P3C067: Where Medicine Meets Pediatrics: Care for the Adolescent in the Adult Hospital

Introduction: Adolescence and young adulthood are phases of life defined by self discovery and independence. Given their unique needs, navigating the medical system can be particularly challenging for patients in this age group. In order to successfully treat this patient population, providers must deliver holistic care which takes into account the patient’s developmental stage of life.

Case Description: A 19 year old male with a history of childhood asthma and tobacco use presented to the emergency department with shortness of breath. He was initially diagnosed with an asthma exacerbation and discharged home. Two weeks later, he presented to the ED for worsening shortness of breath. Chest x-ray revealed a large left sided pneumothorax. CT chest showed multiple bilateral cysts. He required multiple chest tubes and left and right video-assisted thoracoscopic surgeries for recurrent, bilateral pneumothoraces over the course of a three month hospitalization due to pulmonary Langerhans’ Cell Histiocytosis.

After two months, Med/Peds was consulted for pain management due to difficulty weaning his opiate PCA in the setting of a complex social situation with multiple family members involved, resulting in disagreements over his care plan.

Through motivational interviewing, the patient identified his goals were to leave the hospital and graduate high school. To support his goals, the inpatient teacher was consulted, and he set a daily physical therapy goal for himself. His opiate wean was reframed as a step to discharge, and a weaning calendar was created to allow him to anticipate changes and have a sense of control over his medical care. A psychologist was consulted for biofeedback. With the patient’s permission, his family was included in all discussions given their involvement in his care.

The changes to his care plan created radical improvements in the patient’s interface with the primary team. After return of trust in the team, he more quickly progressed through weaning and removal of his chest tubes and PCA. He successfully completed physical therapy and continued his own daily exercises. He was ultimately discharged home without an oxygen requirement. He hopes to share his message with others that, “No matter what it is, you can get through it.”

Discussion: In order to effectively care for adolescents and young adults, we must provide targeted support based on their developmental stage. They are more likely to respond emotionally in stressful situations, and it can be difficult for them to understand their long term plan of their care, particularly given their minimal exposure to the healthcare system. Therefore, their care plan must be focused on their self-identified goals to provide them with a sense of control over their future.

Conclusion: Adolescence and young adulthood is an important developmental stage, and our medical care should be crafted to address their unique needs.