081-NP03L006 ELO D – THE ADOLESCENT (VERSION 2.0)

Adolescence

• Period from the appearance of secondary sex characteristics to the end of growth and emotional maturity
• Divided into early, middle, and late stages, with middle being the most challenging for families
• Major tasks include:
  • Establishing identity
    • Yearning for societal acceptance
    • Questioning their place in the world
  • Separating from family
    • Resistance to parental authority
    • Potential for conflicts with parents
  • Initiating intimacy
    • Learning to avoid emotional isolation
    • Facing the fear of rejection in various forms
  • Developing career choices for economic independence
    • Older adolescents think about future plans

Challenges

• Need for social conformity:
  • Societal pressures can overshadow cultural or traditional practices
  • Impact of technology
  • Less defined family and gender roles
  • Parental needs often placed on adolescent (career dreams, activities, etc.)
• Rapid physical and physiological changes
• Maintaining privacy
• Maintaining open communication
• Developing positive health practices and lifestyle choices

Growth and Development

• Puberty signifies the transition from preadolescence to adolescence
• Reproductive organs become functional and secondary sex characteristics develop
• During childhood, both sexes produce equal amounts of androgens and estrogens
• In puberty, adrenal glands, ovaries (females), and testes (males) release estrogens and androgens in different proportions
• Growth spurt:
  • Rapid period of growth leading to adult height and weight by 18 years old
  • Account for the remaining 20% of mature height and subsequent weight gain due to skeletal mass
  • Skeletal growth is influenced by hormones
  • Asynchrony occurs as different body parts mature at different rates
  • Oily skin and acne are common due to active sweat glands
  • Gross motor development enables enjoyment of sports

Growth and Development in Boys

• Puberty occurs between 10-13 years old
  • Shoulders widen
  • Pectoral muscles enlarge
  • Voice deepens
  • Hair growth on face, chest, axillae, and pubic areas
  • Enlargement of testicles and penis
  • Pigmentation of the scrotum
  • Erections and nocturnal emissions occur
  • Sperm production begins between 13-14 years old
• Good health and hygiene practices are crucial
  • Athletic scrotal support device (jockstrap) is required for activities involving protection of genitalia
  • Perform monthly testicular self-examinations

Growth and Development in Girls

• Puberty starts with menarche (first menstrual period)
  • Usually occurs around 12-13 years old but can range from 10-15
    • Delays may be related to energy balance, activity, and nutrition
  • Secondary sex characteristics become evident before menarche
    • Fat deposition in hips, thighs, and breasts leading to enlargement
    • Perform monthly self-breast exams
    • Hair growth in axillae and pubic areas
• Menstrual health:
  • Education before menstruation is crucial for a positive attitude and answering questions
  • Consideration of cultural and religious influences on menstrual education and understanding
  • Internal and external products are available
  • Safe tampon use is essential:
    • Wash hands
    • Avoid touching the tampon tip
    • Change every 4 hours
    • Do not wear for vaginal discharge between periods or while sleeping
    • Use the least absorbent tampon possible
      • Super absorbent tampons are associated with toxic shock syndrome
  • Prevent vaginal irritation and infection:
    • Regular bathing with soap and water
      • Avoid vaginal sprays or douches
    • Wear cotton underwear and pants
    • Wipe front-to-back to avoid fecal contamination

Psychosocial Development

• Sense of Identity:

  • Physical and cognitive development may vary in adolescents
    • This can cause stress for those who mature early
  • Desire for freedom and independence is crucial for developing individuality
  • Rejection of childhood self (emancipation) is necessary to establish identity
  • Self-concept fluctuates as the adolescent tries on new roles
    • This process can be impacted by illness, family dynamics, education level, etc.
  • Erikson’s identity vs. role confusion:
    • Struggles to master confusion and establish an identity may lead to rigidity, bewilderment, depression, low self-esteem, alienation, or clinging to peer groups
      • Potential future difficulties in entering the adult world

• Sense of Intimacy:

