Care of the

ADOLESCENT

LEARNING OBJECTIVES:

On completion of this unit, you are

expected to demonstrate understanding
of the concepts related to the care of a
family with an adolescent.

Specifically, you are able to:

1. Describe the normal growth and

development of an adolescent and
associated parental concerns.

2. Distinguish each milestone achieved

by the adolescent and its implication.

3. Use critical thinking to analyze

methods of a family-centered care of
an adolescent.
 GROWTH & DEVELOPMENT OF AN
ADOLESCENT

LESSON 15

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to the care of a family with an adolescent. Specifically, students are able
to:

1. Identify key terms that are significant in the care of an adolescent and the family.
2. Discuss the adolescent’s biologic-proportional changes and their implications.
3. Evaluate the relationship among the motor, language, psychosocial, cognitive and
moral milestones of an adolescent.

INTRODUCTION

Adolescence is a period of transition between childhood and adulthood. It is a time of

profound biologic, intellectual, psychosocial and economic change.
In this period, physical and sexual maturity are developing into a more sophisticated
manner along with their reasoning abilities. They become more capable of making
decisions of their own but becomes too aggressive at times that they overlook the
implications of their decisions.
Having these characteristics, it is important that nurses would guide the adolescent and
family as this period is a very challenging time for them. Health teachings and
understanding the growth and development are ways to help them through with this phase
and these can be facilitated by us, nurses.
 ACTIVITY 15.1

READING ACTIVITY
Read in advance the topic on Nursing Care of
A Family with An Adolescent in your textbook,
Maternal and Child Health Nursing by Adele
Pillitteri, pages 885 to 913.

CONCEPT DISCUSSION

ADOLESCENCE
• Is the period between 13 and 18 to 20 years, a time that serves as a transition between child-
hood and adulthood.

3 Periods of Adolescence:
1. Early Period– 13 to 14 years
2. Middle Period– 15 to 16 years
3. Late Period– 17 to 20 years

PHYSICAL GROWTH
• The major milestones of development in the adolescent period are the onset of puberty and
the cessation of the body growth.

• The gain in physical growth is mostly in weight, leading to the stocky, slightly abuse
appearance of prepubescence then thin and gangly appearance of late adolescence.

• Most girls are 1 to 2 inches taller than boys coming into adolescence but generally stop
growing withing 3 years from menarche.
• Girls who started menstruating at 10 years of age, may reach adult height by age 13.

• Girls grow 2 to 8 inches in height and gain 15 to 55 pounds.

• Boys grow about 4 to 1 2inches in height and gain 15 to 65 pounds during adolescence.

• Growth stops with the closure of the epiphyseal lines of long bones. This occurs at about
16 to 17 years of age in females and about 18 to 20 years of age in males.

• The increase in body size does not occur in all organ systems at the same rate. These
differences in growth rates make adolescents appear long-legged and awkward during a
rapid growth spurt because their extremities elongate first, followed by trunk growth.

• Because the heart and lungs increase in size more slowly than the rest of the body, blood
flow and oxygen availability are reduced. This means adolescents may have insufficient
energy and become fatigued trying to finish the various activities that interest them.

• During adolescence, androgen stimulates sebaceous glands to extreme activity, some-

times resulting in acne, a common adolescent skin problem.

• Apocrine sweat glands (glands present in the axillae and genital area) form shortly after
puberty producing a strong odor in response to emotional stimulation.
Teeth
• Adolescents gain their second molars at about 13 years of age and the third molar (wisdom
teeth) between 18 to 21 years old.
• Third molars may erupt as early as 14 to 15 years of age
• Jaw reaches adult size by the end of adolescence

Puberty
•Puberty is the stage at which the individual first become capable of sexual reproduction
•A girl has entered puberty when she begins to menstruate (menarche).
•A boy enters puberty when he begins to produce spermatozoa
•These events occurs between ages 11 and 14 years.

