NUR2031

Care of Adolescents and

Young Adults

After this lecture, you will be able to

discuss the needs for growth and development in adolescents

and young adults
describe assessment for growth and development in
adolescents and young adults

Growth and Developmental Needs of Adolescents and

Young Adults

Growth and Developmental Needs of Adolescents and Young Adults

Adolescents are a diverse population group

They have different needs; their needs are changing from

time to time

Growth and Developmental Needs of Adolescents and Young Adults

Biological development

Cognitive development (Intellectual and moral)

Psychosocial development

Growth and Developmental Needs of Adolescents and Young Adults

Adolescents have their needs that are specific to their age and
developmental status.
Many of the sources of mortality and morbidity in this age group are related
directly or indirectly to risk behaviors that have their onset during
adolescence.

Growth and Developmental Needs of Adolescents and Young Adults

Physical Development
Stages

Physical Development

Early (10-14 years)

Puberty:
Growth of body hair, increased perspiration and oil
production in hair and skin; great physical growth (both
height and weight); breast and hip development and onset of
menstruation (girls); growth in testicles and penis, wet
dreams, and deepening of voice (boys).

Late adolescence (15-19

years)

Physical growth slows for girls but continues for boys

Young adulthood (20-24

years)

Young women are typically fully developed physically; young

men continue to gain height, weight, muscle mass, and body
hair

Growth and Developmental Needs of Adolescents and

Young Adults
1. Physical development: Primary sexual characteristics
Reproductive organs and external genitalia develop rapidly during puberty

Growth and Developmental Needs of Adolescents and

Young Adults
1. Physical development

Frontal cortex development

Neurons grow myelin and speed up the nerve
conduction
Lags behind the limbic system development
**Hormonal surges and limbic system
explain teens occasional impulsiveness

Growth and Developmental Needs of Adolescents and Young Adults

Cognitive Development
Stages

Cognitive Development

Early (10-14 years)

Growth in capacity for abstract thought; mostly interested in

present with little thought about the future; expansion of
and increased importance placed on intellectual interests;
deepening of moral thinking

Late adolescence (15-19

years)

Continued growth in capacity for abstract thought; increased

capacity for setting goals; interest in moral reasoning; think
about the meaning of life

Young adulthood (20-24

years)

Ability to think ideas through from beginning to end; ability

to delay gratification; examination of inner experiences;
increased concern for the future; continued interest in moral
reasoning

Growth and Developmental Needs of Adolescents and Young Adults

Psychosocial Process Development
Stages
Early

Middle

Late

Emotionally related
Adjustment to a new body
image, adaptation to
emerging sexually
Establishment of emotional
separation from parents
Establishment of a personal
sense of identity; further
separation from parents

Socially related
Strong peer effect

Increased health risk

behavior; sexual interests in
peers; early vocational plans
Increased impulse control;
emerging social autonomy;
establishment of vocational
capability

Growth and Developmental Needs of Adolescents and Young Adults

Social and Emotional Development
Stages

Social and Emotional Development

Early (10-14 years)

Struggle with sense of identity; feel awkward about themselves and their
body; worry about being normal; realize that parents are not perfect; have
more conflict with parents; increasingly influenced by peer group; have a
raised desire for independence; return to childish behavior when stressed;
mood swings; test rules and limits; have a growing interest in sex

Late adolescence (1519 years)

Have intense self-involvement, alternating between high expectations and

poor self-identity; continue to adjust to changing body; worry about being
normal; tend to distance themselves from their parents; have a continued
drive for independence; are driven to make friends and have a greater
reliance on them; have a heightened capacity for emotional regulation;
experience feelings of love and passion; even in sex

Young adulthood (20- Have a firmer sense of identity, including sexual identity; have increased
24 years)
emotional stability, concern for others, and independence and self-reliance;
still place importance on peer relationships; develop more serious
relationships; regain some interest in social and cultural traditions

