ADOLESCENCE
• Adolescence is generally defined as the period
between ages 13- 20 years, a time that serves as a
transition between childhood and becoming a late
adolescent.
IT CAN BE DIVIDED INTO:
• Early Period (13 to 14 years)
• Middle Period (15 to 16 years)
• Late Period ( 17 to 20 years)
GROWTH AND DEVELOPMENT
OF AN ADOLESCENT
PHYSICAL GROWTH
• The major milestones of physical development in the
adolescence period are the onset of puberty at 8 to 12
years of age and the cessation of body growth around 16 to
20 years (Sawyer et al.,2018).Between this milestones,
physiologic growth and development of adult coordination
occur.
• Female increase 2 to 8 in. (5 to 20
cm) in height and gain 15 to 55 lb (7
to 25 kg).
• Males typically grow about 4 to
12 in. (10 to 30 cm) in height and
gain about 15 to 65 lb (7 to 30 kg)
during adolescence.
Adolescence may also have
insufficient energy and become
fatigued trying to finish
activities that increase
cardiovascular requirements
because the heart and lungs
increases in size more slowly
than the rest of the body.
Because of this changes, the
pulse rate and respiratory
rate decreases slightly (to 70
beats per minute and 20
breaths per minute), and the
blood pressure increases
slightly to (120/70 mmHg) by
late adolescence.
Throughout adolescence, androgen
stimulates sebaceous glands to
extreme activity, sometimes resulting
in acne which is a common adolescent
skin problem.
APOCRINE SWEAT GLANDS
• glands present in the axillae and
genital area, which produce a strong
odor in response to emotional
stimulation.
TEETH
• Adolescence gain their second molars at
about 13 years of age and their third
molars (wisdom teeth) between 18 to 21
years of age.
• Third molars may erupt as early as 14 to
15 years of age.
• The jaw reaches adult size only toward
the end of adolescence,however. As a
result, adolescents whose third molars
erupt before lengthening of the jaw is
complete may experience pain and may
need these molars extracted because they
do not fit their jawline.
PUBERTY
• It is the time at which an individual first
becomes capable of sexual production.
• A female has entered puberty when
menstruation begins; a male enters
puberty with the production of
spermatozoa.
• The age of first menstruation in females
is gradually decreasing from a median age
of 12 years to 11.9 years.
SECONDARY SEX
CHANGES
• Secondary sex characteristics, such as body hair
configuration and breast growth, are characteristics that
distinguish the sexes from each other.
• Secondary sex characteristics that began in the late school-
aged period continue to develop during adolescence.
•Sexual maturity in males and females is classified according to
Tanner stages, named after the original researcher on sexual
maturity (Tanner, 1962).
DEVELOPMENTAL
MILESTONES
PLAY OR RECREATION
Thirteen-year-old children change from
school-aged acitivities or active games to
more adult forms of recreation. These
includes:
• listening to music
• social media
• texting or chatting
• or following a sports team’s wins and
losses.
Most adolescents spend a
great deal of time talking with
peers for social interaction,
either face to face or through
electronic media. Conflict can
arise if the parents:
• disapprove of the number of
hours spent in this activity.
• afraid their children are
wasting important hours.
• or atleast exchanging a great
deal of trivial conversation.
SEXUAL MATURATION IN
ADOLESCENTS
Female breast and Pubic
hair Development
Male genital and Pubic
hair Development
Emotional Development
According to Erikson (Dunkel & Harbke,
2017), the developmental task in early and
mid-adolescence is to form a sense of
identity versus role confusion. In late
adolescence, it is to form a sense of
intimacy versus isolation.
Early Adolescent
Developmental Task:
Identity Versus Role
Confusion
The task of forming a sense of identity is for
adolescents to decide who they are and what
kind of person they will be. The four main
areas in which they must make gains to
achieve a sense of identity include:
1. Accepting body changes
2. Establishing a personal value system
3. Planning educational goals in preparation
for a career
4. Becoming emancipated from parents
If young people do not achieve a sense
of identity, they may develop a sense
of role confusion (Dunkel &
Harbke,2017). This may lead to
difficulty functioning effectively as
adults because they have difficulty
with new challenges or situations. This
may lead to inappropriate behavior or
acting out.