Secondary Sex Changes

• Secondary sex characteristics such as body hair configuration and breast growth are those
characteristics which distinguish the sexes from each other but play no direct part in
reproduction.
• secondary sex characteristics that began in the late school-age period continue to develop
during adolescence.
DEVELOPMENTAL MILESTONES

PLAY OR RECREATION
 Thirteen-year-old children change from school-age activ-
ities of active games to more adult forms of recreation
such as listening to music, chatting on computers, or fol-
lowing a sports team’s wins and losses.
 Team (or school) loyalty is intense, and following a
coach’s instructions becomes mandatory.
 Urge parents to encourage youngsters to play sports for
their own health and well-being and the companionship
involved, however, even though they do not excel.
 If they do not excel in sports, encouraged to try other
activities in which they can excel, such as science, music,
or art. Overuse injuries from athletics occur in early ado-
lescence.

 Fifteen-year-old children may spend a great deal of time in their room or, in a quiet corner
of the home away from traffic and conversation areas. If they cannot find privacy some-
where in the house, they tend to spend time elsewhere.

 Activities fulfill an adolescent’s need for satisfying interaction with others and are
indications of maturity and willingness to accept adult roles.

EMOTIONAL DEVELOPMENT
Developmental Task: Identity Versus Role Confusion

 The developmental task in

early and middle
adolescence is to form a
sense of identity or decide
who they are and what kind
of person they will be.

 In late adolescence, the

task is to form a sense of inti-
macy or form close relation-
ship with persons of the op-
posite as with as the same
sex.
• 4 main areas to make gains to achieve a sense of identity
1. Accepting their change body image
2. Establishing a value system or what kind of persons they want to be
3. Making career decisions
4. Becoming emancipated from their parents

• If young people do not achieve a sense of identity, they develop a sense of role
confusion or can have little idea what kind of persons they are. This can lead to their
having difficulty functioning effectively as adults.

• Some adolescents may become delinquent or exhibit acting-out (attention-getting)

behavior because they believe it is better to have a negative image than to be nobody at
all.

BODY IMAGE

• Adolescents who developed a strong sense of industry during their school-age years
have learned to solve problems and are best equipped to adjust to their new body
image.

Role of Nurses
educate adolescents about
their bodies and help them
to accept the changes that
mark maturity.

• Adolescents are usually their own worst critics, never pleased with any aspect of their
bodies. Those with low self-esteem may need parental or health care provider support to
understand that a person’s worth is based on more than physical appearance.

SELF-ESTEEM

Changes in Adolescence that challenges self-esteem:

A. Changes in one’s body and physiologic functioning
B. Changes in feelings and emotional focus
C. Changes in social relationships (including relationships with both family and friends)
D. Changes in family and school expectations

 All of these factors can have an effect on adolescents’ feelings about themselves, some-
times resulting in crisis.
 Help parents understand how important it is for adolescents to have immediate success-
es such as making the high school basketball team or having a date for the senior prom.
VALUE SYSTEM

 Adolescents develop values through talking to peers.

• Adolescents develop values through talking adult ear who will listen to their fears, hopes,
dreams and pressures they feel to be somebody.

• early adolescence: girls tend to band together with girls and boys with boys. They dress
identically with other members of their group

• Adolescents who are different for any reason often are excluded from groups. This
behavior may seem immature, but it is necessary establishing a sense of identity.

How to address exclusion:

Helping adolescents to appre-
ciate that it is not fair to ex-
clude others on the basis of su-
perficial characteristics helps
them move more quickly through
this stage.

CAREER DECISIONS

 Part of the feeling of knowing what kind of person you are is knowing what kind of
occupation will be a fit.

• Many adolescents are encouraged to wait until they have been in college for 2 years
before choosing a major.
EMANCIPATION FROM PARENTS

• Emancipation from parents can become a major issue during the middle and late
adolescent years for 2 reasons:
1. Some parents may not be ready for their child to be totally independent, and
2. Some adolescent may not be sure they want to be on their own.

