Growth and Development of Adolescent

CHILD HEALTH NURSING
GROWTH AND DEVELOPMENT OF ADOLESCENT.
Presented By-
Miss . Alisha Parker
MSc Nursing
Vijay Singh Mohite Patil
College of Nursing and Medical Research Institu
Akluj.

INTRODUCTION :
 Growth : growth is a process of physical maturation
result is an increase in size of body and various organ ,
occur by multiplication of cell and increase intracellular
substance.
 Development : development is the process of functional
and physiological maturation of individual characterized
by progressive increase in skill and capacity to function.
 Adolescence : Adolescence is a period of transition
between childhood and adulthood , a time of rapid
physical , cognitive , social and emotional maturation as
boy prepare for manhood and girl prepared for
womanhood.

 Puberty : puberty refers to maturational , hormonal and
growth process that occurs when the reproductive organs
begin to function and the secondary sexual
characteristics develop.
 This process divided into 3 stages :
1 .Pre pubescence (early adolescence) :
 In this stage the child develop preliminary physical
changes that add sexual maturity.
Girls : 10 – 12 years
Boys 12 – 14 years.

2 .Puberty : (middle adolescence)
 It is the when the girl begin to menstruate and boy
to produce spermatozoa.
Girls: 12 – 14 years
Boys: 14 – 16 years
3 .Post pubescent (late adolescence)
It is the period in which skeletal growth is completed
and reproductive function become fairly established
, somatic growth is completed and individual is
psychologically mature, capable of becoming a
contributing member of society.
Girls: 14-18 years
Boys:16-20 years

TYPES OF DEVELOPMENT IN
ADOLESCENT CHILD
 Biological development
 Psychological development
 Intellectual development
 Social development
 Spiritual development
 Psychosexual development
 Moral development

1 . BIOLOGICAL DEVELOPMENT :
1. Hormonal Changes in puberty.
2.Sexual maturation.
3.Physical Growth.

 The physical change in puberty are result of
hormonal activity by CNS.
 The physical change are increased physical growth
and in appearance and development of sexual
characteristics.
 Primary sex characteristics are external and
internal organs that carried out reproductive
functions { eg. Ovaries, breast , uterus , penis}
 Secondary sex characteristics are changes that
occur throughout body as result of hormonal
changes{ eg voice alterations , development of
facial and pubertal hair , fat deposit.}

A . HORMONAL CHANGE IN PUBERTY
 The event of puberty are caused by hormonal
influence and controlled by anterior pituitary in
response to stimulus from hypothalamus.
 Stimulus of gonad function is to produce and
release Gamates and secretion of appropriate
hormones.
 The ovaries ,testis and secrete adrenal sex
hormones like estrogen , progesterone and
testosterone.
 Estrogen is a feminizing hormone found low during
childhood secreted more until age of 11 years. It
remains high at maximum level throughout the
reproductive life of female.

 Androgen is a masculinizing hormone found low in
childhood and gradually increased upto 7 -9 years
of age in both sexes then upto 15 years in boys .
 With beginning of testicular function the level of
androgen mainly testosterone in male increased
that in female and continues to increased till
maturity is attained.

B. SEXUAL MATURATION
 Sexual maturation in girls –
 Breast changes - appearance of breast buds
occurs between 9 to 13 1/2 years of age.
 Pubic hair growth – after 2 – 6 months of breast
changes hair growth starts on monspubis.
 Menarche – age is 10 1/2 to 15 years with average
age being 12 year.
 Ovulation and regular menstrual periods occurs 6 -
14 months after menarche.

 Sexual maturations in boys -
 Enlargement of testicles by thinning , reddening and
increased looseness of scrotum.
 Occurs between 9 – 14 years.
 Pubic hair – early puberty is characterized by initial
appearance of pubic hair.
 Penile enlargement begins and testicular enlargement
and pubic hair growth continue through mid puberty.
 Gynecomastia are common in midpuberty and
disappears within 2 years.
 The spurt in height and weight is seen towards end of
midpuberty.
 By late puberty definite increase in length and width of
penis , testicular enlargement and first ejaculation
occurs.
 Axillaries hairs develops and facial hair over anterior
neck, final voice changes occurs secondary to growth of
larynx.

