Mindanao State University

Iligan Institute of Technology

COLLEGE OF NURSING

Nutrition and Diet Therapy (LEC)

Presented by:
Group 5 (Block 260)

Members:

Bullianday, Dannah

Ducao, Julienne Em D.

Hussain, Fatima Zahra H.

Macmod, Ayessa Alyza B.

Portugaleza, Nicole Denise D.

Tumanda, Valerie T.

Presented to:

Prof. Khandy Lorraine G. Apsay, RN, MAN

Topic: Adolescent Nutrition

Description: This lesson is intended to equip the learners with information about Adolescent
nutrition overview, aspect on nutritional recommendations, concerns, nursing management, and
client education that is geared towards optimal health for adolescents.
 I. INTRODUCTION

Adolescence is the second-fastest growth stage in life after infancy. The adolescent’s growth
spurt during this period creates an increased need for many nutrients. Good nutrition is critical
during teenage years to support healthy growth and development. A healthy diet needs to meet the
changing nutritional needs of a growing teen and importantly, helps prepare them for a lifetime of
healthy eating behaviours. These years are critical period of growth and development, so good
nutrition is essential. During adolescence, the need for most nutrients including energy, protein,
vitamins and minerals increases, so it’s key is to have plenty of healthy foods on offer.

According to the World Health organization (2006), adolescents are the future generation of
any country and their nutritional needs are critical for the well-being of society. In South East Asia
Region, a large number of adolescents suffer from chronic malnutrition and anaemia, which
adversely impacts their health and development. The high rate of malnutrition in girls not only
contributes to increased morbidity and mortality associated with pregnancy and delivery, but also
to increased risk of delivering low birth-weight babies. This contributes to the intergenerational
cycle of malnutrition. In most developing countries, nutrition initiatives have been focusing on
children and women, thus neglecting adolescents. Addressing the nutrition needs of adolescents
could be an important step towards breaking the vicious cycle of intergenerational malnutrition,
chronic diseases and poverty. Researches from both the developed and developing countries
indicate that there is a link between fetal under-nutrition and increased risk of various chronic
diseases during adulthood.

Nutritional guidance for adolescents is important for supporting the development of healthy
lifestyles, preventing weight-related problems, reducing disease risk, and ensuring that all needs
are met for growth and development. In balance with adequate physical activity, healthy dietary
choices help to prevent excess weight gain, iron deficiency anemia, and poor bone mineralization,
among other health problems. Overweight or obesity in adolescence increases the risk for type 2
diabetes and is likely to persist into adulthood. As teens gain more independence, it can also be
tempting to eat more energy dense snack foods and fast foods that are high in fat, sugar and salt
and low in other ‘important nutrients. Eating patterns formed during adolescence also frequently
are carried into adulthood and, therefore, affect future risk for the development of chronic diseases
such as heart disease, osteoporosis, and cancer. Rapid physical growth during adolescence creates
a high demand for energy and certain nutrients (Larson & Sztainer, 2009).

Since adolescents are mostly active and engaged in various physical activities, it is essential
that they get the proper nutrients their bodies need. The nutrient requirement of adolescents is
basically the same as other life-span stages however; they differ in the quantity of intake needed.
 II. CHARACTERIZATION OF AGE GROUP (Who are the people involved?)

ADOLESCENTS

In general, a person between the ages of 13 and 20 is considered an adolescent. Adolescence is

a period of rapid growth that causes major changes. It tends to begin between the ages of 10 and
13 in girls and between 13 and 16 in boys. The growth rate may be 3 inches a year for girls and 4
inches for boys. Bones grow and gain density, muscle and fat tissue develop, and blood volume
increases. Sexual maturity occurs. Boys’ voices change, girls experience the onset of menses.

FOOD HABITS

Adolescents, especially boys, typically have enormous appetites. When good eating habits
have been established during childhood and there is nutritious food available, the teenager’s food
habits should present no serious problem.

