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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
 Cognitive
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
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 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
 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
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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
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 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
 Anxiety related to concerns about normal growth and
development
 Risk for injury related to peer pressure to use alcohol and
drugs
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 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
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 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.
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 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
 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
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 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
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 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
 If an adolescent’s sleep and diet appear to be
adequate, the activity schedule is reasonable and
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physical assessment suggests no illness, then the begins between the ages of 10 and 13 and usually
fatigue may be of emotional origin lasts for 5 to 10 years. In some adolescents, more
severe acne follows the development of comedones,
… It could be a means of avoiding alcohol, reaching a peak 3 to 5 years after the first comedones
avoiding conflict with parents or avoiding appear. Adolescent acne commonly disappears
social situations between the ages 20 and 25. However, severe acne,
also known as nodular acne or cystic acne, may not
 Those who are under stimulated by school may resolve until 30-plus years of age
develop fatigue as a sign of boredom

 Teenagers should be offered guidance to solve the

problem with better diet, more sleep, fewer activities, Source:
and development of better problem-solving techniques
to relieve tensions Pilitterri, A., 2003. Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing family. Philippines: Lippicott
 Menstrual Irregularities Williams and Wilkins.

 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