  • Taking risks in forming close friendships and relationships with the opposite sex
    • Avoidance may lead to isolation
  • Questioning parental values and morals
    • Disagreements often arise around dating, family car, money, chores, grades, friends, smoking, sex, and drug use
    • Adolescents are sensitive to hypocrisy
  • Parental guidance is crucial as the adolescent explores intimacy
    • Create an atmosphere of interest and understanding
    • Allow decision-making practice, even when mistakes are made
    • Set limits and expect them to be challenged, but not exceeded
    • Provide a secure environment for growth and loving detachment
      • Understanding the intrinsic worth of others and feeling good about oneself

• Cultural and Spiritual Considerations:

  • Not all cultures value independence as a goal of emotional development
    • May have distinct social roles and family structures
    • May prioritize family and community over the individual
  • Adolescents decide whether to embrace or separate from family values while pursuing identity
    • Exposure to outside concepts, symbols, and religions helps stabilize group identity

• Body Image:

  • Puberty changes lead to egocentrism (self-centeredness)
  • Belief in an “imaginary audience” - everyone is watching them
  • Trying to hide or flaunt changing body, appearance, skills, and abilities
    • Frustration when the actual self doesn’t match the perceived self
  • Young adolescents value fitting in with peers, while older adolescents prioritize individuality
  • Chronic illness and eating disorders complicate body image issues

• Peer Relationships:

  • Peer groups create a sense of belonging and allow for social experimentation
  • School provides an environment for social interaction
    • Small, exclusive, unisex groups form (cliques)
      • May develop a close relationship with one peer of the same sex within the clique
        • Stable best friend experiences often precede successful relationships later in life
  • Establishes a sense of normality, acceptance, and identity
  • Social norms and pressures can cause problems
    • Confrontation with family due to exaggerated conformity
    • Lack of social competence can lead to inadequacy and low self-esteem

• Career Plans:

  • Understanding one’s identity is crucial for career choices
  • Actions toward future goals:
    • High school curriculum
    • Grades earned
    • Aptitude tests
    • Preparation for a specific vocation
  • Exploration of various fields should be encouraged
    • Parents should observe their children’s interests
    • Resources like colleges, professional organizations, government, internet, and other informational sources provide guidance
  • Choosing a career freely is important for happiness
  • Productive employment should fit into the young person’s life and offer growth opportunities
    • Benefits of employment include:
      • Building self-esteem
      • Promoting responsibility
      • Testing new skills
      • Constructively channeling energy
      • Financial independence
      • Interaction with adults
      • Taking an active role in life
    • Forced employment due to economic pressure can lead to dropping out of school, perpetuating a cycle of low-level work

• Responsibility:

  • Adolescents seek new challenges and responsibilities
    • Freedom of transportation (driving, biking, walking)
    • Working
    • Financial independence
      • Need to learn the value of money
      • Allowances teach financial management
      • Purchasing items provides financial lessons
      • Assistance with banking, checkbooks, and budgeting may be required

Cognitive Development

• Piaget’s theory places adolescents in the stage of formal operations:
  • Progress from concrete thinking (young adolescents) to abstract thinking (older adolescents)
    • Older adolescents can analyze situations from multiple perspectives
    • Able to imagine and explore possibilities
    • Develop sympathy and empathy
    • Patient education should be catered to their cognitive level, empowering them and increasing self-image
• Daydreaming:
  • Significant amount of time spent daydreaming is normal
    • It helps fill loneliness, prepares for interactions, and expresses strong feelings

Sexual Development

• Sexual behavior:

  • Adolescents become familiar with the opposite sex
  • Premarital sexual activity is more common and occurring at younger ages
  • Dating begins
    • Cultural background may clash with American norms
    • Parental opposition often stems from unspoken fears
      • Strict restrictions on curfews, chaperones, and car use
    • Break-ups are often emotionally painful
  • Exploring sexual urges in socially acceptable ways:
    • Dancing
    • Telephone calls
    • Text messaging
  • Developing “crushes”
  • Long-term commitment is rare
  • Sexual experimentation, curiosity, and masturbation arise from:
    • Peer pressure and media
    • Need for pleasure
    • Learning experience
    • Feeling loved
    • Unplanned pregnancies and STIs are complications
    • Sexually advanced friendships can lead to guilt and isolation

