What age constitutes adolescence? Define prepubescence, Puberty, and Postpubescence
- Adolescence: begins with onset of puberty and ends with cessation of body growth at 18-20 years. A time of growing psychologically, physically, and socially to maturation
- Prepubescence: about 2 years before puberty, heralding physical changes
- Puberty: sexual maturity is achieved
- Post Pubescence: 1-2 yr after puberty, skeletal growth is complete and reproductive functions become established
What physical growth occurs in adolescence?
- Primary and secondary sex characteristics
- Boys increase in muscle mass
- Girls increase in fat deposits
How do adolescents mature sexually? What stages are used to determine stage of sexual development?
- Primary sex characteristics: external and internal organs necessary for reproduction
- Secondary sex characteristics: results from hormonal changes- voice change, hair growth, breast enlargement, fat deposits. No direct role in reproduction
- *Tanner stages are used to assess secondary sex characteristics to estimate sexual maturity
What are the female tanner stages?
- Thelarche (8-13): breast buds
- Adrenarche (8-13): pubic hair growth
- Menarche: about 2 yrs after theolarche, menstruation begins
- Puberty delay: no thelarch by 13 or menarch by 16
What are the male tanner stages?
- Stage 1 (9.5-14): testicular enlargement and sparse pubic hair
- Stage 2: increase of stage 1
- Stage 3: Penile enlargement, voice changes, early facial hair, gynocmastia occurs in 1/3 of males mid puberty
- Stage 4: increase in stage 3
- Stage 5: penile growth, first ejaculation, axillary, groin, and facial hair, final voice changes
What physical growth and changes occur in the adolescent?
- Dramatic increase in growth accompanies sexual maturation (20-25% growth increase in 24-36mo)
- Size and strength of heart, blood volume, and systolic BP increases
- Pulse rate and basal heat production decrease
- Resp volume and vital capacity increases
- Increased performance abilities
- *vitals and lab values reach adult levels
What motor development occurs in the adolescent?
- Activities provide outlet for energy
- Opportunity for competition, teamwork, and social relationships
- Sports activities should be grouped according to physical size, otherwise increased risk for injuries
- Cardiovascular capacity increases, allowing for increased endurance in sports
What cognitive and sensory development does the adolescent experience?
- Every aspect of psychosocial development influenced by cognitive development
- Can draw on past experiences and apply knowledge
- Senses completely mature
What language development occurs in the adolescent?
- Understands abstract concepts
- Processes complex thoughts
- Expresses themselves verbally
- Plays role in social development
- Parents should strive to maintain open communication
What stage of Erikson is the adolescent in? How does this impact the three different age ranges of adolescence?
- Identity formation vs. Role confusion
- Early adolescence (11-14): body image, physical changes, group identity v alienation, self-conscience, believes in imaginary audience
- Middle Adolescence (15-17): Most frustrating years, impulsive and impatient, need for constant discipline and structure, feelings of self image and social relationships are intense, transition period from same sex friends to interest in opposite sex
- Late Adolescence (18-21): less turbulent, prepare for education or vocational training (those that have no career goals are at risk of depression), social relationships are more mature
What moral development occurs in the adolescent?
- Internalized set of moral principles
- questioning of existing moral values and relevance to society
- Understand duty and obligation, reciprocal rights of others
- Concepts of justice and reparation being formed
What stage of Piaget is the adolescent in?
- Formal Operations
- Can think abstractly
- Thinks beyond the present
- Mental manipulation of multiple variables
- Concerned about other's thoughts and needs
How does an adolescent's relationship change with their parents?
- Changes from "protection dependency" to "mutual affection and equality"
- Process involves turmoil and ambiguity
- Struggle of privileges and responsibility
- Emancipation from parents may begin with the rejection of parents by the teenager
- Teen mothers can also file for emancipation
What health assessment/teaching should be done for the adolescent?
- Guidelines for adolescent Preventitive Services (GAPS)
- Assessment and teaching based on HEADSS
- H: home
- E: education
- A: Activities
- D: drugs/diet
- S: sexuality
- S: suicide and safety
How can you promote activity and rest in the adolescent?
- Still need 8 hr of sleep, but have difficulty setting realistic sleep schedules due to gaining independence
- Physical activity is important to decrease obesity
- Non-physical activity also necessary
- Time to form lasting bonds with peers
What immunizations are given in puberty?
- -TDaP (booster q10yrs)
- -HPV (3 series)
- -MCV (booster at 16-18)
Describe sexual activity for the adolescent and the importance of sexual education
- Sexuality describes identity
- Middle adolescence marks initial experiment with hetero/homosexual behavior
- Initmate relationships are usually short lived
- Teen pregnancy still a concern (minorities at higher risk), necessary teaching for contraceptive practices
- Safe sex teaching to prevent STIs and pregnancy
- Education should take place at the beginning of puberty (9-10) as early maturation may occur
Describe teenage pregnancy
- Predictors: Sexually active, absent parents, minority, low self esteem
- Effects: 2/3 do not finish HS. May have poor support system as teen pregnancy is more acceptable in certain cultures
- Infants: LBW, late PNC, risks associated with undiagnosed STIs
- Contraception: pull out is most common, often inadequate contraception used
What are some common health problems of the adolescent?
