Growth and Development of the Adolescent: 11 to 18 Years Chapter 27

1. Growth and Development of the Adolescent: 11 to 18 Years Chapter 27

2. LEARNING OBJECTIVES • State the ages of the preadolescent and the adolescent. • Discuss the physical changes that occur in early or preadolescence. • Describe the psychosocial development of the adolescent. • List the secondary sexual characteristics that appear in adolescent boys and in adolescent girls. • Discuss (a) the major cognitive task of the adolescent according to Piaget and (b) the major developmental task according to Erikson. • Explain some problems that adolescents face when making career choices today. • Explain the role of intimacy in adolescence in preparation for long-term relationships. • Discuss the adolescent’s need to conform to peers. • Discuss the influence of peer pressure on psychosocial development. • Discuss adolescent body image and associated problems. • Describe adolescent nutritional concerns, including (a) daily minimum needs and deficiencies, (b) habits and fads, (c) cultural influences, and (d) vegetarian diets. • Explain recommended health maintenance and promotion, as well as health concerns for the adolescent. • Discuss the aspects of sexual maturity that affect the need for health education in the adolescent. • Discuss the issues that the adolescent faces in making decisions related to sexual responsibility, substance use, mental health, and accident prevention. • State factors that may influence the adolescent’s hospital experience.

3. Growth and Development of the Adolescent • Early adolescence (preadolescence, pubescence) • Puberty = reproductive maturity • Begins at about age 10 in girls; ends with menstruation • Begins about age 12 in boys; ends with production of sperm • Adolescence (“to come to maturity”) • Spans the ages of about 13 to 18 • Erikson – Identity versus role confusion -they must develop their own personal identity -a sense of being independent people with unique ideals and goals -if parents, caregivers, and other adults refuse to grant that independence, they may break rules just to prove that they can

4. Preadolescent Development • Physical development • Girls (age 9-11) • Growth spurt lasts about 18 months • Grow about 3” annually until menarche • Begin to develop a figure and pubic hair • “early bloomer or late bloomer” cause concern and often embarrassment • Boys (age 11-13) • Growth is slower and steadier than in girls • Changes in penis, testes and scrotum • Sparse hair at the base of the penis • Nocturnal emissions (often used as the indicator that the preadolescent period has ended)

5. Preadolescent Development (cont.) • Preparation for adolescence (cont.) • School programs may provide good foundation • Still need an adult to turn to • Discussions may prevent (too early) sexual activity • Honest, straightforward answers must be given -the children whose need for information is not met through family, school, or community programs, the information may be inaccurate andcome from peers, movies, television, or other media

6. Adolescent Development • Physical development • Girls achieve 98% of adult height by age 16 • Boys grow rapidly from age 13 until about 20 • Skeletal growth outpaces muscle growth • Girls • Non-ovulatory with early menses (increased estrogen levels are needed to produce ovum mature enough to be released) • Age 13-15 become ovulatory (pregnancy is possible)

7. Adolescent Development (cont.) • Physical development (cont.) • Boys • After age 13 muscle strength and coordination develop rapidly • Larynx and vocal cords enlarge • Voice “changes”

8. Adolescent Development (cont.) • Physical development (cont.) • Characteristics of adolescence for both sexes • Body takes on adult-like contours • Primary sex organs enlarge • Secondary sexual characteristics appear • Hormonal activity increases • Bone growth continues through adolescence and is usually completed by the end of this period

9. Adolescent Development (cont.) • Psychosocial development(table 27-2) • Adolescents develop a sense of moral judgment and a system of values and beliefs that will affect their entire lives • Peer group extends tremendous power • Experiment with potentially dangerous practices (drugs, alcohol, and reckless driving) • Trends and fads dictate clothing choices, hairstyles, music, and other recreational choices • Adolescents need careful guidance and understanding support to help resist this peer influence • Nonconformity can add another stress to this already emotion-laden period

10. Adolescent Development (cont.) • Psychosocial development (cont.) • Personality development • Who am I as a person? • What will I do with my life? • Sex roles stereotypes have been shattered in most careers and professions • More geographic mobility (ie: summers or full school year in foreign country, attend college far away from home, and even begin a career in a more remote location) • Decisions and choices are never simple

11. Adolescent Development (cont.) • Personality development (cont.) • Seek out intimate relationships • Most are heterosexual • Homosexual relationships can be very stressful for the teen and the family • People who fail to achieve intimacy may develop feelings of isolation and difficulty communicating with others • Body image • Closely related to self-esteem • Desire not to be different • Underdeveloped teens have great anxiety • Anorexia nervosa • Teens need positive body image (bone growth is complete- height will remain basically the same, weight fluctuate greatly)

12. Question At what approximate age do muscle strength and development generally occur in boys? a. 11 years b. 12 years c. 13 years d. 14 years

13. Answer c. 13 years Rationale: After age 13, muscle strength and coordination develop rapidly. Q#1, CS

14. CASE STUDY • Katrina, a 11½ -year-old female, and Gabriel, a 14-year-old male, are siblings who are brought to the clinic by their mother, Paulina. Both require a physical examination for school. Katrina has grown over three inches over the last year, while Gabriel has only grown about half an inch. Gabriel states, “She’s already almost as tall as I am and I’m older than she is. That’s not fair. I’m the shortest one of my friends. Am I doomed to be short?” (Learning Objectives 2, 4) • 1. What differences in physical growth and development would the nurse expect to find when assessing Katrina and Gabriel? • 2. What would be important for the nurse to include when responding to Gabriel’s concern about his height?

