Adolescents final


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Adolescents final

  1. 1. Presented by: Jenna Prather, AudriannaWhiteside, Ashley Boyland and Zeena Darji
  2. 2.  Adolescence  “to grow into maturity”  A period of transition between childhood and adulthood.  Time of rapid physical, cognitive, social and emotional maturation.  Is viewed as beginning with the gradual appearance of secondary sex characteristics at about 11 or 12 years of age, ending at 18-20 years.  Early Adolescence: ages 11-14  Middle Adolescence: ages 15-17  Late Adolescence: ages18-20
  3. 3.  Puberty  The maturation, hormonal, and growth process that occurs when the reproductive organs begin to function and the secondary sex characteristics begin to develop.  Divided into three stages 1. Prepubescence: period 2 years before puberty when child is developing preliminary physical changes that herald sexual maturity 2. Puberty: point where sexual maturity is achieved (menstrual flow in girls, but less obvious in boys) 3. Postpubescence: 1-2 year period after puberty where skeletal growth is completed and reproductive functions become fairly well established.
  4. 4.  Physical changes are primarily the result of hormonal activity under the influence of the Central Nervous System Obvious physical changes  Growth  Appearance & development of secondary sex characteristics. Primary sex characteristics- the external and internal organs that carry out the reproductive functions. Secondary sex characteristics- the changes that occur throughout the body as a result of hormonal changes.
  5. 5.  Caused by hormonal influences and controlled by the anterior pituitary in response to a stimulus from the hypothalamus. Stimulation of the gonads has a dual function  Production and release of gametes: production of sperm in the male and maturation and release of ova in the female  Secretion of sex-appropriate hormones: estrogen and progesterone from the ovaries and testosterone from the testes.
  6. 6.  Ovaries, testes, and adrenals secrete sex hormones  Amount produced varies with gender and age.  Adrenal cortex secretes small amounts before puberty  The sex hormone that accompanies the maturation of the gonads is responsible for the biologic changes: puberty
  7. 7.  Estrogen  the “feminizing” hormone  Found in low quantities during childhood  Secreted in slow increasing amounts until about age 11  in males, the gradual increase continues through maturation  In females the onset of estrogen production in the ovary causes an increase that continues until about 3 years after her first menstruation.
  8. 8.  Androgens  the “masculinizing” hormone  Responsible for most of the rapid growth changes in early adolescence.  Secreted in small and gradually increasing amounts up to ages 7-9  There is a rapid increase in both sexes at this time, especially boys, until age 15
  9. 9.  The age that changes are observed and time required to progress from one stage to another varies among children Tanner stages: stages of development of secondary sex characteristics and genital development and are a guide for maturity.  (page 516 in PEDs book)
  10. 10.  Indication of puberty for most is the breast buds (Thelarche) between ages 9 and 13 ½ First menstrual cycle (menarche) occurs about 2 years after the first pubescent changes  Average being 12 years old.  Regular menstruations occur 6-14 months after menarche. Pubertaldelay: if breast development has not occurred by age 13, or if menarche has not occurred within 4 years of the onset of breast development
  11. 11.  First changes are the testicular enlargement  Usually occur between 9 ½ and 14 yrs of age.• During midpuberty there is an increase in muscle mass, voice changes occur, and facial hair  Gynecomastia: temporary breast enlargement and tenderness, common during midpuberty  Height and weight spurts occur toward the end of midpuberty.• Late puberty: Complete development of the male genitals and first ejaculation occurs. Accompanied by auxillary and facial hair, final voice changes along with growth of the larynx• Pubertal Delay: exhibiting no enlargement of the testes or scrotal area by 13 ½ to 14 years or if genital growth is not complete after 4 years after first changes begin.
  12. 12.  Thefinal 20%-25% of height is achieved during puberty.  Most growth occurs during a 24-36 month period (the adolescent growth spurt)  Growth spurt occurs earlier in girls (ages 9 ½-14 ½ yrs)  (slower) the girl gain approx. 2-8 inches and 11.5-55 pounds.  Growth ceases typically 2- 2 ½ years after menarche  Occurs between 10 ½ -16 years of age in boys  During this, the boy gains 4-12 inches and 15.5-66 pounds  Growth ceases at age 18-20 years
  13. 13.  Growth happens in sequence First: Growth in length of extremities and neck precedes growth in other areas.  The hands and feet appear larger than normal in adolescence Second: Hips and chest width happen a few months later Third: Followed by shoulder width several months later All followed by increase in length of trunk and depth of chest.