Growth and Developmental Needs of Adolescents and Young Adults

Sexually maturing body and feelings
Stages
Early

Middle

Late

Sexually maturing body and feelings

Greater interest in privacy
Emerging sexual feelings and exploration
Experimentation with body (masturbation)
Worries about being normal
Opposite sex contact done in groups
Sexual drive emerge
Begin to explore their ability to date and attract a partner
Concern about sexual attractiveness
Complete development
Greater acceptance of physical appearance

Growth and Developmental Needs of Adolescents and Young Adults

Adolescents are going through lessons to be

mature. Therefore, messages and guidance are
important for their growth and development

Growth and Developmental Needs of Adolescents and Young Adults

Major theories of child development
Psychosexual (Sigmund Freud 1856-1939)
Psychosocial (Erik Erikson 1902-1994)

Cognitive (Jean Piaget 1896-1980)

Moral (Lawrence Kohlberg 1927-1987)

Growth and Developmental Needs of Adolescents and Young Adults

Freuds Theory of psychosexual development
Early childhood experiences form the unconscious motivation for actions in later
life
Id- basic sexual energy, seek for pleasure (Present at birth)
Ego- search for acceptance methods of meeting impulses (infancy)
Supergo- the moral and ethical system, contains values and conscience
(childhood)

Growth and Developmental Needs of Adolescents and Young Adults

Growth and Developmental Needs of Adolescents

and Young Adults

Growth and development in adolescents and

Young Adults
HEALTH
A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity
WHO, 1948

Growth and Developmental Needs of Adolescents and Young Adults

Biological development

Cognitive development

Maintain healthy growth and

development
Prevent / delay occurrence of
chronic illnesses
Develop more mature

Psychosocial development

Care of Growth & Developmental Needs

of Adolescents and Young Adults
1) *Identification of needs of adolescents and young adults
Screening/ Diagnostic tests

2) Treatment and care

3) *Continuity of care, education and health promotion

Concerned Areas for Growth & Developmental Needs

of Adolescents and Young Adults
1) Physical/physiological
Acute [communicable & non-communicable diseases]
Chronic [Genetic and acquired]

2) Cognitive
3) Psychosocial
Social
Mental

Growth and Developmental Needs of Adolescents and Young Adults

Biological development

Growth and Developmental Needs of Adolescents and Young Adults

Nutrition

Growth and Developmental Needs of Adolescents and Young Adults

The goal of the treatment plan is to provide optimal nutrition to
support growth, development, health and level of functioning.

Growth and Developmental Needs of Adolescents and Young Adults

Mobility assessment:
low muscle tone, and/or low metabolic rates (e.g., spina bifida, and Down
syndrome) may have problems with excess weight gain.

Growth and Developmental Needs of Adolescents and Young Adults

Energy intake

Physical activity

Growth and Developmental Needs of Adolescents and Young Adults

Feeding

Long-term use of medications

Scoliosis Screening

Occurs 4 in 100 adolescents

Be related to low back pain
Postural screening exam -observing the
adolescents posture in a 360 fashion. The
examiner checks to ensure that neck, head and
pelvis are midline and assess body symmetry
elsewhere: shoulders, scapulas, legs, arms, and
hip.
X ray
MRI study
Observation
Treatment options (physiotherapy, exercise)
Brace
Surgery

Sexual Maturation Rating

Tanner stages
Tanner has proposed a scale, now uniformly accepted, to describe
the onset and progression of pubertal changes Boys and girls are rated
on a 5 point scale.
Boys are rated for genital development and pubic hair growth, and
girls are rated for breast development and pubic hair growth.

Sexual Maturation Rating (SMR)

http://learn.pediatrics.ubc.ca/body-systems/endocrine-system/normal-sexual-maturity-rating/

Breast Assessment
Inspection of the breast
Palpation of the breast
Boys gynecomastia

(unilateral or bilateral breast

engagement; age of 14, commonly
disappear by the time of full sexual
maturity)
Encourage regular self examination
should be developed by age 20 years
Note the menstrual history is also
important
Teens may concern about the size,
asymmetry or the timing of growth

Pelvic Examination
Indication for a pelvic examination
Persistent vaginal discharge;
Dysuria or other urinary symptoms in
a sexually active adolescent girl;
Dysmenorrhea
Amenorrhea;
Abnormal vaginal bleeding;
Lower abdominal pain;
Contraceptive counseling regarding
use of an intrauterine device or
diaphragm;
Evaluating suspected or reported rape
or sexual abuse; or
Pregnancy

