Care of Mother, Child,
Adolescent (Well-Clients)
LECTURE
ADOLESCENCE
PHYSICAL GROWTH OF ADOLESCENTS
 Major milestone of development are the
onset of puberty and cessation of the
body growth.
 Gain in physical growth is mostly in
weight, leading to the stocky, slightly
abuse appearance of prepubescence
then thin and gangly appearance of late
adolescence
 Most girls are 1 to 2 inches taller than
boys coming into adolescence but
generally stop growing within 3 years
from menarche.
 Girls who started menstruating at 10
years of age, may reach adult height by
age 13
 Girls grow 2-8 inches in height and gain
15-55 pounds.
 Important note: Ephiphyseal plate
closure = cessation of growth and wont
accommodate bone growth.
 Boys grow about 4-12 inches in height
and gain 15-65 pounds during
adolescence
 Growth stops with closure of epiphyseal
line of long bones. This occurs at about
16-17 y.o in female and 18-20 y.o in
males.
 Increase in body size does not occur in
all organ system at same rate. These
differences in growth rate make
adolescents appear long-legged and
awkward during rapid growth spurt
because their extremities elongates first,
followed by trunk growth.
 Because of increase heart and lung in
size more slowly than the rest of the
body, blood flow and oxygen availability
are reduced. This means adolescents
may have insufficient energy and
become fatigued trying to finish the
various activities that interest them.
 During adolescence, androgen
stimulates sebaceous glands to
extreme activity, sometimes resulting in
acne, a common adolescent skin
problem.
 Apocrine sweat glands (glands present
in the axillae and genital area) from
shortly after puberty producing a strong
odor in response to emotional
stimulation.
TEETH
 Adolescent gain their second molars at
about 13 years of age and the third
molar (wisdom teeth) between 18 to 21
years old.
 Third molars may erupt as early as 14
to 15 years of age
 Jaw reaches adult size by end of
adolescent.
PUBERTY
 Individual first become capable of
sexual reproduction.
 A girl entered puberty when she begins
to menstruate (menarche).
 A boy enters puberty when he begins to
produce spermatoza (increased in
penis size)
 Occurs ages between 11 and 14 years
SECONDARY SEX CHANGES
 Body hair configuration and breast
growth are those characteristics which
distinguish the sexes from each other
but play no direct part in reproduction
 Begin at late school age and develop
during adolescence
DEVELOPMENTAL MILESTONES:
Play and recreation
 13 y.o change from school age
activities of active games to more adult
forms of recreation such as listening to
music, chatting on computers, or
following a sports team wins and
losses.
 Urge parents to encourage youngsters
to play sports for their own health and
well being and companionship involved,
however, even though they do not
excel.
 15 y.o. may spend a great deal of time
in their room, or in quiet corner of the
home away from traffic and
conversation areas. If they cant find
privacy in the house they tend to spend
time elsewhere.
EMOTIONAL DEVELOPMENT
Developmental task: Identity vs. Role
confusion
 The developmental task in early and
middle adolescence is to form a sense
of identity or decide who they are and
what kind of person they will be
 In late adolescence, the task is form a
sense of intimacy or form close
relationship with persons of the
opposite as it with the same sex
Four (4) main areas to make gains to
achieve a sense of identity:
 Accepting their change body image.
 Establishing a value system or what
kind of persons they want to be.
 Making career decisions.
 Becoming emancipated from their
parents.
IMPORTANT NOTES:
 If young adolescents do not achieve
sense of identity, they develop sense of
role confusion or can have little idea
what kind of person they are. This lead
to their having difficulty functioning
effectively as adults.
 Some adolescents may become
delinquent or exhibit acting-out
(attention getting) behavior because
they believe it is better to have a
negative image than to be nobody at all.
VALUE SYSTEM
 Adolescents develop values through
talking to peers
 Develops through taking adult ear who
will listen to their fears, hopes, dreams
and pressure they feel to be somebody
 Early adolescence: girls tend to band
together with girls and boys with boys.
They dress identically with other
members of their group (to have sense
of belongingness).
 Adolescents who are different for any
reason often are excluded from groups.
This behavior may seem immature, but
it is necessary establishing a sense of
identitiy
HOW TO ADDRESS EXCLUSION:
 Help adolescent to appreciate that it is
not fair to exclude others on the basis of
superficial characteristics helps then
move more quickly through this stage.
BODY IMAGE
 Adolescents who developed a strong
sense of industry during their
school-age years have learned to solve
problems and are best equipped to
adjust their new body image.
