GROWTH AND

DEVELOPMENT

ADOLESCENT
AGES 12-18 YEARS
 At the end of this session students will
be able to:

1. Describe usual physical

development of the Adolescent.
2. Identify developmental task of the
Objectives Adolescent.
3. Identify assessment activities and
expected characteristics of the
Adolescent.
4. Discuss the health risk and nursing
implication of the Adolescent.
 Adolescence is the period during which the person
becomes physically and psychologically mature and
acquires a personal identity. At the end of this
critical period in development, the person should be
ready to enter adulthood and assume its
responsibilities. The length of adolescence is
culturally determined to some extent.

Adolescent
Puberty is the first stage of adolescence in which
sexual organs begin to grow and mature. Menarche
(onset of menstruation) occurs in girls.

Ejaculation (expulsion of semen) occurs in boys. For

girls, puberty normally starts between 10 and 14
years; for boys, between 12 and 16 years.
  Primary sexual characteristics develops, this includes
the reproductive organs such as the testes, penis,
ovaries, vagina, and uterus.
Sexual  Secondary sexual characteristics develops, this
differentiates male from female and include the male
Characteristics from the female but do not relate directly to
reproduction. This includes pubic hair growth, breast
development, and voice changes
 Early adolescence from 12 to 13 years

Middle adolescence from 14 to 16 years

Stages of
Development
Late adolescence from 17 to 18 or 20 years. This
stage is more stable stage than the other two.
Adolescents are involved mostly with planning
their future and economic independence.
Physical Development
During puberty, growth is markedly accelerated compared
to the slow, steady growth of the child. This period, marked
by sudden and dramatic physical changes, is referred to as
the adolescent growth spurt.

Boys, the growth spurt usually begins between ages 12 and

16; in girls, it begins earlier, usually between ages 10 and
14.

Because the growth spurt begins earlier in girls, many girls

surpass boys in height at this time.
 Age 14 growth is fastest for boys
The maximum height is often
reached at about 18 or 19 years.
Physical 20's some men add another 1 or 2 cm
to their height. (During their 20s as
Growth the vertebral column gradually
continues to grow.)

Physical growth
The fastest rate of growth in girls occurs
continues
throughout adolescence. at about age 12.
15 to 16 years reach their maximum
height.
Physical Growth​

Factors influencing growth

Heredity, Nutrition, Medical care, Illness, Physical and emotional
environment, Family size, and Culture.
The head, hands, and feet are the first to grow to adult status. Because
the extremities grow before the trunk, the adolescent looks leggy,
awkward, and uncoordinated.
After the trunk grows to full size, the shoulders, chest, and hips grow.
Skull and facial bones also change proportions: The forehead becomes
more prominent, and the jawbones develop.
Eccrine gland produce sweat; found all over the body

Apocrine glands develop in the axillae, anal and genital areas, in

the external auditory canals, and around the umbilicus and the
Glandular
areola of the breasts. Apocrine sweat is released onto the skin in
response to emotional stimuli only. changes
Sebaceous glands also become active under the influence of
androgens in both males and females. The sebaceous glands,
which secrete sebum, become most active on the face, neck,
shoulder, upper back, and chest and often contribute to an
increased incidence of acne.
  Primary sexual characteristics develops, this
includes the reproductive organs such as the
testes, penis, ovaries, vagina, and uterus.
 Secondary sexual characteristics develops,
Sexual this differentiates male from female and include
Characteristics the male from the female but do not relate
directly to reproduction. This includes pubic
hair growth, breast development, and voice
changes
  Males
 The first noticeable sign that puberty has begun in males is the
appearance of pubic hair and the enlargement of the scrotum
and testes. The milestone of male puberty is considered to be
the first ejaculation, which commonly occurs at about 14 years
of age. Fertility follows several months later.
 Sexual maturity is achieved by age 18.
Females
 A sign of puberty in females is the appearance of breast buds
although the appearance of hair along the labia may precede
this.

Sexual  The milestone of female puberty is the menarche, which occurs

about 1 1/2 to 2 years after breast buds appear. At first,
menstrual periods are scanty and irregular and may occur
Characteristics without ovulation.
 Ovulation is usually established 1 to 2 years after menarche;
ovulation and pregnancy but can occur early as an immediate
precursor to a girl’s first menstruation. Female internal
reproductive organs reach adult size about age 18 to 20.
Psychosocial Development
 According to Erikson, the psychosocial task of the
adolescent is the establishment of identity.
 The danger of this stage is role confusion. The inability to
settle on an occupational identity commonly disturbs the
adolescent. Less commonly, doubts about sexual identity
arise.
 These cliques often exclude all those who are “different” in
skin color, cultural background, aspects of dress, gestures,
and tastes.
 In-groupers of an adolescent clique can be excessively clannish and cruel in excluding
out-groupers; this intolerance is a temporary defense against identity confusion.

In their search for a new identity, adolescents have to reprocess many of the previous
stages of development.

The task of developing trust in self and others is again encountered when adolescents
Psychosocial look for ideal persons whom they can trust and with whom they can prove trustworthy.

Development Free choice and autonomy present conflicts to the adolescent.

Many adolescents experience temporary difficulty in developing a positive self-image.

Establishing a sense of sexual identity and clarifying one’s sexual orientation occurs
during late adolescence. Adolescents explore sexual images, fantasies, ideas, and roles.
Adolescents begin to establish intimacy with a partner or partners. This intimacy lays the
groundwork or the commitments of adulthood.

Homosexual youth may experience a great deal of confusion during this process, since
homosexuality is not openly accepted in all groups and their questions about self and identity
may go unanswered. There is increased risk for sexually transmitted disease and teen age
pregnancy.

