1. Health Promotion of the Adolescent and Family
Chapter 16

2. Promoting Optimum Growth and Development
Transition between childhood and adulthood
Rapid physical, cognitive, social, and emotional maturation
Generally defined as beginning with onset of puberty and ending with cessation of body growth at years

3. Terms Puberty—development of secondary sex characteristics
Prepubescence—approximately 2 yrs before onset of puberty; preliminary physical changes occur
Post pubescence—1-2 yrs after puberty; skeletal growth is complete, reproductive functions

4. Biologic Development Primary sex characteristics
External and internal organs necessary for reproduction
Secondary sex characteristics
Result of hormonal changes: for example, voice changes, hair growth, breast enlargement, fat deposits
Tanner’s Stages on pp
Usual sequence of changes on p. 495

5. Hormonal Changes of Puberty
Hypothalamus stimulates anterior pituitary
Anterior pituitary stimulates gonads
Gonads produce and release gametes
Gonads secrete sex-appropriate hormones
Estrogen and testosterone are present in both sexes during childhood, but jumps during puberty appropriate to gender

6. Estrogen “Feminizing hormone”—produced by ovaries
Low production during childhood
Males: gradual production throughout maturation
Females: increases until about 3 yrs after menarche
Females then remain at this maximum level throughout reproductive life

7. Androgens “Masculinizing hormones”—produced by testes
Secreted in small and gradually increasing amounts up to 7-9 yrs
Then rapid increase in both sexes initially; males continue rapid increase until 15 yrs
Responsible for rapid growth of early teen
Males increase to maximum level at maturity

8. Sexual Maturation: Girls
Thelarche: appearance of breast buds—age 9-13½ yrs
Adrenarche: Growth of pubic hair on mons pubis—2-6 months after thelarche
Menarche: initial appearance of menstruation approximately 2 yrs after 1st pubescent changes —avg age 12 yrs 9½ months in North America

9. Sexual Maturation: Boys
First pubescent changes: testicular enlargement, thinning, reddening, and increased looseness of scrotum—age 9½ to 14 yrs
Penile enlargement, pubic hair growth, voice changes, facial hair growth
Temporary gynecomastia in 1/3 of boys; disappears within 2 yrs

10. Physical Growth
Dramatic increase in growth accompanies sexual maturation
Adolescent growth spurt
20%-25% of total height achieved during puberty—boys have slower epiphyseal closure resulting in longer growth period
Usually occurs within month period
Boys grow 4-12” & lbs; girls 2-8” & lbs
Girls stop growing about 21/2 yrs after menarche; boys grow until yrs

11. Sex Differences in General Growth Patterns
Appear to be result of hormonal effects at puberty
Muscle increases in boys due to testosterone
Fat deposits are sex-related
Obesity associated with early onset of menarche in girls
Obesity effects less predictable in boys

12. Physiologic Changes
Size and strength of heart, blood volume and systolic blood pressure increase
Pulse rate and basal heat production decrease
Adult values for all formed elements of blood
Respiratory volume and vital capacity increase
Increased performance capabilities

13. Psychosocial Development
Erikson: sense of identity
Early adolescent: group identity vs. alienation
Development of personal identity vs. role diffusion
Sex-role identity—adolescents are influenced by peers and adults, but will vary acc’d to culture, geographics, and socioeconomics
Emotionality—vacillate between adult and child-like behavior; mood swings common

14. Piaget: Cognitive Development
Formal operations period
Abstract thinking
Think beyond present—can think about the future and consequences of actions
Mental manipulation of multiple variables
Capable of analysis and strategy
Concerned both about others’ thoughts and others’ needs
Increased understanding of others increases tolerance

15. Kohlberg: Moral Development
Internalized set of moral principles
Questioning of existing moral values and relevance to society
Understand duty and obligation, reciprocal rights of other
Concepts of justice, and making amends for wrongdoing
Are greatly influenced by adults who do or do not “practice what they preach”