 Educate adolescents about their body
and help them accept the changes that
marks maturity.
CAREER DECISION
 Part of the feeling knowing what kind of
person you are is knowing what kind of
occupation will be fit.
 Many adolescent are encourage to wait
until they have been in college for 2
years before choosing a major.
Changes in adolescent that challenges
self-esteem:
 Changes in one’s body and physiologic
functioning.
 Changes in feelings and emotional
focus.
 Changes in social relationships
(including relationships with both family
and friends).
 Changes in family and school
expectations.
SELF ESTEEM
 All of these factors an have an effects
on adolescents feeling about
themselves, sometimes resulting in
crisis.
 Help parents understand how important
it is for adolescents to have immediate
successes such as making the high
school basketball team or having a date
for their senior prom.
Emancipation from parents:
 Some parent may not be ready for their
child to be totally independent.
 Some adolescent may not be sure on
what they want to be on their own.
SENSE OF INTIMACY
 late adolescent; once adolescent
achieved a sense of identity is early or
mid adolescence, they are ready to
work on second developmental task
that of achieving a sense of intimacy.
 The ability to form intimate relationship
is strongly correlated with sense of
trust.
 Some adolescents require help from
parents to differentiate between sound
relationship and those that are based
only on sexual attraction.Intimacy
involves this deeper level of relationship
or developing a sense of compassion or
concern for people of both sexes.
 Empathy, feeling for another or a
developed sense of intimacy in its finest
form.
SOCIALIZATION
 Early teenagers may feel more
self-doubt than self confidence. They
want to look grown up, but they still look
like children
 Both male and female 13 y.o tend to be
loud and boisterous, particularly when
pure of the opposite sex whose
attention they would like to attract are
nearby.
 They are impulsive, and very much like
2 y.o children in that they want
immediately, not when it is convenient
for others
 Many 13 y.o face being in love
 Most 15 y.o face being in love five or six
times a year
 14 y.o often quieter and more
introspective. They becoming used to
their changing bodies, have more
confidence and feel more self-esteem
 Adolescents watch adults carefully
during this period, searching for good
role models with whom they can identify
(IDOLIZATION).
COGNITIVE DEVELOPMENT
Formal operational thought It begins at age
12 or 13 years and grows on dept over the
adolescent years
PIAGET’S FORMAL OPERATIONAL
STAGE:
 Metacognition; our ability to think
about our own thought processes
 Proportional reasoning; the ability to
compare a range of numbers or ratios
 Hypothetical-deductive reasoning;
thoughts evolve into the ability to
ponder hypothetical situations
 Probabilistic reasoning; the ability to
use probabilities to predict likely
outcomes
Moral and spiritual development
 Almost all adolescent question the
existence of God and any religious
practice they have been taught this
questioning is a natural part of forming
a sense of identity and establishing a
value of system at a time when they
draw away from their families.
Nursing Diagnosis (Dx):
 Health seeking behavior related to
normal growth and development
 Low self-esteem related to facial acne
 Anxiety related to concerns about
normal growth and development
 Risk for injury related to peer pressure
to use alcohol and drugs
 Readiness for enhance parenting
related to increased knowledge of
teenage years.
Adolescent safety
 Common is motor vehicles.
 Wear safety helmets to prevent head
injury, long pants to prevent leg burn
from exhaust pipes, fully body covering
to prevent abrasions in case of an
accident.
Other common accidents and injuries:
 Drowning
 Homicide and suicide
 Athletic injuries
Nutritional health
 Nutrients are most apt to be deficient in
both male and female adolescents are:
 Iron- for IDA (iron deficiency anemia).
 Calcium- for rapid skeletal growth.
 Zinc- necessary for sexual maturation
and final body growth.
Daily activities
 Provide the time for self-care, such as
shampooing hair, etc. It is important to
include in NCP.
 Teeth care, they should continue to use
fluoride paste and drink fluorinated
water to ensure firm enamel growth.
HEALTHY FAMILY FUNCTIONING
 Have many disagreements with parents
wanting more independence and partly
from being disappointed in their
bodies
 It may be helpful to counsel parents to
appreciate that although it is not easy to
live with a teenager, it is equally difficult
to be teenager.
COMMON HEALTH PROBLEMS DURING
ADOLESCENCE
 Hypertension
 Poor posture
 Fatigue
 Menstrual irregularities
 Acne
 Obesity
 Sexuality and sexual activity
 Substance abuse
 Attempted suicide