C . PHYSICAL GROWTH :
 Along with sexual maturation there is dramatic
increases in growth.
 The 20 – 25 % of height achieved during puberty
and most growth occurs during 2 – 3 years period
adolescent growth spurt.
 The growth spurt begins earlier in girls between 10
years and 16 years in boys.
 The height of boys is 10 – 30 cm and gain weight
7 -30 kg.
 The growth spurt is slower in girl , gains weigh- 7 –
25kg and height 5 – 20 cm.
 Growth and height stops 2-2.1/2 year after
menarche in girls and 18 to 20 years in boys.

 The increase in size is acquired in characteristics
sequence.
 Growth in length of extremities an neck.
 The hand and feet appear larger than normal in
adolescence .
 Increase in hip and chest breadth takes place after
few month then increase shoulder width. It is
followed by increase in length of trunk and depth of
chest.
 Due to hypertrophy of laryngeal mucosa an
enlargement of larynx and vocal wides there are
voice change of both boys and girls.
 Girls voice become slightly deeper and fuller.
Boys voice shifts from deep to high tone in middle
of sentence.

Growth of lean body mass especially of muscles occurs
after bone growth spurts takes place steadily during
adolescence.
 Lean body mass in both quantitatively and qualitatively
greater than in boys than in females.
 Muscles become well developed in boys whenever in
girls muscles mass is proportionate to general tissue
growth.
 Non lean body mass i.e. fat mass is also increased.
 In boys there may be increased in cutaneous fat just
before skeletal growth spurt.
 Later are variable amount of fat deposit to fill out and
contour mature physique in pattern characteristics of the
adolescent sex, especially in region over things , hips
,buttocks around breast tissue.

 Hormonal influence during puberty causes acceleration
in growth and maturation of skin and its structural
appendages.
 Sebaceous gland become extremely active , especial
those on genitalia and in “flush areas” of body’s i.e face ,
neck, shoulder, upper back, and chest.
 Heavy sweating appears more in girls than boys.
 Body hair assumes characteristic distribution patterns
and changes texture during puberty.
 Due to gonadal and adrenal androgens hair coarsens
darkens and lengthens at site related to secondary
sexual characteristics.
 Pubic hair are more extensive in male than in females.
 Beard , mustache and body hair on chest, upward along
the linear abs and other areas like back shoulder appear
in male .
 Extremity hair also grows in both male and female but
mores in males.

Early adolescent
• Height -
• M-154-172cm
F -151-167
• Weight -
• M- 38-60kg
• F- 40-60kg
• Pulse- 65-73/min
• Resp – 19-23/min
• BP -
• M 114 – 68 mmhg
• F 112 -62 mmhg
Middle adolescent
• Height -
• M - 164-180cm
• F 155-169
• Weight -
• M- 50-60g
• F- 42-64kg
• Resp – 17-20/min
• BP -
• M 116– 70 mmhg
• F 114-70 mmhg
Later adolescent
• Height
• M - 163-182cm
• F 156-170
• Weight -
• M- 56-80kg
• F- 48-72kg
• Resp – 17-20/min
• BP -
• M 126– 74 mmhg
• F 112 -62 mmhg

4. PHYSIOLOGIC CHANGES :
 The size and strength of heart , blood volume and
systolic blood pressure increase where as pulse
decrease.
 All the values of element of blood are increased.
 Respiratory volume and vital capacity are increased
more in males than females.
 Increases in strength and size of muscles and
increased level of cardiac , respiratory and
metabolic functioning.

