Chapter 20: Caring for the Developing Child (Adolescence)

Question 1

Age for Adolescence

Answer 1

12 to 19 years

Question 2

Physical Development

Answer 2

• begins with onset of puberty when the pituitary gland relays messages to sex glands to manufacture hormones necessary for reproduction
• period of great growth, second only to infancy; while the growth rate is not as dramatic as that of the earlier stage, it is still significant
• not unusual for girls to gain 15 to 35 lbs and grow 2 to 8 inches (5 to 20 cm) before reaching maturity
• not unusual for boys to gain 15 to 66 lbs and grow 4 to 12 inches (10-30 cm) before reaching maturity
• girls develop earlier than boys and tend to have smaller overall physical structure
• both boys and girls develop primary and secondary sex characteristics at this stage; timing of development is variable

Question 3

Cognitive Development

Answer 3

• corresponds with Piaget’s Formal Operational stage
• able to think abstractly and uses logic to solve problems and to test out hypotheses
• uses deductive reasoning and can think about thinking
• concerned with such things as philosophy, morality, and social issues
• able to project thoughts over the long term, thus making plans and setting life goals
• compares beliefs with those of peers

Question 4

Language Development

Answer 4

• has highly developed and sophisticated language skills
• ability to speak and write correctly
• able to communicate and debate alternative points of view

Question 5

Psychosocial Development

Answer 5

• according to Erikson, the adolescent crisis is concerned with identity versus role confusion
• adolescent must begin to identify who she is and who she will be in life
• major sources of influence over an adolescent is the peer group; members of the peer group offer differing viewpoints, allow for establishment of strong relationships, and provide the opportunity for the adolescent to practice adult behaviors by becoming active within a social group and increasingly self
• sufficient
• three major issues that must be confronted by the adolescent: selecting an occupation, establishing and subscribing to a set of values, and developing a satisfactory sexual identity; as the adolescent makes these decisions, she becomes more confident in her abilities and gradually develops a sense of who she is becoming

Question 6

Three major issues must be confronted by the adolescent

Answer 6

1. selecting an occupation
2. establishing and subscribing to a set of values
3. developing a satisfactory sexual identity
   >as the adolescent makes these decisions, she becomes more confident in her abilities and gradually develops a sense of who she is becoming

Question 7

Legal Alert- Include the adolescent in the informed consent process

Answer 7

Informed Consent= a way to elicit permission that is given freely that protects a person’s right to autonomy and self-determination
-informed consent is given when the person understands the usual procedures, their rationales, and associated risks
-a parent or legal guardian customarily gives informed consent on behalf of the child
-as children gain critical thinking skills, they can become more active in the consent process
-depending on state law, children under the age of 18 can give legal informed consent under these circumstances: when they are minor parents of the child patient, when they are seeking birth control, counseling, or help for substance abuse, or when they are self-supporting (emancipated)
>in many states, a pregnant teen is considered emancipated and can provide informed consent
-the physician is responsible for explaining the procedure and related risks, and the nurse’s role is to serve as a witness to the signature of a parent for the minor child or an emancipated adolescent
-the nurse is responsible for notifying the physician if the parent (or legal guardian) does not understand the procedure or related risks

Question 8

Nurse’s Role and Informed Consent

Answer 8

-the physician is responsible for explaining the procedure and related risks
>nurse’s role is to serve as a witness to the signature of a parent for the minor child or an emancipated adolescent
>nurse is responsible for notifying the physician if the parent (or legal guardian) does not understand the procedure or related risks

Question 9

Depending on State Law, Children under the age of 18 can give informed legal consent under these circumstances:

Answer 9

• when they are minor parents of the child patient
• when they are seeking birth control, counseling, or help for substance abuse
• when they are self-supporting (emancipated)

Question 10

Moral Development

Answer 10

• at this stage, conflicts emerge between what the adolescent has believed to be right or wrong and what others may believe
• this is a time of great questioning and consternation as the adolescent learns that it is possible for several views of morality to exist

Question 11

Helping the Adolescent make Goal Decisions

Answer 11

nurse can be influential in helping the adolescent make healthy decisions:

• Listen: pay close attention not only to what the adolescent is saying, but also to her nonverbal cues; try to understand her view of the world and stay open minded
• Discuss without judging: the nurse can share a personal understanding of the issues and various perspectives while respecting those of the adolescent
• Encourage critical thought: allow the adolescent to explore and further develop her options

Question 12

Discipline

Answer 12

-stage where she begins to internalize responsibility for behavior
-still needs parental input and guidance in terms of rules (e.g. curfew, home-work, chores etc) and possible consequences for infractions, but much more able than in any previous stage to monitor and regulate her own actions based on her own critical thinking
-it is important in this stage, as in all others, that the parent focus on the positives of the adolescent’s behavior
-natural consequences are powerful motivators, but by this time, the adolescent may have learned that she can avoid consequences by being crafty
>removing privileges may be an effective consequence for the adolescent’s poor decision making

Question 13

Anticipatory Guidance

Answer 13

-adolescence is deeply influenced by the peer group; spends a great deal of time with her peers, often foregoing family activities in favor of time with friends
-depending on the peer group, there may be peer pressure to drink alcohol, smoke, experiment with illicit drugs, or engage in sexual activity
>parents must keep the lines of communication with their adolescent open and teach her how to resist peer pressure
-important for the adolescent to identify a trusted adult with whom she can talk about sensitive issues and from whom to get advice

Question 14

Anticipatory Guidance: Nutrition

Answer 14

• provide 3 healthy meals and 2 to 3 healthy snacks per day
• avoid high-fat, processed, and “fast” foods
• manage weight through exercise and healthy nutrition

Question 15

Anticipatory Guidance: Health Promotion

Answer 15

• immunizations
• oral health
• discuss sex, sexual feelings, protection against sexually transmitted infections
• if having sex, discuss birth control and safe sex practices
• discuss smoking and substance abuse avoidance
• symptoms of stress and how to deal with it

Question 16

Anticipatory Guidance: Focus on Safety

Answer 16

• seat belts
• driving safety
• sports and water safety
• sunscreen
• avoid tanning salons

Question 17

Anticipatory Guidance: Sleep-wake patterns

Answer 17

-require 8 to 10 hours of sleep per night

Question 18

Anticipatory Guidance: Physical Development

Answer 18

• explain development of secondary sex characteristics
• females: explain menstruation and masturbation
• males: explain masturbation and nocturnal emissions

Question 19

Anticipatory Guidance: Cognitive and Emotional Development

Answer 19

• praise academic success
• monitor for academic struggles
• encourage new challenges
• model respect for differing opinions and needs of others
• model conflict resolution strategies
• expect increasing independence from family
• peer groups and activities with peers are increasingly important
• provide for some privacy at home
• development of intimate relationships
• teach to balance school, work, and peer group participation
• begin planning for future

Question 20

Anticipatory Guidance: Motor Development

Answer 20

• daily regular exercise

- support participation in organized sports

Question 21

Anticipatory Guidance: Discipline

Answer 21

• increase levels of responsibility at home to foster movement to adulthood
• restriction of privileges

Question 22

Developmental Milestones of the Adolescent (12 to 18 years)

Answer 22

> Physical Growth:
-Variable
-Girls Weight: increases 15-55 lb
-Girls Height: 2-8 inches
-Boys Weight: 15-66 lbs
-Boys Height: increases 4 to 12 inches
-both genders develop secondary sex characteristics
Gross Motor Skills:
-begins to develop endurance; increases speed, accuracy, and coordination; develops the necessary skills for an identified interest (sports, hobbies)
Fine Motor Skills:
-manipulates complicated objects; high skill level playing video games and using computer; good finger dexterity for writing and other intricate tasks; precise eye-hand coordination
Cognitive, Sensory, and Language:
-abstract thought well developed; uses logic to solve problems; projects thoughts over long term to develop future plans; increased concentration so can follow complicated instructions; senses tied into body image; develops adult preferences based on senses; Language: continues to develop and refine with increased vocabulary up to 50,000 words; improved communication skills; converses with increasing abstract thought and analysis
Psychosocial:
-peer group primary social environment; desires parent involvement yet pushes parent away at the same time; begins to explore romantic relationships; concentrates on goals and life plans
Play:
-cooperative play continues within peer group, team sports, school or community activities, and dating; enjoys solitary time