Adolescents are imitators, like children, but instead of imitating adults, adolescents prefer to
imitate their peers and do what is popular. Unfortunately, the foods that are popular often have
low nutrient density such as potato chips, sodas, and candy. These foods provide mainly
carbohydrates and fats and very little protein, vitamins, and minerals, except for salt, which is
usually provided in excess. Adolescents’ eating habits can be seriously affected by busy
schedules, part-time jobs, athletics, social activities, and the lack of an available adult to prepare
nutritious food when adolescents are hungry or have time to eat.

When the adolescent’s food habits need improvement, it is wise for the adult to tactfully
inform her or him of nutritional needs and of the poor nutrition quality of the foods she or he is
eating. The adolescent has a natural desire for independence and may resent being told what to do.

Before attempting to change an adolescent’s food habits, carefully check her or his food
choices for nutrient content. It is too easily assumed that because the adolescent chooses the food,
the food is automatically a poor choice in regard to nutrient content. It might be a good choice. An
adolescent who has a problem maintaining an appropriate weight may need some advice regarding
diet.
 III. NUTRITIONAL RECOMMENDATION

What should I eat?

Eating three regular meals a day with some snacks will help you meet your nutrition needs.
Skipping meals means you will miss out on vitamins, minerals and carbohydrates, which can leave
you lacking energy or finding it hard to concentrate.

Because of adolescents’ rapid growth, calorie requirements naturally increase. Boys’

calorie requirements tend to be greater than girls’ because boys are generally bigger, tend to be
more physically active, and have more lean muscle mass than do girls.
Except for vitamin D, nutrient needs increase dramatically at the onset of adolescence. Because of
menstruation, girls have a greater need for iron than do boys. The DRIs for vitamin D, vitamin C,
vitamin B12, calcium, phosphorus, and iodine are the same for both sexes. The DRIs for the
remaining nutrients are higher for boys than they are for girls. There is a difference in male and
female adolescent due to their physiologic differences. Below is a list of suggestions for healthy
nutrition prior to conception:

1. Proteins

Protein rich foods include eggs, fish, poultry, lean meat, chicken, dairy products (cheese
and milk), tofu, grains, nuts, seeds, and legumes are good sources of iron and protein. It is needed
for the growth and repair of muscles and tissues, and the production of hormones and enzymes.
Protein is needed for growth and to keep your muscles healthy. Not eating enough protein when
you are still growing, or going through puberty, can lead to delayed or stunted height and weight.
Not enough protein is common when you go on strict diets. Include meat, chicken, fish or eggs in
your diet at least twice a day. Fish is important for your brain, eyes and skin. Try to eat fish 2 to 3
times a week. Protein recommendations for males are 45-59 grams daily, females are
recommended to have 45 grams of protein daily.

2. Iron

. Iron is needed to make red blood cells, which carry oxygen around your body. During
your teenage years, you’ll start to menstruate, or get your period, and this leads to loss of iron. If
you don’t get enough iron, you can develop anaemia, a condition that can make you feel tired and
light-headed and short of breath. Iron recommendation for teen boys is 11 milligrams
of iron a day and teen girls should get 15 milligrams. (Adolescence is a time of rapid growth and
teen girls need additional iron to replace what they lose monthly when they begin menstruating.)
3. Carbohydrates

Breads, grains and cereals are carbohydrates that provide energy for your brain and
muscles. They’re also an excellent source of fibre and B vitamins. Without enough carbohydrates
you may feel tired and run down. Try to include some carbohydrates at each mealtime. Males are
recommended to consume 2,500 to 2,900 kcal daily. While females are recommended to consume
2,200 kcal per day.

4. Fruits and Vegetables

Have lots of vitamins and minerals which help boost your immune system and keep you
from getting sick. They’re also very important for healthy skin and eyes. It’s recommended you
eat two serves of fruit and five serves of vegetables a day. Vary your vegetables. Choose a variety
of vegetables, including dark green, red, and orange vegetables, legumes (peas and beans), and
starchy vegetables. If you are vegetarian or vegan and do not eat meat, there are other ways to
meet your iron needs, for example, with foods like baked beans, pulses, lentils, nuts and seeds.