2 .PSYCHOLOGICAL DEVELOPMENT :
 Developing a sense of identity: Erikson.
 Adolescence begins with onset of puberty and
extended to relative physical and emotional
stability.
 In this age of adolescent develops-
 A. Group identity
 B. Personal identity
 C. Sex role identity
 D. Emotionality

A. Group identity :
 In early stage of adolescence teenagers find it essential
to belong to a group from which they can derive status.
 Belonging to group, crowd helps the adolescence to
difference between themselves and their peer.
 They dress as group dresses , wear make up , do
hairstyle as group criteria.
 Language , music's and dance reflect culture that is
exclusive to adult.
 When adolescent begins to try their fashion and
interests, the style changes immediately.
 Conformity to peer group and non conformity to adult
group provides teenagers with frame of reference for
self assertion and rejection of identity of parents
generations.
 To be different from group is unaccepted and alienated
from group.

B. individual identity :
 As the adolescent establish identity within a group they also
attempt to incorporate multiple body changes into concept of
self.
 Body awareness is part of self awareness.
 Other people hold expectations for behavior of adolescent.
 Adolescent find it too easy to slip into the roles expected by
others. Thus individuals may become what parent or other
wish them to be based on premature decisions.
 Adolescent children get negative identity when society ,
community labels them with words such as failure , juvenile
delinquent.
 Some adolescent accept and live to these labels with behavior
that validate and strengthen them.
 The process of personal identity is time consuming and period
of confusion , depression and discouragement.
 Determining an identity and place in world is critical and
perilous feature of adolescent.
 Later positive identity emerges.

C . Sex role identity :
 During early adolescent the peer group begins to
communicate expectations regarding heterosexual
relationship.
 As development progressive adolescent encounter
expectations for mature sex role behavior from both
peer and adult.

D . Emotionality :
 Adolescent vacillate in their emotional state between
considerable maturity an childlike behavior.
 One minute they are exuberant and enthusiastic the
nearest movement they are depressed and withdrawn.
 Mood swings are common during this time.
 Because of mood swings adolescents are unstable,
inconsistent and unpredictable.
 Little things cause emotional upheaval(violent or sudden
change ) and depending on teenagers interpretations
can mean a great deal.
 Teenagers can control their emotion in later
adolescence they approach problems calmly and
rationally.
 More mature emotions in later adolescent period.

3 . COGNITIVE DEVELOPMENT :
 By Jean Piaget
 Cognitive thinking deals with capacity for abstract thinking.
 This stage is period of formal operation.
 The adolescent think beyond present.
 They can imagine a sequence of event that might occurs such
as college and occupational possibilities, how things may
change in future, such as relationship with parents ,
consequences of their actions.
 Adolescents can make use of assumptions while thinking .
They can solve problem that require abstract thinking.
 In this age, they begin to consider both their own thinking and
thinking of others.
 They wonder what opinion others have of them and they are
able to imagine thoughts of others.
 They are able to understand and aware of others culture and
communities have become norms and standards from their
own, it becomes easier for them to accept members of other
culture and behave in their own it these other culture and
behave in their own culture in accepected manner.

4.PSYCHOSEXUAL DEVELOPMENT :
 During adolescence the child passes through Freud’s
Genital period of development from approximately 11-16
years.
 Puberty and adolescence are period during which there
is great surge of genital sexual development.
 Masturbation and sexual fantasies are common in this
period.
 Adolescent represent a critical time in developing
sexuality. Hormonal, physical , cognitive and social
changes that occur during adolescent have an impact of
sexual development.
 Adolescent faces normal influence , physiological
manifestations such as menstruation , ejaculation.
 Increase level of pubertal hormone contribute to
increased level of sexual motivation among the boys
and girls.
 Development of sexual identity becomes a part of
adolescent identity.

 For young adolescent the process sexual identity
development involve forming close friend with same sex
peer, with whom they may experiment sexually often to
satisfy curiosity.
 During middle adolescent there is a shift from
relationship with same sex peer to intimate relationship
with member of opposite sex.
 Sexual activity is more common during middle
adolescence.
 The relationship between love and sexual expressions is
brought into focus during middle adolescent , hence
adolescent find it hard to believe that sex can exist
without love , therefore they view each relationship as
real love.

