Adolescent (12-20 years)

Learning Guide - 7

Adolescence
Prepubescent : 12-13 year
Pubescent : 14-16 year
Late adolescent : 17-20 year

Text Book
Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8 th
edition.
Chapter 21
Pages: 384 388.

Biologic growth
Height and weight
The second growth spurt is seen in
adolescence. The childhood weight is doubled
by 18-20 years.
Boys: 12-13 years the weight is 38-60 Kg and
height 154-172 cm for boys. It increase to 5680kg and 163-182cms at 17-21 yr.
Girls: For girls the weight is 40-60 Kg and
height 153-167 cm at 12-13 years which
increase to 48-72kg and 156-170 cm at 17-21
yr.

Biologic growth
Growth in adolescence is influenced by
heredity, nutrition, medical care, illness,
physical and emotional stresses, family size
and culture.
The accelerated growth is first noted in the
hands, feet and extremities. The shoulder,
chest and hips develop later.
Poor posture is a common problem in
adolescence.

Biologic growth
Glandular changes.
Eccrine glands (sweat glands all over the
body) and apocrine glands (sweat glands in
the axilla and genital areas) become fully
functional and increase secretions.
Sebaceous glands become active and
secrete sebum. If the glands get blocked
with over production of sebum it result in
acne (pimples).

Biologic growth
Dentition
The number of permanent teeth
increase. Second molars and cuspid
and bicuspid teeth erupt from 10-13
years.

Biologic growth

Sexual development
Primary and secondary sexual characteristics
appear.
Primary sex characteristics: Related to the
organs of reproduction.
Secondary sex characteristics: Features
which differentiate the man from woman.

Biologic growth
Male Puberty
The first sign of puberty in male is the
appearance of pubic hair. The milestone of
male puberty is the first ejaculation which
occur around 14 years. Fertility occurs several
months later. Sexual maturity is attained by 18
years.

Biologic growth
Female puberty
For females first sign of puberty is the
appearance of breast buds. The milestone of
puberty is menarche (first menstruation).
Ovulation usually starts 1-2 years after.
Female internal reproductive organs reach
adult size by 18-20 years.

Motor development
Masters over the skills of day to day
life. Hand and eye coordination
compared to that of an adult.

Cognitive development
(Piaget)

Formal operations
12-13 years- Uses scientific methods
of problem solving.
14-16 years-Expresses concern for
education versus vocational choice.
17-20 year- Further education or enter
a job.

Psychosexual development
(Freud)
Genital period : 11-16 years
Puberty and adolescence are periods
of genital sexual development.
Secondary sexual characteristics
appear. Develop sexual fantasies.
Adolescents are not fully sexually
mature but, they are capable of
reproduction.

Psychosocial development (Erikson)

Developmental task
Early & middle adolescent : Identity versus role
diffusion.
Adolescents are not interested in the groups of
children. They are not accepted in the adult clubs also.
This gives a sort of identity crisis. Adolescents help
one another through this identity crisis by forming
cliques and separate youth culture. They need
independence from parents and have to take their own
decisions.
The adolescent are much concerned about their
bodies, appearances, abilities and styles which give
them an identity. Those who conform to the same
category or style form a group and they develop a
group identity.

Psychosocial development
(Erikson)
The adolescents look for ideal persons whom
they can trust and model. They identify
themselves with this model. If the model is
good a positive personality is developed. If
the model is bad personality may be
distorted.
Sexual role identification is very important for
the adolescents. The male and female sex
roles are to be identified and accepted by
them. If they do not accept the appropriate
roles sex role confusions will develop.

Psychosocial development
(Erikson)
Late adolescent : Intimacy versus
isolation.
In late adolescence the heterosexual
relationship is given more importance. If
they can not develop an intimacy toward
an opposite sex member the future
sexual relationships may be affected.

Moral development (Kohlberg)

Young adolescent: Conventional morality - Stage 4
They obey social order and existing rules. They
examine own values, discard those acquired from
parents in favor of those found in peers.
Middle adolescent: Post conventional morality
Stage 5
Question the rules and laws of society. Conflict
with society.
Late adolescent: Post conventional Stage 6
Universal ethical principles. Respects other
humans and believes that relationships are based
on mutual respect.

Spiritual development (Fowler)

Synthetic conventional stage: World is

structured by the expectations and
judgment of others.
Young adolescent: Come across spiritual
disappointments. Finds out that prayers are
not answered on their own terms.
Middle adolescent: Modify certain religious
practices. Compare the standards set by
parents with those of others. Develops their
own standards.
Late adolescent: Decide on their own
religion and values.

Health promotion
1.

Health maintenance and immunizations.

Routine health assessments.
Periodic dental care.
Vaccinations:
MMR : Protects boys from mumps and
protects girls from rubella. Mumps can lead
to infertility in the boys where as rubella
infection to a pregnant woman results in
congenital abnormalities of the fetus.
-Td : Protection against tetanus.
-Hepatitis B

Health promotion
2.

Prevention of accidents.
Motor vehicle safety.
Avoid crazy driving.
Control the use of bikes and motor
cycles.
Sports safety.
Guidance and counseling from suicides
and homicides.

Health promotion
3.

Skin care

Good personal hygiene.

Control of body odor.
Daily bath and change of clothes.

Health promotion
4.

Nutrition

Balanced diet with all vitamins and

minerals.
1 quart of milk, adequate amount of
meat vegetables, fruits, breads and
cereals.
Regular meals.
Avoid unnecessary dieting.

Health promotion
5.

