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Adolescent Assessment

Physical Growth and Development Adolescents grow rapidly and dramatically during this

period Major milestones include the onset of puberty and the

cessation of body growth Most girls are 1 to 2 inches taller than boys coming

into adolescence and generally stop growing three post menarche

Boys grow about 4 to 12 inches on height and gain 15 to 65 during adolescence

Girls grow 2 to 8 inches in height and gain 15 to 55 lbs.

Growth stops with closure of the epiphyseal lines of long bones- this occurs at about 16 or 17 years in females and about 18 to 20 years of age in males

Increase in body size does not occur in all organ at the same rate

Because the heart and lungs increase in size more slowly than the rest if the body, blood flow and oxygen availability are reduced. Thus adolescents may have insufficient energy and become more fatigued trying to do various activities that interest them

Androgen stimulates sebaceous glands to extreme activity, sometimes resulting in acne, a common adolescent skin problem

Apocrine sweat glands form shortly after puberty which produces a strong odor in response to emotional stimulation. Therefore, adolescents begin to notice they must shower or bathe more frequently than they once did in order to be free from body odor.

They gain their second molars at about 13 years of age and their third molars between 18 and 21 years of age

The jaw reaches adult size only toward the end of adolescence

Secondary sex characteristics distinguish the sexes from each other but play no direct part in reproduction.

The secondary sex characteristics that begin in the late school-age period continue to develop during adolescence

Both sexes do spend a great deal of time playing sports

Team loyalty is intense and following a coach’s instruction becomes mandatory

Young adolescents who do not have the physical ability to compete successfully in sports usually avoid these activities

Most adolescents spend a great deal of time just talking with peers as a social interaction

15-year old children may spend a great deal of time in their room or, if they do not have their own room, in a quiet corner of the home away from traffic and conversation areas.

By age 16, they want part-time jobs to earn money When families were larger, each of the older child had

responsibility for the younger sibling and baby care was a natural activity

Many adolescents engage in charitable endeavors during middle to late adolescence

Cognitive The final stage of cognitive development, the stage of

formal operations, begins at 12 or 13 years and grows in depth over the adolescent years

This step involves the ability to think in abstract terms and use the scientific method to arrive at conclusions

Problem solving in any situation depends on the ability to think abstractly and logically

With the ability to use scientific thought, adolescents can plan their future. They can create a hypothesis.

Personality-Temperament Early teen-agers feel more full of self-doubt than self-

confidence They want to look grown-up, but they still look like

children Most girl’s bodies have not yet fully developed; they

make look at themselves in the mirror and compare their profiles with those of the girls in popular magazines and feel inadequate

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Many 13-year old adolescents fall “in love”

Adolescents watch adults carefully during these period, searching for good role models with whom they can identify The role of temperament and gender in understanding adolescent-parent relationships is examined by exploring: (1) whether mothers' and fathers' temperaments influence the quality of their relationships with their sons and daughters; and (2) whether divergent relationships exist between adolescent temperament and adolescent-parent relationships for boys and girls. Adolescents (age 14 to 18; N= 82) and their parents completed instruments assessing their own temperaments and adolescents rated the quality of their relationships with each parent. Results support the link between parent temperament, particularly maternal temperament, and the quality of adolescent-parent relationships, possibly even overshadowing the role of adolescent temperament. Results also suggest divergent relationships between adolescent temperament and adolescent-parent relationships for boys and girls. Specifically, cross-gender patterns are identified.

Temperament is at the heart of this ongoing discussion because it is that portion of personality observable early in life and believed to be biologically based (Buss, 1989). Temperament is the "how" rather than the "what" of behavior (Thomas & Chess, 1977) and consists of relatively stable behavioral and emotional reaction patterns (Kagan, 1994). Personality theory links dimensions of temperament with those robust factors in personality assessment known as the "Big Five," which appear to transcend environmental factors (Angleitner & Ostendorf, 1994). As the search for precise genetic markers for temperament continues, a variety of interactionist approaches have been proposed to understand the various processes through which individual and contextual variables interact and influence development.

