Maternal and Child Health Nursing
Care of the Childbearing & Childbearing Family
Chapter 33 - Nursing Care of an Adolescent
(ppt based on Joanne Flagg and Adele Pillitteri 8th edition)
2. Adolescence is generally defined as the period
between ages 13 and up to 20 years, a time that serves
as a transition between childhood and becoming a late
adolescent. It can be divided into an early period (13 to
14 years), a middle period (15 to 16 years), and a late
period (17 to 20 years).
3. Growth and Development
of an Adolescent
Adolescents both grow rapidly and
mature dramatically during period from
age 13 to 18 to 20 years.
4. The major milestones of physical development
in the adolescent period are the onset of puberty
at 8 to 12 years of age and the cessation of body
growth around 16 to 20 years.
(Sass&Kaplan,2013).
Physical Growth
5. Most girls are 1 to 2 inch taller
than boys coming into
adolescence but generally stop
growing within 3 years from
menarche and so are shorter
than boys by the end of
adolescence
6. Boys grow about 4 to 12 inch
in height and gain about 7 to
30kg in weight during their
teenage years. While girls
grows 2 to 8 inch in height
and 7 to 25 kg in weight.
7. Growth stops with closure of
the epiphyseal lines of the
long bones which occurs
about 16 to 17 years of age in
female and 18 to 20 years in
male.
8. All during adolescence,
androgen stimulates sebaceous
glands to extreme activity and
sometimes resulting acne.
Apocrine sweat glands produce
a strong odor it forms shortly
after puberty.
9. Adolescents gain their second molars at
about 13 years old of age
Third molars (wisdom tooth) between 18
to 21 years of age. It may erupt as early as
14 to 15 years of age.
Teeth
10. -Puberty is the time at which individual
first capable of sexual reproduction.
-Female entered puberty when she begins
to menstruate
-Male enters puberty when he begins to
produce spermatozoa
-This begins at 11 to 14 years of age.
Puberty
11. Secondary sex characteristics, such as
body hair configuration and breast
growth, are those characteristics that
distinguish the sexes from each other but
that play no direct part in reproduction
Secondary Sex Changes
15. Males sexual maturity are growth
spurt continuing, pubic hair,
enlargement of the scrotum and penis,
axillary hair present, voice changes
and end of skeletal growth
-In Females are growth of pubic hair,
menstruation, breast growth and
making pregnancy possible.
16. Developmental
Milestone
Thirteen year old children changes from
school age activities to more adult form
of recreation such as listening to music,
texting,and sports.
17. Beginning at the age of 16
years, most adolescents
starts to find a job to earn
money, Joining organization
and getting responsible in
their action.
18. Adolescence engage in
charitable activity and they
starts to organizing gym
program, marathons etc.
These actions are indicators
of maturity and willingness to
accept adult roles.
20. Identity
decide whom they are and what king of
person they will be
Role Confusion
Failure to establish a sense of identity within
society ("I don't know what I want to be whe
I grow up")
21. Identity – for adolescents to
decide whom they are and what
kind of person they will be.
The Four main areas in which they must make gains
to achieve a sense of identity:
1. Accepting their changed body image
2. Establishing a value system or what kind of person
they want to be
3. Making a career decision
4. Becoming emancipated from parents
22. If young people do not achieve a sense of
identity, they can have a little idea what
kind of person they are or may develop a
sense of role confusion.
(Dunkel & Harbke, 2017)
23. Body Image
As adolescents are usually their own worst
critics with regard to their bodies, they may
need help from health care provider to realize
their characteristics that make someone
creative, compassionate, and fun to be with,
not one’s physical appearance, are the qualities
on which lasting relationship are built.
24. Self-esteem may undergo major changes
during the adolescent years and can be
challenged by all the changes that occur
during adolescence (Garzon & Dunn, 2013)
- (“It’s hard to be left out”)
Self-Esteem
25. As they increase the amount of time they
spend with their peer group, they may
question these values and participate in
experiences that may put them at risk for
physical and/or psychological harm.
Value System
26. Individuals begin to explore their sexual
preference and may question their gender
identity.
Social Coupling
27. This process may take several years to
achieve, and it varies for each individual.
It is common for adolescents to seek and
experiment with multiple roles before
reaching a decision that is rewarding.
Career Decisions
28. Some parents may not yet be ready for their child to be
totally independent, and some adolescents may not yet be
for sure they want to be on their own.