Rest and sleep

8-10 hours of sleep at night.

Health promotion
6.

Activity / exercise

Variety of physical activities.

Exercise programs.
Body building.
Play sports, music, dance reading,
onlooker plays.

Health promotion
7.

Sexuality

Avoid adolescent pregnancies.

Prevention of sexually transmitting
diseases.
Management of menstrual problems
and breast self examinations for girls.
Management of nocturnal emissions
and testicular self examination for
boys.

Health promotion
8.

Habits

Health education to avoid alcoholism,

drug addiction, smoking, chewing
tobacco.

Smoking

Tobacco consumption
Annual adult per capita consumption has been
decreasing since the mid 1980s, and as of the
early 1990s, averaged around 2,280 cigarettes. In
addition, about 400 tonnes of manufactured
tobacco is also used annually, presumably for
hookah smoking.
Tar/Nicotine/Filters Maximum tar and nicotine
levels for cigarettes in Kuwait are 12 mg. and 0.8
mg, respectively.

Prevalence
In 1991, smoking prevalence was 52% among
males and 12% among females. Prevalence
appears to have been relatively unchanged since
1979.
Smoking: Among male smokers, 39.0% of
Kuwaitis and 43.3% of non-Kuwaitis smoked more
than 30 cigarettes per day. Among female
smokers, 39.7% of Kuwaitis and 40.1% of nonKuwaitis smoked between 10 and 20 cigarettes per
day.
In 1991, smoking prevalence was 50% among high
school children aged 14-18 years, compared to a
reported prevalence of 24% in 1990.

Mortality from Tobacco Use

Age-standardized death rates for lung cancers are
comparatively high (35 for males and 15.3 for
females per 100,000 during the period 1985-1989).

Tobacco control measures

These are implemented jointly by governmental and
non-governmental organizations such as the Ministry of
Health and the Kuwait Society for Cancer Prevention
and others. In 1995, Kuwait implemented a number of
anti-tobacco
laws. products
Control
on tobacco
The plantation of tobacco or import of tobacco seeds
or plants (other than for scientific purposes) is
prohibited in Kuwait.
The importation of tobacco and tobacco products are
prohibited unless they satisfy the conditions
prescribed by the Ministry of Public Health. Maximum
permitted tar and nicotine levels have been fixed at
12mg. and 0.8mg.
Packets must carry a health warning.

Protection of non-smokers
Smoking is banned in health care institutions,
schools, theatres, cinemas and other public places
identified by the Minister of Public Health. There
are some workplaces which have smoking
restrictions. Some hotels assign some non-smoking
rooms and some restaurants allocate areas to nonsmoking.
Smoking is prohibited on buses and ferries.
Smoking is prohibited while driving a motor vehicle.
Smoking is prohibited while preparing food or
beverages to be served to customers.

Provisions for Health Education

Information on smoking and health is included in
school curricula.
Special in-service training courses about smoking
control have been arranged for doctors, teachers,
nurses and social workers. National and regional
workshops, seminars and conferences have been
organized.
Research projects and studies have been carried
out.
A smoking cessation clinic has been opened in
Kuwait.

Passive smoking
Breathing other people's smoke is called passive,
involuntary or secondhand smoking. The nonsmoker breathes "sidestream" smoke from the
burning tip of the cigarette and "mainstream" smoke
that has been inhaled and then exhaled by the
smoker. Secondhand smoke (SHS) is a major
source of indoor air pollution.

Effects of passive smoking

Non-smokers who are exposed to passive smoking
in the home, have a 25 per cent increased risk of
heart disease and lung cancer.
Passive smoking is a cause of lung cancer and
ischaemic heart disease in adult non-smokers.
Passive smoking is a cause of respiratory disease,
cot death, middle ear disease and asthmatic
attacks in children.

Risk to young children

Passive smoking increases the risk of lower
respiratory tract infections such as bronchitis,
pneumonia and bronchiolitis in children.
One study found that in households where both
parents smoke, young children have a 72 per cent
increased risk of respiratory illnesses.
Passive smoking causes a reduction in lung
function and increased severity in the symptoms of
asthma in children, and is a risk factor for new
cases of asthma in children.
Passive smoking is also associated with middle ear
infection in children as well as possible
cardiovascular impairment and behavioural
problems.

Effects on pregnancy
Exposure to passive smoking during pregnancy is
an independent risk factor for low birth weight.
Babies exposed to their mothers tobacco smoke
before they are born grow up with reduced lung
function.
Parental smoking is also a risk factor for sudden
infant death syndrome (cot death).

Developmental problems
1.

Acne

Wash affected area gently 3 times a

day.
Avoid greasy makeup.
Medications in case of infections.

Developmental problems
2.

Obesity

Limit food intake.

Avoid sweets and fried food.
Exercise schedule.

3. Bulimia and anorexia nervosa

Anorexia Nervosa

Over eating

Binge eating

Bulimia

Induce vomiting

Body image distortion

Developmental problems
3.

Bulimia and anorexia nervosa

Give proper attention.

Hospitalization.
Psychotherapy

Developmental problems
4.

5.
6.

Nocturnal emissions
Psychological support.
Masturbation
Generation gap: Clash with elders

Developmental problems
7.

Drug abuse, alcoholism, smoking & Delinquent

behaviors.

Identify the underlying causes.

Inform the hazards.
Raise the moral values.
Self help groups.
Psychotherapy
Counseling

Developmental problems

Dysmenorrhoea
Adolescent pregnancies
STD
Accidents
Dental problems
Postural defects