The Adolescent and Family

Download as ppt, pdf, or txt
Download as ppt, pdf, or txt
You are on page 1of 78

The adolescent and Family

Erikson’s theory of Psychosocial


Development
ADOLESCENT
Developmental Task: Identity vs. Role
Confusion
 Adolescents learn who they are and what kind
of person they will be by adjusting to a new
body image, seeking emancipation from
parents, choosing a vocation, and determining
a value system.
Freud’s Psychosexual Theory
ADOLESCENT
Psychosexual stage: Genital stage
Characteristics:
Energy is directed toward attaining a mature sexual
relationship(heterosexual).
This stage involves a reactivation of the pre-genital
impulses. These impulses are usually displaced, and
the individual passes to the genital stage of maturity.
An inability to resolve conflict can result in sexual
problems, e.g. frigidity, impotence, and the inability to
have a satisfactory sexual relationship.
Nursing implications:
1.Encourage separation from parents,
achievements of independence and decision-
making.
2.Provide appropriate opportunities for the
child to relate with opposite sex.
3.Allow child to verbalize feelings about new
relationships.
• Adolescence is a period of transition between
childhood and adulthood.
• The precise boundaries of adolescence are
difficult to define, but this period is
customarily viewed as beginning with the
gradual appearance of secondary sex
characteristics at about 11 or 12 years of age
and ending with the cessation of body growth
at 18 to 20 years.
• Puberty – refers to the maturational,
hormonal, and growth process that occurs
when the reproductive organs begin to
function and the secondary sex characteristics
develop.
3 stages of puberty
• 1. Prepubescence – the period of about 2
years immediately before puberty when the
child is developing preliminary physical
changes that herald sexual maturity.
• 2. Puberty- the point at which sexual maturity
is achieved, marked by the first menstrual
flow in girls but by less obvious indications in
boys.
• 3. Post-pubescence – a 1-2 year period
following puberty during which skeletal
growth is completed and reproductive
functions become fairly well established.
3 distinct sub-phases of adolescence
• 1. Early adolescence – ages 11-14
• 2. Middle adolescence – ages 15-17
• 3. Late adolescence – ages 18 to 20
Biologic Development
• The obvious physical changes are noted in
increased physical growth and in the
appearance and development of secondary
sex characteristics.
• The less obvious are physiologic alterations
and neurogonadal maturity, accompanied by
the ability to procreate.
• Primary sex characteristics- are the external
and internal organs that carry out the
reproductive functions (e.g., ovaries, uterus,
breasts, penis).
• Secondary sex characteristics – are the
changes that occur throughout the body as a
result of hormonal changes (e.g., voice
alterations, development of facial and
pubertal hair, fat deposits) but which play no
direct part in reproduction.
Sexual maturation in girls
• Thelarche
• – is the appearance of breast buds which
occurs between 9 and 13 ½ years of age.
• - this is the initial indication of puberty in
most girls.
Sexual maturation in girls
• Adrenarche
• – growth of pubic hair on the mons pubis
followed in approximately 2 to 6 months.
• In a minority of normally developing girls,
however, pubic hair may precede breast
development.
• Menarche
• - the initial appearance of menstruation.
• – occurs about 2 years after the appearance
of the first pubescent changes, approximately
9 months after the attainment of peak height
velocity and 3 months after attainment of
peak weight velocity.
• Menarche has been related to a critical gain in
body fat content (more fat content ,earlier
menarche), although this is controversial.
• The normal age range of menarche is usually
10 ½ to 15 years.
• Ovulation and regular menstrual periods
usually occur 6-14 months after menarche.
• Girls may be considered to have pubertal
delay if breast development has not occurred
by age 13 or if menarche has not occurred
within 4 years of the onset of breast
development.
Sexual maturation in boys
Early puberty
- The first pubescent changes in boys are
testicular enlargement accompanied by
thinning, reddening, and increased looseness
of the scrotum that usually occur between 9 ½
and 14 years of age.
• initial appearance of pubic hair.