  14. 14.  Apparentin skeletal growth, muscle mass, adipose tissue and skin.  Skeletal growth: the difference is a function of hormonal effects at puberty that are evident in the limb length  The hormonal effect on female bone growth is much stronger than that of a boy  Boys’ prolonged growth period and less rapid epiphyseal closer results in their great overall height and longer arms and legs.
  15. 15.  Voice changes  Hypertrophy of the laryngeal mucosa and enlargement of the larynx and vocal cords (both boys and girls)  Happens with boys between Tanner stages 3 and 4 (pg 516 in PEDs book), with voice shifting uncontrollably from high to deep tones.
  16. 16.  Lean Body Mass (muscle)  After bone growth spurt  Androgenic hormones increase steadily and influence the development of muscle. Nonlean Body Mass (fat)  May be an increase just before skeletal growth spurt, especially in boys, followed by a modest decrease.  Later deposited to thighs, hips and buttocks, and around breast tissue
  17. 17.  Hormonal Influences  Cause acceleration in growth and maturation of skin  Sebaceous glands become extremely active (face, neck, shoulder, back, and chest) = acne  Apocrine glands (sweat glands) are what cause body odor. Ex: Under the arms
  18. 18.  The size and strength of heart increases Blood volume and systolic blood pressure increases Pulse and basal heat production decreases.
  19. 19. (Erikson) Adolescence come to see themselves as distinct individuals, unique and separate from every other individual Individual strives to attain autonomy from the family and develop a sense of personal identity instead of role diffusion. Role diffusion results when the individual is unable to formulate a satisfactory identity from the multiplicity of aspirations, roles, and identifications
  20. 20.  Group identity is essential to the development of a personal identity in adolescents Attempt to resolve questions concerning relationships with in peer group before they are able to resolve questions about who they are in relation to family and society. During this time pressure to belong to a group is intensified and it is essential to belong to a group which they can derive status Meant to establish differences between themselves and their parents Major conformity takes place; to be different is to be unaccepted and alienated from the group
  21. 21.  Individual identity  As identity with in the group is established they attempt to incorporate multiple body changes into a concept of self as body awareness is a part of self awareness  Significant others holds expectations for the behavior of the adolescents . Often these expectations are persistent enough they make decisions that they would not make if they were solely responsible for identity information.  Therefore an adolescent is labeled negatively it can have a great effect on their personal identity ; they will accept those labels and participate in behaviors that strengthen them
  22. 22.  Sex-role identity- communication of expectations regarding heterosexual relationships begins in early adolescence Emotionality- unpredictable but normal mood swings are common during this time  Control over emotions improve through late adolescence  But are still subject to heightened emotion and when it is expressed, feelings and behaviors reflect feelings of insecurity, tension and indecision
  23. 23.  Piaget’s period of formal operations  Capability of mentally manipulating more than two categories of variables at the same time (abstract thinking)  Thoughts are concerned with the future and possibilities
  24. 24.  The change from childhood when they accept the moral views of adults, adolescents gain autonomy and create their own set of morals and values through questioning the existing morals and values of society and themselves Decisions involving moral dilemmas are based on their existing set of internalized set of moral principles
  25. 25.  Some adolescents question the spiritual ideals of their families Others cling to these spiritual values as they struggle with the conflicts arising from this difficult time Studys show that greater levels of religiosity and spirituality are associated with fewer high-risk behaviors and more health- promoting behaviors
  26. 26.  Relationship with parents  Changes from one of protection-dependency to one of mutual affection and equality  As teenagers assert their rights for grown up privileges tension and conflict arise  They often with draw themselves from home and family activities and confide less in their parents  But parental monitoring remains important throughout adolescence and may have a direct influence on adolescents sexual and substance use behavior
  27. 27.  Relationships with peers  Peers assume more significant role in adolescence than they did during childhood  Peer group serves as a strong support to teenagers which provide a sense of belonging and feeling of strength and power  To gain acceptance by group, younger teenagers tend to conform completely in dress, hairstyle, taste in music and vocabulary  Cliques are usually made up of one sex, made of selected close friends who are emotionally attached to one another  Girls tend to be more cliquish than boys and have a greater need for close friendships  They gain support in leading about themselves, consideration for the feelings of others, and increased ego development and self reliance
  28. 28.  Best friends in adolescents  This relationship is closer and more stable than it is in middle childhood, and it is important in the quest for identity  They provide one-on-one support for one anther and care greatly about what each other thinks  This relationship is an important link in the progress toward an intimate relationship in young adulthood
  29. 29.  Interests and activities  At this age they have a large amount of leisure time which are mostly peer centered  For those adolescents that have jobs, their work experience provide many benefits which include time management, teamwork skills and increased income  But they do not provide opportunities to use what they learn in school  Adolescents should limit their work to not more than 20 hours per week during the school year
  30. 30.  Duringthe adolescent years many adolescents determine their sexuality. Hormonal, physical, and social changes are all contributing factors.
