ADOLESCENT (12 or 13-18)

- the period of primary and secondary sex characteristics begin to develop and mature

- transition period between childhood and adulthood

- subdivided into 3 parts:

Early adolescent – 11 to 14 years old

Middle adolescent – 15 to 17 years old
Late adolescent – 17 to 20 years old

Definition of terms:

PUBERTY – a period of several years in which rapid physical growth and psychological changes

occur, culminating in sexual maturity; being functionally capable of reproduction

ADOLESCENCE – the period of development during which the individual makes the

THELARCHE – beginning of breast development changes during puberty; comes from two

Greek words: “thele” which means nipple and “arche” which means beginning

ADOLESCENT – refers to the psychological maturation of the individual

MENARCHE – first menstruation; it is the first menstrual cycle, or first menstrual bleeding in

female human beings

GROWTH SPURT – it is a sudden increase in the rate of growth in all diresctions

GYNECOMASTIA - excessive development of male breast tissue; a transient occurrence in

normal adolescence

- a male disease and is any growth of an adipose and glandular tissue in male

Breast

ADOLESCENT GROWTH SPURT – a period during adolescence of rapid growth rate, usually

expressed as the age of peak height velocity

BIOLOGIC DEVELOPMENT

- the gross motor has reached to adult level and the fine motor continue to be refined

HORMONAL CHANGES

- puberty involves a predictable sequence of hormonal and physical changes

- starts with the production of GONADOTROPIN RELEASING HORMONE (GnRH) by the hypothalamus
then stimulates the anterior pituitary gland to produce FSH and LH

- in females:

 FSH stimulates the production of estrogen and the growth of ovarian follicles
  LH initiates ovulation, formation of corpus luteum and progesterone production

- in males:

 LH acts as testicular laydig cells prompting the maturation of testicle and testosterone production

- SEX STEROIDS – estrogen, progesterone, testosterone and other androgen arew released from the
gonads and affect biologic changes in various organs like muscles, bones, skin and hair follicles

INITIATION OF PUBERTY

- during childhood, the receptor sites in the hypothalamus are so highly sensitive that circulating sex
hormones are sufficient to inhibit the secretion of gonadotropin releasing hormone

- at puberty, the hypothalamus losses its negative sensitivity which allow the pituitary gonadal mechanism
to attain full secretory function

CHANGES IN THE REPRODUCTIVE SYSTEM

- FEMALE primary sex characteristics:

 Release of an egg or ovum

 Early puberty, production of FSH, estrogen and progesterone
 Mid-puberty, production of large amount of estrogen causing the building of endometrial lining then
the first menstruation or menarche
 Production of mature ovum occur one more year after menarche

- MALE primary sex characteristics:

 Viable sperm, where the FSH acts on the testicular cells to produce sperm
 LH causes increased production of testosterone – analogous to menstruation or ovulation in
females
 Production of viable sperm tends to follow the boys’ first ejaculation which appears one year after
initial testicular enlargement and appearance of pubic hair
 Androgen and testosterone promote growth of testes and penis, scrotum, prostate and seminal
vesicle

SEXUAL MATURATION

PUBERTAL SEXUAL MATURATION

- sex characteristics using TANNER STAGES, named after the original researcher, James Tanner, a British
paediatrician on sexual maturity

Female breast development:

Stage 1: prepubertal
Stage 2: breast buds
Stage 3: further enlargement of breast and areola
Stage 4: projection of areola and papilla to form a secondary mound
Stage 5: adult configuration

Male genitalia development:

Stage 1: prepubertal
Stage 2: initial enlargement of the scrotum and testes with rogation and reddening of
the scrotum
Stage 3: lengthening of the penis, testes and scrotum farther enlarge
 Stage 4: increased length and width of the penis and development of glands, scrotum
darkens
Stage 5: adult pattern

Pubic hair development of male and female:

Stage 1: prepubertal
Stage 2: sparse, long, straight downy hair
Stage 3: darker and coarser, sparse over entire area
Stage 4: dark, curly, abundant at pubic area
Stage 5: adult pattern

