Chapter 35

The Adolescent and Family

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 Promoting Optimum Growth
and Development
 Transition between childhood and adulthood
 Characterized by rapid physical, cognitive,
social, and emotional maturation
 Generally defined as beginning with the
appearance of secondary sex characteristics
and ending with cessation of body growth at
ages 18 to 20 years

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 Terms
 Puberty: Development of secondary sex
characteristics
 Prepubescence: Period of approximately 2 years
before onset of puberty; preliminary physical
changes occur
 Postpubescence: Period of 1 to 2 years after
puberty; skeletal growth is complete;
reproductive functions become well established

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 Biologic Development
 Primary sex characteristics
 External and internal organs necessary for
reproduction
 Secondary sex characteristics
 Result of hormonal changes: Voice change, hair
growth, breast enlargement, fat deposits
 Play no direct role in reproduction

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 Biologic Development (Cont.)
 Neuroendocrine events of puberty
 Estrogen
 Androgens
 Sexual maturation
 Sexual maturation in girls
 Sexual maturation in boys
 Tanner stages of sexual maturity

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Sexual Maturation

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Sexual Maturation (Cont.)

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Sexual Maturation (Cont.)

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 Biologic Development (Cont.)
 Physical growth during puberty
 Growth spurt
 Sex differences in general growth patterns
 Other physiologic changes
 Heart, BP, blood volume, respirations
 Responses to puberty

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 Psychosocial Development
 Developing a sense of identity (Erikson)
 Group identity
 Individual identity
 Development of self-concept and body image
 Sex-role identity

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 Cognitive Development
 Formal operations period (Piaget)
 Abstract thinking
 Formal operations
 Thinking beyond present
 Mental manipulation of multiple variables
 Concern about others’ thoughts and needs

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 Moral Development
 Internalized set of moral principles (Kohlberg)
 Questioning of existing moral values and relevance to
society
 Understanding of duty and obligation, reciprocal rights
of others
 Concepts of justice, reparation

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 Spiritual Development
 Some adolescents may question values and
beliefs of family
 Adolescents are capable of understanding
abstract concepts and of interpreting analogies
and symbols
 Adolescents may fear that others will not
understand their feelings
 Greater levels of spirituality are associated with
fewer high risk behaviors

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 Social Development
 Goal: To define identity independently from
parental authority
 Much ambivalence
 Intense sociability; intense loneliness
 Acceptance by peers

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 Social Development (Cont.)
 Relationships with parents
 Roles change from protection/dependency to mutual
affection/equality
 Process involves turmoil and ambiguity
 Teenager struggles between privileges and
responsibility
 Emancipation from parents may begin with rejection
of parents by teenager

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 Social Development (Cont.)
 Relationships with peers
 Peers assume increasingly significant role in adolescence
 Peer groups provide a sense of belonging and feeling of
strength and power
 Provide a measure of what is normal
 School
 Work
 Interests and activities
 Move to peer centered
 Assist in development of skills
 Social media prominence

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Relationships With Peers (Cont.)

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 Promoting Optimum Health
During Adolescence
 Emotional well-being
 Nutrition
 Dietary habits, eating disorders, and obesity
 Physical fitness
 Hypertension
 Hyperlipidemia
 Immunizations
 Sleep and rest

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Promoting Optimum Health
During Adolescence (Cont.)

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Promoting Optimum Health
During Adolescence (Cont.)

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 Promoting Optimal Health
During Adolescence (Cont.)
 Dental health
 Personal care
 Posture
 Body art
 Tanning
 Stress reduction
 School and learning problems

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Promoting Optimal Health
During Adolescence (Cont.)

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 Promoting Optimal Health
During Adolescence (Cont.)
 Sexual education and guidance
 Media influences are pervasive (7 hr/day)
 Knowledge is often inaccurate
 Adolescents whose parents limit television are less
likely to engage in early sex
 Factual information is available from these sources:
• Parents
• Schools, nurses
• Planned parenthood

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 Promoting Optimal Health
During Adolescence (Cont.)
 Safety promotion and injury prevention
 Motor vehicle-related injuries
• Other vehicle-related injuries
 Firearms
 Care management

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 Special Health Problems
 Disorders of the female reproductive system
 Amenorrhea
 Dysmenorrhea
 Disorders of the male reproductive system
 Care management
 Gynecomastia
 Care management

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 Nutritional and Eating Disorders
 Obesity
 Defined as increase in body weight caused by
accumulation of excessive body fat in relation to lean
body mass
 Obese: Generally considered when body mass index
(BMI) is in >95th percentile for age, gender, and
height
 Overweight: Generally considered when BMI is
between the 85th and 95th percentile
 Proportion of obese children and adolescents: 17%

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 Nutritional and Eating Disorders
(Cont.)
 Effects of childhood obesity
 Risk for adult obesity
 Increase in type 2 diabetes
 Hypertension, hyperlipidemia, cardiovascular disease
 Respiratory and orthopedic conditions
 Social isolation, low self-esteem, depression