15. Nutrition • Nutritional requirements increased during periods of rapid growth (table 27-3, pg.609) • Appetites increase and most teens eat frequently • Food choices not always wise-often influenced by peer pressure • Many skip meals-especially breakfast, snack on empty calorie foods, eat lots of fast foods • Can have nutritional deficiencies • Calcium, iron, zinc, vitamin A, vitamin D, vitamin B6, and folic acid • Girls need additional iron

16. Nutrition (cont.) • Some experiment with food fads and diets • Increased protein and amino acids cause diuresis and calcium loss • Carbohydrate loading can increase muscle glycogen levels to 2 or 3 times normal • Help low-income families find places to buy low-cost, nutritious foods and snacks • Culture influences food choices and habits

17. Nutrition (cont.) • Vegetarian diets • Semivegetarian includes dairy products, eggs, and fish; excludes red meat and possibly poultry • Lacto-ovovegetarian includes eggs and dairy products but excludes meat, poultry, and fish • Lactovegetarian includes dairy products and excludes meat, fish, poultry, and eggs • Vegan excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry

18. Health Promotion and Maintenance • Routine checkups • Recommended at least twice during teen years • Complete history • Immunizations and boosters that are needed • Height, weight, and B/P • Hearing and vision screening • Scoliosis and thyroid • Pelvic for sexually active girls

19. Health Promotion and Maintenance (cont.) • Routine checkups (cont.) • Counsel about sexual activity, sexually transmitted infections, and HIV • Body piercing and tattoos (S&S of infection) • Teens must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care • Continuity of care helps

20. Health Promotion and Maintenance (cont.) • Dental checkups • Need every 6 months • Braces correct malocclusion • Can talk about tongue piercing at dental visits • Family teaching • Caregivers and adolescents struggle with issues related to sexuality, substance abuse, accidents, discipline, poor nutrition, and volatile emotions

21. Health Promotion and Maintenance (cont.) • Health education and counseling • Education and counseling about sexuality, STIs, contraception, and substance abuse are a vital part of adolescent health care • Sexuality • Teens can feel ashamed about bodily changes if unprepared • More teens than ever are sexually active, leading to rise in teen pregnancies and STIs • HIV on the rise in teen population

22. Health Promotion and Maintenance (cont.) • Sexuality (cont.) • Girls need to learn about routine pelvic exams, Pap smears, and breast self-examination • Boys need to know about testicular cancer and self-exam • Masturbation is a common practice

23. Health Promotion and Maintenance (cont.) • Health education and counseling (cont.) • Sexual responsibility • Need information on safe sex • Contraceptives -abstinence is the only completely successful protection -condoms, spermicidal foam • STIs-prevention is primary aim of education -often reluctant to seek treatment due to fear caregivers will find out • HIV • Syphilis, gonorrhea, genital herpes, genital warts, chlamydial and trichomonal infections

24. Health Promotion and Maintenance (cont.) • Sexual responsibility (cont.) • Health care personnel need to be nonjudgmental, supportive, and understanding when dealing with teens seeking treatment for an STI • “Date rape” drug-Rohypnol (causes memory loss, blackouts, and an inability to resist sexual attacks)

25. Health Promotion and Maintenance (cont.) • Health education and counseling (cont.) • Substance abuse • May experiment with addictive substances • Alcohol most common • Health care personnel must stress to adolescents that use of alcohol or mind-altering chemicals is often accompanied by irresponsible sexual behavior Q#2

26. Health Promotion and Maintenance (cont.) • Mental health • Depression, suicide, and conduct disorders • Be sensitive to a teen having a problem • Internet safety • Accident prevention • Increasing numbers of adolescents are dying as a result of violence • Alcohol and other drugs can be causative factors • Violence in the home and school

27. Question Tell whether the following statement is true or false. Teens can feel ashamed about the changes in their body if they are unprepared for these vast changes.

28. Answer True Rationale: A good foundation in sex education can help the adolescent take pride in having reached sexual maturity; otherwise, puberty can be a frightening, shameful experience.

29. The Adolescent in the Health Care Facility • Provide supportive nursing care sensitive to the adolescent’s needs • Encourage as much participation as possible • Clearly and honestly explain all procedures and treatments • Protect privacy by providing screening and covering • Provide a telephone and recreational areas to keep up social contacts with peers DT#1

30. DISCUSSION TOPIC #1 You have been asked to present information to a group of adolescent boys about sexuality and sexual responsibility. a. What areas do you think would be important to cover? b. What specific information would you include? DT#2

31. DISCUSSION TOPIC #2 A parent is concerned that her 16-year-old child is not eating properly to avoid gaining weight. a. What nutrients are commonly deficient in the adolescent? b. What suggestions to the mother could help her make the child understand the importance of balanced nutrition?