 Both parents and adolescents may need help to understand that emancipation does not
mean severance but a change in a relationship.

SENSE OF INTIMACY

• Once adolescents have achieved a sense of identity is early or mid-adolescence, they

are ready to work on second developmental task, that of achieving a sense of intimacy.

• The ability to form intimate relationship is strongly correlated with the sense of trust.

• Some adolescents require help from parents or other adults to differentiate between
sound relationships and those that are based only on sexual attraction.

• Intimacy involves this deeper level of relationships or developing a sense of compassion

or concern for people of both sexes.

• Empathy, is feeling for another or a developed sense of intimacy in its finest form.

SOCIALIZATION

• Early teenagers may feel more self-doubt than self-confidence. They want to look grown
up, but they still look like children.

• Both male and female 13 years old tend to be loud and boisterous, particularly when
pure of the opposite sex whose attention they would like to attract are nearby.

• They are impulsive and very much like 2 years old children in that they want immediately,
not when it is convenient for others

• Many 13 years old face being in love.

• Fourteen-year-olds are often quieter and more introspective than they were the year be-
fore. They are becoming used to their changing bodies, have more confidence in them-
selves, and feel more self-esteem.

• Adolescents watch adults carefully during this period, searching for good role models
with whom they can identify.

• Idolization of famous people or older adolescents fades as adolescents become more

interested in forming reciprocal friendships.

• Most 15 years old face being in love five or six times a year.
COGNITIVE DEVELOPMENT
• Adolescents reach a point of cognitive development termed FORMAL OPERATIONAL
THOUGHT. It begins at age 12 or 13 years and grows on dept over the adolescent
years.

• Involves the ability to think in abstract terms and use the scientific method to arrive at
conclusions. With the ability to use scientific reasoning, adolescents can plan their future.
They can create a hypothesis and think through the probable consequences.

• Thinking abstractly is what allows adolescents to project themselves into the minds of
others and imagine how others view them or their actions (display compassion).

MORAL AND SPIRITUAL DEVELOPMENT

• Almost all adolescents question the existence of God and any religious practice they
have been taught This questioning is a natural part of forming a sense of identity and es-
tablishing a value system at a time when they draw away form their families

Diagnoses:
1. Health seeking behaviors related to normal growth and development
2. low self-esteem related to facial acne
3. anxiety related to concerns about normal growth and development
4. risk for injury related to peer pressure to use alcohol and drugs
5. readiness for enhanced parenting related to increased knowledge of teenage years.
 WELLNESS PROMOTION & INJURY PREVENTION
FOR THE ADOLESCENTS

LESSON 16

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to coping with adolescent concerns, wellness promotion and injury
prevention. Specifically, students are able to:

1. Discuss various parental concerns related to an adolescent’s growth and development .

2. Manage parental concerns related to adolescent’s growth and development through
formulation of health teachings suited for each concern.
3. Recognize important safety issues for the adolescent.
4. Formulate interventions and health teachings for the prevention of injury.

INTRODUCTION

Adolescence is one of the most challenging stages. Concerns emerge as part of the
complexities that happen in the growth and development denoting progress and start of
maturation.
These concerns may be somehow difficult to a family but with the right information through
health teachings and right approaches towards the adolescent and family, this phase can be
experienced in a more exciting way.
Nurses then play an important role to make this transition period from childhood to
adulthood a smooth-sailing one by means of identifying cues and formulating interventions and
teachings that address the concerns in a child and family centered manner.
 CONCEPT DISCUSSION

HEALTH PROMOTION

1. Adolescent Safety
• Accidents, most commonly those involving motor vehicles, are the leading cause of death
among adolescents.

•Theirneed to rebel against authority or to gain attention leads them to take foolish chances
while driving, such as speeding or driving while intoxicated.

•parents need to have the courage to insist on emotional maturity rather than age as the
qualification for obtaining a driver’s license.

