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Adolescent Development, Risk & Safety – Lecture Vocabulary

Pain Management in Hospitalized Adolescents

  • Put NON-PHARMACOLOGICAL options first; combine with drugs when needed.
    • Pictures/virtual reality, preferred music, computer or video games.
    • Deep-breathing, guided imagery, distraction, humour.
  • Children >5 yr can use self-report pain scales; always obtain and honor their rating.
  • Balance autonomy & rules: adolescents dislike feeling over-controlled but still need limits.

Developmental Stages of Adolescence

  • Three overlapping stages (know age range, start & end points):
    • Early / Pubescence (≈ 12–13 yr; lasts ≈2 yr).
    • Begins with dramatic growth spurt (same spurt that ENDS the school-age period).
    • Girls enter ≈2 yr earlier than boys.
    • Ends at reproductive maturity.
    • Middle:
    • Starts at reproductive maturity.
      • Girls → Menarche (first menstruation).
      • Boys → First nocturnal emission ("wet dream").
    • Abstract & critical thinking expand; pronounced mood swings.
    • Late:
    • Ends when linear growth ceases (full adult stature).

Primary vs. Secondary Sex Characteristics (exam: match column!)

  • Primary (directly required for reproduction):
    • Testes, sperm production (male); Ovaries, menarche (female).
  • Secondary (visible markers):
    • Both sexes: axillary & pubic hair, acne (over-active sebaceous glands), body odor (apocrine glands).
    • Male-specific: facial hair, deepening voice (larynx & vocal cords enlarge), thicker skin, genital enlargement.
    • Female-specific: breast (mammary) development, fat redistribution (hips widen).

Physical Growth & Body Systems

  • "Feet grow first" – often out of proportion before height catches up.
  • ↑ Muscle mass, lung volume, cardiac output → athletic potential & huge appetites (esp. males).
  • Brain: Frontal lobe (executive function) not fully myelinated until ext{~24 yr}.

Neuro-cognitive Implications & Risk Taking

  • Immature frontal lobe + heightened limbic reward system ⇒ sensation seeking.
    • "Nothing bad will happen to me" phenomenon.
    • Testosterone amplifies amygdala reactivity – emotional decisions in males.
  • Common risky behaviours: texting while driving, unprotected sex, substance use, shoplifting, dares.

Cognitive, Motor & Language Development

  • Formal-operations thought: can manipulate symbols, understand algebra/trig, future plans.
  • Gross motor: strength & speed ↑; transient clumsiness while fine motor catches up.
  • Vocabulary explodes yet heavy use of slang; adolescents may perceive “foreign language” gap with adults.
    • Example heard in class: “skibbidi”.

Psychosocial & Emotional Themes

  • Ambivalence: crave independence and parental support; unique and desire to fit in.
  • Peers > Parents for advice & approval; rejection → intense self-consciousness.
  • Parent–teen relationship: maintain unconditional love, keep communication lines open.
  • Kohlberg moral reasoning:
    • Early teens – motive = \text{authority approval}.
    • Older teens – motive = personal principles/conscience.
    • Strategy: dialogue & reflection strengthen reasoning.

Gender, Sexuality & Inclusive Care

  • Generational shift: 50\% of 18–34 yr view sex/gender as a spectrum vs. binary.
  • LGBTQ+ stats (know numbers):
    • 5\times ↑ likelihood of ≥2 mental-health disorders.
    • \approx35\% report bullying; \approx20\% experience sexual violence.
    • Avoid/delay care due to perceived bias → nurses must ask pronouns, provide safe space.
  • Suicide risk linked to mistreatment, not inherent orientation.

Depression & Suicide

  • Rising sadness/hopelessness, especially females.
  • Major contributors: overwhelming demands, complicated relationships, negative self-reflection.
  • New mental-health emergency line 988 (use instead of 911 for suicidal crises – reduces lethal-force encounters).

Dating Violence & Safe Dating

  • Higher risk when alcohol/drugs involved; encourage group dating.
  • Teach code-word system with parents for quick, stigma-free “rescue”.
  • Reinforce: victim is never to blame.
  • Long-term outcomes of teen dating violence: impaired ability to form healthy adult bonds.

