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Health Promotion of the Adolescent and Family
Chapter 19 Health Promotion of the Adolescent and Family
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PROMOTING OPTIMUM GROWTH AND DEVELOPMENT
Complex interplay of biologic, cognitive, psychologic, and social change, perhaps more so than at any other time of life Change on multiple levels Biologic maturation Cognitive development Psychologic development
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Misguided Views of Adolescence
Raging hormones determine behaviors Risky and misguided behavior is the norm
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Adolescence Early—ages 11 to 14 Middle—ages 15 to 17
Late—ages 18 to 20 See chart Table 19-1 p. 740 (9th ed) p. 652 (10th ed)
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Biologic Development Neuroendocrine events of puberty
Gonadotropin releasing hormone (GnRH) from the hypothalamus See diagram on next slide.
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Hormonal Interaction Between Hypothalamus, Pituitary, and Gonads
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Changes in Reproductive Hormones
Females Thelarche Menarche Ovulation Males Testicular enlargement Increasing muscularity & voice changes Gynecomastia—resolves within 2 yrs Penile enlargement & ejaculation
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Pubertal Sexual Maturation
Tanner stages 1 through 5 —pp th ed pp ed. Sequence is predictable--know Age of occurrence varies Average age of menarche in United States 12.55 years for Caucasian 12.06 years for African-American 12.25 years for Mexican-American
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Physiologic Growth During Puberty
Pubertal growth spurt—increase in growth of skeletal muscles and internal organs BOYS:14 years GIRLS: 12 years-[generally 1 ½ -2 years before boys] Gains in growth Final 20% to 25% of linear growth Up to 50% of ideal adult body weight
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Pubertal Changes in Boys
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Pubertal Changes in Girls vs Boys
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Physiologic Changes Heart, blood volume, and systolic BP increase in size and strength Heart rate decreases Respiratory vital capacity increases Change in BMR
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COGNITIVE DEVELOPMENT
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Piaget: Emergence of Formal Operational Thought
Formal operational thinking—ages 11 to 14 Abstract terms, possibilities, and hypotheses Decision-making abilities increase May not use formal operational thought and reasoned decision making all the time— “choices”
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Adolescent Conceptions of Self
Adolescent egocentrism Self-absorption Health-related beliefs Imaginary audience (everyone is watching) Personal fable (won’t happen to me)
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Changes in Social Cognition
Understanding of others’ thoughts and feelings Mutual role taking Effect on health-related choices
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Development of Value Autonomy
Struggle to clarify values Development of a personal value system Gradual process in late adolescence
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Moral Development Parallels advances in reasoning and social cognition
Conventional level of moral reasoning--absolute moral guidelines are seen to emanate from authorities such as parents and teachers. Principled moral reasoning—adolescents question absolutes and rules and view moral standards as subjective and based on points of view that are subject to disagreement (p747 9th ed., p th ed.)
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Spiritual Development
Religious beliefs may become more abstract during adolescence Late adolescents may reexamine and reevaluate beliefs and values of their childhood
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Psychosocial Development
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Identity Development Social forces shape sense of self—adolescents may move through these phases in different sequences Identity achievement—establishing a coherent identity after exploring options “Moratorium”—currently engaged in exploration of identity options “Foreclosure”—making identity commitments without exploring and experimenting “Diffusion”—lack of firm identity commitments
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Development of Autonomy
Emotional autonomy—beginning to become > separated from parents, < separated from friends Cognitive autonomy—ability to think for yourself Behavioral autonomy—ability to turn to others for advice when appropriate, weigh alternatives, & reach an independent conclusion; making your own choices rather than comforming
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Achievement Development of motives, capabilities, interests, and behaviors Progress toward occupational achievement Relationship between social class and educational and occupational achievement
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Sexuality Hormonal, physical, cognitive, and social changes affect sexual development Body image Sexual identity—experimenting with sex, developing more intimate friendships 9th grade: 38% of boys and 27% of girls report having had sexual intercourse 12th grade: 62% of boys and 68% of girls > masturbation among boys than girls Sexual orientation—involves several dimensions including attraction, fantasy, actual sexual behavior, self-labeling or group affiliation
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Intimacy Intimate relationship begins to emerge in adolescence—NOT necessarily sexual in nature Developmental course of intimacy Self-focused—meeting personal needs Role-focused—more concerned with conforming to appropriate roles and norms of relationship Individual-connected—more intimate relationships that acknowledge the complexity and contradictions in close relationships
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Social Environments Ecologic model:
Microsystems—most proximal social context Family, peer groups, school, workplace Mesosystems—formed by linkages between microsystems Exosystems—settings that influence adolescent behavior & development Macrosystems—culturally-based belief systems & economic & political systems Can have profound effect on health-related behaviors & development All are intertwined and to effect health, nurses must look at all these systems.
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Families Changes in family structure and parent employment
Family structures vary greatly! Parenting styles Effective conflict resolution and family cohesion contribute to healthy adolescent behaviors Socioeconomic influences
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Peer Groups Significance in socialization—can be an asset or a detriment Significance in development—strongly influenced by socioeconomic factors, family strengths and weaknesses Value placed on peer relationships—influence of peer relationships is individual, but highly influenced by family support, and social support.