5. Calcium

Dairy foods like milk, cheese and yoghurt help to build bones and teeth and keep your
heart, muscles and nerves working properly. You’ll need three and a half serves of dairy food a
day to meet your needs. Calcium AI recommendation for both sexes is 1,300 mg per day.

6. Vitamin D

The teenage years are the most important for bone growth and development. If you don't
get enough vitamin D during your teenage years, you may be at risk for osteoporosis when you get
older. Osteoporosis is the development of weak bones that, over time, can break easily. Teenagers
need vitamin D for many processes in the body to work effectively. It is needed to help with the
absorption and utilisation of calcium and phosphorus, key nutrients in maintaining normal bones
and teeth. Vitamin D is also needed for the normal function of the immune system. The best food
sources of vitamin D are fish such as salmon, tuna, and mackerel, mushrooms, egg yolks, and
products fortified with vitamin D such as milk, orange juice, and some yogurts A teen should get
is 4000 IU per day, and the minimum is 600 IU per day.

7. Vitamin C

Vitamin C helps body cells, including those in the bones, teeth, gums, and blood vessels,
grow and stay healthy. It also helps your body respond to infection and stress, keeping you healthy
even when you're struggling to meet deadlines. Vitamin C has a number of important roles during
 growth and development, including being required for the synthesis of collagen, and
neurotransmitters. Vitamin C is also a highly effective antioxidant and is important for immunity.
Further, vitamin C strongly enhances the absorption of iron. This has special relevance to
adolescent health, considering the fact that iron deficiency is prevalent among adolescents,
especially girls. Citrus fruits such as orange, kiwi, lemon, guava, grapefruit, and vegetables such
as broccoli, cauliflower, Brussel sprouts and capsicums are rich, natural sources of vitamin C. The
RDA for adolescents which was extrapolated from recommendations for adults based on relative
body weight is 75 mg/day and 65 mg/day of vitamin C for boys and girls, respectively.

8. Vitamin B12

Vitamin B12 is needed to keep your blood cells healthy and is used by the body to make
proteins like hormones and enzymes needed for digestion. Most people can easily get all the
vitamin B12 they need from food. However, some groups of people, such as vegans, have to work
harder to get enough vitamin B12 in their diets. Over time, not getting enough vitamin B12 from
food can cause anemia (a condition that makes it harder for your red blood cells to work well).
Vitamin B12 is required for the proper function and development of the brain, nerves, blood cells,
and many other parts of the body. Without enough vitamin B12, someone may feel tired, weak, or
confused and may have low appetite or numbing in their hands and feet. Vitamin B12 can be
found in foods such as meat, fish, and dairy products. The amount of vitamin B12 you need each
day, or recommended daily allowance (RDA), If you are 14 years old or older, you need 2.4
micrograms each day.

9. Phosphorus

Phosphorus is an essential structural component of cell membranes and nucleic acids but is
also involved in several biological processes, including bone mineralization, energy production,
cell signaling through phosphorylation reactions, and regulation of acid-base homeostasis. You
need phosphorus to keep your bones strong and healthy, to help make energy, and to move your
muscles. Phosphorus is found in most food sources and is a component of many commonly used
food additives. The bioavailability of phosphorus from food is usually very high with the
exception of phytate phosphorus in plant sources, such as grains, legumes, and seeds, which is
poorly digested. The amount of phosphorus you need in your diet depends on your age. Adults
need less phosphorus than children between the ages of 9 to 18. The recommended daily intake of
phosphorus is as follows: adults (19 years and older): 700 mg, children (9 to 18 years): 1,250 mg.
10. Iodine

