Adolescent

General Growth Spans and Pace:
- Adolescent growth and development spans ages $11\text{--}21\,\text{years}$ .
- This period is marked by dramatic changes in size and appearance.
- The pace of physical growth in adolescence is second only to that in infancy.
- Growth is accompanied by important psychological changes.
- Primary and secondary sexual characteristics are acquired during this period.
Female Physical Growth and Development:
- Girls experience the budding of breasts and growth of pubic hair.
- Growth in height in girls ceases $2\text{--}2\frac{1}{2}\,\text{years}$ after menarche.
- Fat deposits increase in females.
- Girls achieve reproductive maturity $2\text{--}5\,\text{years}$ after menarche.
Male Physical Growth and Development:
- Boys experience testicular and penile enlargement.
- Boys experience voice changes, facial hair growth, and genital enlargement.
- Growth in height in boys is slower than in girls and ceases between $18$ and $20\,\text{years}$ of age.
- Muscle mass increases in males.
Psychosexual Development and Sexual Maturity:
- Sexual maturity is categorized using Sexual Maturity Ratings (SMRs; Tanner stages).
- Significant hormonal changes occur during adolescence.
- The initiation of pubertal development is occurring earlier than ever before.

Motor Development:
- Adolescents engage in various forms of motor activity, including aerobic exercise, team sports, and dance.
- Motor activity provides an opportunity for competition, teamwork, and building social relationships.
- Large muscle mass increases in adolescents.
- Coordination of gross and fine muscle groups improves.
Cognitive Development:
- Cognitive thinking during adolescence transitions from concrete to abstract reasoning.
- Formal operations characterizes the last stage of cognitive development (Piaget).
- Key aspects of formal operational thought include:
  - Inductive and deductive reasoning.
  - Ability to connect separate events.
  - Understanding of consequences.
  - Understanding of complex concepts using analytical methods.
Sensory Development:
- Eyes and ears are fully developed in adolescents, with specific exceptions:
  - Refraction errors.
  - Minor infections.
  - Myopia occurs in early adolescence.
- Eye injuries are common among adolescents.
- Protective equipment should be worn during athletic activities.

Language Development:
- Adolescents are able to express themselves verbally.
- Adolescents who read are more articulate and possess a broader vocabulary.
- Self-confidence plays a significant role in verbal expression.
- Social media has contributed to abbreviated communication.
- Communication with a teen can be challenging.
Early Adolescence ( $11\text{--}14\,\text{years}$ ):
- Intense feelings about body image.
- Quite egocentric.
- May move from obedience to rebellion.
- Believe everyone is critical of them.
- Audience conscious (Elkind).
- Belief that bad things only happen to others.
Middle Adolescence ( $15\text{--}17\,\text{years}$ ):
- Considered the most frustrating period of adolescent development.
- The teen becomes introspective and narcissistic.
- Characterized by testing of limits, withdrawal, and rebellion.
- Extreme interest in the opposite sex.
- Engagement in vocational exploration.
- Interest in gangs.
Late Adolescence ( $18\text{--}21\,\text{years}$ ):
- Demonstrates the ability to think abstractly.
- Ability to conceptualize verbally and express thoughts and feelings.
- Conformity becomes less important.
- Self-esteem increases, and the adolescent can resist peer pressure.
- Emancipation occurs (leaving home).
- Social relationships become more mature.

Moral and Spiritual Development:
- Develops a respect for law and a society-maintaining orientation (Kohlberg).
- Questions the values of family and society.
- Integrates experiences and beliefs into a personal moral framework.
- Spirituality has a positive effect on health-related quality of life in adolescence.
Age-Related Play and Activities:
- General Activities:
  - Games and athletics are the most common forms of play.
  - Strict rules are in place during play.
  - Competition is important.
- Specific Games and Play:
  - Sports, videos, movies, reading, parties, hobbies, listening to favorite music, experimenting with makeup, playing computer games, talking on the phone, and use of social media.

Nursing Goals for Sports Physical Examinations:
- Assess general health.
- Identify situations that could limit participation or predispose the athlete to injury.
- Assess physical and psychosocial maturity.
- Determine fitness level.
- Assess legal insurance requirements.
- Provide wellness counseling and anticipatory guidance.
Requirements for the Athletic Adolescent:
- Adequate equipment.
- Appropriate training schedule.
- Frequent rest periods.
- Adequate fluids to prevent injury, dehydration, and exhaustion.
- Appropriate removal when concussion is suspected.

General Healthcare Needs:
- Adolescence is generally a period of wellness.
- Health care is commonly sought for sports physicals, skin conditions, acute minor illnesses, and sexuality.
Nutritional Challenges and Influences:
- Age-Related Nutritional Challenges:
  - Fast food and "junk" foods.
  - Eating disorders.
  - Social aspects of food gain importance.
  - High need for nutritional guidance.
- Factors Influencing the Adolescent's Diet:
  - Busy schedule.
  - Body image concerns.
  - Skipping breakfast.
  - Eating away from home.
  - Eating fast food frequently.
  - Beginning to buy and prepare food.
  - Peer pressure.
  - Psychological and emotional problems.
Personal Hygiene:
- In general, adolescents are meticulous about personal hygiene.
- Acne is a common hygiene and skin concern.
Dental Care:
- Cavities decrease.
- Third molars (wisdom teeth) may erupt.
- Potential dental concerns include gingivitis, malocclusion, and trauma to the mouth.
Sleep, Rest, and Activity:
- Sleep and Rest:
  - Shows a propensity for staying up late.
  - Difficulty waking up in the morning.
  - Requires $6\text{--}8\,\text{hours}$ of sleep during the week.
  - Requires $12\,\text{hours}$ of sleep on weekends.
- Exercise and Activity:
  - Involvement in many activities.
  - Ideal time to promote physical fitness.

Safety and Injury:
- Injuries claim more lives during adolescence than all other causes of death combined.
- Key safety domains include:
  - Car safety.
  - Alcohol use and motor vehicle crashes.
  - Water safety.
  - Suicide.
  - Violence toward others.
  - Firearms.
Factors Contributing to Adolescent Violence:
- Low socioeconomic status.
- Crowded housing.
- Single-parent family.
- Limited supervision.
- History of family violence.
- Access to guns.
- Limited education.
- Racism.
- Drug abuse.
- Low self-esteem.
- Aggression.

Body Art:
- Body piercing.
- Tattoos.
Lifestyle and Environmental Concerns:
- Tanning.
- E-cigarettes ("vaping").
Sexual and Relationship Issues:
- Sexual activity.
- Relationship violence.
- Teen pregnancy.
- Sexually Transmitted Diseases (STDs).