It can be helpful to remind parents this step is actually no
different from the one children accomplished when they
grew from infants to toddlers, when they changed from
wanting to be held and rocked to wanting to run.
Emancipation
from Parents
29. Late Adolescent Developmental Task:
Intimacy vs. Isolation
Developing a sense of intimacy means a late
adolescent is able to form long-term, meaningful
relationships with person of the opposite as well as
their same sex (Erikson, 1950, 1968)
30. Late Adolescent Developmental Task:
Intimacy vs. Isolation
- During this stage, the major conflict centers on forming intimate,
loving relationships with other people.
-Young adulthood (18 – 40 years of age)
- Develop a relationship and joint identity with a partner
- Or can be isolated and stay away from meaningful relationship
-Question if the person is ready for new
relationship or if there is a fear of rejection
31. Both male and female early adolescents tend to be loud and
boisterous, particularly when someone whose attention
they would like to attract is nearby.
They are impulsive and very much like 2-years-old children
in that they have want what they want immediately, not
when it is convenient for others.
Socialization
32. Many 13-year-olds begin to experience
“crushes”, or infatuation with schoolmates.
By age 14 years, teenagers have become quieter
and more introspective.
They becoming used to their changing bodies,
have more confidence in themselves, and feel
more self-esteem.
Adolescents watch adults carefully during his
period, searching for good role models with
whom they can identify, they usually have a
hero, a film star, scientist or athlete
33. COGNITIVE
DEVELOPMENT
Formal operational thought
- Begins at age 12 or 13 years and
grows in depth over the adolescent
years, although it may not be
complete until about age 25 years
(Piaget, 1969).
This step involves the ability to
think in abstract terms and use the
scientific method to arrive at
conclusions.
35. Health Promotion for anHealth Promotion for anHealth Promotion for an
Adolescent and FamilyAdolescent and FamilyAdolescent and Family
Because their judgments are still limited,
adolescents still need guidelines in reference
to safety, nutrition, and daily care.
36. PROMOTINGPROMOTING
ADOLESCENT SAFETYADOLESCENT SAFETY
Unintentional injuries, most commonly those involving motor
vehicles, are the leading cause of death among adolescents.
Equally dangerous for adolescents are motorcycles, motorbikes,
and motor scooters, which are appealing because of their low
cost and convenience in parking.
Other common causes of death in adolescents are homicide and
self-harm (i.e.,suicide)
37. HEALTH TEACHING MEASURESHEALTH TEACHING MEASURES
TO PREVENT UNINTENTIONALTO PREVENT UNINTENTIONAL
INJURIES IN ADOLESCENTSINJURIES IN ADOLESCENTS
Motor Vehicle
Always wear safety gears/protective
equipment (e.g. helmet, suits, etc.)
Take theoretical driving lessons and
seminars seriously
Do not drink and drive
Do not take dares
38. Learn how to swim, and
do not swim alone.
Always stay calm
Do not take dares
Use protective equipment (e.g.
facemask for hockey, helmet for
football, etc.)
Do not go beyond physical limits
Stay hydrated before and after
game
Always be careful during
trainings and on game
Firearms
Do not play with guns
Learn safe gun handling
before attempting to clean
a gun or use it
·
Drowning
Sports
39. PROMOTING NUTRITIONAL
HEALTH FOR AN ADOLESCENT
• Unsupervised unhealthy eating habits may lead to obesity
• Refusing to eat healthy foods is another form of rebellion
• Giving an adolescent the responsibility to food planning is an important lesson
• Some adolescence that diets excessively may develop eating disorders (e.g.,
bulimia, anorexia nervosa, etc.)
• Their diet should still be supervised to make sure that they have the right
amount of nutrition
40. Recommended
Dietary Reference Intakes
• An adolescent needs more calories to support occurring rapid body growth
• Food must come from variety of sources to supply the needed nutrients
(carbohydrates, vitamins, protein, and minerals)
• Iron, calcium, and zinc are the most apt to be deficient during adolescence
• Females need more iron to supplement, to avoid iron-deficiency anemia
• Increased calcium and vitamin D, plus physical exercises are needed for
rapid skeletal growth
• Zinc is necessary for sexual maturation
• Meat and green vegetables are good sources of iron
• Calcium can be found in milk and milk products which is also high in zinc
41. Promoting Nutritional
Health With a Varied Diet
Vegetarian Diets
Vegetables contains fewer
calories than meat, so the
need to consume larger
amounts to achieve
adequate caloric intake
Glycogen Loading
A procedure used to ensure
adequate glycogen to sustain
energy (mostly used by athletes)
42. PROMOTING DEVELOPMENT
OF AN ADOLESCENT IN DAILY
ACTIVITIES
Adequate sleep, hygiene, and exercise are important
to adolescents as it will soon become their own
responsibility, and not of their parents.