Care for Persons with Pelvic Examination

Pelvic examinations in adolescents are usually not required, but
the preferred setting for indicated pelvic examinations
Psychological and physical preparation
Fear
Pain

Cognitive Development
Cognitive developmentLearning and experience---capability
Developmental stages

Skills development
Psychosocial development**

Growth and Developmental Needs of Adolescents and Young Adults

Cognitive Development

Cognitive Development
abstract reasoning skills begin, however,
these skills may not be highly
developed.
regress to concrete thinking skills when
faced with overwhelming emotions or
stressful situations.
start to comprehend the relationship
between existing health behaviors and
future health status

Psychosocial Development
School-age child (6-12 years): may take part in activities. Enjoy spending time
with others

Adolescents (12-18 years): spend more time with friends, activities participation
in sports and school activities.

Psychosocial Development
Peer influence
Physical appearance and social behaviors
Seeking acceptance within a peer group.

Influence food intakes

A Psychosocial Interview for Adolescents

HHome life including relationship with
parents
EEducation or employment, including
financial issues
AActivities including sports (also particularly
note friendships and social relationships,
especially close friendships)
DDrug use, including cigarettes and alcohol as
well as drugs
SSex (information on intimate relationships
and sexual risk behaviours may be important in
both acute and chronic illnesses in adolescents)
SSuicide, depression, and self harm
Goldenring et al. Contemporary Pediatrics 1998;Jul:75- 80

A Psychosocial Interview for Adolescents

Home
Environment
Relationships, how is it? Any changes
Any media-related morbidity- how many smart phones, TV,
computers, video games
Education and/ or employment
how are you doing in school? ---FINE..DEAD AIR
Instead try saying
Tell me about your school
Academic performance
Any high risk environment
Extracurricular school activities

A Psychosocial Interview for Adolescents

Activities
Hobbies
Peer activities
Self esteem among the peers
E.g.
Are most of your friends from school or somewhere else? Are they
the same age as you?
Do you hang out with mainly people of your same sex or a mixed
crowd? Do you have one best friend or a few friends?

A Psychosocial Interview for Adolescents

Drug
Tobacco
Cigarettes
Electronic cigarettes
Caffeine containing energy drinks
Medications

A Psychosocial Interview for Adolescents

Sexuality
Embarrassing
Do you mind if I ask you a few more personal questions to learn how I
can best assist you?
Relationship
Contraception
STI
Sexual orientation - LGB

A Psychosocial Interview for Adolescents

Suicide / depression
Severe family problems
Changes in school performance
Changes in friendship patterns
Preoccupation with death
Acting-out behavior and health risk behaviors, including drug, alcohol
and substance abuse Suicide and depression
Depression
Boredom
You have told me that you have been feeling bad lately. Have you felt so
bad that you have thought seriously about harming yourself?

A Psychosocial Interview for Adolescents

Suicide / depression
Severe family problems
Changes in school performance
Changes in friendship patterns
Preoccupation with death
Acting-out behavior and health risk behaviors, including drug,
alcohol and substance abuse

Conclusion
Assessment

Biological
Identify problems of growth and
Development development in accordance with
normal biological development in
term of ages and genders
Cognitive
Intellectual and skill development
Development

1.
2.
3.
4.
1.
2.

Psychosocial Psychological /mental

Development
development
Socialization

3.
1.
2.
3.
4.
5.

Normal growth chart

Tanners
Breast Examination
Pelvic Examination
Learning ability
Coping/problem
solving ability
Skill performance
Assessment:HEADSS
Family
Friends/peers
Classmates/teachers
Mass media

Case Scenario
Mary is 15 year old. She is 86 pounds and 5 feet tall. Her mother takes her to your
community clinic for health advice as Mary only eats less every day. Mary explains
that she looks fat. She feels very upset about her body shape. She isolate herself from
her friends and classmates.
Analyze biological, cognitive, and psychosocial needs at the age of Mary.

Thank you very much