Chapter 10 Adolescents Flashcards
outcomes of this stage of maturity include the development of:
Advanced cognitive abilities
Autonomy
Self-identity
Piaget stages during this age
Age 10–11 years: concrete operations
Age 12 years and older: formal operations
formal operational
Develops analytic thinking
Develops abstract thinking
Shows concern for politics and social issues
Becomes able to think long term and set goals
Compares self with peers
Begins to have some awareness of personal limitations
Becomes able to predict outcomes and consequences
Freud
Age 10–12 years: latency stage
Age 12–18 years: genital stage
erikson
Age 12–18 years: identity versus role confusion
Age 19 years: intimacy versus isolation
Characteristics of adolescent psychology include the following:
Self-conscious
Compares own body with others
Interested in sexuality and gender roles
Emergence of sexual feelings and experimentation
Has a need for privacy
“Tries on” different styles of dress, communication, and personae
Develops personal values Wants to be an adult but still needs the support of the family/caregiver Self-image is dependent on what others think Has mood swings Feels as if “onstage” with others around and paying special attention Believes that he or she is special and unique Has a sense of invincibility Is impulsive Assumes that others have the same perspective Has unrealistic career goals Tests limits and rules Develops a sense of conscience Knows right from wrong Can compromise with others when desired
Measurements
Yearly assessments from 11-21 Height Weight Body mass index Blood pressure Hearing Vision vitals
Cholesterol screening s
once during late adolescence
TB screen
at-risk adolescents, including those who are from countries outside of the United States, who are HIV positive, and who are incarcerated or homeless
General survey
awkwardness normal
Determine developmental history, family composition, and school situation.
Daily fluid requirement
1,500 mL plus 20 mL for every kilogram above 20 kg.
Normal urine output
0.5 to 1 mL/kg/hour.
pain scale
numeric or visual analog scale
indication of school or home avoidance/problems, anxiety and stress, or depression
General somatic complaints without verified diagnostic clinical data
Vitals
Heart rate of 55 to 100 bpm
Respiratory rate of 15 to 20 breaths/minute
Systolic blood pressure less than 120 mm Hg
when performing physical:
Respect privacy.
Inform the adolescent of your actions and explain the rationales.
Focus on the positive aspects of the individual.
Address the adolescent’s concerns directly.
Be cautious about pointing out physical abnormalities.
Examine the genitals last.
Use the correct words for anatomy.
Skin
Hormone changes during puberty cause an increase in sweat secretion and oily skin, especially on the face, back, axillae, breasts, and anus.
acne
self harm
Head
Head reaches adult size during adolescence.
Assess for migraines/stress headaches.
Hair might be brittle and dry if subjected to frequent dyeing or heat styling.
eyes
Visual acuity testing should be done at ages 12 and 15 years
Ears
Hearing testing should be done once between ages 11 and 14, 15 and 17, and 18 and 21 years
mouth
Inspect mouth for ulcers that might indicate inhalant or smokeless tobacco use.
Tooth erosion could indicate that patient has been inducing vomiting.
The third molars (wisdom teeth) erupt between ages 17 and 21 years.
Bruxism, which is teeth grinding, may be present because of stress.
Nose
Piercing
nose may look too large
Cardiovascular
The heart grows in strength and size during adolescence.
Assess for innocent murmurs
Screen for iron-deficiency anemia only if risk assessment is positive
Respiratory
The length and diameter of the lungs increase during adolescence.
Assess for a history of asthma, which is the number one chronic illness in children.
Lungs should sound clear.
Check for signs/symptoms of chronic respiratory issues. Chronic cough that affects sleeping and shortness of breath are the most common. Signs such as barrel chest and clubbed fingers are rarely seen in children.
Gastrointestinal
Assess nutritional status.
Assess constipation/diarrhea/vomiting.
Assess for chronic abdominal pain, which could be an indication of stress/anxiety.
Renal
Assess hydration status.
Assess for enuresis.
Assess signs/symptoms of urinary tract infection, particularly among sexually active adolescents.
Gynecomastia
abnormal breast development in boys.
