Chapter 020 lo

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  • Define secondary sex characteristics.
  • Give examples of each task listed. Give examples of major challenges.
  • What is an example of a parental/adolescent conflict?
  • Give an example of a situation which explains each of these characteristics: Erikson’s stage of intimacy Piaget’s abstract reasoning Freud’s genital stage
  • Define puberty.
  • Discuss the differences among early, middle, and late adolescence regarding growth, behavior, peers, family, and cognitive development.
  • When should testicular self-examination begin? What is the nurse’s role regarding this education?
  • Compare and contrast the changes for both boys and girls.
  • Discuss the importance of wearing a properly fitting bra. Discuss the importance of breast self-examination.
  • How does an adolescent’s identity fluctuate at this stage in life? Give an example of a situation in which an adolescent learns by trial and error. In what cultural and spiritual situations might an adolescent distance himself or herself from the family?
  • Give an example of how an adolescent develops cognitively from early, middle, and late development.
  • What is abstract thinking? How would an adolescent exhibit acceptance of differing values and actions?
  • Discuss how peer relationships change from childhood to adolescence. Give an example of a situation in which an adolescent might learn from a personal, intimate relationship.
  • Which traits could assist an individual toward a career? Give an example of a parent/adolescent situation in which the parent encourages a talent.
  • Discuss the parent’s role in assisting the adolescent to become responsible.
  • Discuss how daydreaming helps the adolescent anticipate and cope with real situations. Audience Response Question #1 Daydreams assist the adolescent to: 1. improve school performance. 2. try on different roles. 3. communicate effectively. 4. All of the above 5. None of the above
  • Give an example of group dates. How does dating provide psychosocial development?
  • Discuss how sexual behavior can affect growth and development.
  • How can the nurse’s biases hinder sex education? Give an example of coping skills appropriate for this age group.
  • In what ways can parents enhance an open dialogue with an adolescent? Give an example of how parents can hinder open communication with an adolescent.
  • What are typical dietary deficiencies for the adolescent? Discuss how parents can ensure their adolescent is receiving essential nutritional elements.
  • Discuss the importance of protein intake in the vegetarian diet and the adolescent involved in sports.
  • Discuss the adolescent’s focus on body image and the potential lack of concern for skin cancer.
  • In what ways can adolescents drive more safely? Discuss the importance of routine sports examinations.
  • What are signs and symptoms of eating disorders?
  • Give an example of a situation in which the school nurse provides substance abuse information to the adolescent and the parent.
  • Discuss the assessment of the acronym PACE. Give an example of a situation which corresponds to each letter.
  • Give an example of a situation in which there has been a change in the adolescent’s behavior which could be a warning sign of depression. What could be warning signs regarding the threat of suicide?
  • Give an example of a situation in which the school nurse must assess and intervene with a depressed adolescent.
  • Discuss the risk factors associated with age and the pregnant adolescent.
  • Chapter 020 lo

    1. 1. Chapter 20The Adolescent
    2. 2. Objectives• List major physical changes that occur during adolescence.• Identify two major developmental tasks of adolescence.• Discuss three major theoretical viewpoints on the personality development of adolescents.• List five life events that contribute to stress during adolescence.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2
    3. 3. Objectives (cont.)• Describe Tanner’s stages of breast development.• Describe menstruation to a 13-year-old girl.• Identify two ways in which a person’s cultural background might contribute to behavior.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3
    4. 4. Objectives (cont.)• Discuss the importance of peer groups, cliques, and best friends in the developmental process of an adolescent.• List three guidelines of importance for the adolescent participating in sports.• Summarize the nutritional requirements of the adolescent.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4
    5. 5. Objectives (cont.)• Discuss two main challenges during the adolescent years to which the adolescent must adjust.• List a source of planning sex education programs for adolescents.• Discuss the common problems of adolescence and the nursing approach.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5
    6. 6. General Characteristics• Appearance of secondary sex characteristics• Ends with cessation of growth and emotional maturity• Divided into early, middle, and late because of the changes that occur between 13 and 18 years of ageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6
    7. 7. General Characteristics (cont.)• Major tasks • Major challenges – Establishing an – Adjusting to rapid physical identity and physiological changes – Separating from – Maintaining privacy family – Coping with social – Initiating intimacy stresses and pressures – Developing – Maintaining open career choices communications for economic – Developing positive health independence care practices and lifestyle choicesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7
    8. 8. General Characteristics (cont.)• Surge toward independence more pronounced• Difficult for adolescent to get along with parents• Bodies rapidly changing• Experience intense sexual drives• Conformity one of strongest needs of adolescents in societyElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8
    9. 9. General Characteristics (cont.)• Erikson: intimacy stage• Piaget: abstract reasoning• Freud: genital stageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9
    10. 10. Growth and DevelopmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10
    11. 11. Physical Development• Adolescence begins in girls 10-13 years of age – Marked by rapid changes in structure and function of various body parts – Distinguished by puberty • During childhood, boys and girls produce somewhat equal amounts of androgens and estrogen – Hypothalamus signals pituitary gland to stimulate other endocrine glands to secrete hormonesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11
    12. 12. Physiological ChangesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12
    13. 13. Physical Development (cont.)• Age of puberty varies• Occurs earlier in girls than boys• Growth spurt occurs by 18 years• Major cause of weight gain is due to increased skeletal massElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13
    14. 14. Physical Development (cont.)• General appearance tends to be awkward• Long-legged and gangling (asynchrony) because different body parts mature at different rates• Sweat glands very active• Oily skin and acne commonElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14
    15. 15. Boys• Puberty begins with hormonal changes between 10 and 13 years of age• Hair begins to grow on face, chest, axillae, and pubic areas• Shoulders widen, pectoral muscles enlarge, voice deepens• Genitals increase in size, pigment changes occur, erection and nocturnal emissions• Important to teach testicular self-examinationElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15
    16. 16. Tanner’s Stages of Sexual MaturityElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16
    17. 17. Girls• Pubertal changes occur 6 months to 2 years before they occur in boys• Easily recognized in girls by onset of menstruation, called menarche• Commonly occurs around 12 to 13 years• Fat is deposited in hips, thighs, and breasts• Energy balance, activity, and nutrition are important factors to evaluate when menstruation is delayedElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17
    18. 18. Psychosocial Development• Sense of identity • Cultural and spiritual – Fluctuates during considerations adolescence – Good of family takes – Molded by demands precedence over personal from a variety of people goals• Sense of intimacy – Focus on values and ideals – Closely entwined with of family resolving of a person’s – Decide to either embrace sense of identity or separate from family – Period of trying and values and ideals testing • Realistic body image – Need practice in making – Believe everyone is looking decisions at them – Take pride in their abilities – Every effort is made to be like peers Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18
    19. 19. Cognitive Development• Piaget – Development is systematic, sequential, and orderly – Still in concrete phase of thinking – By middle adolescence, ability to think abstractly has increased – Stage of formal operationsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19
    20. 20. Cognitive Development (cont.)• Older adolescents can see situations from many viewpoints• Abstract thinking emerges• Nurse must focus on concrete issues and concerns when teaching early adolescents• Able to sympathize and empathize• Can understand their own values and actions• Can understand and accept differing values and actions from othersElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20
    21. 21. Peer Relationships• Help adolescents feel like they belong• School assumes important role• Belonging to a group is extremely important• Cliques form• Develops close personal relationship with one peer of the same sex – Vitally important in helping adolescents define themselves – Social norms and pressures exerted by peers may cause problemsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21
    22. 22. Career Plans• To choose a career that is best-suited for them, they must first know themselves• Parents should observe interests of their children and encourage them to take advantage of their talents• School guidance counselor administers aptitude tests• To be happy in career choice, adolescent must choose it of their own free willElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
    23. 23. Responsibility• Parents must encourage their children to take on new challenges – Working – Driving• Must be taught value of money – Teach adolescent how to use and balance a checkbookElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23
    24. 24. Daydreams• Most of this behavior is normal and natural for this age group• Usually considered harmless• Also a valuable safety valve for the expression of strong feelingsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24
    25. 25. Sexual Behavior• Must meet and become acquainted with members of opposite sex• Dating – Groups – Couples – Single-coupleElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25
    26. 26. Sexual Behavior (cont.)• Sexual experimentation often occurs as a response to peer pressure• Can affect growth and development• Unplanned pregnancy and STIs are two major complications of adolescent sexual interaction, because few use protectionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
    27. 27. Sex Education• Challenging for the adolescent• Should be presented as age-appropriate• Coping skills for dating and sexuality, pregnancy, and birth can be reviewed• Abstinence and contraception are also discussed• Decision-making is emphasizedElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27
    28. 28. Sex Education (cont.)• Studies have shown that adolescents who obtain early sex education information from caring parents or well-informed adults do not have a higher rate of sexual activity• Concerns about being different – Sexual maturity not same as peers• Homosexuality – Behavior not uncommon in adolescenceElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28