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The Peer Group Influences Adolescent Development
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Schools Play increasingly important role in preparation for adulthood
Parental involvement in schools Effect of academic success or failure on self-esteem
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Work Workplace as fourth microsystem Positive or negative
May encourage development of intellectual and social skills, autonomy May result in decreased interest in school, fewer extracurricular activities, and poorer grades
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Technology as a Social Environment
Internet chatrooms and social networking sites have created “virtual” communities Try out identities and interpersonal skills with wider network of people Anonymity Risks Sexting chat rooms
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Community and Society Media influences
Availability of alcohol, tobacco, sexuality, violence in TV, movies, video games, etc. Community’s economic resources play role in health and well-being of young people High employment vs unemployment as well as socioeconomic status affect behaviors and outlook Resources for health promotion Influence quality of local schools and health-related services
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PROMOTING OPTIMUM HEALTH DURING ADOLESCENCE
Empowering individuals, families, and communities Power, authority, and opportunities to make healthy choices Risk reduction in areas of mental health, substance use, sexual behavior, violence, unintentional injury, nutrition, physical activity and fitness, and oral health Causes of 75% of adolescent death: injuries, homicide, and suicide
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Adolescents’ Perspectives on Health
Factors promoting adolescent health and well-being Contexts for adolescent health promotion School-based and school-linked health services Adolescent health screening “SAFE TIMES”: method for screening interviews with teens (p. 761, 9th ed.) Nursing Care Guidelines: Interviewing Adolescents (p. 672, 10th ed) Confidentiality is essential State laws have changed since 2001 to require notification of parents for a variety of health care services
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Health Concerns of Adolescence
Parenting and family adjustment Psychosocial adjustment Intentional and unintentional injury Dietary habits, eating disorders, and obesity Physical fitness
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Nursing Implications Following AAP recommendations (2007):
Assess Ht and Wt annually along with BMI BMI Table 19-2, p. 764, 9th ed; Table 17-2, p. 675, 10th ed. Assess, “Do you feel that you are too heavy, too thin, or about the right weight?” AMA Committee on Prevention & Treatment of Adolescent Overweight and Obesity Screen for Hypertension, Family Hx of Obesity, Type 2 Diabetes. BMI 85th – 95th %ile= overweight BMI > 95th %ile= obese
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Merits of Exercise Advocate for physical fitness– Zipcode for Health Assess physical activity and discuss emotional, social, and physical benefits fo exercise
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Health Concerns of Adolescence— cont’d
Sexual behavior, STDs, and unintended pregnancy Use of tobacco, alcohol, and other substances Depression and suicide Physical, sexual, and emotional abuse Nurse’s role—assess, screen, teach, teach, teach! Healthy lifestyle; consequences of abuse
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Health Concerns of Adolescence— cont’d
School and learning problems Hypertension Hyperlipidemia Infectious diseases/immunizations Safe practices including immunizations Tdap booster, Meningococcal vaccine (MCV4), HPV, MMR booster, 2-dose Hepatitis A vaccine, Varicella if never had it and hasn’t had disease, Annual flu vaccine
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Other Topics Body Art—piercing and tattooing— big factor in establishing ‘identity’. Recommend having them done in ‘safe setting’ to decrease risk of infections or risk of HIV Sleep deprivation & Insomnia Adolescents need 9 hours/night! Allow to sleep in to catch up and allow for proper growth Homeless may suffer further due to lack of food Tanning Educate about detrimental effects of frequent tanning—premature aging, skin cancer
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Health Promotion Among Special Groups of Adolescents
Minority Adolescents—children of African American, Latino-Hispanic, Asian, Ntive American and Alaskan Native descent—are the fastest growing population Provide health promotion strategies if at risk for poverty or poor family support Gay, lesbian, and bisexual adolescents Advocate against bullying that may put these teens at risk for alienation Rural adolescents— improve safety practices with farm machinery. See Guidance During Adolescence p. 772 (9th ed.); p. 683 (10th ed.)
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Acne More than 50% of adolescents affected Etiology Pathophys:
Familial aspect—increased tendency Hormonal influence—aeb premenstrual flare-ups Other influences—stress, exposure to oils in many different venues. Pathophys: Excessive sebum produxn, Comedogenesis Involves hair follicle and sebaceous glands & overgrowth of Propionibacterium acnes
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Acne—cont’d Psychosocial ramifications Therapeutic management
Self-esteem issues Therapeutic management General measures/overall health Cleansing—BID adequate with mild cleanser Medications— topical retinoids, topical benzoyl peroxide, topical antibacterials, then oral antibacterials; OCP—reduce endogenous androgen production Nursing considerations
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Vision Changes Refractory errors peak in adolescence due to growth spurts Vision screening Myopia most common—might excess screen time contribute to incidence?
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Scoliosis pp A complex deformity of the spine that also affects the ribs Lateral curvature of the spine and spinal rotation causes rib asymmetry. Significant if > 10 degrees. Should be assessed at all school physicals by having child bend forward and observing from behind.
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Therapeutic procedures for scoliosis: Bracing
Bracing & Exercise Slows progression 2 types: “Boston”underarm prefabricated plastic ‘shells’ OR TLSO, underarm orthosis made of plastic that is custom-molded Gold standard for mild-moderate scoliosis but may NOT CURE Exercise should be used with the brace Wear it 23 hr/day ideally
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Therapeutic procedures for scoliosis: Surgery
Usually indicated for >45 degree. Arthrodesis Realigns, straightens w/ internal fixation, instrumentation w/bony fusion Instrumentation Harrington system Nat’l Scoliosis Fdn
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Nursing Care (p.1672 9th ed., p. 1590 10th ed.)
Pre-op Teaching is a priority Pain management Catheter post op Mobility post op Testing: x-rays, pulmonary function tests, PT, PTT, Bleeding times, CBC, BMP, UA Possible autologous blood donation Bring ‘security item’ prn Post-op Pain management-PCA Log-rolling to prevent damage Brace worn sometimes Skin care—important Neuro status—critical Respiratory function Vital signs—infection, blood loss Bedrest usu. 24 hr then sit up, and stand after 2nd day I&0—catheter care
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