43. Dress and Hygiene
Adolescents are capable of total self-care
and, because of their body awareness, may
even be overly conscientious about personal
hygiene and appearance.
44. Adolescents are generally very
conscientious about tooth brushing
because of a fear of developing bad
breath.
Care of Teeth
45. Although it is widely believed everyone needs
8 hours of sleep a night, some need more and
others can adjust to considerably less. Because
protein synthesis occurs most readily during
sleep and adolescents are building so many
new cells, this age group may need
proportionately more sleep than any other age
group (Short, Gradisar, Lack, et al., 2013).
Sleep
46. Exercise
Adolescents need exercise every day both to
maintain muscle tone and to provide an outlet
for tension. Unlike younger children, however,
and although they are constantly on the go,
adolescents often receive very little real
exercise. Adolescents who are involved in
structured athletic activities do receive daily
exercise.
47. Sun Exposure
Encourage teenagers to use
sunscreen, avoid tanning beds, and
report to their primary healthcare
provider any skin mole that
changes in shape or color.
48. PROMOTING HEALTHY
FAMILY FUNCTIONING
• Early adolescents may have disagreement with parents because
of different factors like wanting more freedom, and insecurities,
etc.
• It is best if parents acknowledge that it may not be easy living
with a teenager, but it is also not easy being the teenager.
49. • As they grow older, they discover and realize
more, and new things which makes them curious
and wonder.
• At 16, they also become more open and willing to
listen and talk about their problems.
• When it comes to their mind that they want to
prove their selves, that they are old enough, they
may start to experiment with drugs and alcohol,
interpreting the use of it as the mark of being an
adult.
51. *Hypertension is present if blood pressure is above 95th
percentile, or 127/81 mmHg for 16 y/o girls and 131/81 for
16 y/o boys for two consecutive readings in different
settings.
*all children older than 3 years of age should have their
blood pressure routinely
Hypertension
52. *This is due to the imbalance of growth that arises from
the skeletal system growing a little more rapidly that the
muscles attached to it.
* Assess posture at all adolescent health appraisals to
detect the difference between simple poor posture and the
beginning os spinal dysplasia or scoliosis
Poor Posture
53. *body piercing and tattoos are a strong mark of
adolescence
Symptoms
Redness,warmness,drainage, swelling, & mild pain
Caution
Sharing needles for piercing or tattooing carries
the same risk for contacting a blood-borne disease
as sharing needles for intravenous drug use
Body Piercing and Tattoos
54. *it is the most common skin disorder of adolescent
occurring in as many as 80% to 90% of adolescent
* acne is categorized as mild (i.e, comedones or
blocked hair follicle) moderate (i.e papules and
pustules are also present) severe (i.e cysts are
present)
Acne
55. Common location of acne lesions are, the face,
neck, back, upper arms and chest
Peak age for the lesions
14 to 17 years of ages for girls
16 to 19 years of ages for boys
Acne
56. - Many adolescent comment that they feel fatigued to some
degree, it can be considered normal for the age group
-Always assess the diet, sleep patterns, and activity schedules
of fatigued adolescents.
-If an adolescents sleep and diet appear to be adequate his or
her activity schedule reasonable, and physical assessment
suggest no illness then fatigue may be emotional origin.
-Blood test may be indicated to rule out anemia and common
infections in adolescents such as infectious mononucleosis
Fatigue
57. Menstrual disorders in adolescents fall into two
categories
1. Menstruation that is painful or uncomfortable
2. Infrequent or too frequent cycles
Menstrual Irregulations
58. Some adolescents experience abdominal
pain during ovulation from the release of
accompanying prostaglandins
Mittelschmerz
59. The pain is caused by the released of
prostaglandins in response to tissue
destruction during the ischemic phase of
the menstrual cycle which leads to smooth
muscle contraction and uterine pain
Dysmenorrhea
60. Most overweight adolescent have obese parents,
suggesting that both inheritance and
environment play a part in the development of
adolescent obesity.
Attempted suicide rate for obese female
adolescents is higher than non-obese
adolescents
Obesity
61. 1,400 to 1,600 calories per day can rarely be
tolerated by adolescents. They generally
dobetter and will stick with a diet closer to
1,800 calories per day.
