Adolescence

Adolescence Overview

• Adolescence is a period of significant biological, psychological, emotional, and cognitive change.
• Adolescents face new experiences and developmental tasks.
• Physical changes are primarily mediated by hormonal systems in the hypothalamus, pituitary gland, gonads, and adrenal glands.
• Relationships with parents transform, peer interactions become more intimate, and sexual exploration begins.
• Adolescent thoughts become more abstract and idealistic, and biological changes heighten interest in body image.

Biological and Genetic Factors

• Adolescence is distinct from puberty.
• Puberty is the development process that leads to fertility.
• During puberty, physical changes occur in a predictable sequence, but timing varies among individuals.
• Females usually begin puberty 2 years earlier than males.
• Adolescents who do not follow the normal sequence or who have not begun pubertal development by age 14 (males) and 13 (females) should be evaluated by an endocrine specialist.
• Puberty includes an accelerated growth spurt, which begins earlier in girls than in boys.
• Height and weight increases during puberty, with weight increases often following height increases.
• Changes in primary and secondary sexual characteristics accompany puberty.

Sexual Maturation, Height, and Weight

• Pinpointing the start and end of puberty is difficult, but the changes are most noticeable in sexual maturation, height, and weight.
• Early adolescence often sees girls weighing more than boys, but by age 14 boys generally outweigh girls.
• During this period, boys experience a height increase of 10-30 cm (4 to 12 inches), while girls' height increases 5 to 20 cm (2 to 8 inches).
• Weight increases with height, related to fat, bone, and muscle tissue development.

Primary & Secondary Sexual Characteristics

• Primary characteristics are organs directly needed for reproduction (penis, testes, vagina, ovaries, etc).
• Secondary characteristics, which are not essential for reproduction, include breast development, pubic hair, facial hair, and voice changes.
• Gynecomastia (breast development in males) is usually temporary and resolves during puberty.
• Thinning of the scrotal sac and testicular enlargement are first signs of puberty in males.
• Breast budding is the initial sign of puberty in females, followed by the growth spurt.
• Menarche (first menstruation) occurs roughly two years after breast budding, near the end of the growth spurt.

Other Physical Changes

• Heart: Heart grows in size and strength, with a decrease in heart rate.
• Blood volume and blood pressure typically increase.
• Respiratory: Rate of breathing decreases to 15-20 bpm; lung capacity increases.
• Integumentary (skin): Sweat and oil glands become more active, leading to acne.
• Voice: Voice deepens in males during puberty; laryngeal cartilages enlarge, significantly impacting males during puberty.
• Scoliosis: Curvature of the spine; more common in females.

Scoliosis

• Approximately 10% of adolescents experience mild spinal asymmetry.
• Curves greater than 20 degrees are considered abnormal.
• Curvature of the spine may worsen with continued growth.

Gordon's Functional Health Patterns

• Gordon's Functional Health Patterns are a framework for assessing an adolescent's health.
• Several functional categories include Health Perception-Health Management, Nutritional-Metabolic, Elimination, Activity-Exercise, Sleep-Rest, Cognitive-Perceptual, Self-Perception-Self-Concept, Roles-Relationships, Sexuality-Reproductive, Coping-Stress Tolerance, and Values-Beliefs.

Health Perception-Health Management

• Adolescents often experience less acute illness compared to younger children or adults.
• Partnering with adolescents during care, focusing on strengths, and promoting autonomy are key aspects of care.
• Social media is often a source of health information sought by teens.

Nutritional-Metabolic

• Ideal body image is a significant factor.
• There is an emphasis on dieting among teens.
• Dietary intake is a way for teens to gain control.
• Increased needs are present during adolescent growth spurts.
• Increased risk for unhealthy eating habits and nutritional deficiencies.

Body Image

• Preoccupation with body image is pronounced during adolescence, more so during puberty, which can lead to dissatisfaction with one's body.
• Media portrayals often reinforce the ideal of a thin body, causing difficulties for adolescents.
• Early-maturing girls may experience more negative body-related experiences than their peers.
• Early-maturing boys may be prone to weight gain, which may influence their bodies and behaviours.

Disordered Eating

• Anorexia nervosa, bulimia nervosa, binge-eating disorder, and overweight/obesity are disorders that can arise during adolescence.

Anorexia Nervosa

• A relentless pursuit of thinness, self-starving, compulsive exercise, hyper-focus on food intake and calculation of calories may result in anorexia nervosa.

Bulimia Nervosa

• This disorder includes episodes of eating large amounts of food, followed by behaviours that attempt to compensate (purging).

Time Orientation and Language Skills

• Adolescents develop future orientation and are able to delay gratification.
• Cognitive skills and language understanding, receptive and expressive vocabulary, slang, and electronic communication improve

Strategies and Nursing Interventions

• Nurses play a crucial role in promoting health, preventing illness, and providing education.
• Interventions should prioritize independence, privacy, and socializing.
• Communication is key to building rapport.

Self-Perception-Self-Concept

• Peer pressure plays a significant role in adolescent self-perception, impacting self-image, body image, body art/piercing, and gender dysphoria.
• Anticipatory guidance, counseling, and education about healthy decisions improve self-perception.

Roles-Relationships

• Adolescents' roles undergo change, often causing family stress as independence increases.
• Positive strategies include willingness to listen, providing ongoing affection, and negotiating boundaries.
• Peer groups play a strong role in an adolescent's life, influencing their choices, behaviours, and social identity.

Sexuality-Reproductive

• Adolescents become sexually active for various reasons, including peer pressure, seeking affection, and exploring feelings of maturity.
• Dating and sexual exploration are common.
• Condoms are a widely used contraceptive method.
• 2SLGBTQIA+ youth have unique considerations, potentially including greater risks of bullying and social isolation.

Adolescent Sexual Issues

• Sexual assault is a serious issue in this age group, with Indigenous women disproportionately affected.
• Sexting and sexually transmitted diseases are concerns.
• Adolescent pregnancy continues to be a risk.

Adolescent Pregnancy and Health

• The social stigma surrounding teen pregnancy has lessened.
• Teen mothers experience higher rates of mental health problems, interrupted education, and low birth weight infants.
• Counselling and support systems are vital for teens facing pregnancy.

Those Most Likely to Become Pregnant

• Teens with family problems, those exhibiting frequent absenteeism, or lacking vocational goals, those were born to adolescent mothers, or experienced early puberty are more likely to become pregnant.

Coping-Stress Tolerance

• The ability to cope is tested during adolescence.
• Depression and suicide are important concerns in this population.
• Depression may involve low mood, sadness, loss of interest and pleasure, difficulty sleeping, agitated behaviour, feelings of hopelessness.
• Suicidal ideation and attempts are a significant cause of death in adolescents and require vigilant monitoring.
• Nurses need to recognize warning signs and seek professional intervention.

Physical Agents

• Unintentional injuries, e.g., motor vehicle accidents, are a leading cause of death in adolescents.
• Sports injuries, violence (physical, verbal, social, cyberbullying/sexortion), and exposure to infections are also significant physical risks.

Infections

• Sexually transmitted blood-borne infections (STBBIs), meningitis, and infectious mononucleosis are infectious risks affecting adolescents.

Chemical Agents

• Substance use (e.g., alcohol, tobacco, marijuana, e-cigarettes) is a concern during adolescence, which can lead to substance use and abuse.

Nursing Application

• Nurses play a crucial role in influencing health promotion, screening and disease prevention during adolescence.
• Nurses must educate adolescents about predicted changes in their lives and provide tools to deal with any issues that arise.