First gynecological examination
13 and 15 years for external examination only, pelvic examinations are only completed when problems arise such as pain or abnormal bleeding, and Pap tests are no longer conducted until the age of 21 years
breast exam
self monthly
clinical yearly
male checks
Testicular self monthly
hernia
both check
abuse signs
STI signs
puberty girls
between ages 8 and 13 years and is completed in about 4 years
puberty boys
Puberty begins between ages 9 and 14 years and is completed in about 3.5 years.
growth spurt girls
10 to 12 years.
growth spurt boys
12 to 14 years.
breast development
8 to 10 years.
One breast may develop faster than the other. Breast tenderness is common.
menstruation,
shedding of the uterine lining, approximately 2 years after the onset of breast development.
leukorrhea 3-6 months before first
irregular first 1-2 years
assess for PMS
assess for cessation of period after established pattern- maybe ED
precocious puberty and late-onset puberty
before 8 or after 14
Neurovascular
The brain is in a period of rapid development. Judgment is sometimes impaired as the frontal lobe remains underdeveloped until the mid-20s.
Check for equal strength left to right via hand grasps.
Check deep tendon reflexes
Musculoskeletal
chest widens-m
pelvis widens-f
extremes grow first-clumsy
growth plates close by 20
Russell’s sign:
abrasions or cuts from sticking fingers down throat to induce vomiting.
scoliosis check
begin 10-12
social
Challenges the values, traditions, and beliefs of the family Develops own value system Wants independence from caregivers Conflicts with caregivers Resists adult supervision Depends on family in times of crisis Has best friend Idealizes friendships Socializes in cliques of the same sex Compares self with others Strives for peer acceptance Conforms to the norms of the peer group Is influenced by peer pressure Is prone to gang membership because of the desire for peer acceptance May be employed Is focused on activities outside of the home Explores gender roles Seeks out information about sex Experiences emergence of sexual feelings Explores sexual orientation Starts to develop intimate relationships Romances are usually brief but can be very intense May have feelings of being in love Has romantic fantasies
Sexual Identity
When communicating with adolescents, do not assume heterosexuality.
the goal is to create an environment that makes the adolescent feel comfortable to discuss their concerns with you.
spirituality
Adolescents may start to question or disagree with the religious beliefs of the family.
Adolescents understand the permanence of death and may ask questions about an afterlife
medication
Medications obtain a pediatric label through surveying of prescribers.
Some medications are labeled for use in adolescents older than 12, 13, or 17 years.
medication metabolism
Most medications are metabolized faster by a patient in puberty.
After puberty, medication metabolism decreases to adult levels.
Adolescents have the best understanding of medication warnings when directly informed verbally by health-care personnel.
When caring for an adolescent patient, the nurse must:
Obtain guardian consent.
Obtain assent from patient (see Chapter 2).
Explain rationales to family and patient.
Show equipment ahead of time.
Be honest about the potential for discomfort/pain.
Maintain patient confidentiality.
HEADSS health promotion
H—Home
E—Education
A—Activities
D—Drugs/Diet
S—Sexuality
S—Suicide/Safety
home
Assess the caregiver–adolescent relationship.
Assess relationships with siblings.
Assess support of the extended family.
Assess where the adolescent lives.
Ask about substance use in the home.
Ask about violence in the home.
Ask about the safety of the neighborhood.
Ask about community supports and resources.
Education Assessment
Assess school performance, a strong indicator of the adolescent’s overall well-being.
Ask about school absenteeism.
Assess feelings regarding teachers and classmates.
Assess for bullying.
Refer to a mental health professional if the adolescent admits to negative thoughts or feelings surrounding school.
Assess vocational/career aspirations.
activities
Assess for the presence of violence
Assess knowledge of injury prevention.
drugs/diet
assess for tobacco use
assess for alcohol/substance use
nutrition
diet rather than vitamins
encourage healthy choices
assess alternative diets
encourage safe weight management- watch for signs of ED
calories girls
2200
calories boys
2800
exercise
60 min
pregnant adolescents:
Assess pregnancy history.
