Ch 10 - Adolescence

Adolescence Definition

• Transition between childhood and adulthood
• Period of rapid physical, cognitive, emotional, and sexual maturation
• Habits and identity formed now have lifelong effects

Stages of Adolescence — Early (10–13 yrs)

• Rapid physical growth, puberty begins
• Body awkwardness and self-consciousness
• Concrete thinking
• Depends on peers for approval

Stages of Adolescence — Middle (14–16 yrs)

• Abstract thinking starts
• Emotional ups and downs
• Experimentation and risk-taking
• Rebellion against authority
• Strong peer loyalty

Stages of Adolescence — Late (17–20 yrs)

• Identity and values solidify
• Better empathy and self-control
• Realistic career and relationship goals
• Reconnects with family values

Major Developmental Tasks

• Establish personal identity
• Become less dependent on parents
• Plan for career and long-term goals
• Form close peer and intimate relationships
• Stage: Erikson’s Identity vs. Role Confusion

Identity vs. Role Confusion — Outcomes

🟢 Success → Confidence and stable self-concept
🔴 Failure → Role confusion, insecurity, rebellion

Physiological Changes

• Rapid height and weight increase
• Asynchronous growth (limbs grow faster → clumsiness)
• Active sweat and oil glands → acne and odor
• Increased appetite and enlarged stomach/intestines
• Eruption of molars and wisdom teeth
• Improved coordination and strength

Physical Activity Guidelines

• 60+ minutes of physical activity daily
• At least 3 days/week of vigorous exercise
• Include warm-up and cool-down
• Strength training improves bone and muscle mass
• Builds confidence and helps manage stress

Puberty Overview

• Triggered by hypothalamic hormones → pituitary → gonads
• Results in ability to reproduce
• Involves physical and emotional changes

Puberty in Boys

• Begins between ages 10–13
• Testosterone and androsterone increase
• Testes and penis enlarge
• Hair growth on face, body, and pubic area
• Voice deepens (after temporary cracking)
• Muscle mass increases
• Spermatogenesis starts mid-puberty → fertility
• Normal: nocturnal emissions, acne, body odor

Puberty in Girls

• LH & FSH trigger estrogen and progesterone
• Menarche (first period) ~10–15 yrs
• Menstrual cycle (~28 days): follicle → ovulation → thickening → menstruation
• Secondary traits: breast growth, hair, fat redistribution, body contour changes
• Teach menstrual hygiene and body care

Birth Control — Abstinence

• 100% effective
• Protects against STIs ✅

Birth Control — Hormonal

• Examples: pill, patch, ring, implant, IUD
• Regulates ovulation
• Does not protect from STIs ❌

Birth Control — Barrier

• Examples: condoms, diaphragm
• Protects against STIs ✅
• Must be used correctly each time

Birth Control — Permanent

• Vasectomy or tubal ligation
• Irreversible
• No STI protection ❌

Sexual Activity & Education

• ~400,000 U.S. teens give birth yearly
• Reasons: peer pressure, curiosity, coercion
• Early sex education lowers risk
• Teach:

Consent and readiness

STI and pregnancy prevention

Respect for body and relationships

Cognitive Development (Piaget)

• Early: concrete thinking (literal)
• Middle/Late: formal operations (abstract, logical)
• Post-formal: combines logic with emotion
• Frontal lobe still maturing → impulsive, instant gratification
• Needs adult guidance for good decisions

Cognitive Traits

• Rapid and complex thought processes
• Self-consciousness (“imaginary audience”)
• Risk-taking and invincibility beliefs
• Daydreaming helps manage emotions safely

Moral Development (Kohlberg)

• Post-conventional stage
• Motivated by approval and social norms
• Later develops personal moral principles
• Moves from “right vs wrong” → “right for me and others”

Psychosocial Development

• Goal: build self-identity and autonomy
• Family provides security and guidance
• Social skills and reasoning develop
• Risk factors: rejection, conflict, substance use
• Substance use = leading cause of adolescent death

Substance Use Risks

• Early use increases addiction risk
• Affects brain, academics, and safety
• Smokeless tobacco → oral cancer
• Vaping → toxic exposure
• Resources: teen.smokefree.gov | Text iQUIT (47848)

Social Media — Benefits

• Educational opportunities
• Social connection
• Self-expression and creativity

Social Media — Risks

• Exposure to adult or violent content
• Cyberbullying, sexting, and exploitation
• Harmful advertisements
• Creates lasting digital footprint
• Teach safe and responsible use

Development of Responsibility

• Teens seek independence and challenge
• Encourage money management and decision-making
• Parents should guide, not control
• Use positive reinforcement and model responsibility

Cultural Considerations

• Culture shapes beliefs, thinking, and health practices
• Nurses must be culturally competent
• Rituals (bar mitzvah, quinceañera) mark transition to adulthood
• Cultural stability helps identity and belonging

Peer Relationships

• Central to emotional and social development
• Provide belonging and support
• Isolation → low self-esteem and risky behavior
• Parents should encourage healthy friendships

Sexuality, Sex, Gender, and Orientation

• Includes biological sex, gender identity, and orientation
• Influenced by biological, social, and cultural factors
• Forming a sexual identity is essential to self-concept
• Intimate relationships often develop in late adolescence

Nursing Care for Sexuality

• Use inclusive language and pronouns
• Provide nonjudgmental and supportive care
• Teach safe-sex and emotional well-being
• Recognize and support gender dysphoria

Nursing Care — Key Takeaways

• Maintain privacy and trust
• Address nutrition, sleep, hygiene, and activity
• Promote positive body image
• Teach safe habits: seat belts, helmets, protection, no drugs/alcohol
• Support parents in providing structure
• Screen for mental health, substance use, and online safety