Gang Involvement

  • Join to meet unmet needs: belonging, protection, status, finances.
  • Familial pattern common.
  • Warning signs: unexplained money, weapons, new tattoos/colors.
  • Prevention: strengthen family bond, after-school programs, mentorship.

Social Media – Risks & Phenomena

  • Benefits: connection, identity expression, marginalized youth find community.
  • Harms: predators, addiction, body image disorders, misinformation.
    • Snapchat dysmorphia: request cosmetic surgery to match filtered selfies.
    • Bigorexia (muscle dysmorphia) – mostly males.
    • Looks-maxing: extreme regimens, sometimes intentional bone breaks.
    • Crunchy-teen orthorexia: obsessive "clean" eating.
    • Popcorn brain: reduced sustained attention from rapid multitasking.
  • Parental guidance: set limits, encourage offline friendships & hobbies.

Substance Use & Abuse

  • Two prime drivers: risk-taking trait + desire to fit in.
  • Marijuana: most common; adolescent use can permanently blunt pre-frontal development → lifelong executive deficits.
  • Alcohol + caffeine (e.g., energy drinks) hides intoxication but spikes HR & BP.
  • Abuse = any use that disrupts daily function (school, work, relationships).
  • <\tfrac13 of teens with addiction receive evidence-based treatment – screen & refer!

Non-Oral Alcohol Routes (high-yield for exam)

  • "Eyeballing" vodka → corneal burns/vision loss.
  • Rectal or vaginal administration ("butt-chugging", vodka tampons) → bypass GI safeguards, higher BAL, no vomiting.
  • Motives: rapid high, avoid odor/calories, conceal from adults.

Vaping & Other Substances

  • JUUL & similar disguised as flash drives; deliver high-dose nicotine → appetite suppression & dependence.
  • OTC misuse: large doses of cough meds, antihistamines, or caffeine strips (“gel slugs”) at "pharm" parties.
  • Synthetic cannabinoids (Spice/K2): dried herbs soaked in rat-poison chemicals → seizures, psychosis; sold as "not for human consumption".
  • Inhalants (huffing paint/propellants): sudden sniffing death, brain & myocardial damage.

Firearm Safety Education

  • Begin early; adapt depth to age stage.
  • Eddie-Eagle style 4-step rule: Stop → Don’t Touch → Leave Area → Tell Adult.
  • Differentiate real vs toy (orange tip on toys).
  • Discuss school shootings frankly; foster respect, demystify "wow" factor in controlled environment.
  • Study: even trained kids often handled found gun unsafely → supervision & secure storage still essential.

Nutritional Issues

  • Rapid growth = higher needs; common deficits mirror highest needs:
    • Calcium (dairy, leafy greens) – bone mass accrual.
    • Iron, protein if dieting or vegetarian.
  • Obesity trend ↑; use motivational interviewing to set realistic activity & diet goals.

Motivational Interviewing With Teens & Parents

  1. Affirm & Build Rapport ("Tell me about your interests").
  2. Elicit Goals ("Where do you see yourself in 5 yr?").
  3. Explore Discrepancies (guide teen to notice how behaviour hinders goal).
  4. Offer Information & Support only with permission.
  • Teach parents to replace confrontation with curiosity-based dialogue.

Safety & Leading Causes of Death

  • Top teen mortality: Accidents → Suicide → Homicide.
  • Driving: #1 accidental cause; texting, speed, no seat belt.
    • Encourage graduated licenses, zero-tolerance phone use.
  • Water: wear life-jacket on body, not just in boat; everyone sober – no “designated boater”.
  • Dating code-word, situational awareness.

Quick Reference Numbers & Facts

  • Puberty lasts \approx2 yr; girls start 2 yr earlier.
  • Frontal lobe fully developed \sim24 yr.
  • LGBTQ+: 5\times ↑ dual disorders; 35\% bullying; 20\% sexual violence.
  • Emergency: Suicide line 988.
  • <\tfrac13 teens receive addiction care.
  • 18–34 yr: \approx50\% see gender as spectrum.