5 .MORAL DEVELOPMENT:
 By Kohlberg
 The young adults merely accept the decision or point of
view of adults, to gain autonomy from adult , they must
substitute their own set of morals and values.
 When the old principles are challenged but new
independent values have not yet emerged to take their
place , young people search for moral code that
preserves their personal integrity. It guides their
behavior to face pressure to violate old beliefs.
 Late adolescence is characterized by serious
questioning of exiting moral values and their relevance
to society and individual.
 Adolescent can easily take role of others.
 They seriously question established moral code , of ten
as result of observing that adult verbally ascribe code
but do not follow stick to it.

6 .SPIRITUAL DEVELOPMENT :
 During adolescence the adolescent begin to question
religious concept and benefits of childhood.
 He / she explores various religious affiliations and
cultures.
 This may be period of conflict between parents and
adolescent children.
 A young person without religious culture may be
attracted to any new or different religious culture.
 Most teens search for ideal and spectaculate about
illogical statements an conflicting ideologies.
 They tend to keep their thoughts private fearing that no
will understand.
 They may reveal deep spiritual concerns.
 They need support and encouragement in their struggle
for understanding and freedom to questions.

7 .SOCIAL DEVELOPMENT :
 To achieve full maturity , adolescent should free
themselves from parents domination and develop a
self identity than a parental authority. This process
is between both teenagers and their parents.
1.Relationship with Parents.
2.Relationship with Peer.
3.Best Friends

 During adolescence the parent-child relationship
changes from one of protection dependency to one
of mutual affection and equality.
 Behaviors observed of adolescent is struggle for
independence and external restriction.
 On one hand they are accepted as maturing
preadults but other hand because of their
unpredictability and insecurity in evaluating
situations and make judgment they are bound to
regulations an restrictions set by adults.
 Favorite topic of dispute include use of home
telephone , internet , need of personal phone ,
dress , duties, homework, money, atmosphere,
friendship, dating , relationship an other substance
abuse and timing schedules.

 They get away from theirs parents , stay less within
their parents, home and family activities and spend
more time with the peer group.
 Parent should guide adolescent , appropriate
freedom and provide clear , consistent message
regarding expectations.
 To gain adolescent trust , parents must respect his /
her privacy and show honest and sincere interest in
what adolescent believes and feels.

 The majority of teenagers , peers assume a great role in
adolescence.
 The peer group serves as a strong support to teenagers.
 Adolescent are usually socially and group minded.
 Early in adolescent period most of peer relations are
with member of one own sex.
 Later they turn to heterosexual relationship. As
heterosexual groups develop , activities such as playing
volleyball or going to beach becomes important.
 In middle adolescent groups called crowds are focus of
social activities.
 There is we feeling. Association with crowed allows the
adolescent to loose parental ties.
 Dating pattern is started in middle adolescent period. As
dating continues , egocentrism appear at this time ,
which is concern for self and not for dating partner.

 Personal friendship develops between same sex
adolescent.
 This relationship is closer or more in middle
adolescence.
 Best friend is best audience to try out possible role
and identities that adolescent wants to test.
 They try role together, provide support for each
other, care for each other.
 Sense of intimacy grows with permanent
relationship. the stability of same sex friendship is
important link in progress towards intimate
relationship in young adulthood.

NUTRITION
 The nutritional need are closely related to increase in
body mass, peak requirements occurs in the year of
maximum growth during which the body mass double.
 The calorie and protein requirement during this time are
higher than at almost any other time of life.
 Adolescent usually have sufficient intake of protein to
meet their need except who limit their due to economic
problems or to loose weight.
 There is substantial increases in need for mineral are
like calcium for skeletal growth , iron for maximum
expansion of muscle mass and blood pressure and zinc
for both skeletal and bone structure.
 Girls with heavy menses are susptible to iron deficiency.
 Calcium intake in adolescent is important during
adolescent to prevent osteoporosis.