SEXUAL MATURATION

- Girls

 Thelarche – changes in the nipple and areola and development f small buds of breast
tissue and usually occur at 11 years with range of 19 to 13.5 years old
 Pubarche – appearance of pubic hair which occur 2 to 6 months after breast
development
 Physiologic leukorrhea – normal increase in vaginal discharges
 Menarche – first menstruation
 13-15 years old – pubic hair thick and curly, triangular in distribution; breast areola
and papilla form secondary mound; menstruation is ovulatory,
making pregnancy possible
 15-16 years old – pubic hair curly and abundant; may extend onto medial aspect of
thighs; breast tissue adult and nipples protrude; areolas no longer
project as separate ridges from breasts; may have some degree of
facial acne
 16-17 years old – end of skeletal growth

- Boys

 Testicular enlargement
 Thinning, reddening and increased looseness of the scrotum which occur at 9.5-14 years
old
 Early pubertal, there is penile enlargement, appearance of pubic hair, testicular enlargement
 Spermarche – the first ejaculation which occur spontaneously as nocturnal emission or wet
dreams
 13-15 years old – growth spurt continues; pubic hair abundant and curly; testes, scrotum and
penis enlarging further; axillary hair present; facial hair fine and downy; voice changes happening
with annoying frequency
 15-16 years old – genitalia adult pattern, pubic hair abundant and curly; scrotum dark and
heavily rugated; facial and body hair present; sperm production matures
 16-17 years old – pubic hair curly and abundant (adult pattern), may extend along medial aspect
of thighs; testes, scrotum and penis adult in size; may have some degree of facial acne;
gynecomastia, if present, fades at this time
 17-18 years old – end of skeletal growth, could extend to 18 to 20 years

PHYSICAL GROWTH AND PHYSIOLOGIC CHANGES

- Growth is more on weight leading to stocky, slightly obese prepubescence, later comes the
thin, gangly appearance of late adolescence
- Boys grow about 4-12 inches in height and gain 15-65 lbs in weight
- Girls grow 2-8 inches in height and gain 15-55 lbs in weight
- Growth stops with closure of the epiphyseal lines of the long bones. This occurs at about 16
years or 17 years of age in females and about 18-20 years of age in males
- Heart and lungs increase in size more slowly than the rest of the body; blood flow and 0 2
availability are reduced, thus, they have insufficient energy and become fatigued trying to do
 the various activities that interest them
- PR and RR decrease slightly (70bpm and 20cpm), BP slightly increases (120/70 mmHg)
- Androgen stimulates sebaceous glands to extreme activity which causes acne development
- Apocrine sweat glands (glands present in the axilla and genital area) form shortly after puberty
which produces a strong odor in response to emotional stimulation. The reason why
adolescents begin to notice they must have shower or bathe more frequently to be free of body
odor.
- The major milestones of development i the adolescent period are the onset of puberty and the
cessation of body growth

- 4 main focus of physical changes:

 Increased growth rate of skeleton, muscle and vixera
 Sex-specific changes
 Alterations in distribution of muscle and fat
 Development of reproductive system and secondary characteristics

- Eccrine sweat glands fully develop and sebaceous glands become active
- Testosterone – is a hormone associated in boys with the development of genitals, an increase
in height and change in voice
- Estradiol – is a hormone associated in goals with breast, uterine and skeletal development
- During puberty girls experience increase in height and weight, breast development and
increase pelvic girth with expansion of uterine tissues
- Boys during puberty increased in height and weight, muscle mass, penis and testicle size,
facial and body hair grow, voice deepen, nocturnal emission of seminal fluid
- Growth spurt – refers to the general increase in growth of skeleton, muscles, internal organs,
which reaches a peak rate at about 12 years old in girls and 14 in boys

PSYCHOSOCIAL DEVELOPMENT (IDENTITY VS. ROLE CONFUSION)