Midpuberty
- Penile enlargement begins, and testicular
enlargement and pubic hair growth continue
throughout midpuberty.
- during this period there is also increasing
muscularity, early voice changes, and
development of early facial hair.
Midpuberty
• - Gynecomastia (breast enlargement and
tenderness) are common occurring up to 1/3
of boys.
• - the spurts in height and weight occur
concurrently toward the end of midpuberty.
• Note: for most boys, breast enlargement
disappears within 2 years.
Late puberty
• - there is definite increase in the length and
width of the penis, testicular enlargement
continues, and first ejaculation occurs.
• Axillary hair develops, and facial hair extends
to cover the anterior neck.
• Final voice changes occur secondary to the
growth of the larynx.
• Concerns about pubertal delay should be
considered for boys who exhibit no
enlargement of the testes or scrotal changes
by 13 ½ - 14 years of age, or if genital growth
is not complete 4 years after the testicles
begin to enlarge.
Physiologic growth
• A constant phenomenon associated with
sexual maturation is dramatic increase in
growth.
• The 20% to 25% of height is achieved during
puberty, and most of this growth occurs
during a 24 to 36 month period – the
adolescent growth spurt.
• The accelerated growth occurs in all children
but, as in other areas of development, is
highly variable in age of onset, duration, and
extent.
• The growth spurt begins earlier in girls, usually
between ages 9 ½ and 14 ½ years; on the
average it begins between ages 10 ½ and 16
years in boys.
• The average boy gains 10-30 cm (4-12 inches)
in height and 7-30 kg (15-65 lbs.) in weight.
• The average girl, in whom the growth spurt is
slower and less extensive, gains 5-20 cm (2-8
inches) in height and 7 to 25 kg (15- 55 lbs.) in
weight.
• Growth in height typically ceases 2 to 2 ½
years after menarche in girls and age 18 to 20
years in boys.
• The increase in size is acquired in a
characteristic sequence.
• - growth in length of the extremities and neck
precedes growth in other areas, and since
these parts are the first to reach adult length,
the hands and feet appear larger than normal
during adolescence.
• Increases in hip and chest width take place in
a few months, followed several months later
by an increase in shoulder width.
• Increase of the trunk and depth of the chest
follows.
• This sequence of changes is responsible for
the characteristic long-legged, gawky
appearance of the early adolescent child.
Promoting optimum health
during adolescence
Nutrition
The need for minerals calcium, iron, and zinc
substantially increases during periods of rapid
growth.
Nutrition
• Girls with very heavy or frequent menses may
be esp. susceptible to iron deficiency due to
blood loss.
• Calcium intake from food sources is essential
during adolescence to assist in the prevention
of osteoporosis.
Eating habits and behavior
• With adolescence and the move toward
independence, family influences on the child change.
• Children’s interests, attitudes and routines are
altered as an increasing number of meals are eaten
away from home.
• These changes are largely a result of the high value
that teenagers place on peer acceptability and
sociability. Their peers easily influence their eating
habits.
• Pressure for time and commitments to
activities adversely affect the teenager’s
eating habits.
• Omitting breakfast or eating breakfast that is
nutritionally poor in quality is frequently a
problem.
• Snacks, usually selected on the basis of
accessibility rather than nutritional merit,
become more and more a part of the habitual
eating pattern during adolescence.
• Adolescents often eat an insufficient amount
of fresh fruits and vegetables, esp. those that
are rich in ascorbic acid.
• Milk is usually passed over in favor of soft
drinks.
• When adolescent experience the normal
increase in weight and fat deposition of the
growth spurt, teenage girls often resort to
dieting.
• Boys are less inclined to under eat. They are
more concerned about gaining size and
strength.
• Lifestyle changes necessary for adolescents to
lose weight require the involvement of family
members who provide support and encourage
active participation.
Nursing Care Management
• Comprehensive nutrition education with
access to nutritious meals and snacks and
physical activity at school will begin to reverse
the trends of childhood obesity.
• To help teenagers select nutritious diet, it is
best to begin with their present diet and
actively involve them in the process.