• Sex Education:

  • Media, internet, and peers often provide sex education, which may be inaccurate
  • Factual and sensitive information from parents is ideal
  • Developed as a response to STI and HIV exposure
  • Schools should offer formal, comprehensive sex education programs
  • Topics include:
    • Physiology of sex
    • Reproductive systems
    • STIs
    • Sexuality
    • Contraception
    • Safe sex
    • Abstinence
    • Peer pressure
    • Health
    • Coping skills
    • Pregnancy and birth
    • Parenting
    • Relationships
  • Focus on decision-making and consequences
    • Flow charts can illustrate cause-and-effect

• Concerns about being “different":

  • Girls who mature early may feel self-conscious or be teased, while those who develop late may feel insecure
    • Often stereotyped by sensitivity and interpersonal competence
  • Boys who develop late may struggle to compete in sports and feel threatened by other males
    • Stereotyped by activity and achievement
  • Societal pressures dictate acceptable sexual attitudes and behaviors for different genders

• Homosexuality:

  • Sexual attraction to a person of the same sex
    • Lesbian - female who prefers females
    • Gay - male who prefers males
  • Not uncommon in adolescence
    • Experimentation during this period doesn't always indicate adult sexual preference
  • Cultural, biological, and psychological factors influence orientation
  • Nursing role is not to change sexual behavior, but to help cope with reactions from others
  • Referrals to support groups, counselors, or health agencies are often needed for those questioning their sexuality and their families

Adolescence and Family Dynamics

• Media and social media heavily influence adolescent development.
• Parenting adolescents requires adaptation, open communication, respect, trust, confidentiality, and privacy.
• Adolescents need alone time to establish a sense of identity, which can lead to conflicts with families about privacy.
• Negotiation is generally more successful than authoritarian parenting approaches.
• Adolescents seek role models and confidants outside the family, such as coaches and scout leaders.

Adolescent Health Promotion

• Adolescents have increased caloric and protein requirements, often experiencing frequent hunger, which can lead to dietary deficiencies.
• Nutritional needs are more strongly linked to sexual maturity than age.
• Adolescents commonly skip meals, snack frequently, and dine out more often.
• Adolescent diets are often deficient in calcium, iron, and vitamin B12, with zinc being essential for growth and sexual maturation.
• MyPlate serves as a guide for healthy food options and portion sizes.
• Vegetarian diets require careful planning to ensure adequate intake of iron, zinc, and vitamin B12.
• Proper nutrition before exams increases alertness and memory.
• Post-exercise, athletes need rapidly digested carbohydrates to replenish glycogen stores.
• Sports injuries can be hazardous, especially contact sports. Importance of protective gear and awareness of the "female athlete triad," which includes eating disorders, amenorrhea, and osteoporosis.

Common Adolescent Problems

• Adolescents face complex social challenges, including forming new friendships, navigating romantic relationships, and dealing with increased academic rigor.
• Shyness is normal in adolescence, but social anxiety that impairs functioning needs professional care.
• Smoking and vaping rates are changing, with increased use of electronic cigarettes.
• Adolescent drug use is influenced by peer pressure, ease of access, and poor coping with physical and psychological changes.
• Inhalants are often used due to affordability and accessibility, but pose serious health risks including sudden death, organ damage, and cognitive impairments.
• Depression in adolescents can be disguised, requiring attention to signs like drug use, changes in school performance, appearance, and behavior.
• Adolescent pregnancy carries significant health risks for both mother and child, including gestational hypertension, low birth weight, premature delivery, and sexually transmitted infections.
• Nursing care for pregnant adolescents focuses on promoting healthy behaviors, facilitating disclosure of pregnancy, and preparing for labor and newborn care.

Nursing Approach to Adolescents

• Maintain open communication and a sense of humor with adolescents, avoiding artificial attempts to "be cool."
• Distinguish between normal and problematic behaviors that require professional referral.
• Employ open-ended questions to navigate issues and guide health education.