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period of self-examination and emerging identity that spans the second decade, during which
individual changes from being “childlike to adultlike”
The physiologic period between the beginning of puberty & cessation of bodily growth
Divided into:
Peers are usually same sex and age, peer acceptance paramount
Concrete cognition
Limited dating
Limited ability to link cause and effect in regard to health behavior (eg,
smoking, reckless driving, overeating)
Peer group remains very important for social and behavioral norms
Self-identity established
The term puberty refers to the physical changes that occur in a growing girl or boy during the transition from
childhood to adulthood
Puberty is the period in which an individual first becomes capable of reproduction
- Bone age (skeletal maturity) may be disparate by as much as two years from chronological age and still be normal
- Individuals who begin growth spurt early are initially taller than peers,but they will ultimately be relatively shorter
than those who begin their growth spurt later
Five chief physical manifestations of Puberty
-Most girls are 1 to 2 inches taller than boys coming into adolescence
and generally stop growing three years post menarche
-
Secondary Sexual Characteristics
Stage I (Preadolescent) –
Only the papilla is elevated abovethe
level of the chest wall.
Stage I Preadolescent
• Stage V –
Stage I (Preadolescent)
Stage II
- Sparse, long, pigmented,
downy hair, which is straight or
only slightly curled, appears.
These hairs are seen mainly
along the labia.
II
Sparse, pigmented,
long, straight,
mainly along labia
Stage III
Stage V
- Hair is adult in quantity and type and appears IV
to have an inverse triangle of the classically Adult, but
feminine type. There is spread to the medial decreased
distribution
surface of the thighs but not above the base of
the
inverse triangle.
V
Adult in quantity
and type with
spread to medial
thighs
The stages in male pubic hair development are as follows :
• Stage I (Preadolescent)
• Stage II
III
Darker, coarser,
curlier
Stage IV
V
Adult in quantity
and type with
spread to medial
thighs
Stages of Testicular Development
Stage I (Preadolescent
Stage II I
Preadolescent
II
Enlargement,
change in texture
Stage III
• Stage IV III
Growth in length and
circumference
- The penis is significantly enlarged in length and
circumference, with further development of the glans
penis. The testes and scrotum
continue to enlarge, and there is distinct darkening of
the scrotal skin. This is difficult to evaluate on a
black-and-white photograph. 10 to 15 mL
volume IV
Further development of
glans penis, darkening
• Stage V of scrotal skin
- The genitalia are adult with regard to size and
shape. 15 to 25 mL volume
V
Adult genitalia
II. DEVELOPMENT OF SEXUAL
MATURITY
-As adolescents mature emotionally and sexually, they may begin to engage
in sexual behaviors.
Sexual experimentation
world views become important and the individual enters what is called a
"psychological moratorium”
“Psychological moratorium”
- refers to a period of exploring different roles, values, and skills.
The four main areas where adolescents must make
gains to successfully achieve a sense of identity are:
-
Management:
1. imaginary audience
2. personal fable
Management:
- Parents need to have the courage to insist on emotional
maturity rather than age as a qualification for obtaining a
driver’s license
Management:
- Teaching water safety, such as not swimming alone or when
tired, is as important as teaching the mechanics of swimming
3. The second most common cause of death among
adolescents is homicide, r/t to the easy availability of guns to
teenagers.
- Gang violence and the desire to protect them from
this add to this problem
3. Some may turn away from the five pyramid food groups
to eat great quantities of sweets, soft-drinks, or empty
calorie snacks which leaves them poorly nourished
despite the large intake
- Sports stars, rock stars and movie and television icons are
covered in images and piercings; but we expect that of them,
for they are in the public eye
2. Both sexes have ears, lips, chins, navels and breasts pierced
and filled with earrings or tattoos applied to the arms, legs or
their central body
3. These acts have become a way for adolescents to make a
statement: I am different from you!!
Amenorrhea
- An acne lesion (whitehead, blackhead or pimple) occurs when a hair follicle becomes
plugged with the sebum and dead cells.
1. Emotional Stress
2. Menstrual Periods
3. Use of greasy hair creams or make-up that can further plug gland
ducts
Pharmacological Tx:
Nsg Resposibilities:
Alternative Names:
- Spinal curvature; Kyphoscoliosis
3. Degenerative scoliosis - This may result from traumatic (from an injury or illness)
bone collapse, previous major back surgery or osteoporosis (thining of the bones).
4. Idiopathic scoliosis - The most common type of scoliosis, idiopathic scoliosis, has
no specific identifiable cause. There are many theories, but none have been found
to be conclusive. There is, however, strong evidence that idiopathic scoliosis is
inherited.
SCOLIOSIS
• Idiopathic scoliosis
- Lateral deviation and
rotation of the spine
without an identifiable
cause
Scoliosis
Adolescent idiopathic scoliosis
MC form of idiopathic
Scoliosis
Curve progression is
most likely with
Curve > 20 degrees
Age at dx < 12
Symptoms Of Scoliosis
2. Observation
3. Orthopaedic bracing
4. Surgery
5. Exercises
3. Orthopedic bracing
4. Surgery
Based on likelihood of curve
progression
Curve Magnitude
Age at DX
Skeletal Maturity
Presence of Menarche
before after
5. Exercises
1. Swimming is an ideal form of exercise for many complaints that
involve the spine as it frees the joints from bearing weight,
allowing the body to stretch and can be done as gently or as
vigorously as your condition allows.
3.Walking is low impact and has the added benefit of increasing your
overall health. Walking can be done vigorously overlong distances,
or casually as an alternative to more intensive exercise
SCOLIOSIS
A person is considered obese when the total body weight is minimum ten
percent more than the recommended weight for his/her body structure and
height.