BODY IMAGE
Adolescents who were able to develop a strong
sense of industry during their school-aged years
learned to solve problems and are best equipped
to adjust to the body changes that come with
adolescence to form a positive body image.
This adjustment to change is not always easy;
adolescents can feel disappointment if they
have unrealistic expectations.
Adolescents may need assistance from
healthcare or mental health providers to accept
changes that occur during adolescent
development.
SELF - ESTEEM
Like body image, self-esteem may be challenged
by all the changes that occur during
adolescence (Sanchez-Queija et al.,2017).
Help parents understand how important it is for
adolescents to have some successful
experiences. They also need to learn from
disappointments.
Long-term psychological problems, such as
disordered eating, which occur in both males
and females, may result from the inability to
adjust to changes during adolescence.
VALUE SYSTEM
Adolescents develop their values
throughout their childhood as they
interact with their family.
As they increase the amount of time
they spend with their peer group,
they may question these values and
may participate in experiences that
put them at risk for physical and/or
psychological harm.
Identifying risk-taking behaviors and
offering guidance and support are
important in promoting the health of
the adolescent.
SOCIAL BEHAVIOR
In early adolescence, individuals tend to dress and behave
similarly to other members of their peer group.
Bullying behavior may be directed at individuals who do not
conform to or associate with a peer group. Bullying behaviors
should be identified, and the appropriate interventions should be
initiated.
During adolescence, individuals begin to explore their sexual
orientation and may question their gender identity.Encourage an
open dialogue with adolescents to assist them to process their
feelings and establish their own identity.
Counseling may be helpful to assist with family communication if
the family is not accepting.
CAREER
The adolescent may identify an educational and
career trajectory during self-discovery of
personal positive attributes.
This process may take several years to achieve,
and it varies for each individual.
It is common for adolescents to seek and
experiment with multiple roles before reaching a
decision that is rewarding.
Some school-aged children do poorly in school
during preadolescence, but as soon as they
choose a career path, they show increased
interest in learning as they come to see education
as relevant to their future.
EMANCIPATION FROM PARENTS
Encourage parents to give adolescents more freedom in areas such as
choosing their own clothes, decorating their room, or participation in
after-school activities.
Both parents and adolescents may need help to understand that
emancipation does not mean severance of a relationship but rather a
change in a relationship.
It can be helpful to remind parents this step is actually no different from
the one that children accomplished when they grew from infants to
toddlers, when they changed from wanting to be held and rocked to
wanting to run. If parents can think of it in this light, they will gain a
better perspective and may realize they will not lose their child just
because they are becoming an adult.
Late Adolescent
Developmental Task:
Intimacy Versus
Isolation
Developing a sense of intimacy means a
late adolescent is able to form long-term,
meaningful relationships (Erikson,
1950,1968). Those who do not develop a
sense of intimacy are left feeling isolated;
in a crisis, they have no one to whom they
feel they can turn to for help or support.
A sense of intimacy is closely related to
the sense of trust learned in the first year
of life because, without the feeling that
one can trust others, building a sense of
intimacy is difficult.
SOCIALIZATION
Through adolescence and early adulthood,
individuals may have many relationships
and learn from each of these encounters.
When relationships do not continue for
whatever reason, parents can offer
support and be available for openly
discussing any concerns the adolescent
may have.
By age 17 years, adolescents tend to have
adult values and responses to events.
They have left behind the childish
behaviors they used in early adolescence
to get the attention of others.
COGNITIVE DEVELOPMENT
The final stage of cognitive development, the stage of formal operational
thought, begins at age 12 or 13 years and grows in depth over the
adolescent years, although it may not be complete until about age 25 years
(Piaget, 1969).
