Growth and development of the adolescent:
Psychosocial development:
According to Erikson, it is during adolescence that teenagers achieve a sense of identity. As the adolescent is trying out many different roles in regard to his or her relationships with peers, family, community, and society, he or she is developing his or her own individual sense of self. If the adolescent is not successful in forming his or her own sense of self, he or she develops a sense of role confusion or diffusion. The ability of the adolescent to successfully form a sense of self is dependent upon how well the adolescent successfully completed the former stages of development.
Cognitive development:
According to Piaget, the adolescent progresses from a concrete framework of thinking to an abstract one. During this period, the adolescent develops the ability to think outside of the present; that is, he or she can incorporate into thinking concepts that do exist as well as concepts that might exist. The adolescent's thinking becomes logical, organized, and consistent. He or she is able to think about a problem from all points of view, ranking the possible solutions while solving the problem.
Sexuality:
Adolescence is a critical time in the development of sexuality. Sexuality includes the thoughts, feelings, and behaviors related to the adolescent's sexual identity. Adolescence is a time when teens may begin experimentation related to their sexual identity, orientation, and behavior. This experimentation is part of the process of sorting through their sexuality and does not define their sexual identity or orientation.
What are some physiologial changes?
Adolescence is a time of metabolic slowing and of increasing size of some organs. The basal metabolic rate (BMR) reaches the adult level during late adolescence.
What is the age range for an adolescence?
Adolescence spans the years of transition from childhood to adulthood, which is usually between the ages of 11 and 20 years.
General hygiene tips:
Adolescents find that frequent baths and deodorant use are important due to apocrine sweat gland secretory activity. Also, to decrease oily skin due to sex steroids and hormones, teach the adolescent to wash his or her face two to three times per day with plain unscented soap.
Illiciut drugs:
Adolescents may also experiment with or abuse illicit drugs. Substance abuse remains a widespread problem among American adolescents. Marijuana remains the most widely used illicit drug. A national survey on drug use showed the annual prevalence rate for illicit drugs, other than marijuana, are remaining stable at the lowest levels in over 20 years, with 6.1% of 8th graders, 9.6% of 10th graders, and 12.4% of 12th graders reporting substance use.
Promoting appropriate discipline:
Adolescents naturally misbehave or do not follow the rules of the house, and parents must determine how to respond. Adolescents need to know the rules and expectations.
Nursing interventions to decrease substance use among teens:
Adolescents' brains are still developing, leaving them particularly vulnerable to the damaging effects of drugs. Substance use in adolescence is related to poorer health outcomes; therefore, it is important that nurses be aware of interventions to decrease these behaviors. Teen drug use is related to social factors, such as times of life transitions, changing schools, moving, or divorce as well as peer factors such a peer pressure. Programs that focus on increasing awareness of the risks and health consequences of substance use are important. Certain factors have been found to help teens remain drug free.
Subtance abuse:
Agents commonly abused by children and adolescents include alcohol, nicotine, prescribed medications such as Ritalin and OxyContin, hallucinogens, sedatives, analgesics, anxiolytics, steroids, inhalants. The substance abused is related to its availability and cost. Overall the use of illicit drugs with the exception of marijuana are at their lowest level in 20 years. Some of the long-term effects and consequences of drug and alcohol use include possibility of overdose and death, unintentional injuries, irrational behaviors, inability to think clearly, unsafe driving and legal consequences, problems with relationships with family and friends, sexual activity and STIs, and health problems such as liver problems (hepatitis) and cardiac problems (sudden death with cocaine).
Alcohol:
Although alcohol remains the most widely used and abused drug for youth in the United States its use among adolescents has continued a downward trend.
Preventing the development of overweight and obesity:
Although obesity has increased in all segments of the United States population, there are differences specific to race, ethnicity, and socioeconomic status. The prevalence of obesity is highest in Hispanic and non-Hispanic African Americans. This increase in obesity in adolescents has led to increases in hypertension, heart disease, and type 2 diabetes. Influential factors causing obesity include poor food choices, unhealthy eating practices, and lack of exercise. Around 20% of teens reported drinking sugary beverages at least once a day and 48.2%% reported not attending physical education classes.
