1. Chapter 27 Growth and Development of the Adolescent: 11 to 18 Years

2. Growth and Development of the Adolescent
Early adolescence (preadolescence, pubescence)
Puberty: Reproductive maturity
Begins at about age 10 in girls; ends with menstruation
Begins about age 12 in boys; ends with production of sperm
Adolescence
Spans the ages of about 13 to 18
Erikson: Identity versus role confusion

3. Preadolescent Development
Physical development
Girls (occurs age 9 to 11)
Growth spurt lasts about 18 months
Grow about 3 in annually until menarche
Begin to develop a figure
Boys (occurs age 11 to 13)
Growth is slower and steadier than in girls
Changes in penis, testes, and scrotum
Nocturnal emissions

4. Preadolescent Development (cont.)
Preparation for adolescence
Children need information about their changing bodies
Sex education should include hormonal changes
Girls concerned about onset of menstruation
Boys need information about erections and nocturnal emissions
Children need information about changes in opposite sex

5. Preadolescent Development (cont.)
Preparation for adolescence (cont.)
School programs may provide good foundation
Still need an adult to turn to
Discussions may help teens resist pressures promoting premature sexual activity
Honest, straightforward answers must be given

6. Adolescent Development
Physical development
Girls achieve 98% of adult height by age 16
Boys grow rapidly from age 13 until about 20
Skeletal growth outpaces muscle growth
Girls
Nonovulatory with early menses
Age 13 to 15 becomes ovulatory

7. Adolescent Development (cont.)
Physical development (cont.)
Boys
After age 13 muscle strength and coordination develop rapidly
Larynx and vocal cords enlarge
Voice “changes”

8. Adolescent Development (cont.)
Physical development (cont.)
Characteristics of adolescence for both sexes
Body takes on adult-like contours
Primary sex organs enlarge
Secondary sexual characteristics appear
Hormonal activity increases
Bone growth continues through adolescence and is usually completed by the end of this period

9. Adolescent Development (cont.)
Psychosocial development
Adolescents develop a sense of moral judgment and a system of values and beliefs that will affect their entire lives
Peer group exerts tremendous power
Adolescents need careful guidance and understanding support

10. Adolescent Development (cont.)
Psychosocial development (cont.)
Personality development
Who am I as a person?
What will I do with my life?
Sex role stereotypes have been shattered
More geographic mobility

11. Adolescent Development (cont.)
Psychosocial development (cont.)
Personality development (cont.)
Intimacy: Mutual sharing of one’s deepest feelings with another person
Seek out intimate relationships
Most are heterosexual; homosexual relationships can be very stressful for the teen and the family
Body image: Closely related to self-esteem
Underdeveloped teens have great anxiety; anorexia nervosa
Teens need to establish positive body image

12. Question
At what approximate age does muscle strength and coordination generally develop in boys?
a. 11 years
b. 12 years
c. 13 years
d. 18 years

13. Answer
c. 13 years
Rationale: Around age 13, muscle strength and coordination begin to develop rapidly in adolescent males.

14. Nutrition
Nutritional requirements increased during periods of rapid growth
Appetites increase and most teens eat frequently
Food choices not always wise; many skip meals
Can have nutritional deficiencies
Calcium; iron; zinc; vitamin A, D, and B6; and folic acid
Girls need additional iron

15. Nutrition (cont.) Some experiment with food fads and diets
Increased protein and amino acids cause diuresis and calcium loss
Carbohydrate loading can increase muscle glycogen level to two to three times the normal
Help low-income families find places to buy low-cost, nutritious foods and snacks
Culture influences food choices

16. Nutrition (cont.) Vegetarian diets
Semi-vegetarian: Dairy products, eggs, and fish; excludes red meat and possibly poultry
Lacto-ovo-vegetarian: Eggs and dairy products but excludes meat, poultry, and fish
Lactovegetarian: Dairy products and excludes meat, fish, poultry, and eggs
Vegan excludes all food of animal origin, including dairy products, eggs, fish, meat, and poultry

17. Health Promotion and Maintenance
Routine checkups
Recommended at least twice during teen years
Complete history
Immunizations and boosters that are needed
Height, weight, and B/P
Hearing and vision screening
Scoliosis and thyroid
Pelvic for sexually active girls

18. Health Promotion and Maintenance (cont.)
Routine checkups (cont.)
Counsel about sexual activity, STIs, and HIV
Body piercing and tattoos
Teens must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care
Continuity of care helps

19. Health Promotion and Maintenance (cont.)
Dental checkups
Need every six months
Braces correct malocclusion
Can talk about tongue piercing at dental visits
Family teaching
Caregivers and adolescents struggle with issues related to sexuality, substance abuse, accidents, discipline, poor nutrition, and volatile emotions

20. Health Promotion and Maintenance (cont.)
Health education and counseling
Education and counseling about sexuality, STIs, contraception, and substance abuse are a vital part of adolescent health care
Sexuality
Teens can feel ashamed about bodily changes if unprepared
More teens than ever are sexually active, leading to rise in teen pregnancies and STIs
HIV on the rise in teen population

21. Health Promotion and Maintenance (cont.)
Health education and counseling (cont.)
Sexuality (cont.)
Girls need to learn about routine pelvic examinations, Pap smears, and breast self- examination
Boys need to know about testicular cancer and self-examination
Masturbation is a common practice

22. Health Promotion and Maintenance (cont.)
Health education and counseling (cont.)
Sexual responsibility
Abstinence is the only completely successful protection
Need information: Safe sex; contraceptives
STIs
HIV
Syphilis, gonorrhea, genital herpes, genital warts
Chlamydial infections, trichomonal infections

23. Health Promotion and Maintenance (cont.)
Health education and counseling (cont.)
Sexual responsibility (cont.)
Health care personnel need to be nonjudgmental, supportive, and understanding when dealing with teens seeking treatment for an STI
Rohypnol (“date rape drug”)

24. Health Promotion and Maintenance (cont.)
Health education and counseling (cont.)
Substance abuse
May experiment with addictive substances
Alcohol most common
Health care personnel must stress to adolescents that use of alcohol or mind-altering chemicals is often accompanied by irresponsible sexual behavior

25. Health Promotion and Maintenance (cont.)
Mental health
Depression, suicide, and conduct disorders
Be sensitive to a teen having a problem
Internet safety
Accident prevention
Increasing numbers of adolescents are dying as a result of violence
Alcohol and other drugs can be causative factors
Violence in the home

26. Question Tell whether the following statement is true or false.
Teens can feel ashamed about the changes in their body if they are unprepared for these vast changes.

27. Answer
True
Rationale: A good foundation in sex education can help the adolescent take pride in having reached sexual maturity; otherwise, puberty can be a frightening, shameful experience.

28. The Adolescent in the Health Care Facility
Provide supportive nursing care sensitive to adolescent needs
Encourage as much participation as possible
Clearly and honestly explain all procedures and treatments
Protect privacy by providing screening and covering
Provide a telephone and recreational areas to keep up social contacts with peers