BMI
Underweight Less than 18.5
Normal range 18.5–24.9
Overweight 25–29.9
Obese >30
- Obese children between the age of ten and thirteen have eighty percent chances
of growing into obese adults, unless they change their ways and adopt a
healthier lifestyle.
complex neuroendocrine/metabolic systems regulate energy intake, storage, and
expenditure
Aetio-pathogenesis of Obesity
• Causes of obesity remain elusive – likely heterogeneous
4. Cultural factors
— relate to composition of the diet and to changes in the level of
physical activity.
5. Lifestyle
- overeating, bad eating habits, sedentary activities
6. Emotional
- low self-esteem, depressions, emotional problems, stressful life, family problem
7. Medical Disorders
– e.g. Cushing Dyndrome
- medications- eg. steroids
HEALTH
CONSEQUENCES OF
OBESITY
In addition:
6) Some researchers find that obesity is killing people ; in other words, it mean that
it leads to death.
MANAGEMENT
1. Its very important that obese people have the
confidence to try to lose weight
Drink a lot of water or sugar free drinks and stay
away from sugary juices and sodas .
Stop eating when
you feel full and
avoid eating when you
feel bored and upset
Start small
changes and eat
healthy food and
do exercise daily
The important things is don’t miss breakfast and
replace white bread and drink low fat milk.
Get moving to cut calories, take an
aerobics class and try dancing
6. Drugs
• There’s no such thing as a magic weight-loss pill
• Two most commonly used drugs:
a) Sibutramine- acts on the brain making the person feel full sooner or
longer
• Cultural pressures
• Psychological issues
• Family environment
• Genetic factors
• Life transitions
• Perpetuating factors
Cultural Pressures
• In many societies, being extremely thin is the standard of beauty for
women and represents success, happiness, and self-control.
• Women are bombarded with messages from the media that they must
diet to meet this standard. However, this idealized ultra-thin body
shape is almost impossible for most women to achieve since it does
not fit with the biological and inherited factors that determine natural
body weight.
Psychological Issues
Psychological characteristics that can make a person more likely to develop anorexia
nervosa include:
• Low self-esteem
• Feelings of ineffectiveness
• Depression
• Perfectionism
• Overprotective
• Rigid
• Suffocating in their closeness
• Beginning of adolescence
• Beginning or failing in school or at work
• Breakup of a relationship
• Death of a loved one
• Dieting and losing weight can also set off anorexia nervosa
Perpetuating Factors
Once anorexia nervosa has developed, several factors can
perpetuate the disorder. These factors include:
• Symptoms of starvation
• Other people's reactions to the weight loss
• Emotional needs filled by feelings of self-control, virtue, and
power from controlling one's weight
• The resulting cycle makes it more difficult to stop the
disorder and become healthy again.
The resulting cycle makes it more difficult to stop
the disorder and become healthy again.
Effects of Anorexia
Problems associated in weight loss include lowering of:
• Heart rate
• Blood pressure
• Breathing rate
• Body temperature (which may result in feeling cold)
• Thinning or drying of the hair “Lanugo" hair (a fine hair that develops
on the face, back, or arms and legs)
• Dry skin
• Restlessness and reduced sleep
• Yellowish color on the palms of the hands and soles of the feet
• Lack of or infrequent menstrual periods
• Dehydration & Acidosis from starvation
• Death!
Facts about Anorexia Nervosa
• About 90% to 95% are females between ages 13
and 30. However, anorexia nervosa can also
occur in males and people of all ages.
• Starvation
• Dehydration
• Muscle and cartilage deterioration
• Osteoporosis
• Irregular or abnormally slow heart rate
• Heart failure
Hospitalization
- If the patients life is in danger.
Nursing Mgt:
• Constant supervision
• Monitoring vitals
• Parenteral (intervenuous) feeding
• Establishing trust & effective communication
Treatment team
• Doctors !
• Psychologists
• Psychiatrists
• Psychiatry nurses
• Social workers
• Physiotherapist
• Occupational therapist
• Dietitian
• Nutritionists
• Nurses
• Caretakers
• Health visitors
Pro ana and wannarexia
• Pro-ana is a group of people
who promote and support
anorexia as a lifestyle.
• Wannarexia is a group of
people who claim to have
anorexia or they would like to
have.
Adolescent Substance
Abuse
Substance abuse
• is using a drug in a way that is inconsistent
with medical or social norms and despite
negative consequences
Terms:
• Intoxication is use of a substance that results in maladaptive behavior
• Mood and affect: may be tearful, expressing guilt and remorse; angry,
sullen, quiet, unwilling to talk
Assessment: cont’
• Thought processes and content: minimize substance use, blame others
for problems, rationalize their behavior, say they can quit on their own
• Ineffective Denial
• Ineffective Coping
Outcomes / Goals:
The client will:
• Suicidal gesture- any action that appears to be a suicide attempt but that is actually
contrived or manipulative and that results in only minimal harm, such as superficial
cut on the wrist or small overdose of sleeping pills. Suicide threat- verbal threat to
commit suicide.
• Completed suicide- suicide attempt resulting in death
•Suffering
•Stress
•Grief
•Suicide headache
•Unrequited love
Enhancing self-esteem
Coping skills training
Internal attachment – making meaning
External attachment - peer network
Talk therapy –emotional support
Problem solving, decision making
Person centered approach
Cognitive behavior therapy
1. Preoperative chemotherapy
followed by surgery to remove
the tumor
2. Amputation of the limb
3. Thoracotomy – to remove the
tumor with lung metastasis ff by
chemotherapy postop
Assessment:
• A bone tumor should be suspected in any teen
with persisting deep bone pain, swelling and an
abnormal x-ray of the area.