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Lecture 10

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Adolescence is the period between 12 and 18 to 20 years, a time that serves as a transition between childhood and adulthood.

It can be divided into an early period (13 to 14 years), a middle period (15 to 16 years), and a late period (17 to 20 years).

Physical Growth The major milestones of development in the

adolescent period are the onset of puberty and the cessation of body growth.

Adolescents both grow rapidly and mature dramatically during this period.

Weight: At first, the gain in physical growth is mostly in

weight, leading to the stocky, slightly obese appearance of prepubescence; later comes the thin, tall appearance of late adolescence.

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Individual gain about 30%-50% of adult weight during adolescence.

On average, girls gain between (15-55 Ib) (608-25 Kg). On the other hand: boys gain (15-65 Ib) (6.8-29.5 Kg).

Height: Growth stops with closure of the epiphyseal lines of

long bones. This occurs at about 16 or 17 years of age in females and about 18 to 20 years of age in males.

Individual achieve about 20%-25% of adult height in adolescence.

Girls grow 2-8 inches. And ceases at about age 16-17. boys grow 4-12 inches. And ceases at about age 18-

20.

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Pulse rate and respiratory rate decrease slightly (to 70 bpm and 20 breaths/min, respectively), and blood pressure increases slightly (to 120/70 mmHg), reaching adult levels by late adolescence

Teeth: Adolescents gain their second molars at about 13

years of age and their third molars (wisdom teeth) between 18 and 21 years of age.

Puberty: Puberty is the stage at which the individual first

becomes capable of sexual reproduction.

A girl has entered puberty when she begins to menstruate (12-18); a boy enters puberty when he begins to produce spermatozoa (14-20).

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Puberty: period of rapid physical maturation involving hormonal & bodily changes that occur primarily during early adolescence

Menarche: girl‘s first menstruation, occurs at approximately age 12 to 13, but has been declining an average of about 4 months per decade for past century

Key factor in puberty‘s occurrence is body mass-body weight approximating 106 (plus or minus 3 pounds) can trigger menarche

Puberty‘s determinants include nutrition, health, heredity & body mass.

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• The secondary sex characteristics that begin in the late school-age period continue to develop during adolescence.

Gender differences:

• Girls experience increase in height, weight, breast development, and pelvic girth with expansion of the uterine tissue. Menarche (onset of the menstrual period) typically occur about 2.5 years after puberty ‗s onset.

• Boys experience increase in height, weight, muscle mass, penis and testicle. Nocturnal emission of seminal fluid is an overt sign of puberty.

Secondary Sex Changes

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Tanner stages of Sexual maturity

A. Female breast development:

1- stage 1 is the prepubertal stage.

2- stage 2 is characterized by development of the breast buds.

3- stage 3 is characterized by further enlargement of the breast& areola with no separation of contours.

4- stage 4 is characterized by projection of areola & papillae to form secondary mounds.

5- stage 5 is characterized by adult configuration.

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Tanner stages of Sexual maturity

B. Male genitalia development:

1- stage 1 is the prepubertal stage.

2- stage 2 is characterized by enlargement of the scrotum & testes.

3- stage 3 is characterized by lengthening of the penis & further enlargement of the scrotum & testes.

4- stage 4 is characterized by an increase in the length & width of the penis.

5- stage 5 is characterized by adult configuration.

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Pubic hair (male & female) development:

1- stage 1 is the prepubertal stage.

2- stage 2 is characterized by sparse, long, straight downy hair.

3- stage 3 is characterized by darker, curly hair that is sparse over the entire pubis.

4- stage 4 is characterized by dark, curly, and abundant hair in the pubic hair in pubic area only.

5- stage 5 is characterized by an adult pattern.

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Developmental changes resulting from hormonal influences:

Body mass increase to adult size.

Sebaceous glands are activated.

Eccrine sweat glands become fully functional.

Apocrrine sweat glands undergo development.

Body hair is distributed in a characteristics adult-like pattern.

