV

Adult–like hair quality -Coarse and curly hair- area covered greater than in stage 3 but
not as great as in the adult and not yet including the thighs
Tanner V
Hair adult in quantity and quality, spread on the medial surfaces of the thighs but not up
over the abdomen.


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