Ch. 40

Welcome toWong, et al.Maternal Child Nursing Care, 3/eChapter 40 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 1 of 68 Welcome toWong, et al.Maternal Child Nursing Care, 3/eChapter 40

Chapter 40 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 2 of 68 Chapter 40 The Adolescent and Family

Promoting Optimum Growth and Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 3 of 68 Promoting Optimum Growth and Development Transition between childhood and adulthood Rapid physical, cognitive, social, and emotional maturation Generally defined as beginning with onset of puberty and ending with cessation of body growth at 18-20 years

Terms : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 4 of 68 Terms Puberty—development of secondary sex characteristics Prepubescence—approximately 2 years before onset of puberty; preliminary physical changes occur Postpubescence—1-2 years after puberty; skeletal growth is complete; reproductive functions

Biologic Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 5 of 68 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

Hormonal Changes of Puberty : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 6 of 68 Hormonal Changes of Puberty Role of anterior pituitary and hypothalamus Hormones stimulate gonads Gonads produce and release gametes Gonads secrete sex-appropriate hormones

Sex Hormones : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 7 of 68 Sex Hormones Secreted by ovaries, testes, and adrenals Produced in varying amounts by both sexes throughout the span Adrenal cortex causes small amount of secretion before puberty Maturation of gonads produces biologic changes of puberty

Estrogen : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 8 of 68 Estrogen “Feminizing hormone” Low production during childhood Males: gradual production throughout maturation Females: increases until about 3 years after menarche Females then remain at this maximum level throughout reproductive life

Androgens : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 9 of 68 Androgens “Masculinizing hormones” Secreted in small and gradually increasing amounts for up to 7-9 years Then rapid increase in both sexes; males continue rapid increase until 15 years Responsible for rapid growth of early teen Testes secrete testosterone: males increase to maximum level at maturity

Sexual Maturation : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 10 of 68 Sexual Maturation Tanner stages of sexual maturity Stages of development of secondary sex characteristics and genital development Defined as guide for estimating sexual maturity

Sexual Maturation: Girls : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 11 of 68 Sexual Maturation: Girls Thelarche: appearance of breast buds—age 9-13½ years Adrenarche: growth of pubic hair on mons pubis—2-6 months after thelarche Menarche: initial appearance of menstruation approximately 2 years after 1st pubescent changes —average age 12 years, 9½ months in North America

Sexual Maturation: Boys : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 12 of 68 Sexual Maturation: Boys First pubescent changes: testicular enlargement, thinning, reddening, and increased looseness of scrotum—age 9½ to 14 years Penile enlargement, pubic hair growth, voice changes, facial hair growth Temporary gynecomastia in one third of boys; disappears within 2 years

Physical Growth : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 13 of 68 Physical Growth Dramatic increase in growth accompanies sexual maturation Adolescent growth spurt 20%-25% of total height achieved during puberty Usually occurs within 24-36 months Characteristic sequence of changes

Sex Differences in General Growth Patterns : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 14 of 68 Sex Differences in General Growth Patterns Appear to be result of hormonal effects at puberty Obesity associated with early onset of menarche in girls Obesity effects less predictable in boys

Physiologic Changes : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 15 of 68 Physiologic Changes Size and strength of heart, blood volume, and systolic blood pressure increase Pulse rate and basal heat production decrease Adult values for all formed elements of blood Respiratory volume and vital capacity increase Increased performance capabilities

Psychosocial Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 16 of 68 Psychosocial Development Erikson: sense of identity Early adolescent: group identity vs. alienation Development of personal identity vs. role diffusion Sex role identity Emotionality

Piaget: Cognitive Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 17 of 68 Piaget: Cognitive Development Formal operations period Abstract thinking Think beyond present Mental manipulation of multiple variables Concerned about others’ thoughts and needs

Kohlberg: Moral Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 18 of 68 Kohlberg: Moral Development 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, reparation

Spiritual Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 19 of 68 Spiritual Development Some may question values and beliefs of family Capable of understanding abstract concepts, interpreting analogies and symbols May fear that others will not understand their feelings

Social Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 20 of 68 Social Development Goal: to define identity independently from parental authority Much ambivalence Intense sociability; intense loneliness Acceptance by peers

Relationships with Parents : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 21 of 68 Relationships with Parents Roles change from protection-dependency to mutual affection and equality Process involves turmoil and ambiguity Struggle of privileges and responsibility Emancipation from parents may begin with rejection of parents by teen

Relationships with Peers : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 22 of 68 Relationships with Peers Peers assume increasingly significant role in adolescence Peers provide sense of belonging and feeling of strength and power Peers form transitional world between dependence and autonomy