• Teenagers do not respond well to judgmental
attitudes and dislike lectures, but they do
respond when their independence is
respected, and they are given the opportunity
to make their own decisions regarding food
choices.
• Adolescents are body conscious and
concerned about their appearance. Concrete
messages about the relationship between an
attractive appearance and the benefits of a
healthy lifestyle are most effective.
• Adolescents respond best when the counselor
provides straightforward information, uses
instructional methods that actively involve
them, talks with them and not at them, and
listens to what they have to say.
Sleep and Rest
• Teenagers vary in their need for sleep and
rest.
• During growth spurts the need for sleep is
increased.
• Rapid physical growth, the tendency toward
overexertion, and the overall increased
activity of this age contribute to fatigue in
adolescents.
• Their propensity for staying up late makes it
very difficult to arise in the morning, and they
may sleep late at every opportunity.
• Adequate sleep and rest at this time are
important to a total health regimen.
Exercise and Activity
• The practice of sports and games contributes
significantly to growth and development, the
education classes and better health.
• Competitive activities help the teenager in the
process of self-appraisal , the development of
self-respect, and concern for others.
• Children should be encouraged to participate
in activities that contribute to lifelong physical
fitness.
• Youngsters should not be encouraged to
engage in physical activities that are beyond
their physical or emotional capacity.
Dental Health
• Reassure children with corrective orthodontic
appliances regarding the temporary nature if
the annoyance and anticipation of an
improved help make the inconvenience
tolerable.
• It is also important to reinforce the
orthodontic’s directions regarding use and
care of the appliances and to emphasize
careful attention to tooth brushing.
Personal Care
• The hyperactive sebaceous glands and newly
functioning apocrine glands make frequent
bathing or showering a necessity, and
underarm deodorants assume an important
place in personal care.
Vision
• Regular vision testing is an important part of
health care and supervision during
adolescence.
• The increased demands of schoolwork make
adequate vision essential for academic
success.
• The need for corrective lenses can create
psychologic problems for teenagers if they
believe that glasses spoil their appearance or
do not fit their body image. Contact lenses are
preferred solution if they can afford.
Posture
• Many adolescents demonstrate altered
posture.
• Some teenagers may appear awkward or
slump and fail to stand or sit upright due to
rapid skeletal growth associated with slower
muscular growth.
• Some postural defects of adolescence require
early medical intervention.
Body Art
• Body art (piercing & tattooing) is utilized to
assist with adolescent identity formation.
• The skin has become the latest source of
parent-adolescent conflict.
• The adolescent often seeks body art as an
expression of his or her personal identity and
style.
• Tattoos are often obtained to mark significant
life events such as new relationships, births,
deaths.
• It is a nursing responsibility to caution girls
and boys against the practice of having
piercing performed by friends, mothers or
themselves.
Stress Reduction
• Adolescents are faced with pressures from
peers that often involve flaunting adult
authority and taking serious health risks like
pressures for sexual experimentation and use
of drugs, alcohol, and cigarettes, as well as
potentially dangerous physical activities.
• Early-maturing girls and late-maturing
children are esp. sensitive to the stresses of
being different from their peers. They feel out
of place among their classmates.
• Slow maturing children appear to suffer the
most pronounced inner turmoil and may be
hesitant to voice their concerns.
• Slow-maturing youngsters need support and
reassurance that they are not abnormal and
need only be patient until the time comes
when they too will develop the characteristics
for which they yearn.
Sexual Education and Guidance
• Contemporary adolescents are constantly
exposed to sexual symbolism and erotic
stimulation from the mass media. At the same
time, the development of primary and
secondary sex characteristics and the
increased sensitivity of the genitals produce
thoughts and fantasies about sexual
relationships.
• Sexual aspects of interpersonal relationships
become particularly important.
• Societal expectations push adolescents
toward dating and their own sex drive urges
them toward exploration.
• A large portion of adolescent’s knowledge
relating to sex is acquired from peers,
television, the movies, and magazines.