Eating habits and behavior :
 According to recent scenario the children's interest,
attitude are altered as increasing number of meals
are eaten away from home.
 Their peers easily influence their eating habits.
 Pressure for time and commitment to activities
adversely affect teenagers eating habits.
 Overeating or undereating during adolescent period
presents special problems

 The development of primary and secondary sexual
characteristics and increased sensitivity of the genitalia
produce thoughts and fantasies about sexual relationship.
 Societal expectation push adolescent towards dating and
their own sex drive urges them towards exploration.
 So the pubescent and adolescent have a great need for
education about sexuality.
 The time and way in which education is given are both
vitally important.
 Girls receive education at mean age of 13 years and boys at
average of 15years.
 A large amount of knowledge relating to sex is acquired from
peer , Television , magazines., movies etc.
 The responsibility for providing sex education has been
assumed by parent , school , teachers such as planned
parenthood federation of America and health professionals
especially nurse. They should use simple terminology and
language not street language.
 Sexuality education should consist of instruction concerning
normal body function and should be present in straight
forwarded manner using correct terminology. Young
adolescent need reassurance that are the individual
differences and that lags and spurt due normal.

 Girls are concerned about irregular menstruation and
atypical breast development.
 Boys are concerned about masturbation , nocturnal
emission an atypical penile size.
 Teenagers needs to discus intercourse , alternative
method of sexual satisfaction and how resist pressure,
due to increase risk of sexually transmitted diseases
especially HIV infection. The topic of safe sex especially
use of condom essential.
 Accurate and unbiased information regarding sexual
practices should be provided where adolescent feel
comfortable asking questions without being degraded or
feel uncomfortable.
 Adolescent need role model and life experiences with
delayed gratification.
 They need problem solving experience and decision
making skills so that they can anticipate the positive and
negative outcomes of decision.
 With this type of assistance , teenagers can become
sexually responsible adults.

HEALTH PROBLEMS OF ADOLESCENT-
DISORDER RELATED TO REPRODUCTIVE SYSTEM
A . Amenorrhea
B . Dysmenorrhea
C . Vaginitis

A .Amenorrhea :
 Menarche or first menstrual period occurs relatively
late in female pubertal development.
 When a adolescent girl is seen with complaint of
absence of menses a careful history of timing of her
pubertal development is to be taken.
1 .Primary amenorrhea : Absence of secondary
sexual characteristics and no uterine bleeding by
14 -15 yrs or absence of uterine bleeding with
secondary sexual characteristics by 16 years of age
. The cause of primary amenorrhea may be atonic ,
hormonal , genetic or idiopathic.

2.Secondary amenorrhea : It is defined as absence of
menses for 6 month or at least three cycles after
menstruation was previously established.
 Irregular menstrual cycle are common with first or two
years of menarche.
 Girls with later onset of menarche will take longer to
establish regular ovulatory cycle.
 Pregnancy is most common cause of secondary
amenorrhea and should be ruled out in both types of
amenorrhea even if adolescent denies sexual activity.
 Other cause can be stress , environmental changes ,
hypothyroidism , PCOD chronic illness, bulimia nervosa
, ovarian disturbance , contraceptive steroids.

B. Dysmenorrhea : Most girls experiences cramping
, abdominal pain , backache , leg ache but in few cases
pain is intolerable and incapacitating
 Primary Dysmenorrhea - it is painful menses not
related to any pelvic disease. Pain is related to ovulatory
cycle , women may have level of prostaglandin an
overproduction of vasopressin . Pain occurs at time of
menstrual flow or hour before and continue for 48-72
hrs.
 Secondary Dysmenorrhea – It is defined as painful
menses with pathologic condition such as salpingitis ,
congenital anomalies

C . Vaginitis :
 It may be due to forgotten tampon , chemical
irritation like bubble bath , deodorant pads and
tampons.
 Infectious Vaginitis can be caused by candida, fungi
, trichomonas, protozoa, parasites or bacteria.