Our thyroid glands need iodine to produce the hormones that control metabolism, growth
and development. . Dietary iodine is needed to make essential thyroid hormones. If children and
grown-ups don’t get enough iodine in their diets, they might develop iodine deficiency. This can
cause the thyroid gland to increase in size. An enlarged thyroid gland, or goitre, can; affect
hormone production, cause swallowing and breathing difficulties, lead to hypothyroidism, which
can cause problems like weight gain, dry skin, hair loss, tiredness, intolerance to cold and
depression, result in stunted growth, intellectual impairment and a lower level of intelligence
measured by IQ. Good sources of iodine include bread fortified with iodised salt and any type of
seafood, including seaweed. Adolescents need 150 μg of iodine per day.

11. Nutrition for the Athlete

Teen athletes have unique nutrition needs. Because athletes work out more than their less-
active peers, they generally need extra calories to fuel both their sports performance and their
growth. When one is involved in athletic, good nutrition, during the period of life, can prevent
unnecessary wear and tear on the body and can maintain the athlete in top physical form. The
athlete needs additional water, calories, thiamine, riboflavin, niacin, sodium, potassium, iron, and
protein. Plain water is the recommended liquid because it rehydrates the body more quickly than
sweetened liquids or the drinks that contain electrolytes. The “electrolyte” drinks are useful to
replenish fluids after an athletic event but not during one. Salt tablets are not recommended
because despite the loss of salt and potassium through perspiration, the loss is not equal to the
amount contained in the tablets. If there is an insufficient water intake, these salt tablets can
increase the risk of dehydration. The increase in calories depends on the activity and the length of
time it is performed. The requirement could be double the normal, up to 6,000 calories per day.
Because carbohydrates, not protein, are used for energy, the normal diet proportions of 50% to
55% carbohydrate, 30% fat, and 10% to 15% protein are advised. There is an increased need for B
vitamins because they are necessary for energy metabolism. They are provided in the breads,
cereals, fruits, and vegetables needed to bring the calorie count to the total required. Some extra
protein is used during training, when muscle mass and blood volume are increasing. Protein needs
are not increased by physical activity. In fact, excess protein can cause increased urine production,
which can lead to dehydration. The minerals sodium and potassium are needed in larger amounts
because of loss through perspiration. This amount of sodium can usually be replaced just by
salting food to taste, and orange juice or bananas can provide the extra potassium. A sufficient
supply of iron is important to the athlete, particularly to the female athlete. Iron-rich foods eaten
 with vitamin C–rich foods should provide sufficient iron. The onset of menstruation can be
delayed by the heavy physical activity of the young female athlete, and amenorrhea may occur in
those already menstruating. When weight is a concern of the athlete, such as with wrestlers, care
should be taken that the individual does not become dehydrated by refusing liquids in an effort to
“make weight” for the class. When weight must be added, the athlete will need an additional 2,500
calories to develop 1 pound of muscle mass. The additional foods eaten to reach this amount of
calories should contain the normal proportion of nutrients. A high-fat diet should be avoided
because it increases the potential for heart disease. Athletes should reduce calories when training
ends. The pregame meal should be eaten 3 hours before the event and should consist primarily of
carbohydrates and small amounts of protein and fat. Concentrated sugar foods are not advisable
because they may cause extra water to collect in the intestines, creating gas and possibly diarrhea.
Glycogen loading (carboloading) is sometimes used for long activities. To increase muscle stores
of glycogen, the athlete begins 6 days before the events. For 3 days, the athlete eats a diet
consisting of only 10% carbohydrate and mostly protein and fat as she or he performs heavy
exercise. This depletes the current store of glycogen. The next 3 days, the diet is 70%
carbohydrate, and the exercise is very light so that the muscles become loaded with glycogen. This
practice may cause an abnormal heartbeat and some weight gain. Currently, it is recommended
that the athlete exercise heavily and eat carbohydrates as desired. Then, during the week before the
competition, exercise should be reduced. On the day before competition, the athlete should eat a
high-carbohydrate diet and rest. After the event, the athlete may prefer to drink fruit juices until
relaxed and then satisfy the appetite with sandwiches or a full meal. Many athletes will use “power
drinks” or “energy drinks,” which are not any better than soda and contain mostly sugar and
empty calories. There are no magic potions or diet supplements that will increase an athlete’s
prowess, as may be touted by health food faddists. Steroid drugs should not be used to build
muscles. They can affect the fat content of the blood, damage the liver, change the reproductive
system, and even alter facial appearance. Good diet, good health habits, and practice combined
with innate talent remain the essentials for athletic success.