Assess feelings about the pregnancy.
Encourage patient to tell caregiver about pregnancy.
Educate patient about options, such as adoption and terminating the pregnancy.
Provide agency information if considering adoption.
Educate patient about finding a skilled provider if adolescent is considering abortion.
Assist the adolescent in finding an appropriate health-care provider or agency.
Encourage early prenatal care.
Encourage the attendance of a parenting class if adolescent is planning to assume parenting role.
Seek out support resources for pregnant adolescents
suicide assessment
Screen for depression/suicidal ideation/self-harming behavior.
Assess for stressors such as transitioning from high school to college.
Teach stress management/relaxation techniques
safe sex
Abstinence Birth-control options Number of partners STIs Assess condom use Assess engagement in oral/anal sex and educate about risks such as acquiring STIs via oral and anal routes; oral/anal sex is often considered “safe” by adolescents STI testing as appropriate HIV testing as appropriate
Common adolescent emergency injuries/issues include:
Traumatic injury due to risk-taking behaviors, a sense of immortality, and a lack of connection between cause and effect
Injuries related to accidental or intentional alcohol/substance overdose
Motor vehicle accidents (passenger or driver)
Sports injuries
Sexual assault
Mental health emergencies
emergency assessment
Ability to recite ABCs
Pain
Skin for evidence of drug use
Do not resuscitate (DNR) status
Identification of the patient’s guardian
Identification of the patient’s legal status, such as mature/emancipated minor
Contextual information related to the injury/condition
Family/social history
Immunization status
Transportation availability
acute care
Establish nurse–patient relationship
Define roles and establish boundaries.
acute care nurse interventions
Provide treatments in private.
Cluster activities to leave periods of free time for relaxation, homework, or visiting with family and friends.
Encourage the adolescent’s active participation in meeting health-care needs.
Provide appropriate patient education.
Show the patient equipment ahead of time.
Be honest about pain and side effects.
Use pediatric assessment tools when needed.
Use size-appropriate blood pressure cuffs.
Use age-appropriate pain assessment tools, such as a numeric scale.
Use an age-appropriate falls risk tool, such as the Humpty Dumpty Falls Risk Scale.
physical care chronically ill
Ensure that family and adolescent understand condition/treatments.
Educate families and adolescents on how to minimize exacerbations of the condition.
Assure medical control and involvement.
Assess caregiver burden.
Promote self-care and functional independence.
Promote appropriate use of health-care services.
Coordinate services between health-care providers, school, and home.
Follow up with families and adolescents after transitioning to adult-focused care.
Refer families and adolescents to appropriate internet resources.
Advocate for chronically ill adolescents.
Psychosocial/Spiritual Care chronically ill
Use developmental rather than chronological age when caring for chronically ill adolescents, because there may be some developmental delays.
Allow for adolescent completion of tasks as able.
Promote self-esteem and confidence.
Foster realistic expectations in parents regarding the adolescent’s future personal, academic, and career potential.
Ensure continued academic success with tutors or other resources.
Support an adolescent’s desire for a vocation/career.
Assess for grief of losing friends with the same disease (see Chapter 5).
Assess for fear of facing own premature death.
Involve in individual and group therapy as appropriate.
Refer caregivers and adolescents to support groups.
Refer to chaplain as desired.
home care
caregivers might have anxiety over administering care
patient has more chance to socialize
home care allows for collaboration with medical team
The use of EHR
shown to improve care for attention deficit-hyperactivity disorder and depression, increase vaccination rates, and reduce antibiotic misuse
common CAM
Faith healing/prayer, massage therapy, deep-breathing exercises, acupuncture, yoga, tai chi, essential oils/aromatherapy
Fish oil supplements, glucosamine, chondroitin, melatonin, creatine, probiotics, vitamins
Honey, lemon, green tea, chamomile tea
child abuse
Adolescents may be the victims of physical, emotional, or sexual abuse.
Adolescents and young adults have higher rates of sexual assault than any other age group
human trafficking
About 33% of human trafficking victims are minors
