Prepared by:

Hazel Jane M. Tan

 ADOLESCENCE

-is the period during which the person becomes physically and
psychologically mature and acquires a personal identity.
-at the end of the development, the person should be ready to enter
adulthood.

-length is determined culturally.

PHYSICAL GROWTH
-         MAJOR MILESTONE OF DEVELOPMENT

1.      ONSET OF PUBERTY
2.      CESSATION OF BODY GROWTH
Puberty – is the first stage of adolescence in
which sexual organs begins to grow and
mature.
Menarche – onset of menstruation occurs to
the girls
Ejaculation –expulsion of the semen occurs
to the males

Puberty normally starts between:

• Girls - 10 – 14 years.
• boys – 12 – 16
• Three stages adolescent period:
– Early adolescence
• 12 - 13
– Middle adolescence
• 14 - 16
– Late adolescence
• 17 – 18 or 20 years
Physical development
• Growth is accelerated. “Adolescent growth
spurt”
• Boys – begings at ages 12 -16
• Girls – begins 10 – 14
Physical Growth
• Girls – 1-2in taller than boys before
adolescence
– Stops grwing within 3 years from menarche
– Grows: 2-8 inches in height
– Gains: 15 to 55 pounds in weight
– Maximum ht reached at about 15 to 16 years.
• Boys – grows 4 – 12 inches in ht
– Gains: 15 to 65 pounds in wt
– Maximum ht reached at 18 or 19 years

– Physical growth is influenced by: heredity,

nutrition, medical care, illness, physical and
emotional environment, family size, and culture.
– Growth is noted in the musculoskeletal system
• Head, hands and feet are the first to grow to adult
status
• Extremities reach their adult size
 • Extremities grow before the trunk (leggy, awkward)
• After trunk grows to full size. Shoulders, chest, and
hipsgrow
• Forehead becomes more prominent, jawbones
develop
Glandular changes
– Eccrine and apocrine glands increase their
secretions and becomes fully functional during
puberty
– Eccrine- (over most of the body) produce sweat
– Apocrine – (axillae, anal, genital, external
auditory canals, umbilicus, areola) release
sweatdue to emotional stimuli only
 – Sebaceous glands – becomes active, which
create sebum, becomes more active in the face,
neck, shoulder, upper back, and chest (acne)

Sexual Charatceristics
• Primary Sexual Characteristics
– Relate to organs necessary for reproduction
(testes, penis, vagina, uterus)
• Secondary Sexual Characteristics
– Differentiate the male from the female
– Pubic hair, breast development, voice changes
• Males – appearance of pubic hair, enlargement of
scrotum and testes
– Milestone: ejaculation (14 years old)
– Sexual maturity @ 18
• Females – (noticeable sign of puberty) breast bud,
appearance of hair in labia
– Milestone: menarche occurs 2 years after breast bud
– Ovulation: 1-2 years after menarche
– Female internal productive organs reach adult size @
18-20
Psychosocial Development
Erik Erikson
ERIKSON (1993)

EARLY AND MIDADOLESCENT

-Form a sense of identity that is to

decide who they are and what kind of
person they will be.
-Form cliques

LATE ADOLESCENT
-The task is to form a sense of intimacy or
form close relationships with persons of the
opposite as well as the same sex.
-Sexual experimentation (sexual activity is
often included)
 FOUR MAIN AREAS TO ACHIEVE A SENSE OF
IDENTITY:

1. accepting their changed body image

2. establishing a value system or what kind of person they want to be

3. making a career decision

4. becoming emancipated from their parents

If young persons do not achieve a sense of identity, they

develop a sense of role confusion or can have little idea what
kind of person they are
 Value System

Adolescents develop the values through talking to

peers. They also need an attentive adult ear,
someone who will listen to their fears, hopes,
dreams, and the pressure they feel to be somebody,
the pressure of wanting to do something and yet not
knowing what or how.