Dating:
An interest in romantic partnerships occurs during adolescence. Some of the reasons cited for this developing interest are physical development and body changes, peer-group pressure, and curiosity. Middle and late adolescents have group and single dates. Romantic relationships are central to the social life of this age group. By age 18, 70% of adolescents report being in at least one romantic relationship in the past 18 months
Changes in cardiovascular system:
Blood volume reaches higher levels in boys than girls, which may be due to boys' greater muscle mass.
Water safety:
Drowning is a needless cause of death in adolescents. Many drownings are a result of risk-taking behaviors. With the independence of the adolescent, many times, adult supervision is not prevalent and the teen takes a risk that results in drowning.
Integumentary changes:
During adolescence the skin becomes thick and tough. Under the influence of androgens, the sebaceous glands become more active, particularly on the face, back, and genitals. Due to the increased levels of testosterone during Tanner stages 4 and 5 in both boys and girls, both sexes may have increased sebum production, which may lead to the development of acne and oily hair. The exocrine and apocrine sweat glands function at adult levels during adolescence. The exocrine glands are all over the body and they produce sweat that helps to eliminate body heat through evaporation.
What are some neuroligi changes:
During adolescence there is continued brain growth, although the size of the brain does not increase significantly. Neurons do not increase in number, but growth of the myelin sheath enables faster neural processing.
Promoting a healthy sexual identity:
Encourage parents and teens to have discussions about sexuality. In addition, nurses should ensure that adolescents have the knowledge, skills, and opportunities that enable them to make responsible decisions regarding sexual behaviors and sexual orientation.
The nurses's role in adolescent growth and development:
Growth and development in the adolescent is rapid. Nurses must be aware of the usual growth and development patterns for this age group so that they can assess the adolescent appropriately and provide guidance to the adolescent and his or her family. In dealing with adolescents, be aware that they behave unpredictably, are inconsistent with their need for independence, have sensitive feelings, may interpret situations differently from what they are, think friends are extremely important, and have a strong desire to belong.
Homicide:
Homicide is the third leading cause of death in children between 10 and 24 years old, with the majority of victims being male and killed by firearms.
Moral development:
It is during the adolescent years that teenagers develop their own set of values and morals. According to Kohlberg, adolescents are experiencing the postconventional stage of moral development. It is only because adolescents are developing their formal operational way of thinking that they can experience the postconventional stage of moral development. At the beginning of this stage, teenagers begin to question the status quo.
Changes in motor skill development:
It is usually during early adolescence that teenagers begin to develop endurance. Their concentration has increased so they can follow complicated instructions. Coordination can be a problem because of the uneven growth spurts. During middle adolescence, speed and accuracy increase while coordination also improves.
Language development:
Language skills continue to develop and be refined during adolescence. Adolescents have improved communication skills, using correct grammar and parts of speech. Vocabulary and communication skills continue to develop during middle adolescence. However, the usage of colloquial speech (slang) increases, causing communication with people other than peers to be difficult at times.
Promoting growth and development through sport and physical fitness:
Many adolescents are involved in team sports that provide avenues for exercise. High levels of physical activity may reduce cardiovascular disease risk factors and provide disease prevention against cancer, obesity, osteoporosis, diabetes, and depression. To help prevent injury, parents and coaches need to be aware of early warning signs of fatigue, dehydration, and injury. In relation to youth sports, the role of the nurse is to educate to prevent injuries.
Promoting healthy teeth and gums:
Most permanent teeth have erupted with the possible exception of the third molars (wisdom teeth). These molars may become impacted and require surgical removal. The rate of cavities decreases but the need for routine dental visits every 6 months and brushing two to three times per day is very important. Some of the conditions that occur during adolescence include malocclusion, gingivitis, and tooth avulsion. Malocclusion (a poor bite) occurs from facial and mandibular bone growth that results in misalignment of the top teeth with the bottom teeth. It is the most common reason for referral to an orthodontist.
Promoting safety:
Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids. Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers.
Gangs:
Much of youth violence is a result of the behavior of adolescent gangs. Gangs tend to consist of adolescents and young adults but recent trends indicated that younger youth are being recruited. Adolescents who are gang members are more likely to commit serious and violent crimes. Identifying those at risk and providing early intervention is important.