Nursing Intervention/Client Education:

Nutrition interventions may include optimizing the patient’s oral intake, providing oral
nutrition supplements, and administering enteral and parenteral nutrition. Nurses play a key role in
implementing these interventions.

1. Fluids are also an important part of your diet. Drink water to keep hydrated, so you won’t feel so
tired or thirsty. It can also help to prevent constipation.
2. Eating too much fat and oil can result in you putting on weight. Try to use oils in small amounts
for cooking or salad dressings. Other high-fat foods like chocolate, chips, cakes and fried foods
can increase your weight without giving your body many nutrients.

3. Educate about the relationship between psychological state and physiological state and how mind
set affects lifestyle practices and behaviors.

4. Encourage parents/guardians to set a good example in beverage/food choices and exercise.

5. Encourage teen to participate in meal planning, grocery shopping, and cooking.

IV. SPECIAL CONSIDERATIONS FOR THE ADOLESCENT RELATED TO

NUTRITION CONCERNS

Anorexia Nervosa

Studies show, however, that girls sometimes have diets deficient in calories and protein,
iron, calcium, vitamin A, or some of the B vitamins. These deficiencies can be due to poor eating
habits caused by concern about weight. A moderate concern about weight is understandable and
possibly even beneficial, provided it does not cause diets to be deficient in essential nutrients or
lead to a potentially fatal condition called anorexia nervosa.

Anorexia nervosa, commonly called anorexia, is a psychological disorder more common

to women than men. It can begin as early as late childhood, but usually begins during the teen
years or the early twenties. It causes the client to drastically reduce calories, causing altered
metabolism, which results in hair loss, low blood pressure, weakness, amenorrhea, brain damage,
and even death.

Someone with this disorder (an anorexic) has an inordinate fear of being fat. Some
anorexics have been overweight and have irrational fears of regaining lost weight. Some young
women with demanding parents perceive this as their only means of control. Some may want to
resemble slim fashion models and have a distorted body image, where they see themselves as fat
even though they are extremely thin. Some fear growing up. Many are perfectionistic
overachievers who want to control their body. It pleases them to deny themselves food when they
are hungry. These young women usually set a maximum weight for themselves and become an
expert at “counting calories” to maintain their chosen weight. They also often exercise excessively
to control or reduce their weight. If the weight declines too far, the anorexic will ultimately die.
Treatment requires the following:

1. Development of a strong and trusting relationship between the client and the health care
professionals involved in the case.
2. That the client learn and accept that weight gain and a change in body contours are normal
during adolescence.
3. Nutritional therapy so the client will understand the need for both nutrients and calories
and how best to obtain them.
4. Individual and family counseling so the problem is understood by everyone.
5. Close supervision by the health care professional.
6. Time and patience from all involved.

Bulimia

A syndrome in which the client alternately binges and purges by inducing vomiting and
using laxatives and diuretics to get rid of ingested food. Bulimics are said to fear that they cannot
stop eating. They tend to be high achievers who are perfectionistic, obsessive, and depressed.
They generally lack a strong sense of self and have a need to seem special. They know their
binge–purge syndrome is abnormal but also fear being overweight. This condition is more
common among women than men and can begin any time from the late teens into the thirties.A
bulimic usually binges on high-calorie foods such as cookies, ice cream, pastries, and other
“forbidden” foods. The binge can take only a few moments or can run several hours—until there is
no space for more food. It occurs when the person is alone. Bulimia can follow a period of
excessive dieting, and stress usually increases the frequency of binges.
Bulimia is not usually life-threatening, but it can irritate the esophagus and cause
electrolyte imbalances, malnutrition, dehydration, and dental caries.

