5. Health Promotion for the Adolescent

Question 1

Adolescence

* Spans __-__ years of age

* Transition period from childhood to adulthood

* Identity formation

Answer 1

11-21

Question 2

Physical Growth & Development

* Rapid and dramatic change and physical growth

* Changes in boys are not as obvious as changes with girls

> Girls experience budding of the breasts and appearance of pubic hair

> One year after breast development height increases rapidly until reaching its peak

> Growth usually stops 2 to 2-1/2 years after menarche

> Boys experience 1st testicular enlargement followed a year later by penile enlargement

Answer 2

> Growth spurt occurs later than in girls, beginning between age 10 1/2 and 16 and ends between the ages of 13 1/2 and 17 1/2… growth continues at a very much slower pace until the ages of 18-20

> Discuss who should be present in the room during physical assessments

> Growth spurt occurs later in girls

* Nurses help adolescent and parents with health-promoting behaviors, disease prevention, and management of common problems during this stage

Question 3

Psychosexual Development, Hormonal Changes, & Sexual Maturation

* Corresponds to Freud’s final stage of psychosexual development - the ___ stage

* Begins with the production of sex hormones and maturation of reproductive system

> Menarche occurs between ages of 9-15, however this is occurring earlier

> Reproductive maturity in girls occurs 2-5 years after start of menstruation

> __ __ and __ __ are recognized in this stage

> Diet exercise and heredity factors influence height, weight, and body build

Answer 3

genital

sexual orientation; gender identity

Question 4

* Puberty leads to __ __ __ (__) or “growth spurt”

* Development of primary and secondary sexual characteristics in both girls and boys occurs during this stage

* ___ occurs in girls around age 10-11 and boys 13-1/2

Answer 4

peak height velocity (PHV)

PHV

Question 5

Five distinct stages in sexual development or sexual maturity rating (SMR) - ___ Stages of Sexual Development

* ___ staging is important for nurses to assess normal G&D and provide adolescents and parents anticipatory guidance regarding sexual development

Answer 5

Tanner

Tanner

Question 6

* Description of SMR provides more information on physical development than chronological age

> In boys the voice deepens and “cracks” with enlargement of laryngeal cartilage

> Testosterone levels increase which cause enlargement of sebaceous glands and excessive production of sebum - acne

> Facial hair appears in boys

> Anticipatory guidance is important regarding genital maturation and involuntary nocturnal emissions of seminal fluid (“wet dreams”)

Question 7

Female Sexual Maturation - Stage ?

> Preadolescent (none)

Answer 7

1

Question 8

Female Sexual Maturation - Stage ?

> Breast fully matured and contoured

> Pubic hair adult female triangle and adult quantity

Answer 8

5

Question 9

Female Sexual Maturation - Stage ?

> Areola and papilla form secondary mound : 14-17 years of age

> Pubic hair coarse, forming typical female triangle : 14 1/2 - 16 1/2 years of age

Answer 9

4

Question 10

Female Sexual Maturation - Stage ?

> Breasts bud (___?) : 9-13 years of age

> Pubic hair sparse, lightly pigmented : 10-11 1/2

Answer 10

2

Thelarche

Question 11

Female Sexual Maturation - Stage ?

> Breast and areola enlarge, no contour: 12-13 years of age

> Pubic hair darker, coarser, spreads over pubis: 11 1/2-13 years of age

Answer 11

3

Question 12

Male Sexual Maturation - Stage ?

> Pubic hair gets darker and starts to curl: 12.5 - 14.5

> Penis gets longer: 13.5 - 15

> Testes get larger: 13.5 - 14 1/2

Answer 12

3

Question 13

Male Sexual Maturation - Stage ?

> Pubic hair is coarser, less than in adult: 13.5 - 16.5

> Penis gets larger: 13.5 - 16

> Testes get larger and scrotum darker: 13.5 - 17

Answer 13

4

Question 14

Male Sexual Maturation - Stage ?

> Preadolescent (none)

Answer 14

1

Question 15

Male Sexual Maturation - Stage ?

> Pubic hair long, straight, pigmented at base of penis: 12 - 12.5

> Penis slightly enlarged: 10.5 - 14.5

> Testes: in response to testosterone secretion - enlarged scrotum, pink: 9.5 - 13.5

Answer 15

2

Question 16

Male Sexual Maturation - Stage ?