  31. 31.  Puberty- Duringpuberty the adolescent’s begin to see changes in their bodys including Females-  Menstruation  Breast growth  Increase in hormone levels Males-  Ejaculation  Facial hair  Increase in hormone levels
  32. 32.  Sexual Identity Relationships shift during adolescent stage Early adolescent years they tend to associate more with peers of the same sex. While middle adolescents (teenagers) begin to have more serious relationships with the opposite sex. Also often the time when sexual activity occurs. Older adolescents most times know there sexual identity and find someone that fulfills all they need both emotionally and sexual.
  33. 33.  Sexual Orientation- a pattern of sexual arousal or romantic attraction toward persons of the opposite sex (heterosexual), same sex (lesbian or gay), or of both genders (bisexual). Influences may include cultural background, social and family pressure, or not fitting in with their peers.
  34. 34.  Milestones-1. The realization of romantic or attraction to people of one (or both) genders.2. Erotic daydreaming about one or both genders3. Romantic partners or dates without sexual activity4. Sexual activity with people of the preferred gender or genders5. Self-identification of the orientation that best fit one’s current circumstances and understanding6. Publicly self-identifying that orientation, usually to intimate friends and family first, then wider social group7. An intimate, committed sexual relationship with a person of the gender appropriate to one’s orientation
  35. 35.  When developmental changes take place adolescents often feel confused. • Advertise - • Hide - Teenagers often exaggerate the smallest imperfection. Ex. Acne How a teenager views their own body during adolescent years often sticks with them the rest of their life and determines whether they have a positive or negative image of themselves. Table 16-1 pg. 525
  36. 36.  Both males and females may struggle with the changes occurring with their bodies. Males struggle with the sexual feelings they begin to experience. Females struggle with the changes in there body (wider hips, breasts), and menstruation. All adolescents handle the changes differently some are excited while others maybe frighten. Adolescents want to fit in with others their age, by having the same hairstyle and clothing. As they go into late adolescent years they become less concerned with there body image and have become more comfortable with who they are as an individual.
  37. 37.  Health education is one of the most important ways of helping adolescents take care of themselves. Adolescents are beginning to take control of there own health and the responsibility that comes with it. • Maintaining health practices • Properly taking medications • Going to doctor appointments• Can be a difficult transition for parents but it is necessary for the adolescent to learn. Parents should continue to guide adolescent during this time.• Guidelines for Adolescent Preventative Services (GPAS)- provides a framework for health care providers to use in their clinical practice.
  38. 38.  Health education is one of the most important ways of helping adolescents take care of themselves. Adolescents are beginning to take control of there own health and the responsibility that comes with it. • Maintaining health practices • Properly taking medications • Going to doctor appointments• Can be a difficult transition for parents but it is necessary for the adolescent to learn. Parents should continue to guide adolescent during this time.• Guidelines for Adolescent Preventative Services (GPAS)- provides a framework for health care providers to use in their clinical practice.
  39. 39.  Tetanus-diphtheria-acellular pertussis (Tdap) Measles- Mumps- Rubella (MMR) Hepatitis B- If not vaccinated as child Hepatitis A Meningococcal (MCV4)- Age 11-12 Annual Influenza (Flu) – recommended Human Papillomavirus (HPV)- recommended for girls, 3 series of shots given, can be given as early as age 9
  40. 40.  Rapid and extensive increase in height, weight, muscle mass, and sexual maturity results in increased nutritional requirements. Caloric and protein requirements during this time are higher than at almost any other time of life. - Sensitive to caloric restrictions Substantial increase in the need for the minerals calcium, iron, and zinc during periods of growth. Calcium intake is essential during adolescence to assist in the prevention of osteoporosis. Dietary intervention should promote the
  41. 41.  Increasing number of meals are eaten away from the home. - Caused by peer acceptability/sociability Eating breakfast that is nutritionally poor in quality is frequently a problem. Excess intake of calories, sugar, fat, cholest erol, and sodium - Increased risk of obesity/chronic diseases
  42. 42.  Normal increase in weight/fat deposition of growth spurts may cause teenagers to resort to dieting. - consume nutritionally inadequate diets which deprives their growing bodies of essential nutrients. Anorexia nervosa and bulimia occur in adolescent/young adult years
  43. 43.  Adolescents should receive a minimum annual assessment of weight, height, and BMI for age Healthy dietary habits should be discusses as well as the consumption of excessive portion sizes should be identified. Assess level of activity Adolescents are body conscious and concerned about appearance. - Concrete messages about the relationship between an attractive appearance and healthy lifestyle are most effective. - Talk WITH them NOT at them.