Nursinf interventions to decrease youth violence:
Nurses working with adolescents should include violence prevention in anticipatory guidance. Violence is a learned behavior. It is often reinforced by the media, television, music, and personal example. Explain to parents, teachers, and peers the importance of being good role models.
Promoting nutrition:
Nutritional needs are increased during adolescence due to accelerated growth and sexual maturation. Adolescents may appear to be hungry constantly and need regular meals and snacks with adequate nutrients to meet the body's needs.
Weigth and height changes:
On average, boys will gain 10 to 30 cm (4 to 12 in) in height and 7 to 30 kg (15 to 65 lb) in weight. On average, girls will gain 5 to 20 cm (2 to 8 in) in height and 7 to 25 kg (15 to 55 lb)
Caring for body piercing and tattoos:
Other sites such as the genitals, chin cleft, knuckles, and even the uvula have been used. Generally, body piercing is harmless, but nurses should caution teens about performing these procedures under nonsterile conditions and should educate them about complications. Qualified personnel using sterile needles should perform the procedure. Teach the adolescent to cleanse the pierced area twice a day and more often at some sites.
Importance of peers:
Peer groups play an essential role in the identity of the adolescent. Adolescent peer relationships are very important in providing opportunities to learn about negotiating differences; for recreation, companionship, and someone to share problems with; for learning peer loyalty; and for creating stability during transitions or times of stress.
Promoting learnin: School
School plays an essential part in preparing adolescents for the future. Completing school prepares the adolescent for college or employment to make an adequate income. Schools in the United States may not meet the developmental needs of all adolescents. There is evidence that the transition from elementary school to middle school at age 12 or 13, and then the transition to high school, both of which occur at the time of physical changes, may have a negative effect on teens. It is important to observe for transition problems into middle or high school, which may be exhibited by failing grades or behavior problems.
Self-ceoncept and body image:
Self-concept and self-esteem are often tied to body image. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Sexual characteristics are important to the adolescent's self-concept and body image. Boys are concerned about the size of their penis and facial hair while girls are concerned about breast size and the onset of menstruation.
Tobacco and Nicotine:
Smoking remains the leading preventable cause of death in the United States. Long-term consequences of youth smoking are reinforced by the fact that most young people who smoke regularly continue to smoke throughout adulthood. Each day in the United States, approximately 2,000 children younger than 18 years old try their first cigarette, with 300 becoming regular smokers; nine out of 10 adult smokers started smoking before age 18
Suicide:
Suicide is the second leading cause of death in youths 10 to 24 years old (Heron, 2018). In a nationwide CDC study, 17% of adolescents surveyed reported that they had seriously considered suicide within the past 12 months, with 13% creating a plan and 7% attempting to take their own life. • Depression or other mental illness • Mental health changes • Family history of suicide • History of previous suicide attempt • Poor school performance • Family disorganization • Substance abuse • LGBTQ • Giving away valued possessions • Being a loner/having no close friends • Changes in behavior • Incarceration
Nutritional needs:
Teenagers have a need for increased calories, zinc, calcium, and iron for growth. However, the number of calories needed for adolescence depends on the teen's age and activity level as well as growth patterns. Teenage girls who are moderately active require about 2,000 calories per day. Teenage boys who are moderately active require between 2,200 and 2,800 calories per day.
Addresing common developmental concenrs: Violence
The CDC's Injury Center defines youth violence as occurring when "young people between the ages of 10 and 24 years intentionally use physical force or power to threaten or harm others".
What are some major changes?
The adolescent experiences drastic changes in the physical, cognitive, psychosocial, and psychosexual areas. With this rapid growth during adolescence, the development of secondary sexual characteristics, and interest in the opposite sex, the adolescent needs the support and guidance of parents and nurses to facilitate healthy lifestyles and to reduce risk-taking behaviors such as drinking, drug use, sexual activity, and participating in reckless behavior or dangerous activities.
What are some gastrointestinal changes?
The adolescent has a full set of permanent teeth with the exception of the last four molars (wisdom teeth), which may erupt between the ages of 17 and 20 years.