> Pubic hair reaches adult quantity

> Penis adult size

> Testes reach adult size

Answer 16

5

Question 17

Motor Development

* Muscle mass and coordination of gross and fine muscle groups increases

* Muscle mass increases in boys and fat deposits increase in girls

* This leads to boys being larger and stronger than girls once fully developed

* More athletic and also engage in art, music, sewing

* Should have a yearly physical with concussion screening if participating in high school athletics

Answer 17

* Adolescents who participate in school sports should have
> adequate equipment, appropriate training schedules, frequent rest periods, adequate fluids to prevent dehydration and exhaustion, and appropriate concussion precautions and removal from game if concussion suspected

Question 18

___ capacity increases during adolescence

___ is associated to poor posture and is common in adolescents

Recommended screening for ___ twice between ages 10-12 and once for boys between ages of 13-14

Screening is done while the child is standing, then bends forward allowing shoulders to droop with arms hanging freely. Nurse looks for unilateral elevation of the lower thoracic ribs and flank

Answer 18

Cardiopulmonary

Kyphosis

scoliosis

Question 19

Cognitive Development

* Cognition moves from concrete to abstract to analytical thinking

* Piaget characterizes formal operations or abstract thinking as the last stage of cognitive development

* Able to differentiate between others’ perceptions and their own

Answer 19

* Communicating with adolescents in a professional manner
> being patient and flexible; knowing where they are in terms of development; be open to ideas and opinions and be willing to negotiate choices; listen nonjudgmentally; encourage problem solving; maintain confidentiality; be an advocate; allow for questions and analysis of healthcare

Question 20

Sensory Development

* Eyes and ears fully developed

* ___ may occur in early adolescence (11-13) and may require corrective lenses

* With increased participation in sports eye injuries are common so should wear safety and protective equipment

Answer 20

Myopia

Question 21

Language Development

* Adolescents who read more are generally more articulate and have larger vocabulary

* Computer technology may lead to creative expression

* Electronic and digital devices may affect language communication
> Social media like texting, Snapchat, Twitter, and so on often lead to abbreviated communication techniques which contribute to elimination of grammar and sentence construction

* Communicating with adolescents may often seem challenging at times

Answer 21

* When communicating with adolescents, nurses must assure confidentiality, remain nonjudgmental, use open-ended questions

> Avoid using questions that involve just a “yes” or “no” answer such as: “Do you plan to go to college?” “Do you live with your parents?”

> Instead ask questions that can lead to communication such as: “Tell me about your plans for the future?” or “Tell me about your relationship with your boyfriend?”

Question 22

Psychosocial Development

* Developmental task of identity formation that ultimately leads to the emancipation from the family and independence

* Characterized as egocentric or self-absorbed/narcissist

* Experimental period where they try new roles until one fits

Answer 22

* Peer group of utmost importance

* Move from same-sex friendships during childhood to intimate long-lasting relationships as young adults

* Early and middle adolescents are more prone to gang involvement

Question 23

Psychosocial Development: __ __? (11-14)

* Feeling of changes in body image

* Less confident with members of opposite sex, so they group same sex together

* Egocentric and moves from being obedient to being rebellious regarding parental authority

* Self-conscious

Answer 23

Early adolescence

Question 24

Psychosocial Development: __ __? (15-17)

* More introspective and narcissist

* Conflicts escalate between parent and teenager

* May become more secure by becoming member of a group or gang

* Consistent discipline and behavior
* Impulsive and impatient behavior
* Feelings of self-image and social relationships gain importance

* Same-sex friendships transition into opposite sex friendships
* Sexual activity is usually related to peer pressure and self-esteem issues

* Risk taking sexual activities are often impulsive with little regards to consequences

* Job acquisition occurs in this stage with a source of income adolescents become more independent, set realistic expectations and develop self-esteem
* Successful work leads to sense of responsibility and more social interactions

Answer 24

Middle adolescence

Question 25

Psychosocial Development: __ __? (18-21)

* Ability to think abstractly, conceptualize verbally, express thoughts and feelings