HEALTH PROBLEM RELATED TO
SEXUALITY
1 . Adolescent pregnancy
2 . Sexual Transmitted Diseases(STD)
3 . Pelvic Inflammatory Disease(PID)
4 . Sexual assault ( rape )

1 . Adolescent pregnancy :
 In the recent years teenage pregnancy rate has shown a
conditional downward tend due to increase in use of condom
and long term hormonal contraceptive methods among
adolescent.
 The reduction in teen pregnancy is important national goal
because of risk of negative outcome for both mother and child.
 Teenage girls and unborn infants are at greater risk for
complications of both pregnancy and delivery. The most
common complication are premature labor , Low birth weight
baby,high neonatal mortality ,fetopelvic disproportion, iron
deficiency anemia , prolonged labor.
2 . Sexually transmitted diseases :
 Sexually active adolescent are at risk of STD. Physiologically
adolescent girls cervix is much more susceptible to HPV and
Chlamydia infection.
 The rate of Chlamydia and Gonorrhea are highest among
adolescent girls of 15-19 yrs and HPV in highest adolescent
population.

3 . Pelvic inflammatory diseases :
 It is a infection of upper genital tract ,( endometrium, fallopian
tubes and ovaries) most common caused by sexually
transmitted bacteria as Neisseria gonorrhea , Chlamydia
trachoma and variety of anaerobic bacteria.
 PID causes fever , lower abdominal pain , UTI symptoms,
nausea, malaise, diarrhea , constipation.
 Prevention is primary concern of health care professional .
 Contraceptive methods such as condoms is best protection for
prevent STD and PID.
4 . Sexual assault :
 An adolescent girl is particularly vulnerable to sexual assault.
 Sexual assault victims are of all ages, ethnic groups and
economic groups, children with physical or developmental
disability are more vulnerable to sexual abuse than their
peers.

 Definition of SEXUAL ASSUALT- It includes various
types of forces or inappropriate sexual activity . It
includes both physical and psychological coercion
as well as touch , penetrate and other sexual
contract.
 RAPE- Forced sexual intercourse that occurs by
physical force or physiologic coercion, includes
vaginal, anal or oral penetration of body parts or
inanimate objects.

EATING DISORDER
1. Obesity
2. Anorexia nervosa
3 .Bulimia nervosa

1.OBESITY
Obesity is defined as an increases in body mass
resulting from excessive accumulation of body fat
relative to lean body mass.
 Overweight refers to state of weighing more than
average for height and body mass.
 Body mass index measurement is recommended
as most accurate method for screening children,
adolescent for obesity.
 Obesity in adolescent has taken related to elevated
blood cholesterol , high BP , respiratory disorder ,
orthopedic conditions.
 Common emotional consequence of obesity include
poor body image , low self esteem , social isolation
and feeling of depression and rejection.

 BMI = weight in kg
(height in cm)²
 Or weight in pound x 703
(height in inches)²
BMI is <18.5- Underweight
 BMI 18.5-24.9- Healthy.
 BMI 25-29.9 - Overweight
 The best approach to management of obesity Is
preventive one.
 Early recognition and control measure before the
adolescent gets to obese state. Diet modification is most
important along with exercise.

2 . Anorexia nervosa :
 It is a eating disorder characterized by refused to eat
food to maintain a minimal normal body weight and by
severe weight loss in absence of obvious physical
cause.
 Approximately 5% of adolescent females in US have
anorexia nervosa.
 It begins at age of 13yrs but occurs as early as 10 yrs
and as late as 25 years.
 Individual with anorexia nervosa are described as
perfectionists, academically have high achievers.
 They have high energy levels , marked emaciations.
 Patient with anorexia nervosa may eventually develop
bulimia.

3 . Bulimia nervosa :
 Bulimia nervosa refers to an eating disorder.
 It is observed in older adolescent girls and young
women.
 Males with bulimia nervosa are less common.
 They have average or slightly more average weight.
 It is characterized by repeated episode of binge
eating followed by inappropriate compensatory
behavior such as self induced vomiting, misuse of
laxatives , diuretics, excessive exercise, fasting.