  44. 44.  Teenagers vary in their need for sleep and rest. During growth spurts, sleep is increased. Adequate sleep and rest at this time are important for the overall health.
  45. 45.  Most adolescents spend their time and energy practicing and participating in sports activities than any other age group. High schools continue to cut physical education classes, with only half of the students attending these classes in 2005. - To improve health outcomes, adolescents should engage in 60 minutes or more of moderate to vigorous physical activity.
  46. 46.  Practicing sports, games, and dancing contribute to growth, development, and better health. Competitive activities help teenagers in the process of self-appraisal, development of self-respect, and concern for others. Adolescents should NOT be encouraged to engage in physical activities that are beyond their physical or emotional capacity.
  47. 47.  Should not be neglected during adolescence. Pit and fissure sealants are a safe/effective technique for dental caries prevention. Early adolescence is when corrective orthodontic appliances are worn. Important to reinforce directions regarding tooth brushing during this time.
  48. 48.  Hyperactive sebaceous glands and newly functioning apocrine glands make frequent bathing and showering a necessity. - Deodorants assume an important place in personal care Discover hair requires more shampooing, girls may have questions about hair removal, use of cosmetics, and menstrual hygiene.
  49. 49.  Regular vision testing during this time is an important part of health care and supervision. Visual refractive difficulties reach a peak that is not exceed until the fifth decade of life. Corrective lenses can create psychological problems for teenagers if they believe that glasses spoil their appearance or do not fit their body image. - Preferred solution is contact lenses.
  50. 50.  Cochlear damage can occur from continuous exposure to loud sound levels. Earphones inserted into the ear canal are of most concern for health care professionals. - Can cause permanent hearing loss
  51. 51.  Rapid skeletal growth is often associated with slower muscle growth, as a result, some teenagers may appear awkward or slump and fail to stand or sit upright. Scoliosis – a defect of the spine that occurs frequently in adolescence and is more common in girls than in boys.
  52. 52.  Piercings and tattoos Danger of complications include infection, cyst or keloid formation, bleeding, derm atitis, or metal allergy Using same needle on body parts of multiple teenagers can put them at risk for HIV, hepatitis C, and hepatitis B virus transmission Estimated that 13% of people in the United States have at least one tattoo.
  53. 53.  Long-term effects include premature aging skin, increased risk of skin cancer, and phototoxic reactions. Goggles MUST be worn in tanning booths to prevent serious corneal burning. The use of sunscreens, including hypoallergenic products, with a sun protective factor (SPF) of at least 15 and a nonalcohol base without fragrance is important. - Broad-spectrum sunscreens that protect against both ultraviolet A and B are the most effective.
  54. 54.  Multiple changes during adolescence can result in stress Faced with peer pressure Early-maturing girls and late-maturing children especially sensitive to stress of being different Many feel intense anxiety over their identity Slow-maturing adolescents appear to suffer most inner turmoil  Need support and reassurance they aren’t abnormal
  55. 55.  Adolescents are constantly exposed to sexual symbolism from mass media Societal expectations push adolescents towards dating, and their own inner sex drive urges them toward exploration
  56. 56. SEX EDUCATION:  Society plays a role in educating adolescents about puberty  A large portion of their knowledge relating to sex is acquired from peers, television, movies, and magazines  Some is learned from their parents  The information they accumulate can be incomplete or inaccurate
  57. 57. SEX EDUCATION:  The responsibility for providing sex education has been assumed by parents, schools, churches, community agencies (Planned Parenthood), and health professionals
  58. 58. SEX EDUCATION:  Many adolescents perceive nurses as individuals who possess important information and are willing to discuss sex with them  Nurses must have an understanding of the physiological aspects of sexuality and a knowledge of cultural and societal values  Nurses also need to have an awareness of their own attitudes, and feelings about sexuality
  59. 59. SEX EDUCATION: Comprehensive information about sexuality education is offered by the Sexuality Information and Education Council of the United States (SIECUS) SIECUS maintains that every sexuality education program should present the topic from the aspects: biologic, social, health, personal adjustments and attitudes, interpersonal associations and the establishment of values
  60. 60. SEX EDUCATION: Ideallyboys and girls should be able to discuss sexuality objectively, but this is not always possible The rate of maturation between boys and girls and between different members of the same sex make it desirable to discuss certain aspects of sexuality in segregated groups
  61. 61. SEX EDUCATION: Sexuality education should consist of instruction concerning normal body functions  Should be presented straight-forward using correct terminology
  62. 62. SEX EDUCATION:  Many girls arrive at menarche with illogical beliefs  They do not always understand the relationship of menstruation and reproduction  Many are under incorrect impression of the “safe” time for sexual intercourse in relations to their periods
  63. 63. SEX EDUCATION:  Adolescentsneed to know more than the anatomic and physiologic information about sex
  64. 64. SEX EDUCATION:  Girls want answers to questions such as: “What is it like?” “Does it hurt?” “What happens when…?” and “Is it alright if you…?”