Communication

The voices of most boys have not yet dependably deepened, thus they cannot trust their voices to carry the serious tones they wish to convey

Fourteen-year olds are often quieter and more introspective than they were the year before

Emotional In early and midadolescence, developmental task is to

form a sense of identity that is to decide who they are and what kind of person they will be

In late adolescence, the task is to form a sense of intimacy or form close relationships with person of the opposite sex as well as the same sex

It is the concentration of these two tasks that leads to typical adolescent behavior

The four main areas where adolescents must make gains to successfully achieve a sense of identity are:

Accepting their changed body image Establishing a value system of what kind of

person they want to be Making a career decision Becoming emancipated from their parents

If adolescents 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. This can lead to their having difficulty achieving effectively as adults, because they are unable, for example, to decide what stand to take on a particular issue or how to approach new challenges or situations.

Play Girls: social functions, romantic TV shows, reading

romance books cooking, sewing, art and poetry, outings, movies, daydreaming, lengthy telephone conversations

Boys: group activities predominate (e.g. drinking sessions), sports, mechanical and electrical devices, part-time employment, outings, movies, parties

Diagnosis Health-seeking behaviors related to normal growth and

development Low self-esteem related to facial acne

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Anxiety related to concerns about normal growth and development

Risk for injury related to peer pressure to use alcohol and drugs

Readiness for enhanced parenting related to increased knowledge of teenage years

Planning and Intervention for Health Promotion Adolescent Safety

Accidents, most commonly those involving motor vehicles, are the leading cause of death among adolescents.

Parents need to have the courage to insist on emotional maturity rather than age as a qualification for obtaining a driver’s license

Drowning is another chief accident of adolescence, even though it is largely preventable

Teaching water safety, such as not swimming alone or when tired, is as important as teaching the mechanics of swimming

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.

Accidental gunshot injuries increase in early adolescence, often for the same reason that drowning increases: youngsters want to impress friends.

Athletic injuries tend to occur during adolescence because of the vigorous level of competition that occurs.

Overuse injuries result from poor conditioning Nutritional Health

Adolescents experience so much growth that they may always feel hungry

If adolescent’s eating habits are unsupervised, they will tend to eat faddish or quick snack foods rather more nutritionally sound ones

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

Adolescents who are slightly obese because of prepubertal changes may begin to low-calorie or starvation diets to lose excess weight

An adolescent needs an increased number of calories to maintain a rapid period of growth

Because vegetables generally contain fewer calories than meat, adolescents need to consume large amounts of them to achieve an adequate caloric intake with a vegetarian diet

Athletes need more carbohydrate or energy than do people who do not engage in strenuous activity, and the source of carbohydrate that best sustains athletes comes from the breakdown of glycogen because this supplies slow steady release of glucose

As a rule, the goals of nutrition that are best for everyone, such as eating a well-balanced diet, are also best for athletes, rather than diets that interfere with carbohydrate, fluid or fat intake

Adolescent Development in Daily Activities Maintaining adequate sleep, hygiene and exercise are

important and should become the adolescent’s responsibility rather than the parents’.

Parents can, however, encourage adolescents to engage in healthy patterns of living-primarily to role modeling.

Dress and Hygiene: They are capable of total self-care and because of their body awareness, they may even be overly conscientious about personal hygiene and appearance

Care of teeth: They are generally very conscientious about tooth brushing because of the fear of developing bad breath

Sleep: Although it is widely believed that adults need 8h of sleep a night, some need more and others can adjust to considerably less

Many adolescents attempt to get by with too little sleep, because they are constantly busy and because staying up late is a symbol of the adult status they long for

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Exercise: Adolescents need exercise everyday to maintain muscle tone and to provide an outlet of tension.