- The developmental task in midadolescence is to form a sense of identity, they decide who
they are and what kind of person they will be
- The radius significant others is the peer group
- They continue to redefine their self concepts and the roles that they can play with certainty
- Role confusion or having little idea what kind of person they are occur if they don’t achieve a
sense of identity
- An adolescent who can’t develop a WHO they are and WHAT they can become may experience
role confusion and an inability to solve core conflict

4 MAIN AREAS IN WHICH ADOLESCENTS MAKE GAINS TO SUCCESSFULLY ACHIEVE A SENSE OF

IDENTITY:
Accepting their changed body image
Establishing a value system or what kind of person they want to be
Making a career decision
Becoming emancipated from their parents

BODY IMAGE
- Adolescents who develop a strong sense of industry during their school age have learned to
solve problems and are best equipped to adjust to the new body image
- Educate them about their bodies and help them to always accept the changes that marks
maturity
- Those with low self-esteem may need parental or health care provider support to understand
that a person’s worth is based on more tha physical appearance

SELF-ESTEEM
- Major changes of self-esteem include:
Changes in one’s body and physiologic functioning
Changes in feelings and emotional focus
Changes in social relationships
Changes in family and school expectations
VALUE SYSTEM
Need to talk to peer to develop value
Need an attentive adult ear, someone who will listen to their fear, hopes and dreams
Dress identically with other members of the group

CAREER DECISION
 Part of knowing what kind of person you are is knowing what kind of job you can do
 They are encouraged to wait until they have been in college for 2 years before choosing a major

EMANCIPATING FROM PARENT

- An issue during the middle ad late adolescent for two reasons:
 Some parents may not yet be ready for their child to be totally independent
 Some adolescents may not yet be sure that they want to be on their own

PSYCHOSOCIAL DEVELOPMENT
 Genital stage which extend from about age 12-20, adolescent focus on the genitals as an
erogenous zone and engage in masturbation and in sexual relation with others
 During this period of renewed sexual drive, adolescent experience conflict between their own
needs for sexual satisfaction and society’s expectation for control of sexual expression
 The core concerns of adolescents include body image, development and acceptance by the
opposite sex

SEXUAL DEVELOPMENT
 Engage in sexual activity for pleasure, to satisfy drives and curiosity as a means of conquest or
power; to express and receive affection and in response to peer pressure
 Education about sexual function begun during the school age and should expand to cover the
physical growth, hormonal and emotional changes of puberty

COGNITIVE DEVELOPMENT
- Final stage of cognitive development which is the formal operation begins at 12-13 years old
- This involves ability to think in abstract terms and use the scientific method to arrive at –
conclusions
- Thinking abstractly is what allows adolescents to project themselves into the minds of others
and imagine how others view them or their actions (display compassion)
- Develop a special type of egocentrism and begin to think about personality

- Their egocentric thought has 2 parts:

 Imaginary audience: the adolescent believe that the others are as preoccupied with her as
herself. Attention getting, wants to be on stage, noticed and visible
 Personal fable: is the belief that one’s feelings and experience are completely unique. Example:
The girl thinks that in no way the mother sense the hurt she feels because her boyfriend broke
up with her.

- When the adolescent are given information about another person, they consider previous information ad
current information don’t rely so much on the concrete information
- More likely to detect contextual or situational variability in their own and other’s behaviour rather than
think that they and others always behave consistently
MORAL AND DEVELOPMENT

- Young adolescence function at a conventional level of moral development in which absolute moral
guidelines from authorities are followed
- Emergence of principal moral reasoning – absolutes and rules come to be questioned
- Almost all adolescents question the existence of God and any religious practices they have been taught
- This is natural part of forming a sense of identity and establishing a value system at a time in life when
they draw away from their families
- Able to respond to question about right and wrong rather than with immature response at school age

SPIRITUAL DEVELOPMENT

- Beliefs become more oriented toward spiritual and ideological matters and less oriented towards rituals,
practices and the strict observance of religious customs
- Religious beliefs are to become more personalized and less bound and traditional religious practices
which they were exposed to when they were young