•motorcycles, motorbikes, and motor scooters: wear safety helmets to prevent head injury;
long pants to prevent leg burns from exhaust pipes; and full body covering to prevent
abrasions in case of an accident.

•Drowning is another chief accident of adolescence, even though it is largely preventable.

•Teaching water safety, such as not swimming alone or when tired, is as important as
teaching the mechanics of swimming.

•Other common causes of death in adolescents are homicide and suicide.

•It
is important that both water and firearm safety be taught creatively to adolescents by
encouraging problem solving rather than by lecturing

•Athletic injuries tend to increase in number during adolescence

2. Nutritional health
 If adolescents’ eating habits are unsupervised, they tend to eat faddish or quick snack foods
rather than more nutritionally sound ones

 For obese adolescents, a weight-loss diet may be appropriate during adolescence, but it
must be supervised to ensure that an adolescent consumes sufficient calories and nutrients
for growth.

 Foods that supply the necessary carbohydrates, vitamins, protein, and minerals are
essential.
 CONCEPT DISCUSSION

 The nutrients that are most apt to be deficient in both male and female adolescent diets are
iron, calcium, and zinc.
 Iron– for iron-deficiency anemia
 Calcium– for rapid skeletal growth
Zinc- necessary for sexual maturation and final body growth.

 Good sources of iron are meat and green vegetables; calcium is abundant in milk and milk
products; meat and milk are also high in zinc.

3. Daily Activities
• Adequate sleep, hygiene and exercise are important and should become the adolescent’s
responsibility rather than that of the parents.

• Provide adolescents the time for self-care, such as shampooing hair, etc. It is important to
include this in the nursing care plan especially when they are hospitalized.

• Remembering how important clothing is for adolescents also helps you plan care for them
during a hospitalization. Most teenagers seem to improve markedly when allowed to wear
their own clothing rather than a hospital gown.

• In care of their teeth, they should continue to use a fluoride paste and drink fluoridated
water to ensure firm enamel growth

• Because protein synthesis occurs most readily during sleep and adolescents are building
so many new cells, adolescents may need proportionately more sleep than any other age
group.

• Adolescents need exercise every day both to maintain muscle tone and to provide an
outlet for tension.

4. Healthy Family Functioning

• Early adolescents may have many disagreements with parents partly from wanting more
independence and partly from being disappointed in their bodies.

• It may be helpful to counsel parents to appreciate that although it is not easy to live with a
teenager, it is equally difficult to be the teenager.
5. Common Health Problems
A. Hypertension
• Is present if blood pressure is above the 95th percentile (127/80) for 16 years old
girls and 131/81 for 16 year-old boys for two consecutive readings in different
settings.

• Family history is most susceptible factor in developing this disease

• All children over 3 years of age should have their blood pressure taken routinely.

• new medication plus education in risk factors makes treatment at this age
successful

B. Poor Posture
• Most adolescents demonstrate poor posture, a tendency to round shoulders and a
shambling, slouchy walk due to imbalance of growth, the skeletal system growing
a little more rapidly than the muscle attached to it.

• Girls may slouch so as not to appear taller than boys in the belief boys will only
date girls shorter than themselves.

• Girls may slouch to diminish the appearance of their breast size if they are devel-
oping more rapidly than their friends.

C. Body piercing and tattoos

• Body piercing and tattoos are becoming a mark of adolescence

• Both sexes have ears, lips, chins, navels and breasts pierced and filled with ear-
rings or tattoos applied to arms, legs or their central body

• These acts have become a way for adolescents to make a statement different from
you

D. Fatigue
• Adolescents comment they feel fatigued to some degree that this can be consid-
ered normal for the age group.

• Assess an adolescents diet, sleep pattern and activity schedule, because all can
contribute greatly to fatigue

E. Menstrual irregularities
• Can be a major health concern of adolescents girls as they learn to adjust to their
individual body cycles
F. Acne
• Is a self-limiting inflammatory disease that involves the sebaceous glands that
empty into hair shafts mainly of the face and shoulders.