    29. 29. Parenting• Can be difficult for parents to cope with adolescents• Some parents are unsure of their own opinions and may hesitate to exert authority• Adolescents need to talk about their fears• Need assistance in sorting out confused feelings• Important to keep lines of communication openElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29
    30. 30. Health Promotion and GuidanceElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30
    31. 31. Health Promotion• Adolescent warning signs and need for intervention – Spends time on the computer in the early hours of the morning – Changes the screen on the computer when a parent enters the room – Has pornographic material on the computer – Makes frequent long-distance callsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
    32. 32. Nutrition• Dietary deficiencies are more common• Nutritional requirements are more strongly correlated with sexual maturity ratings than with age• Skipped meals, more between-meal snacks, eats out more• Elements most likely to be inadequately supplied are calcium, iron, vitamin B12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32
    33. 33. Nutrition (cont.)• Vegetarian Diet – High intake of grains, bran, and foods rich in oxalic acid can impair absorption of iron• Sports and Nutrition – Athletes exhaust reserves of muscle glycogen – Eating a slowly absorbed glucose source will prevent the development of chronic low muscle energy stores – Caffeine and alcohol deplete body water and are should be avoided – Anabolic steroids are detrimental to bone growthElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33
    34. 34. Personal Care• Hygiene – Bathing is more frequent because of body changes – Body piercings• Dental Health – At risk for dental caries because of inadequate dental maintenance and snack foods – Lack of hygiene fosters growth of plaque and accumulation of food particles• Sunbathing – Important to teach and enforce the need for adequate sun protection to prevent skin cancer – Also need to protect eyes from prolonged exposure to sunElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34
    35. 35. Safety• Road and off-road motor vehicle accidents (MVAs) kill and cripple adolescents at an alarming rate• Preventing MVAs is of utmost importance• Learning how to swim and practice water safety are important• Body contact sports can be hazardous• Encourage the adolescent to wear appropriate protective gearElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35
    36. 36. Safety (cont.)• Female athlete triad – Nurse should assess for • Eating disorder • Amenorrhea • OsteoporosisElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36
    37. 37. Common Problems of AdolescenceElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37
    38. 38. Substance Abuse• Best weapon against drug addiction is education• The need to conform, to be accepted, peer pressure, and the emotional depression that often occur are strong influences for drug experimentation and useElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38
    39. 39. Substance Abuse (cont.)• Adolescents are prone • If two or more of the to mood swings as they PACE letters are adjust to the physical problem areas, the and psychological adolescent may be at changes risk for drug abuse• Nursing assessment for • Appropriate referrals – P—parents, peers, pot should be made – A—alcohol, automobiles – C—cigarettes – E—education Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39
    40. 40. Depression• Drug use can precede the development of depression• A change in school performance, appearance, or behavior can be a warning sign of depression• A threat of suicide is a call for help that must be taken care of without delayElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40
    41. 41. Depression (cont.)• The school nurse can help by – Recognizing the depression – Encouraging open communication – Posting the numbers of available hotlines – Identifying appropriate mechanisms – Providing professional referralsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41
    42. 42. Adolescent Pregnancy• Occurs while the girl is still struggling to deal with developmental issues• Some risk factors are – Age at which the pregnancy occurs – Nutritional intake – Sexual activity – Limited access to health careElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42
    43. 43. Adolescent Pregnancy (cont.)• Tasks of an unplanned pregnancy can be broken down into trimesters – First—confirmation of the pregnancy – Second—focus on newborn as real – Third—preparation for newborn and birth processElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 43
    44. 44. The Nursing Approach to Adolescents• Open lines of • Adolescent hostility may communication be due to fear of unknown• Enable them to feel • Rebellion may be an at ease before effort at grasping initiating care or independence teaching • Guide parents concerning• Provide for privacy the need to listen,• Ensure understand, and share confidentiality and with their adolescent respectElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 44
    45. 45. The Nursing Approach to Adolescents (cont.)• Health care teaching should include – Nutrition – Dental care – Personal care – Body piercing care – Accident prevention – Substance abuse – Self-control – Risk-taking behaviors – Money and time management – Use of open-ended questionsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 45
    46. 46. Question for Review• What are some challenging developmental tasks during adolescence?Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 46
    47. 47. Review• Objectives• Key Terms• Key Points• Online Resources• Critical Thinking Question• Review QuestionsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 47

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