Adolescent Years (13-18)

Tanner stages

1. Pre Puberty 2. Start 3. 4. 5. Fully grown

Identity vs Role Confusion (Erikson)

12-18 •Rapid and marked physical changes •Preoccupation with physical appearance •Examines and redefines self, family, peer group, and community •Peer group very important •Success = confidence in self and identity; optimistic •Fails = develops role confusion and pessimism

Language Development

Able to express themselves verbally Adolescents who read are more articulate and have a broader vocabulary. Self-confidence plays a significant role in verbal expression. Social media has contributed to abbreviated communication. Communication with a teen can be challenging.

Cognitive Development

Cognitive thinking during adolescence moves from concrete to abstract reasoning. Formal operations characterizes the last stage of cognitive development (Piaget). Inductive and deductive reasoning Ability to connect the separate events Understanding of consequences Understanding of complex concepts using analytical methods

Selected Issues Related to the Adolescent

Risk-taking behavior is considered normal Body piercing Tattoos Tanning Sexual Activity Relationship violence Teen Pregnance STD's

Sexual Development

Sexuality maturity ratings Significant hormonal changes Initiation of pubertal development is occurring earlier than ever before Girls reproductive maturity 2-5 years after menarche Boys experience voice changes, facial hair, and genital enlargement.

Health Promotion 2

Sleep and rest Shows a propensity for staying up late Difficulty waking up in the morning 6-8 hours sleep during the week; 12 on weekends Exercise and activity Involvement in many activities Ideal time to promote physical fitness

Piaget's Theory Formal Operations Period

•Abstract thinking (•Think beyond present •Mental manipulation of multiple variables •Concerned about others' thoughts and needs)

Physical Growth

•Adolescence is a time of RAPID GROWTH •Adolescence spans ages 13-18 •Girls grow more rapidly in preadolescence •Boys grow more rapidly around 13 years of age •Adolescents reach full adult height during these years •Girls grow 3 inches a year until menarche - after which growth slows considerably •Menarche can take place in girls as young as 9 years old •Boys enter preadolescence later than girls (11-13) •Nocturnal emissions is often used as a sign preadolescence has ended

Acne Nursing Interventions

•Avoid touching affected area •Reduce oils and make up on affected area •Teach client to cleanse face 2-3 times daily with mild soaps. Astringents are harsh on the skin •Keep hair clean and off face •Administer prescribe comedolytic agents as ordered for mild acne (benzoyl peroxide, erythromycin) •Administer oral antibiotics as ordered for inflammatory acne (doxycycline (abx), minocycline) •Dietary changes do not affect acne

Adolescent Suicide Risks

•Depression or other mental health illness •Personal or family history of previous suicide attempt •Poor school performance •Dysfunctional or disorganized family •Substance abuse •Difficulties with sexual identity •Socially isolated (loner, victim of bullying) •Marked changes in behavior (giving away valued possessions)

Motor Development

•Engages in various forms of motor activity •Aerobic exercise •Team sports •Dance •Provides an opportunity for competition, teamwork, and social relationships •Large muscle mass increases in adolescents. •Coordination of gross and fine muscle groups improves.

Sensory Development

•Eyes and ears are fully developed. •Exception of refraction errors •Minor infections •Myopia occurs in early adolescence. •Eye injuries are common. •Protective equipment should be worn during athletics.

Health Promotion

•Hygiene •In general are meticulous about personal hygiene •Acne 16-18 •Dental care •Cavities decrease •Third molars (wisdom teeth) may erupt •Gingivitis, malocclusion, and trauma to the mouth

Psychosocial Development

•Identity formation - The acquisition of psychosocial, sexual, and vocational identity •Will begin to experiment with new roles outside the family unit

Safety

•Injuries claim more lives during adolescence than all other causes of death combined. •Car safety (#1cause of fatal injuries teens) •Alcohol use and motor vehicle crashes •Water safety •Suicide •Violence toward others •Firearms

Psychological Development

•Intense feelings about body image •Quite egocentric •May move from obedience to rebellion •Believe everyone is critical of them •Audience conscious (Elkind) •Bad things only happen to others.

Adolescent's reaction to hospitalization/illness

•Loss of independence •Loss of identity •Body image disturbance •Rejection by others •Separation from peers is a source of anxiety •Physical appearance is important to their identity perception •May act due to loss of control: anger, withdrawal, uncooperativeness, power struggles, etc. •Reluctant to ask questions, questions competency of others •Personal Fable - nothing can harm them. This results in risk taking and noncompliance

Risk for violence

•Low socioeconomic status •Crowded urban housing •Single-parent family/limited supervision •History of family violence/abuse •Access to guns •PEER PRESSURE OR GANG INVOLVEMENT •LIMITED EDUCATION •RACISM •DRUG OR ALCOHOL USE •LOW SELF ESTEEM/ HOPELESSNESS ABOUT THE FUTURE •AGGRESSION

Nutrition in Adolescence

•Peer pressure; growing wish for independence from family in food choices •Low cost/ convenience/ easy access of fast foods •Family culture relating to food and meal time rituals •Lack of time/opportunities for family meals (busy schedules) •Growing wish for independence in food choices

Assessment of the Adolescent

•Prefer a straight-forward approach. Be careful not to appear condescending. •Show concern for adolescent's perspective. Ex. "First, I'd like to talk about your main concerns" •Begin with less sensitive issues and proceed to more sensitive ones. •Have an open dialog regarding who should be present during the exam (usually without parents present) •Parents should be able to talk with nurse regarding concerns •Provide a gown for the adolescent to wear during exam and be sure to allow for modesty •Perform head to toe exam, including examination of genitals. Allow the teen to ask any questions. Always have witness.

Acne

•Primary lesions are comedones (blackheads and whiteheads) or plugged sebaceous follicles •Inflammation from the bacteria propionibacterium acnes leads to pustules, cysts, and scarring •Acne generally appears on the face, chest, and back •Acne is primarily seen in what age group?