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Hormonal Changes

Hormones: powerful chemical substances secreted by endocrine glands & carried through body by bloodstream

Hypothalamus: structure in higher portion of brain that monitors eating, drinking & sex

Pituitary gland: important endocrine gland controls growth & regulates other glands

Gonads: sex glands - testes in males & ovaries in female

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Two primary classes of hormones

Androgens: male sex hormones

Estrogens: female sex hormones

Testosterone: androgen plays important role in male pubertal development

Estradiol: estrogen plays important role in female pubertal development

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Emotional DevelopmentDevelopmental Task: Identity Versus Role Confusion In late adolescence, the task is to form a sense of

intimacy or form close relationships with persons of the opposite as well as the same sex. It is the concentration on these two tasks that leads to typical adolescent behavior

The four main areas in which adolescents must make gains to achieve a sense of identity1. Accepting their changed body image2. Establishing a value system or what kind of person they

want to be3. Making a career decision4. Becoming uncontrolled by their parents

If young people do not achieve a sense of identity, they develop a sense of role confusion or can have little idea what kind of person they are

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Body Image Adolescents who developed a strong sense of

industry during their school-age years have learned to solve problems and are best equipped to adjust to their new body image.

Nurses who care for adolescents can do much to educate them about their bodies and help them to accept the changes that mark maturity.

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Self-Esteem Like body image, self -esteem may undergo major

changes during the adolescent years and can be challenged by all the changes that occur during adolescence, including:

1. Changes in one's body and physiologic functioning2. Changes in feelings and emotional focus3. Changes in social relationships ( including

relationships with both family and friends)4. Changes in family and school expectations

All of these factors can have an effect on an adolescent's feelings about himself or herself , sometimes resulting in crisis.

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Value System Adolescents develop values through talking to peers.

They also need an attentive adult ear , someone who will listen to their fears, hopes, dreams, and the pressure they feel to be somebody, the pressure of wanting to do something and yet not knowing what or how.

Career Decisions Part of the feeling of knowing what kind of person

you are is knowing what kind of job you can do.

Because of the thousands of opportunities available today, making a career decision becomes more and more difficult.

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Emancipation from Parents Emancipation from parents can become a major issue

during the middle and late adolescent years for two reasons. Some parents may not yet be ready for their child to be totally independent, and some adolescents may not yet be sure they want to be on their own.

They may fight bitterly for a right—for example, to stay out until midnight or later on a weekend—then never use the privilege once they have gained it.

Sense of Intimacy Once adolescents have achieved a sense of identity in

early or mid-adolescence, they are ready to work on a second developmental task, that of achieving a sense of intimacy (Erikson, 1993) . The ability to form intimate relationships is strongly correlated with the sense of trust , the first developmental task in infancy.

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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 (Piaget, 1969). This step involves the ability to think in abstract terms and use the scientific method to arrive at conclusions.

Moral and Spiritual Development Because adolescents enlarge their thought processes

to include formal reasoning, they are able to respond to the question, ―Why is it wrong to steal from your neighbor 's house?‖ with ―It would hurt my neighbor by requiring him to spend money to replace what I stole,‖ rather than with the immature response of the school -age

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Promotion of an Adolescent and Family

Promoting Adolescent Safety Accidents, most commonly those involving motor

vehicles, are the leading cause of death among adolescents.

Promoting Nutritional Health for an Adolescent Adolescents are experiencing so much growth they

may always feel hungry. If adolescents' eating habits are unsupervised, they tend to eat faddish or quick snack foods rather than more nutritionally sound ones because of both hunger and peer pressure. Some adolescents turn away from the five pyramid food groups to eat such great quantities of sweets, soft drinks, or empty-calorie snacks they are left poorly nourished despite their large intake.

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Promoting Development of an Adolescent in

Daily Activities

Maintaining adequate nutrition to support rapid adolescent growth is essential to continued healthy development

Adequate sleep, hygiene, and exercise are also important and should become an adolescent's responsibility rather than the parents'.

Parents can, however, encourage adolescents to engage in healthy patterns of living—primarily through role modeling.

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Dress and HygieneAdolescents are capable of total self-care and,

because of their body awareness, may even be overly conscientious about personal hygiene and appearance.

SleepAlthough it is widely believed adults need 8 hours

of sleep a night, some need more and others can adjust to considerably less. Protein synthesis occurs most readily during sleep. Because adolescents are building so many new cells, adolescents may need proportionately more sleep than school -age children during this time.

ExerciseAdolescents need exercise every day both to maintain

muscle tone and to provide an outlet for tension.

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Common Health Problems of an Adolescent

Poor Posture Many adolescents demonstrate poor posture, a

tendency to round shoulders and a shambling, slouchy walk. This is due in part to the imbalance of growth, the skeletal system growing a little more rapidly than the muscles attached to it .

Poor posture particularly seems to develop in adolescents who reach adult height before their peers. They slouch to appear no taller than anyone around them.

Girls, especially, may slouch to diminish the appearance of their breast size if they are developing more rapidly than their friends.

