Ch9 basic nursing pgs170-177 Flashcards
Teaching About Diabetes
The parents and child must understand that diabetes involves dietary changes, weight loss, and exercise. Medications are required if the lifestyle changes are not sufficient to control blood sugar, but they cannot be relied on. You may need to refer the family to a nutritionist or diabetes counselor.
Teaching About Asthma
Teach parents and children about indoor environmental asthma triggers: mold, cockroaches, pets, and nitrogen dioxide (a gas that is a byproduct of indoor fuel-burning appliances such as gas stoves, fireplaces, or wood stoves
Provide and help fill out, as necessary, an asthma action card for the child to carry when away from home. An action plan should include
(1) the child’s asthma triggers,
(2) instructions for asthma medicines,
(3) what to do if the child has an attack,
(4) when to call the doctor, and
(5) emergency telephone numbers.
Teaching About Violence and Risk-Taking Behaviors:
On the community level:
school violence can be addressed through psychological counseling, weapons-screening devices, school-wide educational programs, and policies calling for the suspension or expulsion of students who are caught intimidating other children or participating in fights on school property. The school-age period offers many opportunities to educate children about the hazards of smoking, drinking, and using drugs, which often contribute to violence.
Helping the Hospitalized Child
Help children express their fears and respond to specific needs.
Hospitalized children may fear the unknown, the strange environment, the strange professionals, afraid of tests and treatments (i.e., operations, needles) pain, and dying, miss the comforts of home: their mother’s cooking, their own room, and so on, bothered by separation from family and friends and by loss of control over their personal needs. You can help them in the following ways:
Maximize their contact with outside friends and school.
Minimize the adverse aspects of the hospital environment.
Offer choices, when possible, to restore some sense of control (e.g., whether to have a tub bath or shower, or what they would prefer to eat for meals).
Encourage parents to bring familiar items from home to personalize their space.
Involve parents in their care and provide them accurate information so they can relieve children’s anxieties.
ADOLESCENCE: AGES 12 TO 18 YEARS
Adolescence marks the transition from child to adult. Puberty refers to the beginning of reproductive abilities. In this period of development, the child experiences progressive physical, cognitive, and psychological change.
Physical Development of Adolescents
Physical and hormonal changes are readily apparent during the adolescent years.
The adolescent reaches adult height and about 90% of peak bone density by the end of this period.
Menarche occurs by age 14 in most girls, who develop adult primary and secondary sex characteristics by about age 16.
Boys have developed adult primary and secondary sex characteristics by about age 17 to 19.
Motor development is equal to that of adults.
Maturation of the central nervous system allows formal operational thought processes, logic, and abstract reasoning.
Psychosocial development includes the teen’s increasing reliance on peers, ambivalent feelings toward family, anxiety over and/or preoccupation with sex and sexuality, and determination of sexual orientation.
Growth
Females undergo a growth spurt between 9 and 14 years of age. Height increases 2 to 8 in. (5.1 to 7.6 cm) and weight gain varies from 15 to 55 lb (6.8 to 24.9 kg). By the onset of menstruation, girls have attained 90% of their adult height.
Males undergo a growth spurt between 10 and 16 years. Height increases by 4 to 12 in. (10.2 to 30.5 cm) and weight increases by 15 to 65 lb (6.8 to 29.5 kg). Boys continue to grow until 18 to 20 years of age. Bone mass continues to accumulate until about age 20.
In both males and females, the blood pressure and the size and strength of the heart increase. The pulse rate decreases. By the time of adolescence, blood values are that of the adult. Respiratory rate, volume, and capacity also reach the adult rates. By the end of the adolescent period, all vital organs reach adult size.
Onset of Puberty
The onset of puberty varies widely, but the sequences of these changes are standard
In females:
the time from the first appearance of breast tissue to full sexual maturation is 2 to 6 years. Menarche (first menstruation) occurs approximately 2 years after the beginning of puberty. The average age of menarche is 12 years, depending on racial group and body mass.
In males
the onset of puberty occurs between 9 and 14 years of age. Throughout puberty, boys become more muscular, the voice deepens, and facial hair begins to grow and coarsen. It may take 2 to 5 years for the genitalia to reach adult size.
In both males and females
in both males and females, hormonal changes are accompanied by increased activity of the sweat (apocrine) glands, and heavy perspiration may occur for the first time. For the same reason, the sebaceous glands become active, and the adolescent may experience acne.
Cognitive Development of Adolescents
Piaget refers to adolescence as the period of formal operations. The adolescent develops the ability to think abstractly and is receptive to more detailed information. This opens the door to scientific reasoning and logic. She can now imagine what may occur in the future as well as the consequences of her own decisions. Although the adolescent has more refined cognitive abilities, adolescents may still lack judgment and common sense. These develop later through life experience.
Psychosocial Development of Adolescents
The major psychosocial task of the adolescent is to develop a personal identity.
Teenagers shift their emotional attachment away from their parents and create close bonds among their peers (Fig. 9-9). This helps the teenager to further characterize the differences between himself and his parents. The adolescent often takes on a new style of dress, dance, music, or hairstyle; develops personal values; and begins to make choices about career and further education.
