Adolesence PDF

Adolescence The Nature of Adolescence Adolescents face dramatic biological changes, new experiences, and new developmental tasks The physical changes experienced during adolescence are mediated primarily by the hormonal regulatory systems in the hypothalamus, pituitary gland, gonads, and ad...

Adolescence The Nature of Adolescence Adolescents face dramatic biological changes, new experiences, and new developmental tasks The physical changes experienced during adolescence are mediated primarily by the hormonal regulatory systems in the hypothalamus, pituitary gland, gonads, and adrenal glands Relationships with parents take a different form, moments with peers become more intimate, and dating occurs for the first time, as do sexual explorations The adolescent’s thoughts are more abstract and idealistic. Biological changes trigger a heightened interest in body image Bergen 2022  Adolescence vs. puberty Physical growth Adolescence: psychological, Accelerated growth spurt emotional, cognitive, and moral Onset of puberty: changes transition from childhood to occur in a predictable young adulthood sequence, but onset and Puberty: development of duration of sequence differ maturation of reproductive, among individuals. endocrine, and structural Biology and process that leads to fertility Females usually begin puberty 2 years earlier than males and experience growth spurt earlier. Genetics Adolescents who do not follow the normal sequence or who have not begun pubertal development by the age of 14 for males, and 13 for females, should have an endocrine evaluation. Menarche (females) late in puberty Sexual Maturation, Height, and Weight Pinpointing the beginning and the end is difficult; but During early adolescence, The growth spurt occurs the most notable changes girls tend to outweigh boys, earlier in girls than it does in are signs of sexual but by about age 14 boys boys maturation, height, and begin to surpass girls weight Increases in weight follow Boys grow 10 to 30 cm while increases in height, both of girls grow 5 to 20 cm during which are related to this period increases in fat, bone, and muscle tissue Bergen 2022 Primary & Secondary Sexual Characteristics Primary: Organs necessary for reproduction (Penis, testes, vagina, ovaries, & uterus) Secondary: External features not essential for reproduction Breast development, facial and pubic hair growth, and voice changes Estrogen produces all secondary sexual characteristics except axillary and pubic hair, which are controlled by androgens Breast development is usually confined to females however, some degree of gynecomastia may appear in early puberty in males, just before the growth spurt. Usually temporary and disappears. First sign of puberty in males: Thinning of scrotal sac and enlargement of testes. Ejaculation: A milestone of puberty and precedes fertility by several months. First sign of puberty in females: Appearance of breast buds, followed by the growth spurt. Menarche approximately 2 years after the appearance of breast buds and near the end of the growth spurt. Other Physical Changes Integumentary Sweat and sebaceous glands become more Heart active; clogged and inflamed (because of puberty causing acne!) Grows in size and strength, HR Soap and water; topical medication; stress management decreases Voice Blood volume and BP increase Voice becomes deeper (significant with males during puberty) Laryngeal cartilages enlarge Respiratory Scoliosis S-shaped curvature of spine Rate decreases to 15-20 bpm More common in females Volume and vital capacity increase Screening to identify  Approximately 10% of adolescents have a mild asymmetry Curves greater than 20 degrees are considered abnormal With continued growth the curvature can increase Gordon’s Functional Health Patterns Health Perception–Health Management Pattern Nutritional–Metabolic Pattern Elimination Pattern Activity–Exercise Pattern Sleep–Rest Pattern Cognitive–Perceptual Pattern Self-Perception–Self-Concept Pattern Roles–Relationships Pattern Sexuality–Reproductive Pattern Coping–Stress Tolerance Pattern Values–Beliefs Pattern Bergen 2022  Less acute illness than in younger children Less chronic illness than in adults Health Perception – Negative health choices and outcomes Health Adolescent experimentation Risk-taking behaviors Management Social media for health information Pattern Partnering approach in care Support autonomy Focus on strengths Nutritional–Metabolic Pattern Ideal body (?) Activities requiring weight restriction Fast foods, consumption of sugar and sugar- Competing factors sweetened drinks, alcohol Peer pressure