G&D2

Preadolescence/Pubescence

• Occurs at the end of the school-age years

• Developmental stage from 10-14 years

• Marked by rapid physiological changes with accompanying psychological and social implications

• Puberty signifies appearance of secondary sex characteristics at ages 10-12 years

Development of Primary and Secondary Sex Characteristics

Female Primary Sex Characteristics

• Increase in size of internal and external genitalia

• Changes in endometrial lining and vaginal secretions

• Ovulation begins, leading to menarche

Female Secondary Sex Characteristics

• Increase in breast size

• Bone growth and increased basal metabolic rate (BMR)

• Changes in shape of the female pelvis

• Increased fat deposits in breasts, buttocks, and thighs

• Development of pubic and axillary hair patterns

Male Primary Sex Characteristics

• Growth and development of testes, scrotum, and penis

• Production of male sperm

Male Secondary Sex Characteristics

• Changes in body hair distribution

• Increase in size of vocal cords

• Increased thickness of skin and sebaceous secretions

• Increased BMR and bone growth leading to broader shoulders

Prepubertal Changes Among Girls

• Breast development usually begins at ages 10-11

• Stimulated by the release of estrogen

• Tanner Staging: Stages 1-5

Premenstrual Syndrome (PMS)

• Experienced by 10% of women

• Physical and emotional changes include:

  • Headaches

  • Backache

  • Fatigue

  • Irritability

  • Weight gain and crying spells

  • Cramps

• Development of pubic and axillary hair

Prepubertal Changes Among Boys

• Testicular enlargement occurs first

• Followed by penile enlargement

• Scrotum becomes thinner and reddens

• Tanner Staging: Stages 1-5

Menarche in Girls

• Occurs approximately 2 years after breast buds appear

• Menstrual periods are usually irregular during the first years

• Menarche may or may not be accompanied by ovulation

• Average age of menarche in the U.S. is 12.8 years

Male Prepubertal Changes

• Development of facial, axillary, and pubic hair

• Variability in timing can be as much as 4 years

• Precocious puberty may result in aggressive behavior

• Delayed puberty can lead to self-esteem issues

• Emotional changes are associated with increasing hormone levels

• Nighttime emissions are normal

Health Promotion

• Help parents and child prepare for pubescence

• Expect a growth spurt

• Provide accurate sex education

• Prepare for energetic but potentially stormy behavior

• Encourage support for the child’s growth while managing regression

Regular Health Care

• Regular health and dental check-ups

• Engagement in appropriate physical activities

• Providing a safe physical and emotional environment

• Teaching and modeling safety practices

• Increased sleep needs

• Education regarding experimentation with potentially harmful activities (e.g., sports injuries, firearms, sex, drugs)

Adolescence

• Subdivided into three levels:

  • Early adolescents: 11-14 years

  • Middle adolescents: 15-17 years

  • Late adolescents: 18-20 years

Growth Patterns

Girls

• Girls grow faster, reaching maximum height by ages 16-17

• 90% of height is obtained by menarche

• Weight gain is between 15-55 lbs, height increase of 2 to 8 inches

Boys

• Growth is slower, with maximum height reached by ages 18-20

• Weight gain is also 15-55 lbs, height increase ranges between 4 to 12 inches

Adolescent Self-Concept and Social Interaction

Early Adolescents

• May choose a uniform for identity

Late Adolescents

• More comfortable with individualized appearance

• Self-concept gained through impressions from others

Developmental Stages in Adolescence

Cognitive Development - Piaget

• Emergence of formal operations

  • Thinking in abstract terms

  • Considering possibilities

  • Forming hypotheses

  • Future-oriented thinking regarding life choices (e.g., college and jobs)

  • Empathy develops (ability to step into others' shoes)

• Older adolescents begin to confront conflicts between home teachings and peer pressure

Psychosocial Development - Erikson

• Developmental task: Identity versus role confusion

  • Involves developing a coherent self-image integrating past and present experiences alongside future aspirations

  • Concerns over body image, appearance, and physical abilities

  • Acceptance and support from family and peers contributes to identity development

Psychosexual Stage - Freud

• Genitalia stage: Energy focuses on genitalia and establishing emotional commitment

  • Sexual identification plays a major role during adolescence

• Striving for masculine and feminine roles development

  • Intimacy becomes significant

  • Majority of adolescents are sexually active but still require love, guidance, and balanced restrictions

