Nursing Care of a Family with an Adolescent

AN ADOLESCENT WITH DEPRESSION

Donna is a 17-year-old brought to an ambulatory clinic by her father.

CHIEF CONCERN:
“She sleeps all the time but has absolutely no energy.”

HISTORY OF CHIEF CONCERN:

The father states his daughter’s behavior has changed over the past year from an active sports-minded
teenager to one who presently participates in no sports and misses school at least 1 day a week from
“fatigue,” although she did thoroughly clean her room this week and give away her Barbie dolls to a
cousin.
She says she doesn’t think there is anything wrong with her: “A person doesn’t have to be going
every minute to be all right.” She appeared self-conscious talking about self; she very often spoke to
hands instead of examiner. She sighs frequently and maintains sad facial expression.

FAMILY PROFILE:
The father and daughter live in a rented apartment on west side of city. The parents were separated 1
year ago. Donna’s younger sister and mother remain living in the family house. Donna spoke of that
bitterly, as younger sister is still able to attend old school, whereas Donna had to change schools. Donna
and mother had numerous arguments since separation; when Donna was suspended from school for
smoking, her mother asked if she could live with her father. This required the change in school. The
teenager describes new school as “a school, they’re all the same” when her father was in the examining
room but as “the high school from hell” when she was alone.
The father works as a real estate salesman. He describes finances as “okay” but “what good
does working all your life do when all you end up with is a rented apartment while your wife takes
everything?” A further concern is a former boyfriend from Donna’s old school may be stalking her.

HISTORY OF PAST ILLNESSES:

Donna had chickenpox about age 7 years. She had stepped on a rusty nail at 12 years and had tetanus
immunization booster; there is no sequelae. She had “bad acne” since she was age 14 years; she used to
take tetracycline for this: she hasn’t had the energy to go back to former doctor to have prescription
renewed so hasn’t used anything for the last 3 months.

DAY HISTORY:
Nutrition: 24-hour recall:
Breakfast: 2 pcs pan de sal, 1 glass milk
Lunch: 1 cup rice, 2 bananas, 1 pc fried chicken
Dinner: 1 cheeseburger, a serving of French fries, 1 cup coffee
Snack: 1 bowl popcorn, 1 can cola drink; she used to do glycogen loading before track meets but no
longer does this
Sleep: The patient sleeps 10 hours per night.
Recreation: She used to run with track team; she dropped out last summer. She reports a 24-hour recall
of present activity: Got up at 7 am; rode 30 minute jeepney ride to school; rode back again at 3:30 pm;
participates in no after-school activities; “hung out” at city mall until 6 pm when she walked two blocks
home for dinner. Her father bought fast-food dinner and they ate together. In the evening, she visited at
a girlfriend’s house until 10 pm. She was asleep by 11:00 pm.
Growth and development: She is a senior in high school (no failed grades); admits she was an A student
in previous school; is “closer to a D” in new school. Her attributes change in grades to “things being
taught differently at new school.”
She is sexually active; states she is aware of the symptoms of STIs and necessity to use condoms. She
admitted that she uses alcohol occasionally; she smokes 1 pack of cigarettes daily (father is a chain
smoker).
She wishes she wasn’t so shy around boys; she says, “Thank God, I’m over puberty.”

REVIEW OF SYSTEMS:
Negative but for chief concern; there is no recent vision or hearing examination or immunizations.

PHYSICAL EXAMINATION:
Weight: 110 lb (10%); height: 69 in. (15%); BMI: 17.2
General appearance: Tall, rangy-appearing, 17-year-old with bored expression on face
Head: Normocephalic; hair is thick but feels greasy
Eyes: Red reflex; pupils equal in size; react to light and accommodate; tested by Snellen chart: 20/30
both eyes
Ears: Normal alignment; tympanic membranes pink; landmarks present; responds to whispered words
Nose: Midline septum; nares patent
Face: Scattered reddened lesions on nose and cheeks; numerous black comedones on erythematous
bases present on forehead and cheeks
Mouth and throat: Palate intact; lower third molars partially erupted; areas tender to touch; midline
uvula; gag reflex intact; tonsillar issue not inflamed; metal rod piercing tongue
Neck: Full range of motion; no nodes palpable; midline trachea: thyroid, not enlarged
Chest: Supernumerary nipple present; 3 cm below left nipple; rhonchi heard in all four lobes of lungs;
respiratory rate: 18 breath/min
Heart: Rate: 72 beats/min; marked sinus arrhythmia
Abdomen: Bowel sounds heard in all four quadrants; no masses; neither spleen nor liver palpable; naval
piercing rod in place; no erythema
Genitalia: Normal female genitalia; Tanner 4
Extremities: Full range of motion; walks with easy relaxed gait
Neurologic: Deep tendon reflexes 2+; nose to finger, Romberg accomplished without difficulty; sensory
and motor responses grossly intact
Donna is diagnosed as a teenager with symptoms of depression.