  65. 65. SEX EDUCATION:  Boys are often concerned about the fallacy that a relationship exists between penis size and sexual function
  66. 66. SEX EDUCATION:  All adolescents need reassurance that:  masturbation is normal  homosexuality in early adolescence is not unusual  Oral-genital relations can be normal substitution for intercourse
  67. 67. SEX EDUCATION:  Adolescents need to discuss:  intercourse  alternative methods of sexual satisfaction  STDs  “safe-sex”  Abstinence, use of condoms and birth control
  68. 68. SEX EDUCATION:  Role-playingcan help teenagers learn approaches to dealing with difficult situations  Sex cannot be taught without:  Discussions of mature decision making  Sexual responsibility  Values clarification
  69. 69. SEX EDUCATION:  Adolescents may receive inaccurate information about sexual behavior  Therefore accurate and unbiased information should be provided in a setting wherein they feel comfortable asking questions
  70. 70. SEX EDUCATION:  Withthis type of guidance, teenagers can become sexually responsible young adults
  71. 71.  Physical injuries are the single greatest cause of death in the adolescent age-group and claim more lives than all other causes combined
  72. 72. INJURY PREVENTION: Most vulnerable ages are 15-24  Accidental injuries account for 60% deaths in boys and 40% deaths in girls Peak physical, sensory, and psychomotor function gives teens a feeling of strength Physiologic changes give impulsion to many basic instinctual forces
  73. 73. INJURY PREVENTION: 36% of all teen deaths in the U.S. are the result of motor vehicle crashes Contributing Factors:  Lack of driving experience  Lack of maturity  Following too close  Driving too fast  Having other teen passengers in the car  Using alcohol
  74. 74. INJURY PREVENTION:  Nurses should educated teenagers and their parents about the risk of driving while drinking alcohol  Also ensure use of safety restraint
  75. 75. INJURY PREVENTION:  Many families arrange a no questions asked ride home  Families are also encouraged to require adolescents to log many hours of supervised driving practice before taking car out alone
  76. 76. INJURY PREVENTION:  The increasing use of motorcycles, all-terrain vehicles, jet skis and snowmobiles has caused an increase in injury among young people  Many adolescents ride bicycles without helmets or lights at night
  77. 77. INJURY PREVENTION:  Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm
  78. 78. INJURY PREVENTION:  Gun carrying among adolescents is on the rise  Family members and acquaintances are a common source of guns
  79. 79. INJURY PREVENTION: Presence of gun in household increases risk of teen suicide and homicide  All families should be assessed for the presence of a gun in the home and informed of this risk  Families then must take preventative measures
  80. 80. INJURY PREVENTION:  Guns that do not use powder are viewed as toys by many but account for almost as many injuries as powder guns EXAMPLES: BB Gun Air Riffle
  81. 81. INJURY PREVENTION:  Regulations of nonpowder guns are relaxed  Few states regulate their use  Nurses should act as child advocates and urge passage of laws to regulate their sales
  82. 82. INJURY PREVENTION:  The degree of physical maturation, size, coordination, and endurance varies greatly among adolescents of the same age, therefore sports competition between young people who differ greatly in strength and agility is hazardous
  83. 83. INJURY PREVENTION:  Every sport has some potential for injury  Overuse injuries are common in adolescents  Large number of injuries occur to youths who are not physically prepared for the activity  Injuries can involve any part of the body  Range from minor cuts and bruises to total incapacitating central nervous system or death
  84. 84. INJURY PREVENTION:  The leading cause of serious sports injuries among boys is football, whereas for girls it is gymnastics
  85. 85. INJURY PREVENTION:  Injury prevention is an ongoing part of nursing responsibility throughout the childhood years  Anticipatory guidance to parents  During adolescence however health and safety education are more effective when the young people are involved
  86. 86. INJURY PREVENTION:  Prevention can occur on many levels  Safety advocacy  Public policy changes  Legislation  Health education
  87. 87.  Both adolescents and parents are confused about the changes of this stage of development Parents need support and guidance Parents may need help to “let go” and promote the changed relationship from one of dependence to one of mutuality