  • Peer groups contribute to a sense of belonging and pride concerning sex roles

Moral Development - Kohlberg

• Post-conventional stage:

  • Morality shifts to supporting laws and order for determining right and wrong

  • Begins to question societal norms and establish personal values

  • Moral maturity is context-dependent

  • Peer pressure may conflict with personal moral reasoning

Promoting Health and Wellness

• Routine exams and dental care

• Recommended immunizations: Tdap, HPV, MenB, Menactra

• Awareness of potential drug use, smoking, and alcohol usage

• Consideration of sexual activity and safe sex practices

• Importance of skin care, nutrition, sleep, and exercise regulation

Safety Concerns

• Leading cause of death: Accidents

• Assessment of readiness for personal responsibilities is essential

• Major issues include:

  • Suicide

  • Homicide

  • Psychophysiology

  • Eating disorders like anorexia and bulimia

  • The influence of drugs and alcohol on promiscuity

Adulthood Developmental Stages

Young Adulthood (20 to 40 years)

• Financial independence from parents and establishment of careers

• Formation of close relationships and family planning

Middle Age (40 to 65 years)

• Balancing careers, family, and support for aging parents

• Developmental task: Generativity versus stagnation

  • Generativity includes guiding the next generation and engaging in charitable endeavors

Elderly (over 65 years)

Physical Development in Young Adults

• Skeletal maturity is typically reached by 20 years

• Physical peak performance occurs in this period

Psychosocial Development in Young Adults - Erikson

• Key developmental task: Intimacy versus isolation

  • Building intimate, lasting relationships or investments in causes

  • Negative outcomes involve exclusivity or feelings of isolation

• Identification of significant others and supporters is important; must consider domestic violence risks

Cognitive Development - Piaget

• Piaget's model extends into adulthood with no substantial new stages

• Adult learning theories suggest different learning processes in adults

Moral Development in Adulthood - Kohlberg

• Post-conventional morality involves definition based on personal principles rather than societal rules

  • May lead to actions like protesting laws when aligned with moral beliefs (e.g., environmental conservation)

Health Promotion in Adulthood

• Annual physical check-ups and preventative measures

• Health screenings:

  • Visual examinations (every 2-4 years)

  • Yearly Pap smears for women

  • Prostate examinations every 5 years for men

  • Td vaccinations every 10 years

  • Vaccinations such as Hep B and influenza

Cancer Detection Guidelines

• Breast self-examinations and mammography for women

• Testicular exams for men

• Importance of skin cancer awareness and sunscreen use

• High-risk groups for cervical cancer include those with frequent STDs

Health and Safety in Adults

• Emphasis on accident prevention strategies, particularly among ages 15-24

• Motor vehicle accidents (MVA) recognized as the leading cause of death

• Suicide is another significant risk in this age group

• Nurses should monitor and assess for depressive symptoms and domestic violence situations, as most homicides occur by known perpetrators

Health Promotion Considerations

• Focus on:

  • Nutrition

  • Exercise

  • Sexual health

  • Occupational hazards

  • Personal relationships

Middle Age Adults

• Typically balance careers, schooling, and family while managing relationships with children and aging parents

Psychosocial Development - Erikson in Middle Age

• Reflect on generativity versus stagnation; the goal includes establishing the next generation's welfare and fulfillment through benevolent actions

Physical Changes in Middle Age

• Most adults maintain effective function similar to their twenties

• Notable physical changes often appear after age 40

• Menopause occurs typically between ages 45-55

• Andropause refers to male hormonal changes, with fertility possible into the 80s

• Experience of mid-life crisis can lead to fears of aging

Stagnation Characteristics

• Individuals struggling with this may experience:

  • Boredom

  • Difficulty accepting aging bodies

  • Withdrawal and isolation

  • Regression to adolescent behaviors

Support During Middle Age

• Encourage exploring interests previously unpursued

• Assist parents coping with changing roles (e.g., empty nest syndrome, aging parents)

• Emphasize positive outcomes and retirement planning

Cognitive Development in Middle Age

• Cognitive and intellectual abilities remain stable over time

• Memory and problem-solving capabilities are maintained

• Life experiences contribute to a rich social, career, and family background

Final Health Promotion Guidelines

• Continuing routine physical exams and screenings

• Safety awareness and accident prevention strategies

• Nutritional considerations and exercise recommendations

• Management of personal relationships and mental health during transitions such as divorce or loss

• Staying vigilant about substance use, including smoking and alcohol (both prescription and non-prescription)