SOCIAL DEVELOPMENT

- Early teenagers feel more of self doubt than self confidence

- Both male and female tend to be loud and boisterous particularly when peers of the opposite sex whose
attention they would like to attract are nearby
- They are impulsive and very much like 2-year old that they want what they want immediately
- 13 years old – fall in love
- 14 years old – often quieter and are more introspective; have more self-confidence and more self
esteem
- Usually have a hero- a film star, writer, scientist, etc. whom they want to grow up to be like, the reason
why they form friendship with older adolescent of the same sex, trying to imitate that person
- 15 years old – falls in love 5 to 6 times a year; sexually attracted because of physical appearance not
by inner qualities or characteristics
- Infatuation is fleeting which leads to extremely intense but brief attachments that fade
- 16 years old – boys are becoming sexually mature

SELF CONCEPT AND BODY IMAGE

- Body image and related self concepts are significant factors

- Adolescents are usually their own worst critics

- safety concerns:

 When teaching adolescents about safety, keep in mind that adolescent commonly feel that they are
invulnerable
 Likely to take risks and often don’t consider safety before action
 This behaviour contribute substantially to motor vehicle accident through:
- inexperience and poor judgment
- reckless driving or speeding
- driving under the influence of drug or alcohol
- failure to use seatbelt
- unsafe driving practices in response to peer pressure
 Prone to accidents from unsafe use of bicycles, skateboards, motorcycles and boats
 Gunshot is another source of accident death
IMMUNIZATIONS

- hepatitis B vaccine
- hepatitis A vaccine
- influenza vaccine
- measles, mumps, rubella
- pneumococcal polysaccharide vaccine
- tetanus, diphtheria and toxoids
- varicella virus vaccine

SLEEP AND REST

- over exertion in activities and a tendency to stay up late which commonly interferes with sleep and rest
requirements
- in an attempt to “catch-up” on missed sleep, many adolescent sleep at every opportunity

EXERCISE AND ACTIVITY

- although they are always on the go, they often receive little real exercise
- those who are involved in structured athletic activity do receive daily exercise

NUTRITION

- daily intake should balance among food groups ad other requirements like caloric intake
- girls
 11 to 14 years old – 48 kcal/kg/day
 15 to 18 years old – 38 kcal/kg/day
- boys
 11 to 14 years old – 60 kcal/kg/day
 15 to 18 years old – 42 kcal/kg/day
- milk for calcium and protein are needed in sufficient quantities to promote muscle and bone growth

DENTAL HEALTH

- generally very conscientious about tooth brushing because of fear of developing bad breath
- continues to use a fluoride paste rather than a brand advertised as providing white teeth
- some may develop cavities for the first time during this period

PERSONAL CARE

- capable of total self-care and because of their body awareness, they may even be overly conscientious
about personal hygiene and appearance
- often wash their hair everyday
- acutely aware of what their peers are wearing, so that when they can’t trust or are disappointed in their
Bodies, it is very reassuring to be dressed exactly like everyone else

SEXUALITY EDUCATION

- adolescent needs accurate, complete information on sexuality

- moral and cultural values information must be included like how pregnancy occur, methods of preventing
pregnancy, stressing that both partners are responsible for contraception; responsible for transmission of
and protection against sexually transmitted disease especially AIDS
COMMON HEALTH PROBLEMS

1. Hypertension – BP of 127/81 mmHg for 16 years old girls

- BP of 131/81 mmHg for 16 years old boys

2. Poor posture – round shoulder and shambling, slouchy to walk

- urge children to use good posture during rapid growth years

3. Body piercing and tattoos – caution them about the spread of infection and report to health care
Provider if this occurs
4. Fatigue – can be a sign of boredom; blood test may be indicated to rule out anemia

5. Menstrual irregularities

6. Acne – stress out proper hygiene

7. Obesity

8. Substance abuse: drugs, alcohol, tobacco, etc.

9. STD, unintended pregnancies