* Development of unique identity, and self-esteem increases

* Changing career goals is not uncommon

* Ability to consider others’ needs increases

* Friendships developed during this phase usually last a lifetime

Answer 25

Late adolescence

Question 26

Moral & Spiritual Development

* Sense of justice is developed

* For example, a teenager may view stealing from others as wrong regardless of whether one is caught or punished

* Respect for law and order

Answer 26

* Older adolescents may begin to question religious affiliation of the family

* Nurses need to include an assessment of spiritual beliefs and values when working with adolescents

Question 27

Nutrition

* Accelerated growth leads to increased nutritional needs

* Soft drinks replace milk

* Fast foods and low nutrient “junk foods” main diet

* Always allow involvement in planning

* Assess present dietary habits then develop a plan

* USDA recommendations 1800-2000 calories/day for girls and 2000-2800 calories/day for boys

Answer 27

* Calcium and Vitamin D

* Iron and folic acid (400 mcg/day) for girls

* Body image is important

* Body mass index (BMI) is a useful tool to identify nutritional discrepancies
> BMI = weight (kg) / height (m²) OR BMI = weight (lb) x 703 / height (in²)

Question 28

Nutrition: Factors Influencing the Adolescents’ Diet

* Busy schedule like sports activities and jobs

* Body image concerns which can lead to undereating

* Skipping breakfast

* Eating away from home beginning to buy and prepare food

* Peer pressure

* Psychological and emotional problems

Question 29

Hygiene

* Generally meticulous regarding personal hygiene

* Encourage change of clothes after sports

* Encourage deodorant use

* Major issue here is ?

Answer 29

Acne

Question 30

Dental Care

* Dental caries decreases in adolescents

* Third molars (wisdom teeth) may erupt at this time or remain impacted and may need to be removed surgically

* ___ may occur as a result of increased hormonal activity, high sugar diets, dental braces…gums will appear pale and swollen and bleed easily

> Malocclusion (malalignment) may occur from facial and mandibular bone growth and dental crowning…use of braces to correct…may feel self conscious

Answer 30

Gingivitis

Question 31

* Dental trauma like ___ (tooth knocked out) may need to be reimplemented

Answer 31

Avulsion

> The sooner within 30 minutes better prognosis… avulsed tooth should only be touched at the crown, rinsed with lukewarm tap water and placed in saline or milk… never scrub tooth, do not use cleaning agents or disinfectants on tooth

Question 32

Sleep & Rest

* Staying up late and difficulty waking up in the morning common

* Recommended average of 8-9 hours per night

* Sleep deprivation related to after school activities which lead to homework being completed late at night, electronic devices in rooms, socialization late into the night

* Effects of sleep deprivation include fatigue, distraction, attention deficit, poor school performance, and psychologic adverse effects

Answer 32

* Encourage
> routine bedtime schedule and wake up schedule
> avoid caffeine before bed
> shut down electronic devices
> listen to quiet relaxing music

Question 33

Exercise & Activity

* Normally active with sports

* Initiate exercise program…team sport or individual activity

* Gradual increase of exercise over 1-3 week period with a goal of vigorous exercise of 60 minutes daily to enhance cardiovascular fitness

Answer 33

Safety

* Injuries = main cause of death in adolescence

* Impulsivity, inexperience, and peer pressure, and sense of invulnerability lead to unsafe situations

Question 34

Car safety

* Leading cause of death among adolescents

* Drivers license is a passage into adulthood

* Lack of judgment, opposition to authority, need to express independence may lead to dangerous driving practices

* Risk-taking behaviors play a major role in car-related injury and death…drive faster and take more chances

* Distracted driving, alcohol consumption, not wearing seatbelts

Answer 34

Water safety

* Second cause death (10-14) and third cause of death (15-24)

* Mostly occur in lakes, rivers, ponds

* Risk-taking behaviors account for the majority of injuries (death and spinal cord injuries)

* Swimming lessons, water safety classes, CPR, and effects of alcohol

Question 35

Suicide

* ___ leading cause of death (15-24)

* Identification of high-risk adolescents is imperative

* Depression is common

* Drug overdoses lead to unintentional poisoning deaths

Answer 35

2nd

Question 36

Violence toward others

* ___ leading cause of death (15-24)

