1st year MSc(N)
Is a period of transition between
childhood and adulthood.
A time of rapid physical, cognitive, social
and emotional maturing as the boy
prepares for manhood and the girl
prepares for womanhood.
Adolescence is generally regarded as
the psychologic, social, and
maturational process initiated by the
It involves three stages
Physical changes of puberty are primarily
the result of hormonal activity under the
influence of central nervous system.
BIOLOGICAL DEVELOPMENT cont.…..
Obvious changes are
- Increased physical growth
-Development of secondary sexual
-Physical distinction between the sexes
Primary sex characteristics- The external and
internal organs that carry out the reproductive
Secondary sex characteristics- Changes that
occur through out the body as a result of
The Tanner scale (also known as the
Tanner stages) is a scale of physical
development in children, adolescents and
The scale defines physical
measurements of development based on
external primary and secondary sex
Breasts (female )
no glandular tissue: areola follows the skin contours of the chest
(prepubertal) [typically age 10 and younger]
breast bud forms, with small area of surrounding glandular tissue;
areola begins to widen [10-11.5]
breast begins to become more elevated, and extends beyond the
borders of the areola, which continues to widen but remains in contour
with surrounding breast [11.5-13]
increased breast size and elevation; areola and papilla form a
secondary mound projecting from the contour of the surrounding
breast reaches final adult size; areola returns to contour of the
surrounding breast, with a projecting central papilla. [15+]
Pubic hair (both
male and female)
no pubic hair at all (prepubertal Dominic state) [typically age 10 and
small amount of long, downy hair with slight pigmentation at the base
of the penis and scrotum (males) or on the labia majora (females) [10–
hair becomes more coarse and curly, and begins to extend laterally
Adult-like hair quality, extending across pubis[disambiguation needed]
but sparing medial thighs [13–15]
hair extends to medial surface of the thighs [15+]
prepubertal (testicular volume less than 1.5 ml; small penis of 3 cm or
less) [typically age 9 and younger]
testicular volume between 1.6 and 6 ml; skin on scrotum thins,
reddens and enlarges; penis length unchanged [9-11]
testicular volume between 6 and 12 ml; scrotum enlarges further;
penis begins to lengthen to about 6 cm [11-12.5]
testicular volume between 12 and 20 ml; scrotum enlarges further
and darkens; penis increases in length to 10 cm and circumference
testicular volume greater than 20 ml; adult scrotum and penis of
15 cm in length [14+]
I t is caused by the hormonal influence and
control by anterior pitutary in response to the
stimulus from hypothalamus.
Functions of gonads-
1) Production and release of
1) Secretion of sex appropriate
Estrogen- Feminizing hormone, it is secreted
slowly increasing amount until 11yrs. It
increases and continuous until about 3yrs after
the onset of menstruation.
Androgen-Masculinizing hormone, they are
secreted in small and gradually increasing
amount up to about 7 or 9yrs of age
Usual sequence of maturational
Breast changes Enlargement of testicles
Rapid increase in height and
Growth of pubic hair, axillary
hair, hair on upper lip, hair on
elsewhere on body
Growth of pubic hair Rapid increase in height
Appearance of axillary hair Changes in the larynx and
consequently the voice
begins 2yrs after first signs)
Abrupt deceleration of linear
Abrupt deceleration of linear
In girls - If breast development has not occurred
by age 13 or if menarche has not occurred
within 4 years of the onset of breast
In boys – If no enlargement of the testis or
scrotal changes by 13.5-14 years of age ,or if
genital growth is not complete 4 years after
testicles begin to enlarge.
General growth pattern
Increased shoulder width Due to hormonal effect bones are
more strong, Broader hip
Voice become striking, deep to
high tones as a result of
enlarged larynx and vocal cords
Voice become slightly deeper and
Lean body mass Chubby body
Muscles well developed Muscle mass increase is
proportionate to general tissue
Sebaceous gland is more active Sebaceous gland is more active
Fat deposits present over body
Fat deposits present over body
Heavy sweating Less sweating
Extremity hairs are more Less extremity hair
Psychosocial development- Identity v/s role confusion
Psychosexual – Genital stage
Cognitive development – Formal operative
Moral development –Internalised set of moral
Spiritual development – Deep spiritual concerns
Adolescence see themselves as distinct individuals
During this period the adolescent is faced with the
problem of group identity.
It is followed by developing a sense of personal identity
as opposed to role diffusion
Group identity appears to be essential to the
development of a sense of personal identity.
Cognitive thinking cumulates with the capacity for
abstract thinking .
This stage, the period of formal operations, is piaget’s
fourth and last stage.
They think beyond the present.
They can imagine a sequence of events that might occur
Thoughts can be influenced by logical principles rather
than just their own perceptions and experiences
Strong pressure to violate the old beliefs.
Their decision involving moral dilemmas must be based
on an internalised set of moral principles .
Late adolescence is characterised by serious
questioning of existing moral values and their relevance
to society and the individual.
Adolescent are capable of understanding abstract
concepts and of interpreting analogies and symbols.
They are able to empathize, philosophize, and think
Tendency towards introspection and emotional intensity
often makes it difficult for others to know what they are
May reveal deep spiritual concerns.
Adolescents want to grow up and to be free of parental
They are fearful as they try to comprehend the
responsibilities that are linked with independence.