This step involves the ability to think in abstract terms and use the
scientific method (i.e., deductive reasoning) to arrive at conclusions. The
problems that adolescents are asked to solve in school depend on this type
of thought. Problem solving in any situation depends on the ability to think
abstractly and logically. With the ability to use scientific reasoning,
adolescents can plan their future.
They can create a hypothesis such as, "If I don’t go to college, I think I can
start earning money right away,” and think through the probable
consequences such as "I might not earn as much in the long run as if I do go
to college."
MORAL AND SPIRITUAL
DEVELOPMENT
Because adolescents broaden their thought processes to include formal
reasoning, they are able to respond to the question,"Why is it wrong to
steal from others?" Some adolescents, however, may have difficulty
envisioning a department store or a large corporation as capable of
suffering economic loss from stealing, a concept that can contribute to
the frequent practice of shoplifting at this age.
Almost all adolescents question the existence of God and any religious
practices they have been taught (Kohlberg,1984). This questioning is a
natural part of forming a sense of identity and establishing a value system
at a time in life when they draw away from their families.
Health Promotion for
an Adolescent and
Family
PROMOTING ADOLESCENT
SAFETY
Unintentional injuries, most commonly those
involving motor vehicles, are the leading
cause of death among adolescents.
Risk-taking behavior is common during
adolescence, as common as believing they
are invincible.
In the interest of an adolescent's safety
and that of others, parents need to have
open conversations about progressively
granting more independence.
PROMOTING NUTRITIONAL
HEALTH FOR AN ADOLESCENT
Adolescents experience such rapid growth that they
may increase their food intake. Encouraging family
meals and their participation in meal preparation is
helpful in maintaining proper nutrition.
Disordered eating, being overweight, and obesity
are health issues that present during adolescence.
Encouraging healthy food intake and regular
physical activity for the adolescent and the family
promotes lifelong healthy behaviors (Ells et al., 2018).
Promoting Nutritional Health
With a Varied Diet
VEGETARIAN DIETS GLYCOGEN LOADING
• Because vegetables generally • is a procedure used to ensure
contain fewer calories than there is adequate glycogen to
meat, adolescents need to sustain energy through an
consume large amounts of them athletic event. Although used by
to achieve an adequate caloric many high school athletes, the
intake from a vegetarian diet. effects of frequent glycogen
loading in this age group are not
well studied and so should be
done cautiously.
PROMOTING DEVELOPMENT OF
AN ADOLESCENT IN DAILY
ACTIVITIES
Adequate sleep, hygiene, and
exercise are important health
education discussions for
adolescents, as these become
an adolescent's responsibility
rather than the responsibility
of their parents.
DRESS AND HYGIENE
Adolescents are capable of total
self-care and, because of their
body awareness, may be overly
conscientious about personal
hygiene and appearance.
Adolescents can be acutely aware
of how their peers dress.When
hospitalized, encouraging
adolescents to wear their own
clothing may improve their sense of
well-being.
CARE OF TEETH
Adolescents should continue to
practice oral care including flossing
and brushing at least twice a day
and receiving dental care every 6
months. They should continue to
use a fluoride paste and drink
fluoridated water in recommended
quantities (Fernando et al., 2019).
Adolescents with braces should
follow the instructions provided by
their orthodontist to prevent tooth
decay.
SLEEP
Although it is widely believed that everyone
needs 8 hours of sleep a night, some need
more and others can adjust to
considerably less.
In addition, with extracurricular activities
sometimes extending late into the evening,
demanding school requirements, and early
school start times, going to sleep early
enough to ensure adequate rest can be a
challenge (Bartel et al., 2015).
EXERCISE
Like younger children, adolescents
need daily exercise to maintain
muscle tone and cardiovascular
health. They should strive to
participate in aerobic exercise 30
to 60 minutes a day and perform
muscle-strengthening activities
three to four times a week on
alternate days.
SUN EXPOSURE
Adolescents, depending on their
geographic location and/or
preference for being outdoors,
may sustain sun exposure that puts
them at risk for skin damage and
possible skin cancer.