• The peak age for the cession to occur in girls is 14-17 years, for boys 16-19 years

• The goal of therapy for acne is threefold: (a) decrease sebum formation, (b) pre-
vent comedones, and (c) control bacterial proliferation.

G. Obesity
• Most overnight adolescents have obese parents, suggesting that both inheritance
and environment play a part in the development of adolescent obesity.

H. Sexuality and sexual activity

• Because of increasing exposure to and acceptance of pre-marital sexual relation in
society, more adolescents than ever before engage in sexual intercourse.

• Counseling can help adolescents improve their perspective and learn how to say
no.

• Falsehoods about sex must be explored through discussion, because adolescents

who believe them may never be comfortable with sexual relationships.

• Be certain to provide information on date rape and rape prevention as well when
discussing sexual behaviors, because adolescents are in a high-risk age group for
date rape.

I. Stalking
• It refers to repetitive, intrusive and unwanted actions directed at an individual to
gain the individuals attention or evoke fear.

• Stalking behavior can occur in adolescents either males or females can become
stalker or victim.

• Measures to help avoid being stalked are the same as those for avoiding rape,
such as advising adolescents not to put themselves in positions where they will be
vulnerable to being alone with a stalker

J. Hazing
• It refers to the demeaning or humiliating rituals that prospective members have to
undergo to join sororities, fraternities or adolescents gangs.

• Parents need to be aware of what clubs or organizations their adolescent is

attempting to join and what the requirements for membership will be.

• Health care providers can help adolescents make sound decisions about what type
of hazing their organization advocates by asking teenagers about the subject at
health assessments.
K. Substance abuse
• Refers to the use of chemicals to improve a mental state or induce euphoria

• This is common among adolescents that as many as 50% of high school seniors
report having experimented with some form of drugs.

• Types of abused substance are Tobacco, Alcohol, Steroid, Marijuana, Cocaine

and Hallucinogens

L. Attempted Suicide
• Is deliberately self-injury with the intend to end one life

• Successful suicide occurs more frequently in males than in females, although more
females apparently attempt suicide than males.

M. Runaways
• Defined as an adolescents between the ages of 10 and 17 years who has been
absent from home at least overnight without permissions of a parent or guardian.

• Runaway adolescents are most likely to be from low and high income families.

• Unemployment alcoholism, sexual abuse, attempted suicide and poverty are the
frequent characteristics.
 EXERCISE 16.1

NOTRE DAME OF MARBEL UNIVERSITY

MOVIES AND REFLECTION: Watch the movie “Mean Girls” through this link: https://
drive.google.com/file/d/1KaD8SBelmdW5Bgn8lhIYtz1f8ckpP5Yt/view?usp=sharing.

Make a reflection paper composed of not less than 400 words. The reflection paper must con-
tain your thoughts and realizations about our discussion on the nursing care of a family with an
adolescent. Point out the details on our lesson that you have identified in the movie and relate
them into your personal experiences as an adolescent.

The reflection paper must be in a short-sized document, using the following format: an Arial 12
font style and size , 1.5 spacing, justified paragraph format.

FEEDBACK
Let us look into how well you fared. If you answered all
questions correctly, congratulations! It shows that you are
already familiar with the topics discussed in lesson 15 and 6.
If your answers are quite not close to the discussion, you
have some ideas about the topics covered but need to learn
more.
Now, you have a glimpse of the Wellness promotion and
injury prevention of an Adolescent. Read on and continue ex-
ploring this topic.
Read further on your textbook pages _______ to _________
and on other Maternal and child health nursing references.
 Quiz 14.1

Congratulations! You are done with Lesson 16. In order to see how much you have learned,
an online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your NDMU Academic Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 17 entitled Wellness promotion and Injury
prevention of an Adolescents.
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf