The Adolescent

and
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the Family
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Adolescence

▪ defined as the period between ages 13 and up to 20 years

▪ is a period of transition between childhood and adulthood—a time of rapid

physical, cognitive, social, and emotional maturation as boys prepare for
manhood and girls prepare for womanhood

▪ Adolescence, which literally means “to grow into maturity,” is generally

regarded as the psychologic, social, and maturational process initiated by the
pubertal changes.

▪ It involves three distinct subphases: early adolescence (ages 11–14), middle

adolescence (ages 15–17), and late adolescence (ages 18–20).

▪ The term teenage years is used synonymously with adolescence to describe

ages 13 through 19 years
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▪ Several terms are used to refer to this stage of growth and development.

▪ Puberty refers to the maturational, hormonal, and growth process that

occurs when the reproductive organs begin to function and the secondary
sex characteristics develop.

▪ This process is sometimes divided into three stages:

▪ Prepubescence- the period of about 2 years immediately before puberty
when the child is developing preliminary physical changes that herald sexual
maturity;

▪ Puberty- the point at which sexual maturity is achieved, marked by the first
menstrual flow in girls but by less obvious indications in boys;

▪ Postpubescence- a 1- to 2-year period after puberty during which skeletal

growth is completed and reproductive functions become fairly well
established.
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GROWTH AND DEVELOPMENT
• Biologic Development

• Psychological Development

• Cognitive Development

• Moral Development

• Spiritual Development

• Social Development
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BIOLOGIC DEVELOPMENT

▪ The physical changes of puberty are primarily the result of

hormonal activity

▪ The obvious physical changes are noted in increased

physical growth and in the appearance and development of
secondary sex characteristics

▪ The less obvious are physiologic alterations and

neurogonadal maturity, accompanied by the ability to
procreate.
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▪ Primary sex characteristics are the external and internal

organs that carry out the reproductive functions (e.g., ovaries,
uterus, breasts, penis).

▪ Secondary sex characteristics are the changes that occur

throughout the body as a result of hormonal changes (e.g., voice
alterations, development of facial and pubertal hair, fat deposits)
but that play no direct part in reproduction
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Physical Growth

▪ A constant phenomenon associated with sexual

maturation is a dramatic increase in growth.

▪ The final 20% to 25% of height is achieved during

puberty, and most of this growth occurs during a 24-
to 36-month period—the adolescent growth spurt.

▪ The growth spurt begins earlier in girls, usually

between ages 9 1/2 and 14 1/2 years; on average it
begins between ages 10 1/2 and 16 years in boys.
 ▪ The gain in physical growth is mostly in weight, leading to the
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stocky, slightly obese appearance of prepubescence; later comes
the thin, gangly appearance of late adolescence

▪ Most girls are 1 to 2 in. (2.4 to 5 cm) taller than boys coming into
adolescence but generally stop growing within 3 years from
menarche and so are shorter than boys by the end of
adolescence.

▪ Boys typically grow about 4 to 12 in. (10 to 30 cm) in height and

gain about 15 to 65 lb (7 to 30 kg) during their teenage years.

▪ Girls grow 2 to 8 in. (5 to 20 cm) in height and gain 15 to 55 lb (7

to 25 kg).

▪ Growth stops with closure of the epiphyseal lines of the long

bones, which occurs at about 16 or 17 years of age in females
and about 18 to 20 years of age in males.
 ▪ Because the heart and lungs increase in size more slowly
z than the rest of the body, adolescents may have insufficient
energy and become fatigued trying to finish the various
activities that interest them.

▪ Pulse rate and respiratory rate decrease slightly (to 70

beats/min and 20 breaths/min, respectively), and blood
pressure increases slightly (to 120/70 mmHg) by late
adolescence.

▪ All during adolescence, androgen stimulates sebaceous

glands to extreme activity, sometimes resulting in acne, a
common adolescent skin problem.

▪ Apocrine sweat glands (i.e., glands present in the axillae and

genital area, which produce a strong odor in response to
emotional stimulation) form shortly after puberty.
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Teeth

▪ Adolescents gain their second molars at about 13 years of

age and their third molars (wisdom teeth) between 18 and
21 years of age.

▪ Third molars may erupt as early as 14 to 15 years of age.

The jaw reaches adult size only toward the end of
adolescence, however.

▪ As a result, adolescents whose third molars erupt before

the lengthening of the jaw is complete may experience
pain and may need these molars extracted because they
do not fit their jawline
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Hormonal Changes

▪ The events of puberty are caused by hormonal influences and

controlled by the anterior pituitary (adenohypophysis) in response
to a stimulus from the hypothalamus.

▪ Stimulation of the gonads has a dual function:

▪ 1. Production and release of gametes—production of sperm in the

male and maturation and release of ova in the female
▪ 2. Secretion of sex-appropriate hormones—estrogen and
progesterone from the ovaries (female) and testosterone from the
testes (male)
 ▪ The ovaries, testes, and adrenals secrete sex hormones.
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▪ Estrogen, the feminizing hormone, is found in low quantities during
childhood. This hormone is secreted in slowly increasing amounts until
about age 11 years.
▪ In males, this gradual increase continues through maturation.
▪ In females, the onset of estrogen production in the ovary causes a pronounced
increase that continues until about 3 years after the onset of menstruation, at
which time it reaches a maximum level that continues throughout the
reproductive life of the female.

▪ Androgens, the masculinizing hormones, are also secreted in small and

gradually increasing amounts up to about 7 or 9 years of age, at which
time there is a more rapid increase in both sexes, especially boys, until
about age 15 years.
▪ These hormones appear to be responsible for most of the rapid growth
changes of early adolescence. With the onset of testicular function, the level of
androgens (principally testosterone) in males increases over that in females
and continues to increase until a maximum is attained at maturity
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Sexual Maturation

▪ The visible evidence of sexual maturation is achieved

in an orderly sequence, and the state of maturity can
be estimated on the basis of the appearance of these
external manifestations.

▪ The stages of development of secondary sex

characteristics and genital development have been
defined as a guide for estimating sexual maturity and
are referred to as the Tanner stages.
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Sexual Maturation in Girls
▪ In most girls, the initial indication of puberty is the appearance of breast buds, an
event known as thelarche, which occurs between 8 and 13 years of age.

▪ This is followed in approximately 2 to 6 months by growth of pubic hair on the

mons pubis, known as adrenarche.

▪ The initial appearance of menstruation, or menarche, occurs about 2 years after

the appearance of the first pubescent changes, approximately 9 months after
attainment of peak height velocity, and 3 months after attainment of peak weight
velocity.

▪ Ovulation and regular menstrual periods usually occur 6 to 14 months after

menarche.

▪ Girls may be considered to have pubertal delay if breast development has not
occurred by age 13 years or if menarche has not occurred within 4 years of the
onset of breast development.
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Sexual Maturation in Boys

▪ The first pubescent changes in boys are testicular enlargement

accompanied by thinning, reddening, and increased looseness of
the scrotum.

▪ These events usually occur between 9 1/2 and 14 years of age.

▪ Early puberty is also characterized by the initial appearance of

pubic hair.

▪ Penile enlargement begins, and testicular enlargement and pubic

hair growth continue throughout midpuberty. During this period,
there is also increasing muscularity, early voice changes, and
development of early facial hair.
z▪ Temporary breast enlargement and tenderness, gynecomastia, are
common during midpuberty, occurring in up to one third of boys.

▪ The spurts in height and weight occur concurrently toward the end of
midpuberty.

▪ For most boys, breast enlargement disappears within 2 years.

▪ By late puberty, there is a definite increase in the length and width of the
penis, testicular enlargement continues, and first ejaculation occurs.

▪ Axillary hair develops, and facial hair extends to cover the anterior neck.

▪ Final voice changes occur secondary to the growth of the larynx.

▪ Concerns about pubertal delay should be considered for boys who exhibit
no enlargement of the testes or scrotal changes by 13 1/2 to 14 years of
age or if genital growth is not complete 4 years after the testicles begin to
enlarge.
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PSYCHOSOCIAL DEVELOPMENT

▪ According to Erikson, the developmental task in early and mid-

adolescence is to form a sense of identity versus role
confusion.

▪ In late adolescence, it is to form a sense of intimacy versus

isolation.
 Early Adolescent Developmental Task: Identity Versus Role
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Confusion

▪ The task of forming a sense of identity is for adolescents to decide whom they are and
what kind of person they will be. The four main areas in which they must make gains to
achieve a sense of identity include:

▪ 1. Accepting their changed body image

▪ 2. Establishing a value system or what kind of person they want to be

▪ 3. Making a career decision

▪ 4. Becoming emancipated from parents

▪ If young people do not achieve a sense of identity, they can have little idea what kind of
person they are or may develop a sense of role confusion. This can lead to difficulty
functioning effectively as adults because they are unable, for example, to decide what
stand to take on a particular issue or how to approach new challenges or situations.
Body Image
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▪ Adolescents adjust to the changing body image that comes with adolescence.

▪ This adjustment to changes is not always easy, however, because adolescents can feel
disappointed with their final height or general appearance.

▪ As adolescents are usually their own worst critics with regard to their bodies, they may
need help from healthcare providers to realize the characteristics that make someone
creative, compassionate, and fun to be with, not one’s physical appearance, are the
qualities on which lasting relationships are built.

Self-Esteem

▪ Like body image, self-esteem may undergo major changes during the adolescent years
and can be challenged by all the changes that occur during adolescence. Help parents
understand how important it is for adolescents to have immediate successes.

▪ Compassionate understanding (“It’s hard to be left out”) is a better communication

technique.
Value System
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▪ Adolescents develop their values throughout their childhood as they interact with their
family.

▪ As they increase the amount of time they spend with their peer group, they may
question these values and participate in experiences that may put them at risk for
physical and/or psychological harm.

▪ Identifying risk-taking behaviors and offering guidance and support is important in

promoting the health of the adolescent.

Social Coupling

▪ During adolescence, individuals begin to explore their sexual preferences and may
question their gender identity.

▪ Encourage an open dialogue with adolescents to assist them to process their feelings
and establish their own identity. Counseling may be helpful to assist with family
communication if the family is not accepting.
Career Decisions
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▪ The adolescent may identify an educational and career trajectory during self-discovery of
personal positive attributes.

▪ It is common for adolescents to seek and experiment with multiple roles before reaching
a decision that is rewarding.

▪ Some school-age children do poorly in school during preadolescence but, as soon as

they choose a career, show increased interest in learning as they come to see education
as relevant to their future.

Emancipation from Parents

▪ Emancipation from parents can become a major issue. Some parents may not yet be
ready for their child to be totally independent, and some adolescents may not yet be sure
they want to be on their own.

▪ They may fight bitterly for a right and then never use the privilege once they have gained
it. Winning the battle may be more important than exercising the newly won right.
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▪ Encourage parents to give adolescents more freedom in areas such as choosing

their own clothes or after-school activities; at the same time, help parents continue
to place some restrictions on adolescent behavior

▪ Both parents and adolescents may need help to understand that emancipation
does not mean severance of a relationship but rather a change in a relationship
because people who are independent of one another can have even better
relationships than those who are dependent on one another.

▪ It can be helpful to remind parents this step is actually no different from the one
children accomplished when they grew from infants to toddlers, when they
changed from wanting to be held and rocked to wanting to run.

▪ If parents can think of it in this light, they will gain a better perspective and may
realize they will not lose the children because they become adults.
Late Adolescent Developmental Task: Intimacy Versus Isolation
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▪ Developing a sense of intimacy means a late adolescent is able to form long-term,
meaningful relationships with persons of the opposite as well as their same sex.

▪ Those who do not develop a sense of intimacy are left feeling isolated; in a crisis
situation, they have no one to whom they feel they can turn to for help or support.

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

▪ Some parents may not be able to listen to their adolescent without interjecting their
own opinions because they worry that relationships based on infatuation will lead to a
sexual relationship.

▪ Parents should feel an obligation to inform their children of their feelings about early
sexual relationships. At the same time, they have to be realistic that some adolescents
will not follow their advice. If parents suspect their adolescent is sexually active,
counsel them to be certain their child is knowledgeable about safer sex practices.
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COGNITIVE DEVELOPMENT

▪ Cognitive thinking culminates with the capacity for abstract

thinking. This stage, the period of formal operations, is
Piaget’s fourth and last stage.

▪ Adolescents are concerned with the possible. They think

beyond the present.

▪ Without having to center attention on the immediate situation,

they can imagine a sequence of events that might occur and
how things might change in the future, and the consequences
of their actions.
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▪ At this time, their thoughts can be influenced by

logical principles rather than just their own
perceptions and experiences.

▪ They become increasingly capable of scientific

reasoning and formal logic.

▪ In adolescence, young people begin to consider both

their own thinking and the thinking of others. They
wonder what opinion others have of them, and they
are able to imagine the thoughts of others.
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MORAL DEVELOPMENT
▪ When old principles are challenged but new independent values have not yet
emerged to take their place, young people search for a moral code that preserves
their personal integrity and guides their behavior, especially in the face of strong
pressure to violate the old beliefs.

▪ Their decisions involving moral dilemmas must be based on an internalized set of

moral principles that provides them with the resources to evaluate the demands of
the situation and to plan actions that are consistent with their ideals.

▪ Late adolescence is characterized by serious questioning of existing moral values

and their relevance to society and the individual.

▪ They understand duty and obligation based on reciprocal rights of others and the
concept of justice that is founded on making amends for misdeeds and repairing or
replacing what has been spoiled by wrongdoing.

▪ However, they seriously question established moral codes, often as a result of

observing that adults verbally ascribe to a code but do not adhere to it.
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SPIRITUAL DEVELOPMENT
▪ As adolescents move toward independence from parents and other authorities,
some begin to question the values and ideals of their families. Others cling to
these values as a stable element in their lives as they struggle with the conflicts
of this turbulent period.

▪ Generally, the stated importance of participation in organized religion declines

somewhat during the adolescent years.

▪ Late adolescence appears to be a time when individuals reexamine and

reevaluate many of the beliefs and values of their childhood.

▪ Consistent with developmental changes in value autonomy, the religious beliefs

of young people are likely to become more personalized and less bound to the
traditional religious practices they may have been exposed to when they were
younger.
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SOCIAL DEVELOPMENT
▪ Early teenagers may feel more self-doubt than self-confidence when they
meet another adolescent with whom they would like to begin a lasting
relationship

▪ Both male and female early adolescents tend to be loud and boisterous,
particularly when someone whose attention they would like to attract is
nearby. They are impulsive and very much like 2-year-old children in that
they want what they want immediately, not when it is convenient for others.

▪ Many 13-year-olds begin to experience “crushes,” or infatuations with

schoolmates. At this age, however, they may spend more time longing for
someone than they do instituting an in-depth and rewarding relationship.
They have too little experience with life and too limited a frame of reference
yet to know how to offer a deep commitment to another or accept one from
that person.
▪ By age 14 years, teenagers have become quieter and more introspective.
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They are becoming used to their changing bodies, have more confidence in
themselves, and feel more self-esteem.
▪ Adolescents watch adults carefully during this period, searching for good role
models with whom they can identify.

▪ They may form a friendship with an older adolescent, trying to imitate that
person in everything from thoughts to clothing.
▪ If the older adolescent has dropped out of school or plays a particular sport, the younger
person may express a wish to drop out or train for that sport, too.

▪ Idolization of famous people or older adolescents of this nature fades as

adolescents become more interested in forming reciprocal friendships.
▪ Attachments to older adolescents are often severed abruptly and painfully as
older teenagers make it clear they are more interested in being with people
their own age.
▪ Rejection by an older member of a pair forces the younger member to turn to
his or her own-age friends and ends the intense hero worship so typical of
early adolescence.
▪ Most 15-year-olds fall “in love” five or six times a year.
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▪ However, many of these relationships are based on attraction because of
physical appearance, not because of inner qualities or characteristics that are
compatible with their own.

▪ Because infatuation is fleeting, it can lead to extremely intense but brief

attachments that fade once the two young people discover they have little in
common.

▪ Beginning romantic attachments this often, however, does not mean their feelings
are any less strong or that they feel any less pain when the relationship ends.

▪ By age 16 years, boys are becoming sexually mature (although they continue to
grow taller until about 18 years of age). Both sexes are better able to trust their
bodies than they were the year before.

▪ By age 17 years, they tend to have adult values and responses to events. They
have left behind the childish behaviors they used in early adolescence—shoving
and punching—to get the attention of others.
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COPING WITH CONCERNS RELATED
TO NORMAL GROWTH AND
DEVELOPMENT
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Fatigue
▪ Because so many adolescents comment that they feel fatigued to some
degree, it can be considered normal for the age group.

▪ However, fatigue may also be a beginning symptom of disease, so it is

important that it is not underestimated as a concern.

▪ Always assess the diet, sleep patterns, and activity schedules of fatigued
adolescents.

▪ If an adolescent’s sleep and diet appear to be adequate, his or her activity

schedule is reasonable, and a physical assessment suggests no illness,
then the fatigue may be of emotional origin. It can be a means of avoiding
school, conflict with parents (e.g., when children appear ill, parents are
more sympathetic), or social situations (e.g., too tired to go to the mall).
Those who are under stimulated by school may develop fatigue as a sign
of boredom.
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Acne

▪ Acne is a self-limiting inflammatory disease that involves the sebaceous

glands, which empty into hair shafts (the pilosebaceous unit).

▪ It is the most common skin disorder of adolescence, occurring in as many

as 80% to 95% of adolescents. It occurs slightly more frequently in boys
than in girls.

▪ The peak age for the lesions occurring in girls is 14 to 17 years of age; for
boys, 16 to 19 years of age.
▪z Changes associated with puberty that cause acne to develop include:

▪ • As androgen levels rise in both sexes, sebaceous glands become active.

▪ • The output of sebum, which is largely composed of lipids, mainly triglycerides,

increases.

▪ • Trapped sebum causes whiteheads, or closed comedones.

▪ • As trapped sebum darkens from accumulation of melanin and oxidation of the

fatty acid component on exposure to air, blackheads, or open comedones, form.
Leakage of fatty acids causes a dermal inflammatory reaction.

▪ • Bacteria (generally, Propionibacterium acnes) lodge and thrive in the retained

secretions and ducts.

▪ The most common locations of acne lesions are the face, neck, back, upper
arms, and chest. Flare-ups are associated with emotional stress, menstrual
periods, or the use of greasy hair creams or makeup that can further plug
gland ducts.
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PROMOTION OF HEALTH DURING
ADOLESCENT PERIOD
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NUTRITION

▪ Adolescents experience such rapid growth that they may always

feel hungry.

▪ The rapid and extensive increase in height, weight, muscle mass,

and sexual maturity of adolescence is accompanied by increased
nutritional requirements.

▪ Because nutritional needs are closely related to the increase in

body mass, the peak requirements occur in the years of maximum
growth, during which the body mass almost doubles.

▪ The caloric and protein requirements during this time are higher
than at almost any other time of life.
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▪ Recent guidelines by the National Heart Lung and Blood Institute (NHLBI)
include dietary recommendations to reduce the risk of cardiovascular
disease.

▪ In these guidelines for adolescents is a total daily fat intake of 25% to 30% of
estimated energy requirements, with emphasis on a reduction of saturated fat
and avoidance of trans (unsaturated) fat.

▪ The guidelines also address the need for an increased intake of dietary fiber,
consumption of 3 meals per day, avoidance of tobacco, and routine
screening for hyperlipidemia and hypertension in children and adolescents.

▪ Caloric intake can be tailored to meet adolescents’ increased growth needs

as well as activity level such as involvement in sports.

▪ Additional guidelines recommend the reduction in added sugars; adolescents

consume most of their added sugars in sweetened beverages such as soda
and energy and sports drinks.
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▪ Adolescents usually have sufficient intake of protein to meet their
needs except for those who limit their food intake because of
economic problems or in an attempt to lose weight.

▪ There is a substantial increase in the need for the minerals

calcium, iron, and zinc during periods of rapid growth: calcium for
skeletal growth, iron for expansion of muscle mass and blood
volume, and zinc for the generation of both skeletal and bone
tissue.

▪ The Estimated Average Requirement for calcium in adolescents 14

to 18 years of age is 1100 mg.

▪ Dietary intervention should promote the regular consumption of

breakfast and a balanced intake of a variety of foods.
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Eating Habits and Behavior
▪ Adolescent interests, attitudes, and routines are altered as an increasing
number of meals are eaten away from home.

▪ These changes are largely a result of the high value that teenagers place
on peer acceptability and sociability. Their peers easily influence their
eating habits.

▪ Pressure for time and commitments to activities adversely affect teenagers’

eating habits.

▪ Omitting breakfast or eating a breakfast that is nutritionally poor in quality is

frequently a problem.

▪ Snacks, usually selected on the basis of accessibility rather than nutritional

merit, become increasingly a part of the habitual eating pattern during
adolescence.
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▪ Excess intake of calories, sugar, fat, cholesterol, and sodium is common
among adolescents and is found in all income and racial or ethnic groups
and both genders.

▪ Overeating or undereating during adolescence presents special problems.

▪ When they experience the normal increase in weight and fat deposition of
the growth spurt, teenage girls often resort to dieting. The desire for a slim
figure and a fear of becoming “fat” prompt teenage girls to embark on
nutritionally inadequate reducing regimens that drain their energy and
deprive their growing bodies of essential nutrients. They resort to diets on
their own or with peers in an effort to conform.

▪ Many adopt current fad diets and are victims of food misinformation.

▪ Boys are less inclined to undereat. They are more concerned about
gaining size and strength. However, they tend to eat foods high in calories
but low in other essential nutrients.
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Nursing Care Management
▪ Adolescents should receive at a minimum an annual assessment of weight,
height, and BMI for age plotted on a standard growth reference chart.

▪ Healthy dietary habits should be discussed with all adolescents.

▪ The frequency of eating at fast-food and other restaurants, consumption of

sweetened beverages, and consumption of excessive portion sizes should be
identified.

▪ In addition to food intake, the nurse should assess the level of physical activity,
sedentary behaviors, and sleep patterns.

▪ Readiness to change; environmental supports and barriers; and family history

of diabetes, heart disease, and early stroke must be considered when planning
nutritional education and guidance.

▪ Nurses in the school setting can assist in advocating for comprehensive

nutritional services for preschool through grade 12 students.
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SLEEP AND REST

▪ Teenagers vary in their need for sleep and rest.

▪ Rapid physical growth, the tendency toward overexertion, and

the overall increased activity of this age contribute to fatigue in
adolescents.

▪ During growth spurts, the need for sleep is increased.

▪ Their propensity for staying up late makes it difficult to arise in

the morning, and they may sleep late at every opportunity.

▪ Adequate sleep and rest at this time are important to a total

health regimen.
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EXERCISE AND ACTIVITY
▪ Adolescents need exercise every day both to maintain muscle tone and to
provide an outlet for tension. Unlike younger children, however, and
although they are constantly on the go, adolescents often receive very little
real exercise.

▪ To improve health outcomes, school-age children and adolescents should

engage in 60 minutes or more of moderate to vigorous physical activity
daily.

▪ Adolescents who are involved in structured athletic activities do receive

daily exercise.

▪ The practice of sports, games, and even dancing contributes significantly

to growth and development, the education process, and better health.
These activities provide exercise for growing muscles, interactions with
peers, and a socially acceptable means of enjoying stimulation and conflict.
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▪ Because physical fitness appears to be a major influence on one’s
lifelong health status, children should be encouraged to participate in
activities that contribute to lifelong physical fitness.

▪ Nurses can encourage participation as a way to promote health and

build self-esteem.

▪ However, adolescents should not be encouraged to engage in

physical activities that are beyond their physical or emotional
capacity.

▪ If they have not participated in competitive sports before, they may

need advice on increasing exercise gradually so they do not overdo
it and consequently develop muscle sprains or other overuse
injuries.
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DENTAL HEALTH
▪ Dental health should not be neglected during adolescence. It is recommended that
an evaluation for caries take place at a minimum of every year and optimally at 6-
month intervals.

▪ Pit and fissure sealants are a safe and effective technique for dental caries
prevention.

▪ Early adolescence is usually when corrective orthodontic appliances are worn, and
these are frequently a source of embarrassment and concern to youngsters.

▪ Reassurance regarding the temporary nature of the annoyance and anticipation of

an improved appearance help adolescents tolerate the inconvenience.

▪ It is also important to reinforce the orthodontist’s directions regarding use and care
of the appliances and to emphasize careful attention to toothbrushing during this
time.

▪ During late adolescence, an evaluation of the third molars (wisdom teeth) should
take place to determine appropriate management.
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PERSONAL CARE

▪ Body changes associated with puberty bring special needs for

cleanliness.

▪ The hyperactive sebaceous glands and newly functioning apocrine

glands make frequent bathing or showering a necessity, and
underarm deodorants assume an important place in personal care.

▪ Adolescents discover that hair requires more frequent shampooing,

and girls often have questions about hair removal, use of
cosmetics, and menstrual hygiene.

▪ Nurses are in a position to help them evaluate the relative merits of

commercial products.
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Vision
▪ Regular vision testing is an important part of health care and supervision
during adolescence.

▪ During adolescence, visual refractive difficulties reach a peak that is not

exceeded until the fifth decade of life.

▪ The increased demands of schoolwork make adequate vision essential

for academic success.

▪ The need for corrective lenses can create psychologic problems for
teenagers if they believe that glasses spoil their appearance or do not fit
their body image.

▪ Contact lenses may be a preferred solution; a variety of lenses are now

available at fairly reasonable prices. For some, the impact of a visual
defect, no matter how slight, may be stressful.
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Hearing

▪ Cochlear damage from relatively continuous exposure to the loud

sound levels of rock music has been documented.

▪ The popularity of personal music players with lightweight

earphones that are inserted into the ear canal is of particular
concern to health care professionals. When these units are used
for extended periods, permanent hearing loss can occur.

▪ Although appeals for more judicious use are not always

successful, teenagers should be informed of the risk.
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Posture

▪ Many adolescents demonstrate altered posture.

▪ Rapid skeletal growth is often associated with slower muscular

growth, and as a result, some teenagers may appear awkward or
slump and fail to stand or sit upright.

▪ Urge children of both sexes to use good posture during these

rapid-growth years. Assess posture at all adolescent health
appraisals to detect the difference between simple poor posture
and the beginning of spinal dysplasia or scoliosis
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Body Art

▪ Body art (piercing and tattooing) is an aspect of adolescent identity

formation.

▪ It is a nursing responsibility to caution girls and boys against having

piercing performed by friends, parents, or themselves. There is always a
risk of complications such as infection, cyst or keloid formation, bleeding.
A qualified operator using proper sterile technique should perform the
procedure.

▪ The presence of body art in the form of tattoos and branding is common
among adolescents and young adults. The risk to adolescents receiving
tattoos is low. The greatest risk is for the tattoo artist, who comes in
contact with the client’s blood.
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Sun Exposure
▪ Because some adolescents spend a great deal of time outdoors
participating in athletics, it is a critical time for them to avoid
excessive sun exposure so they do not develop skin cancer (i.e.,
melanoma) from ultraviolet rays.

▪ Encourage teenagers to use sunscreen, avoid tanning beds, and

report to their primary healthcare provider any skin mole that
changes in shape or color.