Encourage activities to burn calories are
swimming, gym classes or walking their
dog
65. Hazing
Is a form of organized bullying refers
to demeaning or humiliating rituals
that prospective members have to
undergo to join sororities, fraternities,
or adolescent gangs
69. Prescription and Over-the-Counter
Drugs
Adolescents who use drugs this way can easily
overdose because they are unaware of usual drugs this
is called pharming
Ex. Sedatives, pain medication, ketamine, or cough
syrup Methylphenidate (Ritalin) - is a drug frequently
prescribe for attention deficit hyperactivity disorder
Mephedrone - commonly called "bath salts" a stimulants
that creates an enjoyable high
70. Alcohol
•Alcohol use cannot be taken lightly, it can
cause disease such as cirrhosis and is
linked to destructive behaviors such as
addiction, depression and vulnerability to
date rape
71. •Adolescents usually begin smoking because
the habit conveys a stamp of maturity
•Chewing tobacco it can cause gingival
recession and lip and mouth cancer.
Tobacco
73. are derivatives of the natural hormone
testosterone. These substances have
side effects of euphoria and lessened
fatigue, which make them doubly
appealing
Athletes using them and paying vigorous
sports can die from ventricular
hypertrophy
Anabolic Steroids
74. is a second drug used to enhance
athletic performance
Human Growth Hormone
Cannabis sativa is the most
frequently abused illicit substance next
to alcohol used by adolescents
Marijuana
75. - Euphoria
- Sense of well being
- Temporary impairment of coordination
- Rapid mood swing
- Decreased attention span
- Loss of memory for recent event
Physical and
Psychological Effects
76. - Pulmonary Disorder
- Lack of Sperm Formation
Long Term Side Effects
Amphetamines
- group of drugs used in the treatment of
hyperactivity and narcolepsy
- Called "uppers" or"speed"
- Some side effects: aggressive or demanding
behavior, paranoia, extreme restlessness
-Chronic methamphetamine abuse result in
destruction of teeth enamel or blackened
77. - Drugs used by adolescents are lysergic acid
diethylamide (LSD) dimethyltryptamine (DMT)
Methaqualone (Quaalude)
- This drugs gives users feelings of euphoria,
pleasure, distorted time and sensory perception
Hallucinogens
Opiates
Opiates include drugs such as
heroin, meperidine and morphine.
Can be extremely dangerous, there
is a tendency to decrease one's
respiratory rate.
78. •One of the most popular drugs of
abuse for late adolescents
•It is combined with heroin
Cocaine
Produces Physical
Effects
Increased pulse rate,
respiratory rate,
increased temperature,
increased blood pressure,
decreased appetite
82. •Self-injury
includes a range of self-destructive actions
from cutting to suicide, the planned intent to
end one's life.
•Cutting is found more frequently in girls
than boys and can begin as early as grade
school
83. •In males, active suicide happens more often
than in females.
•Suicide is so prevalent in teenagers that it
ranks in the 10 to 24-year-old age group among
the top four causes of death.
The reasons why adolescence attempts
suicide:
•incest, maltreatment, increased chemical
dependence, family, marital dysfunction, weak
capacity to solve problems
84. •Depression can be expressed through
behavioral issues such as defiance, temper.
•LGBT youth appear to have higher levels of
suicide than others, reflecting the level
of stress they may be experiencing.
85. Homeless
Runaway Youth
•A runaway is commonly defined as an
adolescent between the ages of 10 and 17 years who has been absent
from home at least overnight without permission of aparents or
guardian.
•Stress factors such as family, unemployment, alcoholism, sexual
maltreatment, incest, attempted suicide, poverty are frequent
characteristics in their families
86. Common health reasons for which runaway
adolescents are seen at healthcare facilities are:
•Sexually Transmitted Diseases,
•Including HIV and AIDS,
•Rape Pregnancy,
•Substance Use Disorders,
•Hepatitis and Vaginitis.
87. A Physically Challenged
or Ill Adolescent
•Achieving a sense of identity may be difficult for adolescents
who have a chronic illness or other challenges.
•Adults who are chronically ill are likely to be difficult to be as
independent as they would like to be. They are at high risk of
drug use disorder or self injury
•Adolescents who are not fully mobile must be mindful of their
overall consumption of calories because they may become
obese as growth needs decrease at the end of adolescence.
