Screening for biological illness

25th November 2010

Listen to the young person!

  • Often a young person will have symptoms that are distressing or worrying them; listening to these concerns, and responding appropriately, is the most fundamental responsibility of the KeyWorker.
  • Young people are frequently very anxious about conversations relating to their physical bodies - any discussions about this should acknowledge this, and ensure that the young person is comfortable about talking.
    • Sometimes having a friend or family member to support them in such a conversation is helpful
    • Sometimes an additional "chaperone" for the KeyWorker may be required.
Note that, apart from a visual examination of injection sites or specific injuries (which even then may not be appropriate, as in the case of groin-injecting) we do not expect the KeyWorker to be making formal physical examinations of young people; this is the role of the nurse or doctor.)

Signs to look for:

It is plainly unwise to list specific symptoms and signs to look out for. Young people may look quite obviously run down and in poor health - the key determinant of best practice is not to allow oneself to ignore such an observation.

Look out particularly for signs that appear to deteriorate over time, as these can be harder to spot:
  • Weight loss (most young people would expect to be putting on weight until they have finished growing)
  • Coughs or breathing problems (wheeze, shortness of breath).
  • Problems with bladder or bowels.
  • Pain that has no obvious cause.
  • Weakness in limbs
  • Altered sensations that persist.
  • Dental problems (these are particularly common in people with mental health problems.)

Special groups:

  • Intravenous drug users are at risk of many helath problems:
    • Local infection of injection sites is a problem - ask to see these if they are on the arms: look for redness, tenderness and heat over the area, which might suggest a developing abscess.
    • Hepatitis (B and C) - keep an eye out for jaundice (a yellow tinge to the skin, and the whites of the eye), tiredness, etc (any young person who is injecting drugs MUST be offered (and encouraged to take up) Blood Borne Virus Screening)
    • HIV - sometimes (but only in later stages) associated with multiple other infections.
    • Septicaemia - look for high temperatures, or cold extremities.
  • Sexually Active youth
    • Sexually transmitted diseases - most of these can easily screened for at a local Genito-urinary clinic - many hosptials have special clinics for young people.
    • Pregnancy - workers should have access to the means for pregnancy testing. Remember that continued heavy drinking or Drug use during pregnacy is known to be damaging to the unborn baby, and constitutes a form of Neglect (see Child Protection) by the mother-to-be.
  • Fighting/Bullying/Physical Abuse
    • Stab wounds may not be reported because of fears of Police involvement.
    • Bruises, and small fractures may easily be covered up, or overlooked. (Look for the position of bruising - is it in a site that fits the young person's description of how it occurred?)
  • On medication already
    • Check what PrescribedMedication young people are taking
    • Some medications have common or important side effects.
    • Antipsychotic medication (for instance Risperidone, Olanzepine, Quetiapine, Haloperidol...) has a wiode variety of side effects, and some are given below (not an exhaustive list.) Note that these drugs are sometimes prescribed for non-psychotic conditions, such anxiety, or aggression...
      • Look out for stiffness (especially in the neck, and causing the eyes to wander upwards) - this is a dystonia and is relatively common, easily treated, and should not be left.
      • Sometimes antipsychotics can cause constipation or difficulty passing urine.
      • Sometimes they can cause disturbance of periods (in women) or production of breastmilk/secretions at the nipples (men or women) - this is rarely mentioned by young people, but can be very worrying and cause them to stop taking a medication. It is often easily manged by adjuting the dose or switching to an alternative medication.
      • Rarely, antipsychotics (and some other drugs too) cause very dangerous side effects such as Neuroleptic Malignant Syndrome (NMS) - the signs of this are that the person is obviously poorly, sometimes with a lowering of the level of consciousness, and unstable central features such as pulse (high or low), temperature (usually high, but can be low), blood pressure (high or low) etc. The body is noticeably stiff. THIS IS A MEDICAL EMERGENCY AND MEDICAL CARE NEEDS TO BE CALLED IMMEDIATELY - in most cases the person would need to be admitted to a medical ward immediately, as this can worsen and lead into coma and even death (NB this is very rare.)

What to do if a Health concern arises:

  • Young people should all be registered with a local GP - if this is not already the case it should be an early priority in the Care Plan.
  • GP's or A&E clinics are available - try to use A&E clinics only for genuine medical emergencies, rather than routine concerns that a GP could manage just as well.
  • Use the How to speak to a... material to get the best out of the health service workers.