• Some information obtained from their parents
may be inaccurate.
• To be able to discuss topics about sex
adequately, nurses must not only understand
the physiologic aspects of sexuality and have
knowledge of cultural and societal values but
also be aware of their own attitudes, feelings
and biases about sexuality.
• The differences in the rate of maturation
between boys and girls and between different
members of the same sex often make it
desirable to discuss certain aspects of
sexuality in segregated groups.
• As a general rule, the need for separate
discussion groups diminishes as young people
progress toward maturity.
• Sexuality education should consist of
instruction concerning normal body functions
and should be presented in a straightforward
manner using correct terminology.
• When discussing sex and sexual activities,
nurses should use simple but correct
language, not street language, highly scientific
terminology, or evasive jargon.
Teenagers’ curiosity and desire for
information extend beyond the need for
anatomic and physiologic knowledge. They
need to know more than the mechanics of
conception, pregnancy and birth.
• Adolescents, girls in particular want answers
to questions such as “what it is like?” “Does it
hurt?” “what happens when …..?” “is it alright
if you…?”
• Boys are often concerned about the fallacy
that a relationship exists between penis size
and sexual function.
• Boys need reassurance that masturbation is a
normal and common practice, that some
degree of homosexuality is not unusual in
early adolescence.
• Teenagers need to discuss intercourse,
alternative methods of sexual satisfaction and
how to resist peer pressure.
• The topic of “safe sex” esp. abstinence and
the use of condom is essential to prevent STD.
• Role playing can help teenagers learn effective
approaches to dealing with difficult situations.
• Adolescents need role models and life
experiences with delayed gratification.
• Most important, they need problem
experience and decision-making skills so that
they can anticipate the positive and negative
outcomes of a decision.
• With these type of assistance, teenagers can
become sexually responsible young adults.
Injury prevention
Developmental abilities related to
risk of injury
• Need for independence and freedom
• Testing independence
• Age permitted to drive a motor vehicle
(varies)
• Inclination for risk taking
• Feeling of indestructibility
• Need for discharging energy, often at experience of
logical thinking and other control mechanisms.
• Strong need for peer approval
• May attempt hazardous feats
• Peak incidence for practice and participation in
sports
• Access to more complex tools, objects, and locations
• Can assume responsibility for own actions
Motor/non-motor vehicles
Pedestrian
• Emphasize and encourage safe pedestrian
behavior
• At night, walk with a friend
• If someone is following you, go to nearest
place with people
• Do not walk in secluded areas, take well-
traveled walkways
• Passenger-promote appropriate behavior
while riding in a motor vehicle.
• Driver – provide competent driver education;
encourage judicious use of vehicles;
discourage drag racing; maintain vehicle in
proper conditioning.
• Teach and promote safety and maintenance
of two-wheeled vehicles
• Promote and encourage wearing of safety
apparel such as helmet
• Reinforce the dangers of drugs, including
alcohol when operating a motor vehicle.
Drowning
• Teach non-swimmer to swim
• Teach basic rules of water safety
• Judicious selection of place to swim
• Sufficient water depth for diving
• Swimming with companion
Burns
• Reinforce proper behavior in areas involving
contact with burn hazards (gasoline, electric
wires).
• Advise regarding excessive exposure to
natural or artificial sunlight (UV burn)
• Discourage smoking
• Encourage use of sunscreen
Poisoning
• Educate the hazards of drug use, including
alcohol
Falls
• Teach and encourage general safety measures
in all activities
Bodily damage
• Promote acquisition of proper instruction in
sports and use of sports equipment
• Instruct in safe use of and respect for firearm
and other devices with potential danger
• Provide and encourage use of protective
equipment when using potentially hazardous
devices
• Promote access to and/or provision of safe
sports and recreational facilities
• Be alert for signs of depression (potential
suicide)
• Discourage use of and/or availability of
hazardous sports equipment
• Instruct regarding proper use of corrective
devices (contact lenses, glasses, hearing aids).
• Encourage and foster judicious application of
safety principles and prevention

You might also like