Treatment

1. Limiting eating to mealtimes

2. Portion control
3. Close supervision after meals to prevent self-induced vomiting.
4. Diet therapy helps teach the client basic nutritional facts so that he or she will be more
inclined to treat the body with respect.
5. Psychological counseling will help the client to understand his or her fears about food.
Group therapy also can be helpful.
Food Allergy

A food allergy is the overreaction of the immune system to a food protein or other large
molecule that has been absorbed and interacts with the immune system that produces a response.
The body produces antibodies to protect itself from the foreign substance, the protein allergen.
The reaction causes a variety of physical symptoms that occur immediately (less than 2 hours),
intermediately (2 to 4 hours), or delayed (over 24 hours). The most common food allergies
experienced by children are peanuts, milk eggs, and wheat. Seafood and peanuts are more
common among older children and adults. Cross reactivity also occurs. For example, if a person is
affected by a ragweed allergy, reaction to melons and bananas may occur.
Symptoms may include skin, respiratory, and gastrointestinal reactions . Reactions may
affect breathing ability if the upper airway becomes obstructed because of swelling. If the
symptoms are treated as asthma, instead of a true food allergy, the misdiagnosis may trigger more
serious physical responses and a continuation of symptoms because the offending food may
continue to be consumed.
Reactions for a small number of individuals may be so severe to be life threatening. This
type of reaction is called anaphylaxis and may occur immediately after eating the food substance.
Peanuts, eggs, shellfish, and nuts may cause anaphylaxis in sensitive individuals. Symptoms may
include hives, breathing difficulties, and unconsciousness. It requires immediate medical care or a
plan of action in case advertent consumption of the offending food occurs. Caregivers, whether the
parents, school officials, family, or friends, must be aware of the potential reaction and the
appropriate and immediate treatment for the anaphylaxis response.

Treatment

The only way to treat food allergy is to avoid consumption of the food. Referral to the
registered dietitian for nutrition counselling is important, and family and caregivers should be
included in the nutrition counselling process. Nutrition counselling identifies alternative sources of
nutrients to assure appropriate substitutions for the foods eliminated. Nutrition counselling also
assists in teaching how to use food labels to recognize the different terms of allergic items.

Food Intolerance
Food intolerance is an adverse reaction to a food that does not involve the immune system.
The symptoms are triggered by a reaction of the body to a food. Pharmacologic properties of
foods (e.g., tyramine in aged cheese, theobromine in chocolate), metabolic disorders (e.g., lactose
intolerance), or idiosyncratic responses may cause the reaction. The lack of lactase limits the
digestion of lactose, leading to physical symptoms of bloating, flatulence, diarrhea, and nausea.
The resulting symptoms can be similar to and mistaken as a food allergy.
Treatment
For lactose intolerance, products are available that contain reduced lactose, or there are
pills (e.g., Lactacid) that break down lactose, thus easing digestion.

Overweight

Being overweight during adolescence is particularly unfortunate because it is apt to

diminish the individual’s self-esteem and, consequently, can exclude her or him from the normal
social life of the teen years, further diminishing self- esteem.

Heredity is believed to play a role. Just as one inherits height, color of hair, or artistic
talents, it appears that one may inherit the tendency (or lack of it) to be overweight. Overfeeding
during infancy and childhood also can be a contributing factor. The problem of being overweight
during adolescence is especially difficult to solve until the individual involved makes the
independent decision to self-esteem feelings of self-worth change lifestyle habits. After making
such a decision, the teenager should see a physician to ensure that his or her health is good.

