Chapter 33 summary

Nursing Care of a Family with an Adolescent

Definition and Age Range

 Adolescence: A transitional period typically from ages 13 to 18 or 20, characterized by

significant physiological, psychological, and sociological changes.

Subdivisions of Adolescence

1. Early Adolescence: Ages 13-14

2. Middle Adolescence: Ages 15-16
3. Late Adolescence: Ages 17-20

Key Characteristics

 Physical, Psychological, and Sociological Changes: Adolescents undergo substantial

changes affecting their appearance and emotional state, influenced by societal and
parental expectations.

Pressures and Dilemmas

 Navigating Maturity: Adolescents face pressures related to sexual exploration,

independence, and parental expectations, leading to conflicts that may affect their
development.

Growth and Development of Adolescents

Growth Period
  Adolescents experience rapid growth from ages 13 to 20, including significant weight
and height changes.

Physical Growth Milestones

1. Onset of Puberty: Between ages 8 and 12.

2. Cessation of Growth: Typically around 16 to 20 years.

Growth Patterns

 Early Growth: Initial weight gain during prepubescence leads to a stockier appearance.
 Late Growth: Transition to a taller, thinner physique; significant height and weight
variations between genders.

Height and Weight Changes

 Girls:
o Height gain: 2 to 8 inches (5 to 20 cm).
o Weight gain: 15 to 55 lbs (7 to 25 kg).
o Stop growing about 3 years after menarche.
 Boys:
o Height gain: 4 to 12 inches (10 to 30 cm).
o Weight gain: 15 to 65 lbs (7 to 30 kg).

Physiological Changes

 Slower growth of heart and lungs may lead to fatigue.

 Vital signs shift: Decreased pulse (70 bpm), respiratory rate (20 breaths/min), and
increased blood pressure (120/70 mmHg).

Skin and Dental Development

 Skin Changes: Increased acne and body odor due to gland activity.
  Dental Development: Second molars erupt by age 13; wisdom teeth can appear from 18
to 21, requiring monitoring for space and pain.

Puberty

 Definition: The phase of sexual maturity beginning with menstruation in girls and sperm
production in boys.

Secondary Sex Characteristics

 Development of body hair and other secondary sexual characteristics, evaluated through
Tanner stages.

Social Changes

 Shift from active games to adult leisure activities.

 Increasing importance of peer interactions and part-time employment for responsibility
and social skills.

Emotional Development

Erikson’s Stages

 Early and Mid-Adolescence: Struggle with identity vs. role confusion.

 Late Adolescence: Focus shifts to intimacy vs. isolation.

Early Adolescent Developmental Tasks

 Identity Formation: Essential for developing self-concept, body image, values, and
career aspirations.
 Consequences of Role Confusion: Potential for poor decision-making and negative self-
perception.
Late Adolescent Developmental Tasks

 Intimacy Development: Emphasizing the importance of meaningful relationships and

empathy.
 Isolation Risks: Lack of intimate relationships can lead to feelings of loneliness.

Social Interaction Dynamics

 Friendships evolve from superficial "crushes" to deeper connections as adolescents

mature. Romantic relationships often focus on physical attraction but can lead to
emotional distress during breakups.

Cognitive Development

Formal Operational Thought

 Begins around age 12; characterized by the ability to think abstractly and use deductive
reasoning.

Problem-Solving and Future Planning

 Adolescents develop the capacity to analyze situations and consider the implications of
their choices regarding their future.

Moral and Spiritual Development

 Moral Reasoning: Expansion of understanding regarding the impacts of decisions on

others, allowing for more sophisticated discussions on ethics.
 Questioning Beliefs: Adolescents often re-evaluate their religious beliefs as part of their
personal identity formation.
Health Promotion for Adolescents and Families

General Health Promotion

1. Need for Guidance: Adolescents often lack judgment skills, making external guidance
essential for their well-being.
2. Key Discussion Topics:
o Safety: Importance of understanding safety measures to mitigate risks.
o Nutrition: Guidance is crucial for healthy eating to support growth and
development.
o Daily Care: Discussions should cover self-care practices to promote overall
health.
3. Health Care Visits: These visits provide a platform for open conversations between
healthcare providers, adolescents, and families about health and safety matters.