* Exposure to violence is a contributing factor

* Violence is a learned behavior so identifying risk factor is crucial, especially within the family unit

Answer 36

3rd

Question 37

Selected Issues Related to the Adolescent - Body Art

* Piercing and tattooing

* Body piercing is harmless but should be done under sterile conditions with knowledge of complications (bleeding, infection, keloid formation, allergies to metal)

* Risk of contracting bloodborne diseases from improper sterilized needles

Answer 37

* Healing takes 6 weeks up to a year

* Hand hygiene, cleansing the site, monitor for signs of infection

* Tattoo risks include bloodborne infections, skin infections, and allergic reactions to dyes

Question 38

Selected Issues Related to the Adolescent - Tanning

* Harmful to skin and may lead to skin cancer

* Use of tanning salons occurs in adolescents

* Effects of UV light exposure include eye injury, premature aging of skin, increased risk of skin cancer

* Encourage use of sun protection products during water sports or any other activities that involve exposure to sun

Answer 38

E-cigarettes (vaping)

* Nicotine is harmful to adolescents developing brain

Question 39

Selected Issues Related to the Adolescent - Sexual Activity

* Adolescent stage of sexual experimentation may lead to unwanted effects like pregnancy, STDs, despair over failed relationships

* Adolescence is a period of risk taking so many choose to become sexually active unprotected

* Social media also affects onset of sexual activity by facilitating sharing of personal information such as sexting

* Relationship violence effects can be severe including emotional effects, unwanted pregnancy, STDs, alcohol use, and depression

Answer 39

* Nurses should recognize signs of relationship abuse

* Early identification of teen pregnancy risk and provide guidance

* Sex education in schools

* Comprehensive healthcare includes providing services to sexually active adolescents, this includes screening for and managing STDs, contraceptive services, and psychosocial counseling

* Emphasize use of condoms to prevent against STDs

* Encourage both partners to assume responsibility when it comes to contraception

Question 40

Selected Issues Related to the Adolescent - Immunizations

* Nurses should review immunization records and administer immunizations

* Administer Tdap at age 11-12

* Meningococcal conjugate vaccine at age 11-12 and administer a booster dose at age 16

* HPV vaccine - recommended at 11-12 for boys and girls
> 3 doses - give second dose 2 months after the first; give third dose 6 months after the first

* Influenza vaccine annually

Question 41

Selected Issues Related to the Adolescent - Health Screenings

* Hearing and vision screenings

* Scoliosis screenings

* Hgb/hct

* Urinalysis by dipstick

* Blood pressure

Answer 41

* Fasting lipid screen at age 11 and if at risk

* STD risk assessment with screening; HIV screening at age 16-18

* Emotional and stress screening

Question 42

Stressors Associated with Illness and Hospitalization - Separation

* Some adolescents don’t want parents with them during hospitalization enjoying freedom and independence, while other adolescents want their parents close by and become more dependent as a response to illness

* Fear of losing friends or that friends go on with their lives without them

* Allow for visitation

Answer 42

Stressors Associated with Illness and Hospitalization - Fear of Injury and Pain

* Appearance is crucial therefore injury or illness that affects or changes self-perception highly impacts the adolescent
> e.g. diabetes → adolescents may not want to draw attention to themselves so may not control their diet or skip monitoring or medication

* May show that they are cool and not afraid

* May feel guarded when need to be examined for sexual development assessment

* May take risks and be nonadherent to treatment regimen because they feel invincible

Question 43

Stressors Associated with Illness and Hospitalization - Loss of Control

* Control is important

* Allow for some control

* Loss of control can be exhibited in the form of anger, withdrawal, and general un-cooperativeness

* Include adolescents in their plan of care

Question 44

Factors Affecting a Child’s Response to Illness and Hospitalization - Age & Cognitive Development

How to approach hospitalized adolescents:

* Provide privacy

* Encourage wearing normal clothes and grooming

* Use scientific and medical terminology to explain procedures

* Provide for a special activity area and allow for interaction with other adolescents on the unit

Answer 44

* Encourage peers to call or visit

* Assist parents in communicating, supporting, and guiding adolescents

* Allow favorite foods to be brought in

* Approach with caring, understanding, and acceptance

* Provide educational needs