Health Promotion of

the Adolescent and

Family
 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
• Puberty—development of secondary sex characteristics
• Prepubescence—approximately 2 yrs before onset of puberty; preliminary
physical changes occur
• Post pubescence—1-2 yrs after puberty; skeletal growth is complete,
reproductive functions
 Biologic Development
• Primary sex characteristics
• External and internal organs necessary for reproduction
• Secondary sex characteristics
• Result of hormonal changes: for example, voice changes, hair growth,
breast enlargement, fat deposits
• Tanner’s Stages on pp. 496-7
• Usual sequence of changes on p. 495
 Hormonal Changes of Puberty
• Hypothalamus stimulates anterior pituitary
• Anterior pituitary stimulates gonads
• Gonads produce and release gametes
• Gonads secrete sex-appropriate hormones
• Estrogen and testosterone are present in both sexes during childhood, but
jumps during puberty appropriate to gender
 Estrogen
• “Feminizing hormone”—produced by ovaries
• Low production during childhood
• Males: gradual production throughout maturation
• Females: increases until about 3 yrs after menarche
• Females then remain at this maximum level throughout reproductive life
 Androgens
• “Masculinizing hormones”—produced by testes
• Secreted in small and gradually increasing amounts up to 7-9 yrs
• Then rapid increase in both sexes initially; males continue rapid increase until
15 yrs
• Responsible for rapid growth of early teen
• Males increase to maximum level at maturity
 Sexual Maturation: Girls
• Thelarche: appearance of breast buds—age 9-13½ yrs
• Adrenarche: Growth of pubic hair on mons pubis—2-6 months after
thelarche
• Menarche: initial appearance of menstruation approximately 2 yrs after 1st
pubescent changes —avg age 12 yrs 9½ months in North America
 Sexual Maturation: Boys
• First pubescent changes: testicular enlargement, thinning, reddening, and
increased looseness of scrotum—age 9½ to 14 yrs
• Penile enlargement, pubic hair growth, voice changes, facial hair growth
• Temporary gynecomastia (pembesaran payudara) in 1/3 of boys; disappears
within 2 yrs
 Physical Growth
• Dramatic increase in growth accompanies sexual maturation
• Adolescent growth spurt
• 20%-25% of total height achieved during puberty—boys have slower
epiphyseal closure resulting in longer growth period
• Usually occurs within 24-36 month period
• Boys grow 4-12” & 15-65 lbs; girls 2-8” & 15-55 lbs
• Girls stop growing about 21/2 yrs after menarche; boys grow until 18-20
yrs
 Sex Differences in General Growth Patterns

• Appear to be result of hormonal effects at puberty

• Muscle increases in boys due to testosterone
• Fat deposits are sex-related
• Obesity associated with early onset of menarche in girls
• Obesity effects less predictable in boys
 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
• Erikson: sense of identity
• Early adolescent: group identity vs. alienation
• Development of personal identity vs. role diffusion
• Sex-role identity—adolescents are influenced by peers and adults, but will
vary acc’d to culture, geographics, and socioeconomics
• Emotionality—vacillate between adult and child-like behavior; mood
swings common
 Piaget:
Cognitive Development
• Formal operations period
• Abstract thinking
• Think beyond present—can think about the future and consequences of
actions
• Mental manipulation of multiple variables
• Capable of analysis and strategy
• Concerned both about others’ thoughts and others’ needs
• Increased understanding of others increases tolerance
 Kohlberg:
Moral Development
• Internalized set of moral principles
• Questioning of existing moral values and relevance to society
• Understand duty and obligation, reciprocal rights of other
• Concepts of justice, and making amends for wrongdoing
 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—may be reluctant to
disagree with norms
• More religious or spiritual adolescents are less likely to engage in high-risk
behaviors
 Social Development
• Goal: to define identity independently from parental authority
• Much ambivalence
• Intense sociability; intense loneliness
• Acceptance by peers, a few close friends, and strong family support are all
important for maturity
 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 and defiance of and
withdrawal from parents
 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
 Heterosexual Relationships
• Dating—crushes in early yrs; group to double to single
• Sexual experimentation—wide range; ½ have intercourse by age 18. Sex before 14
could mean abuse in past
• Reasons for sexual experimentation
• Curiosity
• Pleasure
• Conquest
• Affection, belonging
• Peer pressure to conform
 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
• Leisure activities center around peers—favorites are phone, movies, eating
out
• Adolescent work experiences may provide benefits
• Time management concerns between school, fun, and work
• Work time should not exceed 20 hours/week
Development of Self-Concept and Body Image

• Feelings of confusion in early adolescence—may feel strange about rapid

body changes
• Acute awareness of appearance, comparison of appearance with others
• Blemishes/defects and growth differences magnified out of proportion—
want “perfect body”
• Frequently pose and primp especially in private
 Promoting Optimum Health During
Adolescence
• Immunizations—tetanus, MMR, and Hep B if not received during school-
age years. Meningococcal strongly recommended for college bound
• Nutrition—calorie and protein requirements higher than any other time in
life. Need more calcium, iron, and zinc
• Eating habits and behaviors—skipping breakfast, snacking, dieting, eating hi-
fat fast food and very little fruits and vegs
 Promoting Optimum Health cont’d
Healthy lifestyle habits:
• teaching good nutrition is not enough—must also have access to high-
quality foods and snacks at home and school
• Relationship between attractive appearance and healthy lifestyle can be
effective
• Provide info and involve teen—don’t dictate and judge
• Role-modeling is important
 Promoting Optimum Health cont’d
• Sleep and rest—need rest due to increased growth and increase in activities.
Naps are not uncommon—sleeping late is common
• Exercise and activity—sports has increased, but PE programs can be
emphasizing games and competition and not activities that contribute to
lifelong fitness
• Dental health—caries are down. If needed, orthodontics are started in early
adolescence—need extra hygiene
 Promoting Optimum Health cont’d
• Personal Care:
• Vision and hearing need to be checked because of frequent incidence of
refractive errors and hearing loss
• Posture can be a problem because teen is worried about being too tall and
fatigue
• Body piercing—needs to be done by professional
• Sunscreen needs to be stressed. Dangers of tanning beds. Self-tanners are best
• Personal hygiene needs include education re: frequent bathing, deodorant,
menstrual hygiene, douching
Stress Reduction
 Sexuality Education
and Guidance
• Knowledge often acquired from peers, TV, movies, magazines and is often
inaccurate
• Need for factual info, presentation based on developmental maturity
• Topics nurses should be prepared to discuss include sexual attitudes and
values, disease transmission, birth control, physiology and body changes,
menstruation, pregnancy and birth
 Injury Prevention
• Motor vehicle crashes—single greatest cause of serious and fatal injuries in
teens—60% male—alcohol frequently a factor; 10% may have been suicides
• Firearms/other weapons—powder, paint, BB
• Sports injuries—football with boys; gymnastics with girls. Important that
sport fits body type and ability and that protective gear is worn
 Anticipatory Guidance—
Care of Families
• Parents need for support and guidance
• Information needs regarding developmental changes and process of gaining
independence