Acceptance by peers, a few close friends, and the
secure love of a supportive family are requisites for
Relationship with parents
During adolescence the parent- child relationship
changes from protection-dependency to mutual affection
On the one hand adolescents are accepted as maturing
On other hand they must conform to regulations and
restrictions set by adults.
Teenagers become more competent, and with this
competence come a need for more autonomy.
Parents should use an authoritative style of parenting in
which authority is used to guide the adolescent while
allowing developmentally appropriate levels of freedom
and providing clear, consistent messages regarding
To gain trust of adolescents, parents must respect their
youngster’s privacy, as well as show a sincere interest
in what the adolescent believes and feels.
Relationship with peers
The peer group serves as a strong support to teenagers
providing them with a sense of belonging and a feeling
of strength and power.
To gain acceptance by a group, younger teenagers tend
to confirm completely in such things as mode of dress,
hairstyle, taste in music and vocabulary
Within the larger groups smaller, distinct, and rather
exclusive crowds or cliques of selected close friends
who are emotionally attached to each other.
Cliques are usually made up of one sex, and girls tend
to be more cliquish than boys.
To be ignored or criticized by peers creates feelings of
inferiority, inadequacy and incompetence
Interest and activity
Adolescent spend a large amount of time engaging in
leisure time activities.
In addition to providing teenagers with fun and
enjoyment, leisure time activities assist in the
development of social, physical, and cognitive skills.
Leisure time activities also allow teenagers the
opportunity to learn to set priorities and structure their
Increased nutritional requirements.
The calorie and protein requirement during this
time are higher than at almost any other time of
There is a substantial increase in the need for the
minerals, calcium, iron, and zinc for the generation
of both skeletal and bone tissue.
Girls with very heavy or frequent menses may be
especially susceptible for iron deficiency resulting from
Dietary intervention should promote the regular
consumption of breakfast and a balanced intake of a
variety of foods.
Nutritional requirements for
The average teenage boy get about 2,800 calories per
day and the average teenage girl get about 2,200
calories a day.
All teens should aim to get at least half of their grains
from whole grain products.
girls who are between the ages of 14 and 19 should get
6 oz and boys between the ages of 14 and 19 should get
9 oz. (1 OZ = ½ CUP)
All teenage girls should get 5 oz. equivalents of protein
each day. Teenage boys who are 13 should also get 5
oz. of protein a day, and teenage boys older than 13
should get 6 ½ oz. equivalents.
All teenagers, regardless of age or gender, should get 3
cups of dairy each day.
Sleep and rest
Rapid physical growth the tendency towards
overexertion, and the overall increased activity of this
age contribute to fatigue in adolescents.
Teenagers vary in there need for sleep and rest.
Adequate sleep and rest at this time are important to a
total health regimen.
Exercise and activity
Many adolescents participated in sports within the
The practice of sports, games and even dancing
contributes significantly with growth and
development, the educational process, and better
The activities provide exercise for growing muscles,
interactions with peers, and a socially acceptable
means of enjoying stimulation and conflict.
Competitive activities provide teenagers a sense of
self-appraisal and development of self-respect
TT Booster at 10 and 16 years
Rubella As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if
not given earlier
MMR 1 dose at 12-13 years of age. (if not given earlier)
Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier
Typhoid TA, Vi or Oral typhoid vaccine every 3 years
Varicella* 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not given earlier)
2 doses (0 and 6 months) if not given earlier
Dental health should not be neglected during
adolescence, although the rate of caries formation is not
as great as in childhood. Early adolescence is usually
when corrective orthodontic appliances are worn, and
these are frequently a source of embarrassment and
concern to the youngsters.
Body changes associated with puberty bring special
needs for cleanliness.
The hyperactive sebaceous glands and newly
functioning apocrine glands make frequent bathing or
showering a necessity, and underarm deodorants
assume an important place in personal care
Sexuality education and guidance
The development of primary and secondary sex
characteristics and the increased sensitivity of the
genitals produce thoughts and fantasies about sexual
The responsibility for providing sex education has been
assumed by parents, schools, churches , community
agencies and health professionals.
Sexuality education should consist of instruction
concerning normal body functions and should be
presented in a straight forward manner using correct
When discussing sex and sexual activities, nurse should
use simple but correct language, not highly scientific
terminology or evasive jargon.
Teenagers need to discuss intercourse,and how to resist
peer pressure, prevention of sexually transmitted
disease and also value education.
Make them to develop decision making skills and
problem solving so that they can anticipate negative and
positive outcomes of a decision
Physical injuries are the common cause for death in
adolescent age group.
The most vulnerable age are 15-25yrs
Accidental injuries accounts for 60% in boys and 40% in
Educate the child regarding safety precautions.
They must also help to initiate and develop prevention
strategies that will decrease the number and severity of
Encourage parents to:
Accept adolescent as individual.
Respect their ideas, likes and dislikes.
Listen their views
Avoid comparing with other children
Avoid criticism about no win topics
Provide opportunity to select solutions and accept their
Encourage learning by doing.
Respects adolescent privacy.
Try to make the communication clear.
Provide clear reasonable limits.
Avoid comparison with sibling.
Assist them in selecting appropriate career goals and
prepare them for adult role.
Provide unconditional love.
Be willing to apologize when mistaken.