Avoiding the sun between the hours
of 10 a.m. to 2 p.m. in the summer
and using sunblock are important in
limiting the damage caused by sun
exposure.
COMMON HEALTH PROBLEMS OF
AN ADOLESCENT
Hypertension
Poor Posture
Body piercing and tattoos
Fatigue
Menstrual irregularities
Acne
Obesity
CONCERNS REGARDING
SEXUALITY AND SEXUAL
ACTIVITY
Adolescents who engage in sexual risk behaviors may
have unintended health outcomes, including
unplanned pregnancies and STIs including HIV. During
routine health assessments of adolescents and
preadolescents, this topic should be explored.
When discussing sexuality with adolescents, the nurse should avoid
assumptions about adolescents gender and sexual orientation. Ask
open-ended questions when providing education on health-
promoting behaviors. This may encourage dialogue that is more
open.
Information on date rape and rape prevention should be provided
as adolescents are in a high-risk age group for date rape (Banvard-
Fox et al., 2020)
One form of date rape occurs when flunitrazepam (Rohypnol) (i.e.,
the"date rape" drug"), a colorless, odorless, and favorless
benzodiazepine drug, is unknowingly added to a drink, causing
drowsiness, impaired motor skills, and amnesia for a time (De Sousa,
2019).
CONCERNS REGARDING HAZING
OR BULLYING
Bullying, which may begin during school age can easily continue into
adolescence and has the potential to become more serious as the bullied
child may retaliate through self-destructive behavior or school violence.
Hazing, a form of organized bullying, refers to demeaning or humiliating
rituals that prospective members undergo to be a member of a sorority,
fraternity, adolescent gang, or sports tam (Diamond et al., 2016).
Parents should be informed of this behavior and discuss it with their
adolescent child. They can inquire what clubs or organizations their
adolescent joins and become informed as to the requirements for
membership.
CONCERNS REGARDING
SUBSTANCE USE
DISORDER
Substance use disorder (formerly referred to as substance
abuse disorder) refers to the use of chemicals to affect or
in-fuence a mental state or induce euphoria. Drug use
during adolescence has a multitude of precipitating factors,
ranging from the desire to experiment or conform to
seeking relief from undesirable situations or symptoms.
There is a family component including genetic and
environmental aspects.
CONCERNS REGARDING
DEPRESSION AND
SELF- INJURY
• Self-injury includes a range of self-destructive actions from
cutting to suicide, the planned intent to end one's life. Cutting
is found more frequently in females than. males and can begin
in school-aged children (Griffin et al., 2018).
• Depression may first present during adolescence as the
adolescent adjusts to more complex life vents and they are
expected to become increasing y more independent (Huang et
al., 2017).
The reasons for adolescent suicide are varied:
•Incest
•maltreatment
•increased chemical dependency
•marital instability in the family
•poor problem-solving ability
are all posibly underlying factors that may lead an adolescent
Is decide that death may be easier than coping with
overwhelming problems.
CONCERNS OF THE
ADOLESCENT AND FAMILY WITH
UNIQUE NEEDS
Youth Who Are Experiencing
Homelessness
or Have Run Away
• A runaway is commonly defined as an adolescent
between the ages of 10 and 17 years who has been absent
from home at least overnight without permission of a
parent or guardian.
• Stress factors such as family unemployment, alcohol use
disorder, sexual maltreatment, incest, attempted suicide,
and poverty are characteristics in their families (Gewirtz
et al., 2020).
• They are slightly more likely to be male than female.
Adolescents With Chronic
Illnesses or
Physical Disabilities
Adolescents with chronic illnesses or physical
disabilities may have difficulties achieving
independence if they are dependent on others
for physical care and transportation. They
may not be able to attend school regularly
due to illness or hospitalizations and
therefore have gaps in education and social
interactions. They may need assistance in
making educational and career choices.
THANK
YOU VERY
MUCH!