Relationship with parents:
The adolescent is striving for self-identity and increased independence. He or she spends more time with peers and less time with family and attending family functions. Parents sense that they have less influence on the adolescent as the teen questions family values and becomes more mobile. This may lead to a family crisis, and the parents may respond by setting stricter limits or asking questions about the teen's activities and friends.
What are some respiratory changes in adolescentL
The adolescent years see an increase in diameter and length of the lungs. Respiratory rate decreases and reaches the adult rate of 15 to 20 breaths per minute. These changes in the quality of the child's voice are often preceded with some voice instability where voice cracking is heard. Deepening of both male and female voices occurs but is more pronounced in boys.
Promoting healthy sleep and rest:
The average number of hours of sleep that teens require per night is nine to 10. Also, in this independence-seeking phase of adolescence, the teen may stay up later to do homework, to complete projects or to participate in activities and may have difficulty awakening in the morning. Rapid growth and increased activities may produce fatigue and the need for more rest. Parents may relate that the teen sleeps all the time and never has the time or energy to help with household chores.
Motor and vehicle safety:
The largest numbers of adolescent injuries are due to motor vehicle crashes. When the adolescent passes his or her driving test, he or she is able to drive legally. However, driving is complex and requires judgments that the teen is often incapable of making. Also, the typical adolescent is opposed to authority and is interested in showing peers and others his or her independence. It is also normal for teens to take risks. These factors coupled with inexperience with driving may lead to underestimating hazardous and dangerous situations. Teenagers are the least likely age group to wear a seat belt.
Promoting healthy eating habits:
The nurse must understand normal growth and development of the adolescent in order to provide guidance that fits the quest for independence and the need for teens to make their own choices. Assess the eating habits and diet preferences of the adolescent. The assessment should include an evaluation of foods from the different food groups that the adolescent eats each day. Also, assess the number of times that fast foods, snacks, and other junk food are eaten per week.
What are some musculoskeletal system?
The ossification of the skeletal system is incomplete until late adolescence in boys. Ossification is more advanced in girls and occurs at an earlier age. During the growth spurt, muscle mass and strength increase. At similar stages of development, muscle development is generally greater in boys.
Changes in physical growth:
The rapid growth during adolescence is secondary only to that of the infant years and is a direct result of the hormonal changes of puberty. Both girls and boys experience changes in appearance and size. Height in girls increases rapidly before menarche and usually ceases 2 to 2½ years after menarche. Boys' growth spurt occurs later than girls' and usually begins between the ages of 10½ and 16 years and ends sometime between the ages of 13½ and 17½ years.
Firearm and safety:
The risk of dying from a firearm injury among 15- to 19-year-olds has been rising. Eighty-three percent of homicides and 45% of suicides in children and adolescents were caused by a firearm.
What are some physioloigic changes associated with puberty:
The secretion of estrogen in girls and testosterone in boys stimulates the development of breast tissue in girls, pubic hair in both sexes, and changes in male genitalia. These biologic changes that occur during adolescence are known as puberty. Girls reach physical maturity before boys and menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years). Breast budding (thelarche) occurs at approximately age 9 to 11 years and is followed by the growth of pubic hair. The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, usually occurring in Tanner stage 2. As testosterone levels increase, the penis and scrotum enlarge, hair distribution increases, and scrotal skin texture changes.
Chagnes in fine motor skills:
The use of computers has greatly increased the fine motor skills of teenagers. In the early adolescent years, the teenager increases his or her ability to manipulate objects. The adolescent's handwriting is neat and he or she increases his or her finger dexterity.
Dating violence:
Violent behavior that takes place in a context of dating or courtship is not a rare event and can have serious short-term and lifelong effects. In a recent survey, approximately 12% of high school females reported physical violence and 16% reported sexual violence from a dating partner while more than 7% of high school males reported physical violence and about 5% reported sexual violence from a dating partner in the past 12 months.
Promoting proper media use:
With greater technology and media access comes benefits such as enhancing communication skills, increasing social connections, and improving technical skills, but risks also exists, such as cyberbullying, sexting, exposure to inappropriate content, privacy issues, internet addiction, and sleep deprivation. Health care providers need to assess media use and advise parents on ways to decrease media risks. Parents should be advised to evaluate websites their adolescent wants to participate in and verify they are age-appropriate.