 Binge behavior consists of secretive consumption
of large amount of high calorie food during brief
time(less than 2 hours).
 Characterized by weight control methods by
purging, It is followed by self depreciating thoughts,
depressed mood and awakeness that eating
pattern is abnormal.

SERIOUS
HEALTH PROBLEM OF ADOLESCENT
1 . Substance abuse
2 . Alcohol
3 . Drugs
4 . Suicide

National and statewide survey indicate that despite a
steady increases in incidence of adolescents using
tobacco, marijuana between 12-18yr of age,it is
been reported that 51% of American youth have
tried illegal drugs by time of high school
graduations.
 Most drug use begin with experimentation. It
become part of drug centered lifestyle.
 Adolescent use drug for curiosity.
 They fall into category of experimentees ,
compulsive users, , recreational users .They use
drugs such as marijuana , cocaine , alcohol etc.

 Alcohol drinking is likely to begins in middle school years
and increases with age by 18 yrs of age. 80% – 90% of
adolescent have tried alcohol.
 Ethanol is a depressant that reduces inhibitor against
aggressive and sexual acting out.
 Through abrupt withdrawal physical and psychological
symptoms are seen especially of brain and liver cell.
 The most effect is seen on CNS which includes changes
in cognitive and autonomic function such as judgment ,
memory , learning activity , ability intellectual capacities.
 Young alcoholics rely on substance as defense against
depression , anxiety , fear and anger.

It is used for cigarette smoking.
 Although the number of adults and adolescent
smokers declined in recent years, but still it is
considered the chief avoidable cause of death.
 Because of its addictive nature , smoking begins in
childhood and adolescent results in lifetime habits
with increases morbidity and early mortality.
 Cigarettes are considered to be gateway drugs and
teenagers who smoke are 11.4 times more likely to
use illicit Drug.
 Teenagers smoking is due to imitations of adult
behavior , peers , movies and advertisement, desire
to control weight especially females.

 Cocaine is available in two forms ; water soluble cocaine
hydrochloride , which is administered by “snorting” or IV
injections and non soluble alkaloid cocaine is used for
smoking. It is smoked in either waste pipes or
mentholated cigarette.
 The use of cocaine is increased in recent years because
of its availability and affordability .Its association with
person in glamorous occupational, peer pressure and
its reputations as sexually enhancing drugs.
 Cocaine creates a sense of euphoria.
 The withdrawal does not produce dramatic symptoms
like other withdrawal substance. The effects are
commonly seen in depression , including lack of energy
and motivation , irritation , appetite changes ,
psychomotor retardation and irregular sleep patterns.

 Narcotics drug includes opiates such as heroin and
morphine and opioids such as hydromorphine ,
hydrocodone , fentanyl , meperidine and codeine.
 These drugs produced a state of euphoria by removing
painful feelings and creating a pleasurable experience
and sense of success accompanied by clouding of
unconscious and dreamlike state.
 Physical signs of narcotics abuse include constricted
pupils , respiratory depression , cyanosis.
 Needle marks may be visible on the arms or legs in
chronic users .

D. CENTRAL NERVOUS SYSTEM
DEPRESSANT :
ROHYPNOL-FLUNITRAZEPAM

 CNS depressant include variety of hypotonic drugs that
produce physical dependence and withdrawal
symptoms on abrupt discontinuation.
 They create a feeling of relaxation and sleepiness but
impair general functioning.
 Drugs in this includes barbiturates , non barbiturates
and alcohol.
 Flunitrazepam Rohypnol known as the date rape drug
is a recent hypnotic drug used by adolescent.
 Many women report being raped after unknowingly
being given Rohypnol in drink.
 Rohypnol is 10 times more powerful than diazepam
(valium )
 It produced prolonged sedation, a feeling of well being
and short term memory loss.