Promoting Adolescent Safety

1. Unintentional Injuries: Leading cause of death among adolescents, primarily due to

motor vehicle accidents.
o Teens often engage in risky behaviors like speeding and reckless driving to assert
independence or seek attention.
2. Driver Safety: Emphasize emotional maturity in determining readiness for driving rather
than just age. Adhere to graduated licensing requirements.
3. Seat Belt Usage: Consistent education is needed to stress the importance of seat belts for
safety.
4. Motorcycle and Scooter Safety: Although appealing due to convenience, they pose
safety risks. Always wear helmets and protective clothing.
5. Water Safety: Teach adolescents essential practices, like never swimming alone or when
fatigued, to prevent drowning.
 6. Mental Health and Violence: Homicide and suicide are significant death causes,
influenced by factors like depression and exposure to violence. Education on gun safety
is crucial.
7. Firearm Safety: Teach adolescents about firearm safety through engaging problem-
solving methods.
8. Athletic Injuries: Increased focus on health education can minimize unintentional
athletic injuries.

Promoting Nutritional Health for Adolescents

1. Growth Necessities: Adolescents need supervised meals to ensure proper nutrition

during rapid growth phases and to avoid unhealthy snack choices.
2. Nutritional Risks: Poor food choices can lead to obesity; rebelliousness towards healthy
foods can pose challenges.
3. Parental Involvement: Parents can encourage healthy eating by stocking nutritious
foods and involving adolescents in meal planning.
4. Weight Management: Supervision is necessary to prevent unhealthy dieting practices,
which can lead to eating disorders.
5. Nutrient Needs: Essential nutrients include iron, calcium, vitamin D, and zinc to support
growth and development.
6. Vegetarian Diet Considerations: Vegetarian teens should ensure adequate protein
intake while being mindful of social interactions during meals.
7. Glycogen Loading for Athletes: Athletes may perform better with higher carbohydrate
intake, and appropriate management of this process is necessary.

Promoting Development of an Adolescent in Daily Activities

1. Daily Health Activities: Adolescents must take responsibility for their health
management, including sleep, hygiene, and exercise.
 2. Dress and Hygiene: Self-care routines become important, reflecting their identity;
attention to peer influence is crucial.
3. Dental Care: Strong emphasis on oral hygiene is vital, along with specific care for
braces if applicable.
4. Sleep Needs: Adolescents typically require more than 8 hours of sleep, and quality sleep
can significantly impact their health.
5. Exercise: Regular physical activity is essential, and adolescents often underestimate their
exercise needs. Structured sports can help combat sedentary behaviors.
6. Sun Exposure: Adolescents need to be educated about skin protection to prevent damage
and skin cancer.

Promoting Healthy Family Functioning

1. Independence and Family Dynamics: Early adolescents may challenge parental

authority as they seek independence. Understanding these dynamics is crucial.
2. Parental Challenges: Parents should empathize with their adolescent's experiences and
provide guidance.
3. Changing Perspectives: As adolescents grow, they may reevaluate their relationships
with authority figures, which can affect their performance.
4. Senior Year Transition: Anticipation of changes can lead to anxiety; maintaining family
traditions can provide comfort during transitions.
5. Risky Behaviors: Some older adolescents may experiment with drugs or alcohol,
mistakenly viewing this as a rite of passage.

Common Health Problems of Adolescents

1. Regular Health Maintenance: Regular assessments are crucial to monitor health issues
like hypertension, poor posture, body modifications (piercings/tattoos), fatigue, menstrual
irregularities, and acne.
 2. Obesity Issues: Recognizing the impacts of obesity on self-esteem and social interaction
is vital, with nutrition education and psychological counseling as potential interventions.
3. Sexuality and Sexual Activity: Increased engagement in high-risk behaviors necessitates
discussions about safe practices, sexual orientation, and the need for support and
counseling.
4. Stalking: Awareness of stalking behaviors and providing strategies for adolescents to
protect themselves is essential for personal safety.