Increased needs with growth spurt Dietary intake: way of gaining control, exerting independence Bergen 2022 Body Image Preoccupation with one’s body image is strong throughout adolescence, but it is especially acute during puberty, a time when adolescents are more dissatisfied with their bodies than in late adolescence This dissatisfaction maybe due to media portrayals of the attractiveness of being thin and the increase of body fat during puberty Early maturing girls are more likely to smoke, drink, be depressed, have an eating disorder, engage in delinquency, struggle for earlier independence from their parents, and have older friends Early maturing boys have been characterized as more overweight or obese, compared to average or late maturing boys Bergen 2022 Disordered Eating  Anorexia Nervosa Physical Signs: Behavioural Warning Significant weight loss Signs: Brittle hair and nails Relentless pursuit of thinness Self-starving Yellow tinged skin Compulsive exercise Growth of fine hair Hyper-focused on food intake Lack of menstruation Portioning and calorie counting Anemia Constipation Bulimia Nervosa Eating huge Alternates with amounts of high- Purging diets caloric foods Risks of: Weight Dehydration fluctuations Teeth erosion Electrolyte imbalances Bergen 2022 Disordered Eating Resources Bergen 2022 Diabetes Increasing prevalence Risk increases with obesity, inactivity (type 2) Activity – body movement that is fun yet challenging (cardiac activity & muscle maintenance/building) Eating balanced diet (paying attention to what is put in their body) Bergen 2022 Elimination Pattern Consistent with adults Issues of privacy or self-protection May inhibit normal elimination in public places; e.g., schools Abnormal variation with eating disorders Sleep-Rest Pattern Need at least 8–10 hours of sleep per night – some indication that teens may need more during teen years, natural patterns of staying up later and sleeping later Risk of sleep deprivation is a common problem o Multiple activities and responsibilities o “Too much on their plate” = common scenario o Stay up late, then rise early for school o Texting or gaming after bedtime is a major problem o electronic devices  Cognitive–Perceptual Pattern Piaget’s stage of formal operations Lays groundwork for abstract thinking Introspection resurfaces egocentrism Erikson’s stage: identity vs. role confusion Restaging of each previous stage of development Adolescence develop a sense of personal identity. Successful leads them to the ability to be true to themselves and have an identity they are proud of Threats to identity can result in delinquent behaviour and mental health issues Bergen 2022 Time Orientation & Language Skills Time Ability for future orientation Able to delay immediate gratification Language Increased cognitive skills and understanding of language Receptive and expressive vocabulary increase Slang, electronic communication Bergen 2022 Strategies and Nursing Interventions Independence Privacy Free time Socialization Encourage questions & taking part in their own care Trust & understanding helps build rapport Privacy – Ask certain questions without the parents’ around Encourage Peer support groups/peer contact Nursing interventions: st Having friends come over and visit at the hospital – 1 Priority intervention nd Meeting other teens receiving similar treatments – 2 priority intervention A teen refusing classmates visit could indicate a risk of social isolation Self-Perception–Self-Concept Pattern Self-perception Anticipatory Peer pressure and body image guidance = Acne can be education and problematic in adolescence counselling Body art and piercing As well peers can play a big part of one’s self perception and Gender as nurses we can influence an adolescents self perception and/or body through education, counselling and encouragement of good dysphoria decision making and healthy choices Bergen 2022 Roles–Relationships Pattern Changing roles—stressful family time Increasing independence for adolescent Parents try to learn to “let go” (try not to baby them) Positive strategies Willingness to listen, ongoing affection for and acceptance of teen, negotiation of limits Peer groups Moving from child in family to member of group Strong influence on adolescent Bergen 2022  Adolescents become sexually active for a variety of reasons: - affection - peer pressure - symbol of maturity - as spontaneous experimentation - to feel close to another Sexuality- - because it feels good or right Reproductive They fantasize about relationships and sex and gradually experiment with dating and a myriad of coital and noncoital physical contacts. Pattern 28% of males & 21% of females had 1st heterosexual intercourse prior to the age of 14 years Condoms - contraceptive method of choice for 70% both males and females.  Gender identity & Sexual Orientation 2SLGBTQIA+ Approximately 4% of Canadian youth Sexuality– Higher rates of mood and anxiety disorders Poorer self-perceived health status and higher Reproductive risk of suicide Victims of bullying Pattern Greater risk of social isolation Nurse’s role Create a supportive, non-judgemental climate Rainbow Health Ontario Bergen 2022  Nearly half of all sexual assault incidents were against women aged 15 to 24 (stats Canada, 2014). Indigenous women were three times more likely to be a victim of violence Adolescent Sexual (2016). Issues Sexting 2SLGBTQIA+ Sexually transmitted and blood-borne infections Adolescent pregnancy Adolescent Pregnancy and Health The social stigma once attached to pregnancy outside of marriage has diminished All first pregnancies carry the challenge of higher rates of hypertensive disorders (pre-eclampsia/eclampsia); in teens who might have additional nutritional deficiencies, anemia, and /or disordered eating, the risk for hypertensive disorders increases Adolescent mothers are more likely than their peers to experience mental health issues and interruption in education Infants born to adolescent parents are more likely to have low birth weights When pregnancy occurs, adolescents and their families deserve honest and sensitive counselling about options available to them, as well as the support systems available for them throughout the pregnancy, birth, and subsequent parenting. Bergen 2022 Those most likely to become pregnant are those who: were born to are experiencing undergo early have been sexually adolescent family problems puberty abused mothers have frequent have siblings who live in group absenteeism were pregnant use alcohol, drugs, homes, detention and/or lack during and tobacco centres, or on the vocational goals adolescence street Bergen 2022  Ability to cope is tested during adolescence Depression Major depressive disorders ( 5% male & 12% female) Low, sad, hopeless, worried, bored, discouraged Coping–Stress (suspect depression), agitation, trouble sleeping Tolerance Depressed or irritable mood or diminished interest and pleasure Pattern Assess for signs &symptoms of depression; refer for treatment Suicide Second leading cause of death in 10 to 24 year olds Recognition of warning signs and prevention is essential Bergen 2022  Unintentional injury Unintentional injury along with suicide and homicide, continues to be the leading cause of death into adolescence 71% of all deaths in ages 15 to 19 years of age are related to Physical motor vehicle crashes Things to encourage: Agents Avoid the use of cell phones Avoid distractions Drive during daytime hours, avoid driving at night Do not drive under the influence of any substance or alcohol wear a safety belt Indigenous teens death rate from unintentional injuries is 3 to 4 times more, particularly from MVA and drowning  Sports Injuries Traumatic brain injury (concussion) Violence Death from violence in home, Physical Agents school, and communities Bullying – 4 Types: Physical Verbal Social Cyberbullying /Sextortion Adolescent Violence: Contributing Factors Bergen 2022  Infections Infections Biological STBBIs Meningococcal (IMD) Agents Infectious mononucleosis- “kissing disease”: self- limiting viral infection transmitted by direct contact with oropharyngeal secretions, caused by Epstein-Barr virus Available immunizations, education on risk, safe sexual practices Chemical Agents o Chemical use increasing—precursor to substance abuse Substance Use and Abuse o Opioid use among adolescents is leading to one of the fastest-growing rates of hospitalization for overdoses. o Tobacco use - e-cigarettes, vaping Alcohol, tobacco, cannabis, drugs o Cannabis use - often starts in Motivations for you: to feel better, look better, act more adolescence sociable, stay awake, sleep, be sexy or erect, or lose weight o Focus on preventing nonsmokers Influence of movies, sports stars, and musicians from starting and helping smokers to Making the choice to experiment quit Alcohol is most common, followed by Cannabis Inhalant abuse, opioids Tobacco, hookah or waterpipe or shisha Nursing Application Nurses play a pivotal role in influencing health promotion, preventive screening, and disease prevention activities during the adolescent period. The primary responsibility of the nurse is to provide education about some of the expected changes and how to deal with them. Bergen 2022