▪ Do this as creatively as possible because teenagers have difficulty

looking to the future and imagining how drastically the
development of melanoma could affect their lives
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STRESS REDUCTION
▪ The multiple changes occurring in adolescence can result in great
stress.

▪ Adolescents are faced with pressures from peers that often

involve taking serious health risks.

▪ Early-maturing girls and late-maturing children are especially

sensitive to the stresses of being different from their peers. Many
feel intense anxiety over their identity. Both early- and late-
maturing children feel out of place among their classmates.

▪ Slow-maturing adolescents need support and reassurance that

they are not abnormal and need only be patient until the time
comes when they, too, will mature physically.
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SEXUALITY EDUCATION AND GUIDANCE

▪ Social media use is a routine part of contemporary adolescents daily

lives, and there are many positive benefits including enhancing
communication, social connection, and computer skills.

▪ However, some evidence indicates that there are often online

expressions of sexual experimentation, including sending and
receiving sexually explicit messages, photographs, or images via
smartphones and computers.

▪ All media sources provide adolescents potential exposure to

information that may be inaccurate, riddled with cultural and moral
judgments, and not very helpful.
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▪ The responsibility for providing sexuality education has been assumed by
parents; schools; churches; community agencies; and health professionals,
especially nurses.

▪ Many adolescents perceive nurses, especially school nurses, as individuals

who possess important information and who are willing to discuss sex with
them.

▪ To be able to discuss the topic adequately, nurses must have not only an
understanding of the physiologic aspects of sexuality and a knowledge of
cultural and societal values but also an awareness of their own attitudes,
feelings, and biases about sexuality.

▪ Whether nurses counsel young people on an individual basis, in mixed

groups, or in groups segregated by gender makes little difference.

▪ The differences in the rate of maturation between boys and girls and among
different members of the same sex often make it desirable to discuss certain
aspects of sexuality in segregated groups for early adolescents.
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▪ Sexuality education should consist of instruction concerning normal

body functions and should be presented in a straightforward
manner using correct terminology.

▪ When discussing sex and sexual activities, nurses should use

simple but correct language, not street language, highly scientific
terminology, or evasive jargon. After they understand the meaning
of biologic terms such as uterus, testicles, and vagina, most
teenagers prefer to use them in their discussions.

▪ Teenagers’ curiosity and desire for information extend beyond the

need for anatomic and physiologic knowledge. They need to know
more than the mechanics of conception, pregnancy, and birth.
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▪ Teenagers need to discuss intercourse, alternative methods of

sexual satisfaction, and how to resist peer pressure. With the
increased incidence of sexually transmitted infections, the topic of
“safe sex” is essential.

▪ Sex and sexuality cannot be taught without discussions of mature

decision making, sexual responsibility, and values clarification.

▪ Accurate and unbiased information regarding sexual practices

should be provided in a setting wherein the adolescent feels
comfortable asking questions without being degraded or made to
feel uncomfortable for seeking information.
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PREVENTION OF INJURY
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▪ Physical injuries are the greatest single cause of death in the
adolescent age group and claim more lives than all other causes
combined.
▪ The most vulnerable ages are 15 to 24 years, when accidental
injuries account for about 60% of deaths in boys and 40% of
deaths in girls.
▪ During adolescence, peak physical, sensory, and psychomotor
function gives teenagers a feeling of strength and confidence that
they have never experienced before, and the physiologic changes
of puberty give impetus to many basic instinctual forces.
▪ One manifestation of this is an increase in energy that simply
must be discharged through action, often at the expense of
logical thinking and other control mechanisms. Their propensity
for risk-taking behavior plus feelings of indestructibility make
adolescents especially prone to injuries.
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▪ Although drowning tends to occur in younger children, it does

occur in adolescents when good swimmers go beyond their
capabilities on dares or in hopes of impressing friends.
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 self-harm (i.e., suicide). These are related to the easy
accessibility of guns when added to depression, binge
drinking, and impulsivity.
Anticipatory
Guidance for
Families
with
Adolescents