E . CENTRAL NERVOUS SYSTEM
STIMULANT -
METHAMPHETAMINE

 Amphetamine and cocaine do not produce strong
physical dependence and can be withdrawn without
much damage.
 However psychologic dependence is strong and acute
intoxication can lead to violent aggressive behavior or
psychotic episodes characterized by paranoia ,
uncontrollable agitation and restlessness. When
combined with barbiturates, the euphoric affect are
particularly addictive.
 Methamphetamine can be snorted , injected , swallowed
or smoked and produces burst of energy in its users
along with intense alternating attacks of boldness and
paranoia.
 It provides excitement far more immense than caused
by cocaine.
 The drug with the street names crank , meth and crystal
is inexpensive.

F . MILD ALTERING DRUGS :
MARIJUANA, HASISH

 Hallucinogens are the drugs that provides vivid
hallucination and euphoria.
 These drugs do not produce physical dependence and
they can be abruptly withdrawn without ill effect.
 Cannabis ( marijuana , hashish ) and lysergic acid
diethylamide (LSD).

 Suicide is defined as the deliberate act of self injury with
the intent that the injury results in death.
 Suicidal attempts is intended to cause injury or death.
 The term parasuicide is used to refer behaviors ranging
from gestures to serious attempts to kill oneself.
 Recent result shows that 8.4% of students nation wide
had attempted suicide at least once during 12 month
preceding survey.
 Suicide is the 3rd leading cause of death during teenage
years
 The causes of suicide are mainly psychiatric disorder ,
substance abuse ( alcohol more than 50% of suicidal
family issues , lack of support , emotional disturbance
and isolation within the family.
 Firearms are most commonly used instrument in
committing for both male and female .Other methods
are hanging , overdose, strangulation.

NURSING CARE MANAGEMENT RELATED TO
THERAPEUTIC MANAGEMENT
Nurses who have contact with children and
adolescent are in an excellent position to provide
information about substance abuse and to serve as
patient advocates.
1. Exercising overdose or withdrawal symptoms.
2. Manifesting bizarre behavior or confusion
secondary to drug ingestions.
3.Worried that they are or will become addicted.
4. Worried about a friend, family members who is
addicted.
5.It is necessary to asses for possible trauma
sustained while the pt. was under the influence of
the drug.

 Nurses should be alert for any physical or behavioral
clues that indicate onset of withdrawal or effects of drugs.
 School nurses or community nurses play essential role in
identifying children, adolescents and family with
substance abuse family.
 School nurse may be the first to identify a child who has
ingested a particular drug by child's erratic behavior in
class.

 REHABILITATION-It involves fostering healthy
interdependent relationship with caring and
supportive adults. Person working with trouble
youth must be prepared for tendency to relapse.
 FAMILY SUPPORT
 PREVENTION-Nurses play important role in
education efforts as well as in individual
observation ,assessment and therapy related to
substance abuse. Health compromising behaviors
are often inter connected and have common
antecedents . Peer pressure is the common tool
and can be used effectively in substance abuse
prevention.

 SUICIDE-Nurses play pivotal role in reducing adolescent
suicide. Care includes early recognition, management, and
prevention. Peers are excellent source of information about
potential suicide attempt.
 Confidentiality is essential part of adolescent counseling

BIBLIOGRAPHY
1. Marilyn j . Hockenberry David Wilson Wongs
 Essential of pediatric nursing
 8th edition ,
 page no 514-571
2 . Dorothy R Marlow Barbara A Redding
 A textbook of pediatric nursing
 6th edition ,
 page no 1114 – 1168
3 . Mukesh Agarwal
 A textbook of pediatrics
 2nd edition ,
 page no ; 352 – 359

4. A Parthasarathy Piyush Gupta MKC Nair
 IAP textbook of Pediatrics
 5th edition ,
 page no ; 844- 853
5 . OP Ghai , Vinod k Paul , Arvind Bagge
 Ghai essential pediatrics
 7th edition ,
 page no : 42 – 46

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