Although they are constantly on the go, they often receive little real exercise

Healthy Family Functioning Early adolescents may have many disagreements with

parents that seem partly from wanting more independence and partly from being so disappointed in their bodies

It is frustrating for children to be told by parents that they are too old to behave in a certain manner when they still don’t feel or look older

At other times, just when they begin to accept their maturing appearance, parents tell them they are too young to do something

Adolescents find even more fault in their parents and wonder how they can exist with their outdated ideas

They have trouble respecting parents who are so obviously imperfect

School marks may slump as a reflection of this “fallen angel” syndrome

These adolescents may follow health advice poorly because they view health care personnel in the same light

By the time they are 16, adolescents generally become more willing to listen and to talk about problems

Concerns related to Normal Development Hypertension

This is present if blood pressure is above the 95th

percentile, or 127/81 mmHg for 16 years old girls, 131/81 for 16 years old boys for two consecutive readings in different settings

Adolescents who are obese, are African American, eat a diet high in salt, or have a family history of hypertension are most susceptible to developing the disease

Poor Posture

Many adolescents demonstrate poor posture, a tendency to round shoulders and a shambling, slouchy walk

This is due in part to the imbalance of growth, the skeletal system growing a little more rapidly than the muscles attached to it

Poor posture particularly seems to develop in adolescents who reach adult height before their peers

They slouch to appear no taller than anyone around them

Body Piercing and Tattoo These are becoming a mark of adolescence Contemporary adolescent and young adult culture has

embraced tattooing and body piercing, ostensibly as a form of self-expression. It seems that if not tattooed themselves, there are very few degrees of separation between any adolescent and someone in their life who bears a tattoo or is pierced somewhere on their body. 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.

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

These acts have become a way for adolescents to make a statement: I am different from you!!

Be certain they know the symptoms of infection at a piercing or tattoo site and to report these to a health care provider if they occur

Caution them that sharing needles for piercing or tattooing carries the same risk of sharing needles for intravenous drug therapy

Fatigue So many adolescents comment that they feel fatigued

to some degree that this can be considered normal for the age group

Because fatigue may be a beginning symptom of disease, however , it is important that it be investigated as legitimate concern and not underestimated

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If an adolescent’s sleep and diet appear to be adequate, the activity schedule is reasonable and physical assessment suggests no illness, then the fatigue may be of emotional origin

It could be a means of avoiding alcohol, avoiding conflict with parents or avoiding social situations

Those who are under stimulated by school may develop fatigue as a sign of boredom

Teenagers should be offered guidance to solve the problem with better diet, more sleep, fewer activities, and development of better problem-solving techniques to relieve tensions

Menstrual Irregularities These can be a major health concern of adolescent

girls as they learn to adjust to their individual body cycles

Acne Acne is a self-limiting inflammatory disease that

involves the sebaceous glands that empty into hair shafts mainly on the face or the shoulders

It is the most common ski disorder of adolescence, occurring slightly more frequently in boys than in girls

Studies show that during adolescence close to 100% of the population has at least an occasional whitehead, blackhead or pimple—regardless of race or ethnicity. These studies also confirm that acne most frequently occurs between the ages of 12 and 20. The likelihood of developing acne is greatest during adolescence because hormone levels become elevated. Elevated hormones stimulate the sebaceous glands, glands that are attached to hair follicles, to produce greater amounts of sebum—an oily substance. An acne lesion (whitehead, blackhead or pimple) occurs when a hair follicle becomes plugged with the sebum and dead cells. In most cases, acne begins between the ages of 10 and 13 and usually lasts for 5 to 10 years. In some adolescents, more severe acne follows the development of comedones, reaching a peak 3 to 5 years after the first comedones appear. Adolescent acne commonly disappears

between the ages 20 and 25. However, severe acne, also known as nodular acne or cystic acne, may not resolve until 30-plus years of age

Source:Pilitterri, A., 2003. Maternal and Child Health Nursing: Care of

the Childbearing and Childrearing family. Philippines: Lippicott Williams and Wilkins.