Erikson's theory of psychosocial development states that adolescents experience identity vs. role confusion as they learn who they are. Freud's psychosexual theory describes adolescence as the genital stage where sexual energy is directed towards relationships. Nursing implications include encouraging independence from parents and allowing relationships. Adolescence involves biological, cognitive, and social/emotional changes as children transition to adulthood. Puberty involves physical sexual maturation through secondary sex characteristics. Promoting optimal health during adolescence requires addressing nutrition, eating habits, and lifestyle.
Erikson's theory of psychosocial development states that adolescents experience identity vs. role confusion as they learn who they are. Freud's psychosexual theory describes adolescence as the genital stage where sexual energy is directed towards relationships. Nursing implications include encouraging independence from parents and allowing relationships. Adolescence involves biological, cognitive, and social/emotional changes as children transition to adulthood. Puberty involves physical sexual maturation through secondary sex characteristics. Promoting optimal health during adolescence requires addressing nutrition, eating habits, and lifestyle.
Erikson's theory of psychosocial development states that adolescents experience identity vs. role confusion as they learn who they are. Freud's psychosexual theory describes adolescence as the genital stage where sexual energy is directed towards relationships. Nursing implications include encouraging independence from parents and allowing relationships. Adolescence involves biological, cognitive, and social/emotional changes as children transition to adulthood. Puberty involves physical sexual maturation through secondary sex characteristics. Promoting optimal health during adolescence requires addressing nutrition, eating habits, and lifestyle.
Erikson's theory of psychosocial development states that adolescents experience identity vs. role confusion as they learn who they are. Freud's psychosexual theory describes adolescence as the genital stage where sexual energy is directed towards relationships. Nursing implications include encouraging independence from parents and allowing relationships. Adolescence involves biological, cognitive, and social/emotional changes as children transition to adulthood. Puberty involves physical sexual maturation through secondary sex characteristics. Promoting optimal health during adolescence requires addressing nutrition, eating habits, and lifestyle.
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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
DR Premitha Damodaran V GTK (A Child Suing Through Her Father and Litigation Representative, Taranjeet Singh Al Bhagwan Singh) - Anor and Another Appeal