The document discusses various topics related to adolescent development including: 1) Physical changes during puberty like growth spurts and development of secondary sex characteristics. 2) Psychosocial challenges such as developing identity and independence from family while establishing intimacy. 3) Health issues adolescents may face including nutrition, sexual health, substance abuse, depression, and pregnancy. The nurse's role in health promotion and guidance is also covered.

1. Chapter 20
The Adolescent

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.
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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.
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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.
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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.
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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 age
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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
choices
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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 society
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9. General Characteristics (cont.)
• Erikson: intimacy stage
• Piaget: abstract reasoning
• Freud: genital stage
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10. Growth and Development
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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
hormones
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12. Physiological Changes
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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 mass
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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 common
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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-examination
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16. Tanner’s Stages of Sexual Maturity
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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 delayed
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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
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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 operations
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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 others
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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 problems
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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 will
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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
checkbook
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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 feelings
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25. Sexual Behavior
• Must meet and become acquainted with
members of opposite sex
• Dating
– Groups
– Couples
– Single-couple
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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 protection
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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 emphasized
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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 adolescence
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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
open
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30. Health Promotion and Guidance
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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 calls
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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 B12
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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 growth
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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
sun
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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 gear
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36. Safety (cont.)
• Female athlete triad
– Nurse should assess for
• Eating disorder
• Amenorrhea
• Osteoporosis
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37. Common Problems of
Adolescence
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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 use
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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
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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 delay
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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 referrals
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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 care
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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
process
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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
respect
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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 questions
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46. Question for Review
• What are some challenging developmental
tasks during adolescence?
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47. Review
• Objectives
• Key Terms
• Key Points
• Online Resources
• Critical Thinking Question
• Review Questions
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