This also can occur from carrying backpacks that are too heavy.

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Body Piercing and Tattoos

Body piercing and tattoos are becoming a mark of adolescence. Both sexes have ears, lips, chins, navels, and breasts pierced and filled with ear rings, or tattoos applied to arms, legs, or their central body.

These acts have become a way for adolescents to make a statement (― I am different from you‖). Be certain they know the symptoms of infection at a piercing or tattoo site ( redness, warmness, drainage, swelling, mild pain) and to report these to a health care provider if they occur.

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Fatigue

So many adolescents comment they feel fatigued to some degree that this can be considered normal for the age group.

Because fatigue may be a beginning symptom of disease, however , it is important it be investigated as a legitimate concern and not underestimated.

Assess an adolescent's diet, sleep patterns, and activity schedules, because all can contribute greatly to fatigue.

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Menstrual Irregularities Menstrual irregularities can be a major health

concern of adolescent girls as they learn to adjust to their individual body cycles.

Dysmenorrhea is painful menstruation. it was thought to be mainly psychological, needing no treatment other than reassurance that it was a normal phenomenon and something women should endure.

Today, it is known that the pain is caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle . Prostaglandin release causes smooth muscle contraction in the uterus.

Dysmenorrhea can also be a symptom of an underlying illness such as PID, uterine myomas (tumors), or endometriosis (abnormal formation of endometrial tissue).

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Management of dysmenorrheal

Warm bath

Heating pads applied to abdomen

Exercise

Good posture

Mild analgesic

Diuretics to relieve fluid retention

Psychotherapy

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Pre menstrual syndrome: immediately preceding menstruation as:

Nervous tension Depression Irritability Leg pain Depression Anxiety Headache Tender abdomen and breast These symptom lead to poor achievement in school&

emotional upset

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Acne Acne is a self -limiting inflammatory disease that

involves the sebaceous glands that empty into hair shafts ( the pilosebaceous unit ), mainly of the face and shoulders.

It is the most common skin disorder of adolescence, occurring slightly more frequently in boys than girls. The peak age for the lesions to occur in girls is 14 to 17 years; for boys, 16 to 19 years.

Although not proven, genetic factors may play a part in their development .Cigarette smoking may also increase the number of inflammatory lesions.

Therapeutic Management The goal of therapy for acne is threefold: (1)

decrease sebum formation, (2) prevent comedones, and (3) control bacterial proliferation.

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Obesity

Most overweight adolescents have obese parents, suggesting that both inheritance and environment play a part in the development of adolescent obesity.

Most obese adolescents continue to be obese adults. It can be difficult for adolescents to learn to like themselves (achieve a sense of identity) if they do not like their reflection in a mirror.

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Substance abuse:

refers to the use of chemicals to improve a mental state or induce euphoria.

This is so common among adolescents that as many as 50% of high school seniors report having experimented with some form of drug use occurs in adolescence from a desire to expand consciousness or to feel more confident and mature

it also can be a response to peer pressure or a form of adolescent rebellion. This type of rebellion is more emotionally charged than acts such as staying out late or wearing clothing other than those approved by parents, because it is not only harmful but also illegal.

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Assessment of Substance Abuse

If adolescents trust health care personnel, they will generally admit they have engaged in drug experimentation. Some common findings on the health history that suggest an adolescent is abusing some substance are:

1. Failure to complete assignments in school2. Demonstration of poor reasoning ability3. Decreased school attendance4. Frequent mood swings5. Deteriorating physical appearance6. Recent change in peer group7. Expressed negative perceptions of parents

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Concerns Regarding Attempted Suicide

Leading Causes of Death in Adolescence.

3 leading causes of death in adolescence: accidents, suicide, & homicide

Suicide is deliberate self -injury with the intent to end one's life. Successful suicide occurs more frequently in males than in females, although more females apparently at tempt suicide than males (about 8:1) .

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Sexually Transmitted Diseases

Teenagers tend to believe that:

Sexually transmitted diseases (STD) always happen to someone else.

STDs can be easily cured without any harm done

STDs are too horrible for a nice young person to even hear about.

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Eating Disorders

Eating disorders are complex, involving genetic inheritance, physiological factors, cognitive factors & environmental experiences

Anorexia nervosa: is disorder that involve voluntary refusal to eat, accompanied by sever loss of body weight without an organic cause

Bulimia: individual consistently follows binge-and-purge eating pattern.( episodes of binge eating , followed by self – inducing vomiting