- Eating Disorders are the most common
- Obesity, Anorexia Nervosa, Bulimia
What is obesity in the adolescent related to?
- Poor eating habits
- Over eating or binging
- Lack of exercise
- Family history of obesity
- Medical illness endocrine, neurological problems)
- Medications (steroids, some psych meds)
- Stressful life events or changes (Separations, divorce, death, abuse)
- Family and peer problems
- Low self-esteem
- Depression or other emotional problems
What are the risks and complications of obesity?
- Increased risk of heart disease
- Breathing problems
- Sleep disorders
How can obesity be treated and what nursing interventions should be done?
- Start a weight management program
- Change eating habits (Eat slowly, develop a routine, manage portions)
- Plan meals to make better food selections, eating more fruits and vegetables
- Control portions to consume less calories
- Increase exercise and physical activity
- Eat meals with family instead of during relaxing and boredom
- Eat breakfast
- Do not use food as a reward
- Attend a support group
What three factors are involved in acne?
- 1. Excessive sebum production
- 2. Comedogenesis: formation of noninflammatory lesion called a comedone (open comedome is a black head, closed is a white head)
- 3. Overgrowth of Propionibacterium, which draws WBCS causing inflammatory papules, pustules, nodules and cysts
What medications can be used to treat acne?
- Tretinion/Retin-A: topical cream, gel, liquid
- -only drug that interferes with comedone production
- -apply 30 min after washing face at night, use spf 15 during day
- Benzoyl Peroxide: antibacterial agent that inhibits growth of P. acne organisms
- -gradually increase strength and amount
- -bleaching effect on hair, linens
- Topical Antibacterials: clindamycin, erythromycin, metronidazole, azelaic acid
- -interferes with all 3 factors of acne when combined with Retin-A
- Oral Antibiotics: tetracycline, erythromycin, minocycline, doxycycline, clindamycin, trimethoprim-sulfamethozale
- -used when mod/severe acne does not respond to topical treatment
- Oral contraceptive pills: for females, used in combo with topicals
Describe the use of Accutane and its teaching
- Used only for cystic acne not responsive to other treatments
- Treatment lasts 20 weeks supervised by dermatologist
- Teratogenic side effects so females must be on BC even one month after
- Cholesterol and triglyceride levels should also be monitored
What teaching can be done for adolescents with acne?
- Only use gently cleanser 2x daily, do not use harsh scrubbing or abrasive products
- Use water based cosmetics and lotions
- Squeezing pustules can worsen acne by breaking down duct walls
- Education patient family on cleaning and medication routine, along with written information
- Promote adequate rest, hydration, exercise, diet, and stress management
- The first menstrual period ave age between 12-18
- Initial cycle is irregular and may be anovulatory for 12-18 mo
- Sexually active females should use contraception due to unknowing of when ovulation will begin
- May experience mittleschmertz
- Associated with the luteal phase of the menstrual cycle
- Woman must report 1 emotional or physical symptom present only during the luteal phase consistently for 3 mo
What is the treatment for PMS?
- Ca, Mg, Vit B supplements
- restrict foods with methyxanthines (coffee, chocolate, cola)
- Restrict alcohol, smoking, red meat, salts, sugars
- Increased complex carbs, proteins, fruits/vegs, aerobic exercise
What is dysmenorrhea?
- Primary: painful menses
- Secondary: related to endometriosis, adhesions, infection
- begins with menstrual flow and lasts 48-72 hours
- Cramping, abdom pain, backache, leg ache, n/v/d
- Treated with NSAIDs, oral contraceptives, and PMS management
What is amenorrhea? What are the two types?
- Primary amenorrhea: absence of secondary sex characteristics and no menses by 15 y/o or presence of secondary sex characteristics with no menses by 16.5 y/o
- Secondary: absence of menses for 6 mo or at least 3 cycles after menstruation was previously established
- *pregnancy is the number one cause. Others include exercise induced, eating disorders, and hyperandrogenism
Describe mononucleosis and the s/s
- Also called the kissing disease (transmitted through saliva), caused by the Epstein-Barr virus (herpes family)
- Incubation 30-50 days, no immunization
- S/S: fever, sore throat and tonsillitis, palatine petechiae, swollen lymph nodes, splenomegaly, jaundice, extreme fatigue, HA, abd pain, epistaxis
- Dx: monospots, clinical symptoms, get culture to rule out strep
What is the treatment for mononucleosis?
- Analgesic and antipyretic therapy
- Supportive only
- Fluids, soft bland diet
- Corticosteroids for complications
- Bed rest
- Avoid contact sports due to splenomegaly
- Can generally resume activities within 1 mo