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Mosby items and derived items © 2006, 2002 by Mosby, Inc. 23 of 68

Heterosexual Relationships : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 24 of 68 Heterosexual Relationships Dating Sexual experimentation—wide range Reasons for sexual experimentation Curiosity Pleasure Conquest Peer pressure to conform

Slide 25: 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 25 of 68

Homosexuality in Adolescents : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 26 of 68 Homosexuality in Adolescents Development of sexual identity during adolescence Risk of health-damaging behaviors by homosexual and bisexual youths Early initiation of sex behaviors STDs Running away from home Suicide and suicidal ideation

Interests and Activities : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 27 of 68 Interests and Activities Leisure activities center around peers Adolescent work experiences may provide benefits Time management concerns

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Mosby items and derived items © 2006, 2002 by Mosby, Inc. 28 of 68

Development of Self-Concept and Body Image : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 29 of 68 Development of Self-Concept and Body Image Feelings of confusion in early adolescence Acute awareness of appearance, comparison of appearance with others Blemishes/defects magnified out of proportion Mature to self-concept based on uniqueness/individuality

Responses to Puberty : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 30 of 68 Responses to Puberty Responses differ depending on stage of development Curiosity in early adolescence Concerns with “Am I normal?” Concerns for late-maturing teens Concept of “perfect body” achievement

Promoting Optimum Health During Adolescence : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 31 of 68 Promoting Optimum Health During Adolescence Immunizations Nutrition Eating habits and behaviors Healthy lifestyle habits

Promoting Optimum Health During Adolescence : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 32 of 68 Promoting Optimum Health During Adolescence Sleep and rest Exercise and activity Dental health Personal care Vision, hearing Posture Body piercing Sun tanning/UV damage

Stress Reduction : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 33 of 68 Stress Reduction

Sexuality Education and Guidance : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 34 of 68 Sexuality Education and Guidance Media influences Knowledge often acquired from peers, TV, movies, magazines Knowledge often inaccurate Need for factual info, presentation based on developmental maturity

Injury Prevention : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 35 of 68 Injury Prevention Motor vehicle crashes—single greatest cause of serious and fatal injuries in teens Firearms/other weapons Sports injuries

Anticipatory Guidance—Care of Families : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 36 of 68 Anticipatory Guidance—Care of Families Parents need for support and guidance Information needs regarding developmental changes and process of gaining independence

Disorders Related to the Reproductive System : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 37 of 68 Disorders Related to the Reproductive System Primary amenorrhea No secondary sex characteristics and no menarche by 14-15 years of age or Secondary sex characteristics present but no menarche by age 16-16½ years No uterine bleeding after SMR 5 for 1 year or after breast development for 4 years

Secondary Amenorrhea : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 38 of 68 Secondary Amenorrhea Absence of menses for 6 months or absence of three cycles after menstruation was previously established Most common cause—pregnancy (even with primary amenorrhea) Other causes—eating disorders, stress, other causes of severe weight loss

Dysmenorrhea : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 39 of 68 Dysmenorrhea Primary dysmenorrhea Secondary dysmenorrhea Therapeutic management NSAIDs Estrogen therapy Oral contraceptives Dietary changes Exercises, comfort measures

Vaginitis : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 40 of 68 Vaginitis Causes may be physical, chemical, or infectious Diagnosis confirmed by vaginal exam, microscopic evaluation of vaginal secretions Health teaching

Male Reproductive Disorders : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 41 of 68 Male Reproductive Disorders Most anomalies identified in early childhood Infections (e.g., urethritis) Hematuria Penile problems (phimosis, trauma, carcinoma) Scrotal varicocele Testicular torsion

Gynecomastia : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 42 of 68 Gynecomastia May occur with normal achievement of male puberty and resolves within 1 year Can be caused by anabolic steroid use or endocrine disorders Testosterone supplementation may aggravate gynecomastia Plastic surgery?

Health Problems Related to Sexuality : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 43 of 68 Health Problems Related to Sexuality Sexual activity Teen pregnancy STDs

Rape/Sexual Assault : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 44 of 68 Rape/Sexual Assault SANE—Sexual Assault Nurse Examiners Diagnostic evaluation Obtain account of incident Sensitivity to victim’s emotional status Physical evidence Vaginal secretions for evidence of sperm, blood, DNA GC culture to r/o preexisting condition HIV testing, other STD testing initially and at appropriate intervals

Rape Trauma Syndrome : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 45 of 68 Rape Trauma Syndrome Acute phase of disorganization LT reorganization process Nightmares, fears, phobias, panic reactions Feelings of helplessness, powerlessness Victim recovery