16. Spiritual Development
Some may question values and beliefs of family
Capable of understanding abstract concepts, interpreting analogies and symbols
May fear that others will not understand their feelings—may be reluctant to disagree with norms
More religious or spiritual adolescents are less likely to engage in high-risk behaviors

17. Social Development
Goal: to define identity independently from parental authority
Much ambivalence
Intense sociability; intense loneliness
Acceptance by peers, a few close friends, and strong family support are all important for maturity

18. Relationships with Parents
Roles change from “protection-dependency” to “mutual affection and equality”
Process involves turmoil and ambiguity
Struggle of privileges and responsibility
Emancipation from parents may begin with rejection and defiance of and withdrawal from parents

19. Relationships with Peers
Peers assume increasingly significant role in adolescence
Peers provide sense of belonging and feeling of strength and power
Peers form transitional world between dependence and autonomy

20. Heterosexual Relationships
Dating—crushes in early yrs; group to double to single
Sexual experimentation—wide range; ½ have intercourse by age 18. Sex before 14 could mean abuse in past
Reasons for sexual experimentation
Curiosity
Pleasure
Conquest
Affection, belonging
Peer pressure to conform

21. Homosexuality in Adolescents
Development of sexual identity during adolescence
Risk of health damaging behaviors by homosexual and bisexual youths
Early initiation of sex behaviors
STDs
Running away from home
Suicide and suicidal ideation

22. Interests and Activities
Leisure activities center around peers—favorites are phone, movies, eating out
Adolescent work experiences may provide benefits
Time management concerns between school, fun, and work
Work time should not exceed 20 hours/week

23. Development of Self-Concept and Body Image
Feelings of confusion in early adolescence—may feel strange about rapid body changes
Acute awareness of appearance, comparison of appearance with others
Blemishes/defects and growth differences magnified out of proportion—want “perfect body”
Frequently pose and primp especially in private

24. Promoting Optimum Health During Adolescence
Immunizations—tetanus, MMR, and Hep B if not received during school-age years. Meningococcal strongly recommended for college bound
Nutrition—calorie and protein requirements higher than any other time in life. Need more calcium, iron, and zinc
Eating habits and behaviors—skipping breakfast, snacking, dieting, eating hi-fat fast food and very little fruits and vegs

25. Promoting Optimum Health cont’d
Healthy lifestyle habits:
teaching good nutrition is not enough—must also have access to high-quality foods and snacks at home and school
Relationship between attractive appearance and healthy lifestyle can be effective
Provide info and involve teen—don’t dictate and judge
Role-modeling is important

26. Promoting Optimum Health cont’d
Sleep and rest—need rest due to increased growth and increase in activities. Naps are not uncommon—sleeping late is common
Exercise and activity—sports has increased, but PE programs can be emphasizing games and competition and not activities that contribute to lifelong fitness
Dental health—caries are down. If needed, orthodontics are started in early adolescence—need extra hygiene

27. Promoting Optimum Health cont’d
Personal Care:
Vision and hearing need to be checked because of frequent incidence of refractive errors and hearing loss
Posture can be a problem because teen is worried about being too tall and fatigue
Body piercing—needs to be done by professional
Sunscreen needs to be stressed. Dangers of tanning beds. Self-tanners are best
Personal hygiene needs include education re: frequent bathing, deodorant, menstrual hygiene, douching

28. Stress Reduction

29. Sexuality Education and Guidance
Knowledge often acquired from peers, TV, movies, magazines and is often inaccurate
Need for factual info, presentation based on developmental maturity
Topics nurses should be prepared to discuss include sexual attitudes and values, disease transmission, birth control, physiology and body changes, menstruation, pregnancy and birth

30. Injury Prevention
Motor vehicle crashes—single greatest cause of serious and fatal injuries in teens—60% male—alcohol frequently a factor; 10% may have been suicides
Firearms/other weapons—powder, paint, BB
Sports injuries—football with boys; gymnastics with girls. Important that sport fits body type and ability and that protective gear is worn

31. Anticipatory Guidance— Care of Families
Parents need for support and guidance
Information needs regarding developmental changes and process of gaining independence