Fast Foods

Many people have become extremely fond of fast foods. Many others are highly critical of
their nutrient content. Examples of these foods—most of which are favorite of teenagers—include
hamburgers, cheeseburgers, French fries, milkshakes, pizza, sodas, tacos, chili, fried chicken, and
onion rings. Many fast-food companies have the nutrient content of their products available to
help the public make better choices.

Generally speaking, fast foods are excessively high in fat and sodium, as well as calories,
and contain only limited amounts of vitamins and minerals (other than sodium) and little fiber.

Nevertheless, these foods are more nutritious than sodas, cakes, and candy. When used
with discretion in a balanced diet, they are not harmful. However, teens often use fast foods as a
snack to hold them over until dinner, and this results in consumption of many extra calories.

A person with high calorie intake has a risk for development of obesity, cardiovascular
disease, and diabetes. A person with high fat intake has a risk of insulin resistance, damages blood
vessels, and risk for heart diseases. A person with high sodium intake increases the risk of kidney
disease and stones and increase water retention in the body which leads to bloating and puffiness
 of the body, and weight gain.

Nursing management / Client Education:

The health care provider can play an important role by offering guidance on changing
eating habits, increasing exercise, and adopting a healthier lifestyle.

Recreational Drugs (Alcohol, Marijuana, Coccaine, Tobacco and other addictive drugs)

a. Alcohol

In a process called fermentation, sugars and starches can be changed to alcohol. Enzyme
action causes this change. Alcohol is typically made from fruit, corn, rye, barley, rice, or potatoes.
It provides 7 calories per gram but almost no nutrients.

Alcohol is a substance that can have serious side effects. Initially, it causes the drinker to
feel “happy” because it lowers inhibitions. This feeling affects the drinker’s judgment and can lead
to accidents and crime. Ultimately, alcohol is a depressant; continued drinking leads to sleepiness,
loss of consciousness, and, when too much is consumed in a short period, death.

Abuse (overuse) of alcohol is called alcoholism. Alcoholism can destroy the lives of
families and devastate the drinker’s nutritional status and thus health. It affects absorption and
normal metabolism of glucose, fats, proteins, and vitamins. When thiamine and niacin cannot be
absorbed, the cells cannot use glucose for energy. Blood cells, which depend on glucose for
energy, are particularly affected. Over time, if alcohol abuse continues, fat will accu- mulate in the
liver, leading to cirrhosis. Alcohol causes kidneys to excrete larger-than-normal amounts of
water, resulting in an increased loss of minerals. In a poor nutritional state, the body is less able to
fight off disease.

In addition, excessive, long-term drinking can cause high blood pressure and can damage
the heart muscle. It is associated with cancer of the throat and the esophagus and can damage the
 reproductive system. When a pregnant or lactating woman drinks, however, she puts the fetus or
the nursing infant at risk as well. Alcohol can lower birth weight and cause fetal alcohol syndrome
or fetal alcohol effect, with related developmental disorders. The health professional is in a good
position to spread the message that alcohol is a substance and can cause severe economic and
family problems, as well as addiction, disease, and death.

b. Marijuana

Marijuana use continues to increase among teenagers. Marijuana increases appetite,

especially for sweets. One marijuana cigarette is as harmful as four or five tobacco cigarettes
because the marijuana smoke is held in the lungs for a longer period of time. As marijuana is
smoked, the lungs absorb the fat-soluble active ingredient, delta-9-tetrahydrocannabinol (THC),
and store it in the fat (Indiana Prevention Resource Center, 2003). Experts believe that the use of
marijuana can lead to the use of other drugs such as cocaine. Common street names for marijuana
include grass, weed, pot, and dope.

c. Cocaine

Cocaine is highly addictive and extremely harmful. It causes restlessness, heightened self-
confidence, euphoria, irritability, insomnia, depression, confu- sion, hallucinations, loss of
appetite, and a tendency to withdraw from normal activities. Cocaine can cause cardiac
irregularities, heart attacks, and cardiac arrests resulting in death. Weight loss is very common,
mostly because it decreases appetite; addicts would give up food for the drug. The smokable form
of cocaine is crack, which is more addictive than any other drug. It is estimated that half of all
crimes against property committed in major cities are related to the use of crack cocaine and the
addict’s need for money to buy the drug.

d. Tobacco

Cigarette smoking is addictive. Cigarette smoking by teenagers is very preva- lent.