Emancipation from Parents

Emancipation from parents can become a major issue during the middle and
late adolescent years for two reasons.

1. Some parents may not yet be ready for their child to be totally independent;
2. Some adolescent may not yet be sure they want to be on their own.

Note: parents are confused to their children’s hostility – icreases controls

which adolescents rebel at.
-Tend to be loud and boisterous
-Spends more time longing for someone

-Often quieter and more introspective

then 13 year olds
-Has more confidence and self-
esteem
-Often forms a friendship of the same
age
-Falls in love 5 to 6 times a year
-Most relationship are based on physical
attraction

-Boys sexually matures

-Left behind childish behaviors
-Jean Piaget
-Begins at 12 to 13 years and grows over the
adolescent years / 11-15
-Has the ability to think in abstract terms and
uses the scientific method to arrive at
conclusions (imaginative and idealistic)
-Logic, organized, consistent
 -Kohlberg – conventional level of moral
development
With formal reasoning adolescents are
able to respond with the question:

Why is it wrong to steal from your neighbors house?

“It would hurt my neighbor by requiring him to spend money to

replace what I stole.”

Rather than the immature respond of the school age child

:The police will punish me.
-Almost all adolescent question the existence
of God and the religious practices they have
been taught.
-According to Fowler – synthetic-conventional
stage of spiritual development
-Present an open, accepting attitude to
adolescents questions and statements
regarding spiritual matters
-Arrange to see a member of their religious
faith
-Provide a comfortable environment
 Heath Problems
• Motor-vehicle crashes
• Homicides
• Suicide
• Other unintentional injuries (falls,
drowning, poisoning)
is the act of terminating one's own life.
the metaphorical sense of "willful destruction of one's self-interest"
it is one of the leading causes of death in the world.
 Warning sign of suicide: 

Ideation (thinking, talking or wishing about suicide)

Substance use or abuse (increased use or change in substance)

Purposelessness (no sense of purpose or belonging)

Anger

Trapped (feeling like there is no way out)

Hopelessness (there is nothing to live for, no hope or optimism)

Withdrawal (from family, friends, work, school, activities, hobbies)

Anxiety (restlessness, irritability, agitation)

Causes: 

Depression

Substance abuse (alcohol and drugs)

Anger with others

Loss of a parent

Loss of a girlfriend or boyfriend

Loss of community

Loss of self-esteem
Prevention: 

Tell someone you trust what's going on with

you.

Be around people who are caring and positive.

Ask someone to help you figure out what to

do about a problem you're facing.

Work with a therapist or counselor if problems

are getting you down and depressed — or if
you don't have a strong support network, or
feel you can't cope.
is a road traffic incident which usually involves one road
vehicle colliding with, either another vehicle, another road user,
or a stationary roadside object, and which may result in injury or
property damage, or possibly death.
Causes: 

Driver behavior

Speed choice

Driver impairment

Alcohol abuse

Cardiac disease or neurologic

Disorder

Violating traffic rules

Stress
 Prevention: 

Establishing and enforcing a written policy requiring drivers and passengers to use seat
belts.

Conducting driver's license background checks on prospective employee drivers before

they are hired.

Ensuring that drivers comply with designated speed limits, and prohibiting workers
from driving on the job when they are fatigued.

Making sure employees in construction and maintenance zones wear high-visibility

clothing and use appropriate barriers and traffic control.

Training drivers in safe driving practices and proper use of vehicle safety features.

Establishing written procedures for proper maintenance of vehicles.

Equipping vehicles with the latest safety features, such as anti-lock brakes.
 DROWNING

- is death as caused by suffocation

when a liquid causes interruption of
the body's absorption of oxygen from
the air leading to asphyxia. The
primary cause of death is hypoxia
and acidosis leading to cardiac
arrest.
Prevention:

Teaching the Children on how to swim.