Concerns Regarding Hazing, Bullying, Substance Abuse, and Unique Needs

Among Adolescents

Overview of Bullying and Hazing

 Bullying: Often begins in childhood and can escalate during adolescence, leading to
increased risks of self-destructive behavior and potential retaliatory actions, such as
school violence.
 Hazing: A form of organized bullying that includes humiliating rituals for new members
of various groups (e.g., sororities, gangs, sports teams). Historically viewed as a rite of
passage, it has evolved into increasingly dangerous practices that include physical abuse,
psychological stress, and alcohol misuse.

Nature of Hazing Rituals:

 Hazing may involve forced clothing, demeaning behaviors, physical violence,

psychological stress from isolation, and alcohol abuse, potentially leading to severe
consequences including death or illegal activities.

Prevention and Awareness:

 Parents should monitor organizations their adolescents join and engage in discussions
about hazing practices to ensure safe choices.
Concerns Regarding Substance Abuse in Adolescents

 Definition: Substance abuse involves using chemicals to improve mood or induce

euphoria, with about 50% of high school seniors reported experimenting with drugs.

Stages of Drug Use:

1. Experimentation
2. Regular Use

Types of Abused Substances:

1. Prescription and Over-the-Counter Drugs: Pharming, methylphenidate abuse,

inhalants, and “bath salts.”
2. Alcohol: Up to 90% of seniors have consumed it; physical and mental health risks are
associated with episodic heavy drinking.
3. Tobacco: Significant number of adolescents using cigarettes, cigars, or smokeless
tobacco, influenced by perceived maturity and peer pressure.
4. Performance-Enhancing Drugs: Such as anabolic steroids and human growth hormone,
which can lead to severe health risks.
5. Marijuana: The most commonly abused illicit drug among high schoolers, noted for its
psychoactive properties and long-term health impacts.
6. Amphetamines and Cocaine: Both are known for their addictive and harmful effects on
physical and mental health.
7. Hallucinogens: Drugs like LSD and ecstasy cause distortions in perception.
8. Opiates: Increasing usage among adolescents, posing significant risks of addiction and
overdose.

Assessment of Substance Abuse:

 Trust in healthcare providers encourages disclosure about substance use, and behavioral,
medical, and physical indicators can help identify potential abuse.
Concerns Regarding Depression and Self-Injury

 Self-Injury and Suicide: Self-destructive behaviors frequently occur during adolescence.

Suicide is the third leading cause of death in this age group, with particular timing
correlating with school stress.

Factors Contributing to Depression and Suicide:

 Achievement pressures, relationship issues, and family dynamics can lead to suicidal
thoughts, with differences in behavior among genders noted.

Assessment:

 Healthcare providers should conduct thorough evaluations during health maintenance

visits, noting behavioral changes and seeking input from family and friends on warning
signs of suicidal intent.

Intervention and Care:

 Focus on comprehensive support and ongoing therapeutic care tailored to the needs of at-
risk adolescents.

Concerns of Adolescents and Families with Unique Needs

1. Homeless or Runaway Youth:

o Characterized by being absent from home without permission; often linked to
significant family stressors.
o Young runaways face health risks such as STDs and substance abuse and require
sensitive healthcare approaches.
o Support through relevant resources like crisis hotlines and fostering
communication about family dynamics is essential.
2. Physically Challenged or Chronically Ill Adolescents:
o Identity challenges arise as these adolescents often define themselves by their
health conditions.
o Feelings of exclusion and depression are common due to their conditions and can
lead to substance abuse.
o Support strategies include nurturing their aspirations, promoting independence in
nutrition, and reinforcing a sense of self-worth.