Group Acceptance
One of the strongest needs for teens is to feel accepted within a group of their own choosing. Acceptance on a sports team, into a club, or into a clique or gang increases the teen’s sense of self-esteem. In contrast, unpopular teens feel alienated, resentful, and antagonistic and may react with violence directed at themselves or others
Tattoos and Piercings
Adolescents may engage in the trend of body art and piercings for a number of reasons, including a desire for social bonding, to look like their peers, and to commemorate a friend or loved one. In the 10-year period after the mid-1990s, the number of teens who had tattoos increased from 4.5% to 14%. The average age at time of tattooing is around 17 years. Body piercings, likewise, are not unusual. Both tattoos and piercings can cause skin infections and bloodborne diseases such as HIV and hepatitis. Some studies have reported a significant relationship between piercing and substance abuse, leading some to speculate that body piercing may serve as a marker of an at risk teen
Emerging Sexual Orientation
Most adolescents have a sense of their emerging sexual orientation. Approximately 1.9% of people between 18 and 44 years of age identify themselves as homosexual and 1.1% as bisexual (CDC, 2014c). A higher percentage report having had same-sex intercourse at least once, but consider themselves heterosexual. Some youth are bisexual—that is, attracted somewhat equally to both males and females.
Common Health Problems of Adolescents
In the United States, 72% of all deaths among young people aged 10 through 24 years result from four causes: motor vehicle crashes (26%), other unintentional injuries (13%), homicide (15%), and suicide (16%). Many adolescents engage in behaviors that increase their likelihood of death of injury from these four causes: distracted driving (e.g., texting, eating), driving under the influence of alcohol or drugs, carrying a weapon, and using alcohol or other drugs. In a recent year, 25% of high school students reported having been in a physical fight (CDC, 2014b). Illnesses are responsible for less than one-fourth of deaths; cancer and heart disease are the most common.
Example Problem: Substance Abuse
Substance abuse is a major concern because it is widespread and because of the physical, mental, and spiritual toll it takes on teens, families, and communities.
Definition
Regular use of drugs or other substances for purposes other than medical use that causes physical or psychological harm to the person.
Incidence
- In 2013, 36% of high-school seniors said they had used marijuana in the past year, compared with 30% in 2006.
- It is illegal to sell tobacco to minors, yet 9.5% of middle school students and 25.6% of high school students currently use some form of tobacco. Over 54% say they have tried a cigarette.
- Prescription and over-the-counter medications account for most of the top drugs abused by 12th graders in 2013.
- Abuse of prescription drugs is highest among young adults aged 18 to 25, with 5.9% reporting nonmedical use in the past month.
Possible Consequences
- Violence, sexual assault, rape, and alcohol/drug overdose
- Associated with risk-taking behaviors resulting in injury and death (e.g., automobile accidents, falls, drowning, suicide)
- Increased risks of cancer, high blood pressure, cirrhosis, epilepsy, and homicide
- Persons diagnosed with drug disorders are roughly twice as likely to have mood or anxiety disorders.
- Every year, 599,000 people are unintentionally injured while under the influence.
- And more than 1,700 die.
Depression
Depression affects up to 8.5% of adolescents in the United States compared with 11% of the adult population.
A government survey identifies an even higher percentage: During the 12 months preceding the survey, 28% of students nationwide had felt so sad or hopeless almost every day for more than 2 weeks in a row that they stopped doing some usual activities
Risk factors for depression
family history of depression, cigarette smoking, stress, loss of a loved one, breakup of a romantic relationship, learning disorders, attention or behavioral disorders, chronic illnesses (e.g., diabetes), abuse, neglect, or other trauma such as natural disasters.
Suicide
Suicide is the third leading cause of death in teenagers. The CDC (2014b) estimates that 8% of high school students have attempted suicide. Twice as many adolescent girls as boys attempt suicide, but because boys tend to use more lethal methods, such as guns and hanging, they are more likely to die from the attempt. Risk factors include problems at school or in romantic or family relationships, low self-esteem, social isolation, substance abuse, and depression.
Eating disorders
Although anorexia and bulimia create nutritional problems and manifest as eating disorders, they are psychiatric disorders that require medical and psychiatric intervention.
Anorexia Nervosa
A person with anorexia nervosa dramatically restricts food intake and may exercise excessively in an attempt to lose weight. Anorexia is characterized by a distorted body image; often the person sees herself as fat in spite of being markedly thin.
It is the third most common chronic illness among adolescents.
It occurs predominately in, but is not limited to, high-achieving adolescent females from upper-middle-class backgrounds. Physical consequences include amenorrhea, bradycardia, low white blood cell count, anemia, infertility, and bone loss.
Eating disorders have the highest mortality of any mental illness: 5% to 10% of patients die within 10 years of developing anorexia nervosa. One in five dies by committing suicide
Bulimia
Bulimia is another eating disorder seen in adolescent girls as well as in boys who participate in sports that require them to maintain a specific weight. Bulimia is characterized by binge eating followed by inappropriate mechanisms to remove the food that was consumed (usually inducing vomiting, using laxatives, or engaging in excessive exercise). Binge eating may occur every few days or as often as several times a day. People with bulimia frequently experience electrolyte imbalances, decayed teeth (from gastric acid exposure), or abdominal pain (from gastric overload or laxative use).