Obesity : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 46 of 68 Obesity Defined as increase in body weight due to accumulation of excessive body fat relative to lean body mass Obese: generally considered when weight >95th percentile for age, gender, and height Overweight: generally considered when >90th percentile 25%-30% children are obese

Impact of Childhood Obesity : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 47 of 68 Impact of Childhood Obesity Increase in type 2 diabetes Risk of adult obesity Hypertension, hyperlipidemia, cardiovascular disease Social isolation, low self-esteem, depression

Causes of Childhood Obesity : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 48 of 68 Causes of Childhood Obesity 5% due to underlying disease (hypothyroidism, other metabolic disease, CNS disorders) Role of heredity Inactivity Patterns of eating behaviors

Diagnostic Evaluation : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 49 of 68 Diagnostic Evaluation Skinfold measurements Body mass index calculations Body fat measurements Diagnostics to r/o metabolic and endocrine disorders

Nursing Considerations : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 50 of 68 Nursing Considerations Assessment, planning, implementation Diet, exercise, behavioral and group therapy Prevention, evaluation Medical therapies Pharmacologic—generally not recommended in children Surgical—hazardous in children

Anorexia Nervosa : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 51 of 68 Anorexia Nervosa Eating disorder: refusal to maintain normal body weight Primarily in adolescent and young adult females Mean age of onset 13.75 years, ranging from 10-25 years or more Life threatening

Etiology/Pathophysiology of AN : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 52 of 68 Etiology/Pathophysiology of AN Etiology unclear Distinct psychologic component Diagnosis based on psychologic and behavioral criteria Relentless pursuit of thinness Distorted body image Media impact Concept of “control”

Clinical Manifestations of AN : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 53 of 68 Clinical Manifestations of AN Severe weight loss Altered metabolic activity Amenorrhea Bradycardia, decreased BP Hypothermia, cold intolerance Dry skin, brittle hair and nails Appearance of lanugo

Therapeutic Management of AN : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 54 of 68 Therapeutic Management of AN Treat life-threatening malnutrition IV, tube feedings Monitor CV status Behavior modification LT (lifelong?) treatment and management

Bulimia : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 55 of 68 Bulimia Eating disorder characterized by binge eating May be followed by purging behaviors Laxative abuse Self-induced vomiting Diuretic abuse Rigorous exercise regimens Up to eight or more cycles per day

Bulimia : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 56 of 68 Bulimia Weight may be normal or slightly above normal Weight may be low—bulimarexia Tooth erosion, esophageal damage, other GI concerns Psychologic issues Self-deprecating thought; depressed mood History of unsuccessful dieting; overweight in childhood Low impulse control

Therapeutic Management : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 57 of 68 Therapeutic Management Similar to anorexia management Hospitalization to treat potassium depletion, esophageal damage Cardiac monitoring indicated Behavioral management

Smoking : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 58 of 68 Smoking

Smoking Statistics : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 59 of 68 Smoking Statistics 1997—36.4% of high school students smoke cigarettes More students using smokeless tobacco and/or cigars Increasing rates in all racial, ethnic, and gender groups

Smoking Hazards : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 60 of 68 Smoking Hazards Undisputed damage related to tobacco use Decreased lung function Addiction/dependence on nicotine Earlier age of smoking—more difficult to quit later in life

Why Do Kids Smoke? : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 61 of 68 Why Do Kids Smoke? Imitation of adult behavior Peer pressure Perceived popularity of smokers Less likely to smoke if parents/family do not smoke Less likely to smoke with high-performance sports activities

Smokeless Tobacco : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 62 of 68 Smokeless Tobacco Increasing popularity Serious hazards Carcinogenic Periodontal disease, tooth erosion, soft tissue damage

Anti-Smoking Campaigns : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 63 of 68 Anti-Smoking Campaigns Peer-led programs Emphasize social consequences rather than LT health problems Use of multimedia images School and community settings Begin in elementary school and through high school

Substance Abuse : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 64 of 68 Substance Abuse Drug abuse, misuse, and addiction Voluntary behaviors Culturally defined Use of drugs for other than acceptable medical purpose Drug tolerance and physical dependence Involuntary physical responses

Types of Drugs Abused : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 65 of 68 Types of Drugs Abused Alcohol Cocaine Narcotics CNS depressants CNS stimulants Hallucinogens Inhalants

Nursing Considerations : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 66 of 68 Nursing Considerations Acute care LT management Family needs/family support Prevention

Suicide : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 67 of 68 Suicide Third leading cause of death in teens Suicide Suicidal ideation Suicide attempt/parasuicide

Suicide : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 68 of 68 Suicide Etiology Methods Motivation Diagnostic evaluation/therapeutic management Nursing considerations