Following the safe water rules such as:

Never swim alone
No diving into shallow end of swimming pools
No hyperventilating before swimming under water
No swimming beyond limit

Dares has no place in water safety.

refers to the act of killing another
human being. Is one of the common
causes of death among teenagers,
related to the easily accessibility of
guns to teenagers
Prevention:

Always consider the gun is loaded and

potentially lethal.

Encourage the clients to learn safe gun

handling before attempting to clean a gun or
hunt.
Common health problems of
Cause
adolescents
Hypertension - it occurs as a secondary
manifestation of another disease or
health problems.
Poor posture -Imbalance growth; the skeletal
muscle growth is more rapid than the
muscles attached to it.
-Lack of self – confidence.
-Result of carrying back pack that
are too heavy.
Body piercing and tattoos -The adolescents “new” way of
expressing themselves.
Nursing management
Educate parent and child about the
long term effect of hypertension in
adolescents (increased risk of
developing heart diseases).
In obese adolescents with essential
hypertension:
a.Place on a weight reducing diet.
b.Urge to increase level of exercise.
Urge adolescents to use good
posture during this rapid growth
years and point-out advantages of
having a good posture.
Be certain that they know the
symptoms of infection at a piercing
or tattoo site and report his to the
health care provider if they occur.
Caution them that sharing needles
for piercing or tattooing carries the
same risk as sharing needles for IV
Fatigue -Lack of rest because
adolescents, sometimes, in an
attempt to be popular, they
tend to take on a schedule that
would exhaust three people.
Assess adolescents’ diet,
sleep patterns and activity
schedules.
Discuss lifestyle changes
and limitations that need to be
imposed to eliminate fatigue.
Assist client to identify
appropriate coping behaviors
Common health problems of
Cause
adolescents
Menstrual irregularities -The mechanisms that control
ovulation and menstruation aren’t
mature yet and missed period are
common.
Nursing management
 Advise client to:
a. Eat citrus fruits. Eat or drink
with your meals to enhance
iron absorption into the body,
since iron is easily depleted
during menstruation.
Exercise regularly. This increases
circulation to the pelvic region
and helps clear out
prostaglandins.
Try using sanitary pads. Tampons
can cause cramping.
Do the pelvic tilt to relieve cramps.
Lie on your back with your
knees bent and your feet flat.
Tighten your abdominal
muscles and your buttocks and
raise your pelvis, angling it
toward your head. Press your
lower back to the floor, and
hold the position for a few
seconds. Gently lower your
buttocks to the floor. Repeat
several
ACNE -Increase in androgen levels that
cause the activation of sebaceous
glands.
-Bacteria (Proprionibacterium
acnes) lodge and thrive in the skin
(face, neck and shoulders)
-Emotional stress
-Menstrual periods
-Use of greasy hair creams and
make-up (cosmetics)
Obesity -Genetic, hereditary,
environmental, metabolic
and eating disorders.
-Medical Conditions such as
hypothyroidism, that can also
cause weight gain
Advice the client:
a.Not to prick or squeeze the acne
lesions which rupture gland and
secrete sebum into the skin.
b.Avoid make-up and greasy hair
greasy hair preparations.
Encourage client to wash daily
to remove excess sebaceous gland
secretions and irritating fatty acids.
Reduce diet of fewer than 1,400
– 1,600 cal/day. Made up of about
60% fat, 10% carbohydrate, and
30% protein.
Urge the adolescent to exercise
more frequently.
 ADOLESCENTS IS AT RISK OF ENGAGING:

Sexual Intercourse

Stalking

Concerns Regarding Hazing

Concerns Regarding Substance Abuse

 Types of Substance Abuse:

Tobacco

 Alcohol

Anabolic Steroid Abuse

 Marijuana

Amphetamines

Cocaine  Hallucinogens

Opiate
- Runaways are commonly defined as a
adolescent between the ages of 10 to 17
years who have been absent from home at
least overnight without permission of a parent
or guardian
 Health Assessment and
Promotion
• Screening for tobacco, alcohol, and drug
use and for sexual practices, and checking
blood pressure, height, and weight.