Need help with adolescent/teen annual physicals

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    I am a new FNP working in a small pediatrics office. Only 3 providers- the pediatrician, another PNP and me- all female. I am having a lot of difficulty handling annual physical exams for our teen population, specifically inquiring about drug and alcohol use and sexual activity. I grew up in a very strict Catholic household where my mother was very uncomfortable broaching physical development and changes in puberty and there was virtually no discussion of these issues. It has been far more difficult for me to bring up these issues now that I am a provider than I had previously imagined when I was still a student and following a preceptor.

    In our office we generally do not have teens undress prior to their physicals. We lift up shirts and expose skin as neccesary for skin and scoliosis checks. For the boys, I try to offer them a drape when doing their hernia and testicular exams (I still get a good view but they don't realize it). Regarding the girls- we do not do any gyn exams and I generally only check external genitalia if there is a reported problem or concern, otherwise we refer to ob/gyn.

    I do a thorough exam in all other areas but I know I may be missing something important by skimping on these sensitive issues.

    I really could use some help with this. It's one thing to get an hour's lecture on adolescent exams while in school; it's another to have to do it in practice.

    For those nurses who have experience with teen exams, do you always request that the parent leave the room before the start of the physical exam? And how do you bring up alcohol use, drug experimentation, or sexual activity? What statements do you make about confidentiality that helps them to open up? Any suggestions or comments from other experienced nurses, advanced practice or not, would be most welcome.
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    I'm not FNP, I'm BSN- RN I work with high risk sexual behavior teens. juvenile detention center. When we do initial screening at intake these questions are ask to all juveniles. Maybe your clinic can have a sheet with questions about substance a use and sex. It can be done initially by nursing then you can reviewed it providing privacy. You should always have a chaperone if you are a female provider with male patient. Don't you have to document tanner stage?


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