Psychosocial
15 years, many adolescents gradually draw away from the family and gain independence.
This need for independence. Developmen
t
Adolescents also have to resolve their ambivalent feelings toward the parent of the opposite
sex. As part of the resolution, adolescents may develop brief crushes on adults outside the
family—teachers or neighbors, for example.

Peer groups assume great importance and has a number of functions. It provides a sense of
belonging, pride, social learning, and sexual roles.
  Between the ages of 11 and 15, the adolescent begins Piaget’s
formal operations stage of cognitive development.
 The main feature of this stage is that people can think beyond the
present and beyond the world of reality.
 Adolescents are highly imaginative and idealistic. This type of
thinking requires logic, organization, and consistency.
 In social interactions, adolescents often practice this increasing
Cognitive ability to think abstractly. Parents may misunderstand their child’s
intent, seeing the teen as arguing or being contrary, which can lead
Development to unnecessary confusion and conflict.
 The adolescent becomes more informed about the world and
environment. Adolescents use new information to solve everyday
problems and can communicate with adults on most subjects. The
adolescent’s capacity to absorb and use knowledge is great.
 Adolescents usually select their own areas for learning; they
explore interests from which they may evolve a career plan. Study
habits and learning skills developed in adolescence are used
throughout life.
According to Kohlberg, the young
adolescent is usually at the conventional
level of moral development. Most still
accept the Golden Rule and want to abide
by social order and existing laws.
Adolescents examine their values,
standards, and morals. They may discard
some of the values they have adopted from
parents in favor of values they consider
more suitable.

When adolescents move into the post

Adolescents consider the possibility of
conventional or principled level, they start
rationally changing the law and emphasize
to question the rules and laws of society.
individual rights. Not all adolescents or
Right thinking and right action become a
even adults proceed to this post
matter of personal values and opinions,
conventional level
which may conflict with societal laws.

Moral Development
 According to Fowler, the adolescent or young adult reaches the synthetic-conventional
stage of spiritual development. As adolescents encounter different groups in society,
they are exposed to a wide variety of opinions, beliefs, and behaviors regarding religious
matters.

Nursing activities relative to this stage of spiritual development include:

Spiritual Presenting an open, accepting attitude to adolescents’ questions and statements

Development regarding spiritual matters and their implications for health

Arranging for adolescents to see a member of their religious faith if so desired, or to talk
with members of their church peer group for support

Providing a comfortable environment in which adolescents can practice the rituals of

their faith.
 Adolescents face
With communal many health risk
living late including
adolescents are also consequences of
at increased risk for risky behavior.
infectious diseases Psychological and
such as measles and
pneumococcal
meningitis
emotional challenges
of adolescence. Health
Risk
Also, the developing brain is
susceptible to addiction; and
the first manifestation of
schizophrenia may appear in
late adolescence.
 High risk behaviors
 ■ Behaviors contributing to unintentional injury or
violence
 ■ Tobacco use
 ■ Alcohol or other drug use
 ■ Sexual activity that contributes to pregnancy and
sexually transmitted disease, including HIV
 ■ Physical inactivity/ Unhealthy diet
 ■ Motor vehicle crashes
 ■ Other unintentional injuries (e.g., falls, drowning,
poisoning)
 ■ Homicides
 ■ Suicide
 Bullying is generally defined as a
specific type of aggression that is
intended to harm and occurs
repeatedly over time with a more
powerful person or group attacking
someone less powerful.
School bullying among adolescents
affects school achievement and
psychological well-being for both
victims and perpetrators.

Violence
Adolescent bullying can take
different forms: physical (e.g.,
Boys are more involved in direct
hitting, pushing, and kicking), verbal
bullying (physical and verbal), while
(e.g., name-calling), relational/social
girls are more involved in indirect
(e.g., social exclusion, spreading
bullying (social).
rumors), and the emerging new
form of cyber or electronic bullying.
  The highest nutrient and energy demands occur during the growth spurt in
adolescence. However, many adolescents engage in unhealthy dietary practices,
and eating disorders are a serious health problem.
 Increasing obesity rates are making type 2 diabetes more common among
teens, whereas previously it occurred mostly in adults.
 Common problems related to nutrition and self-esteem among adolescents
includes: Obesity, anorexia nervosa, and bulimia.

Eating Nurses need to help adolescents create a wellness plan that addresses body image,
diet, weight concerns, and exercise.

Disorder Non-suicidal Self-Injury

 The number of adolescents who engage in non-suicidal self-injury appears to be
increasing internationally, with self-cutting as a primary form of self-harm.
 Adolescents who harm themselves have a wide range of psychosocial
problems, including anxiety disorder, which may contribute to the behavior.
Eating disorders and self-injury are often related.
  Adolescents are usually self-directed in meeting their health needs.
Because of maturation changes, however, they need teaching and
guidance in a number of health care areas.
Promoting health and wellness includes:
 Screening for tobacco, alcohol, and drug use

Health  Screening for sexual practices

 Screening for mental health status
Assessment  Checking blood pressure, height, and weight; and ensuring that

and immunizations are current.

 Education on sex and prevention of unplanned pregnancies and
Promotion sexual transmitted diseases.
 To prevent motor vehicle crashes, insist on driver’s education
classes and enforce rules about safe driving.
 Prompt identification of psychological problems is crucial and
referral for appropriate help is vital.
  Berman, A., Synder, S.J. (2012) Kozer & Erb’s
Fundamentals of nursing: Concepts, process, &
Reference practice. (8th ed.). New Jersey: Pearson Education