Teenagers smoke to “be cool,” to look older, because they think it will help them lose weight, or
because of peer pressure. Smoking can influence appetite, nutrition status, and weight. Smokers
need the DRI for vitamin C plus 35 mg because smoking alters the metabolism. Low intakes of
vitamin C, vitamin A, beta-carotene, folate, and fiber are common in smokers. Smoking increases
the risk of lung cancer and heart disease.

e. Other Addictive Drugs

Methamphetamine is the most potent form of amphetamines. Amphetamines cause heart,

breathing, and blood pressure rates to increase. The mouth is usually dry, and swallowing is
difficult. Urination is also difficult. Appetite is depressed. The users’ pupils are dilated, and
reflexes speed up. As the drug wears off, feelings of fatigue or depression are experienced. Street
names include crank, speed, crystal, meth, zip, and ice.

Nursing Management/Client Education:

1. Ask the teenager’s views. Avoid lectures. Instead, listen to your teen's opinions and questions
about drugs. Assure your teen that he or she can be honest with you.

2. Discuss reasons not to use drugs. Avoid scare tactics. Emphasize how drug use can affect the
things that are important to your teen — such as sports, driving, health and appearance.
3. Discuss ways to resist peer pressure. Brainstorm with your teen about how to turn down offers
of drugs.
4. Discourage adolescents from using recreational drugs. Addiction is a serious problem and is
difficult to treat; the best way to do when exposed to these drugs is to consult to a provider.

Adolescent Pregnancy

Pregnancy during adolescence — a time when the girl is still growing herself — has been
associated with increased risk of miscarriage, prematurity, low birth weight infants (<2,500
grams), and increased maternal and neonatal mortality (2, 118-119). Pregnant adolescents are also
at a heightened risk for pregnancy-related complications, including pregnancy-induced
hypertension and anemia (119). Because they are growing themselves, it is extremely important
for pregnant adolescents to meet dietary intake recommendations.

Recommendations for some key micronutrients needed for adolescent growth, including
calcium, magnesium, phosphorus, and zinc, are higher than those for older pregnant women.
Pregnant adolescents are at increased risk for select micronutrient inadequacies, especially iron,
zinc, calcium, magnesium, folate, vitamin B6, vitamin D, and vitamin E. A woman is
recommended to consume per day during the second and third trimesters of pregnancy. The RDA
for protein during pregnancy is 60 g per day.

Folate is important to prevent neural tube defects. The DRI for folate during pregnancy is
increased to 600 mcg per day. Iron recommendation is 30 mg/day. All women should take a
supplement with 30 mg ferrous iron daily beginning in the second trimester to prevent iron-
deficiency anemia. The AI for calcium is 1300mg/day. Calcium is particularly important for the
mineralization of fetal skeleton. Adequate nutrition is important not only for a healthy pregnancy
outcome but also for the overall and skeletal health of the adolescent. A recent cross-sectional
study of 719 postmenopausal women associated their pregnancy during adolescence with lower
bone mineral density at several sites and a two-fold higher risk of osteoporosis compared to
women without a history of adolescent pregnancy (122). However, it is not known whether
adequate calcium intake during adolescent pregnancy might prevent age-related declines in bone
mineral density or osteoporosis.

V. REFERENCES:

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0

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The women’s the royal women’s hospital Victoria Australia (n.d). Food and nutrition for
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Roth, R. (n.d). Diet During Adolescent. Retrieved September 20, 2019 from
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American Academy of Pediatrics healthychildren.org (2016, March 1). A Teenager’s Nutritional

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Cincinnati Children’s (2018, March). Adolescent Nutrition. Retrieved September 23, 2019 from
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