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 Nutritional and Eating Disorders
(Cont.)
 Obesity (Cont.)
 Etiology and pathophysiology
• Familial influence
• Environmental conditions
• Perinatal factors
• Community factors
• Institutional factors
• Physical inactivity
• Appetite regulation
• Psychologic factors

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 Nutritional and Eating Disorders
(Cont.)
 Obesity (Cont.)
 Diagnostic evaluation
• Careful history
• Physical assessment
• Skinfold measurements
• BMI calculations
• Body fat measurements
• Diagnostic tests for metabolic and endocrine disorders

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 Nutritional and Eating Disorders
(Cont.)
 Obesity
 Therapeutic management
• prevention
• Early recognition and prevention
 Care management
• Nutritional counseling
• Behavioral therapy
• Group involvement
• Family involvement
• Physical activity
• Prevention

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 Nutritional and Eating Disorders
(Cont.)
 Anorexia nervosa
 Eating disorder: Refusal to maintain normal body
weight
 Severe weight loss in the absence of obvious physical
causes
 Primarily in adolescent girls and young women
 Mean age at onset: 13 years, ranging from 10 to 25
years or more
 Life-threatening

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 Nutritional and Eating Disorders
(Cont.)
 Bulimia nervosa
 In older adolescents and young women
 Eating disorder characterized by binge eating
 May be followed by purging behaviors
• Laxative abuse
• Self-induced vomiting
• Diuretic abuse
• Rigorous exercise regimens
 As many as eight or more cycles per day

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 Nutritional and Eating Disorders
(Cont.)
 Other eating disorders
 Eating disorder not otherwise specified (EDNOS)
 Binge eating disorder (BED)
 Avoidance\restrictive food intake disorder (ARFID)

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 Etiology and Pathophysiology
of Eating Disorders
 Causes unclear
 Distinct psychologic component
 Common initiator: dieting
 Relentless pursuit of thinness
 Distorted body image
 Media impact
 Triggered by an adolescent crisis

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 Therapeutic Management
 Diagnostic evaluation and screening
 Therapeutic management
 Three major goals of treatment
• Reinstitution of normal nutrition and reversal of malnutrition
• Resolution of the disturbed pattern of family interactions
• Individual psychotherapy to correct deficits and distortions in
psychologic functions

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 Therapeutic Management (Cont.)
 Nutrition therapy
 Refeeding syndrome
 Cognitive behavioral therapy
 Pharmacotherapy
 Psychotherapy
 Care management
 Interprofessional care management

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Health Problems With a Behavioral
Component
 Substance abuse
 Drug abuse, misuse, and addiction
• Voluntary behaviors
• Culturally defined
 Drug tolerance and physical dependence
• Involuntary physical responses
 Motivation
• Usually begins with experimentation

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Health Problems With a Behavioral
Component (Cont.)
 Types of drugs abused
 Nicotine
 Alcohol
 Cocaine
 Narcotics
 Central nervous system (CNS) depressants
 CNS stimulants
 Mind-altering drugs

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Health Problems With a Behavioral
Component (Cont.)
 Tobacco
 Use has declined slowly since its peak in 1999
 The use of available tobacco products did not change
from 2006 to 2009
 Secondhand smoke has deleterious effects on health
 Although the rate of smoking has declined over the
past decade, smoking is still the chief avoidable
cause of death

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Health Problems With a Behavioral
Component (Cont.)
 Reasons for tobacco use
 Imitation of adult behavior
 Peer pressure
 A desire to control weight
 Less likelihood of smoking if parents/family do
not smoke
 Less likelihood of smoking with high-
performance sports activities

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Health Problems With a Behavioral
Component (Cont.)
 Smokeless tobacco
 Place in mouth but not ignited
 Increasing popularity
 Serious hazards
 Carcinogenic
 Periodontal disease, tooth erosion, soft-tissue
damage

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Health Problems With a Behavioral
Component (Cont.)
 Antismoking campaigns
 Prevention is most effective way to reduce incidence
 Programs that focus on long-term effects have been
ineffective
 Peer-led programs more successful
 Media are used in smoking prevention
 School-based programs focus on prevention

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Health Problems With a Behavioral
Component (Cont.)
 Care management
 Alcohol
 Cocaine
 Narcotics
 CNS depressants
 CNS stimulants
 Mind-altering drugs

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Health Problems With a Behavioral
Component (Cont.)
 Care management—Substance abuse
 Interprofessional care management—Acute care
 Interprofessional care management—Long term
 Family support
 Prevention

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 Suicide
 Suicide is a deliberate act of self-injury that
causes death
 Suicidal ideation is a preoccupation with suicidal
thoughts
 Suicide attempt is intended to cause death or
serious injury
 “Parasuicide” describes behaviors ranging from
gestures to serious attempts

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 Suicide (Cont.)
 Etiology
 Methods
 Motivation
 Diagnostic evaluation
 Therapeutic management
 Interprofessional care management
 Nursing alert
 No threat of suicide should be dismissed

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 Question
Matt, age 14 years, seems to be always eating,
although his weight is appropriate for his height. The
best explanation for this is:

a. This is normal because of increase in body mass

b. This is abnormal and suggestive of future obesity
c. His caloric intake needs to be excessive
d. He is substituting food for unfilled needs

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