1. Wants to be exactly like peers.
      2. Becomes hostile toward parents, adults, family.
      3. Concerned with vocation, life after high school.
    1. Parental guidance, teaching
      1. Offer firm but realistic limits on behavior.
      2. Continue to offer guidance, support.
      3. Allow child to earn own money, control own finances.
      4. Assist adolescent to develop positive selfimage.
      5. Review Recommended Health Screenings (see Tables 5-1 and 5-2) with parents of adolescents.
    2. Additional information about behavioral concerns for each age group may be found in Tables 5-3 and 5-4.

  1. Physical growth (by 18 yr)
    1. Height and weight
      1. Adolescent growth spurt lasts 24-36 mo.
      2. b. Growth in height commonly ceases at 16-17 yr in girls, 18-20 yr in boys.
      3. Boys gain more weight than girls, are generally taller and heavier.
    2. Vital signs approximately those of the adult. See Table 5-5.
    3. Cardiac system
      1. Increased heart size and strength to nearadult values.
      2. Decreased heart rate, increased blood pressure from school-age values.
    4. Pulmonary system
      1. Lungs increase in size to near-adult levels, but not as rapidly as other body systems (may explain lack of energy).
      2. System is “mature” by 12 yr.
      3. Continued decreased respiratory rate from school-age values.
    5. Gastrointestinal system
      1. Continued need for increased calories.
    6. Genitourinary system
      1. Fully developed; bladder can hold 700 mL.
    7. Immune system
      1. Fully developed; infections become increasingly rare in a healthy adolescent.
      2. Lymphoid tissue matures and regresses.
    8. Neurological system
      1. Fully developed.
    9. Sensory
      1. Fully developed.
    10. Teeth: 32 permanent teeth by 18-21 yr.
    11. Sexual changes
      1. Girls
        1. Changes in nipple and areola; development of breast buds.
        2. Growth of pubic hair.
        3. Change in vaginal secretions.
        4. Menstruation - 12.8 yr (average); range 10.5-15 yr
        5. Growth of axillary hair.
        6. Ovulation.
      2. Boys
        1. Enlargement of genitalia.
        2. Growth of pubic, axillary, facial, and body hair.
        3. Lowering of voice.
        4. Production of sperm; nocturnal emission (“wet dreams”).

  2. Developmental norms
    1. Motor development
      1. Early (12-15 yr) - awkward, uncoordinated, poor posture, decrease in energy and stamina.
      2. Later (15-18 yr) - increased coordination and better posture; more energy and stamina.
    2. Cognitive
      1. Academic ability and interest vary greatly.
      2. "Think about thinking" - period of introspection.
    3. Emotional
      1. Same-sex best friend, leading to strong friendship bonds.
      2. Highly romantic period for boys and girls.
      3. May be moody, unpredictable, inconsistent.
    4. Social
      1. Periods of highs and lows, sociability and loneliness.
      2. Turmoil with parents - related to changing roles, desire for increased independence.
      3. Peer group is important socializing agent - conformity increases sense of belonging.
      4. Friendships: same-sex best friend advancing to heterosexual “relationships.”

  3. Nursing interventions/parental guidance:
    1. Play
      1. School-related group activities and sports.
      2. Develops talents, skills, and abilities.
      3. Television - watches soap operas, romantic movies, sports.
      4. Develops interest in art, writing, poetry, musical instrument.
      5. Girls: increased interest in makeup and clothes.
      6. Boys: increased interest in mechanical and electronic devices.
    2. Safety - motor vehicles (cars and motorcycles) - as passenger or as driver
      1. Encourage driver education; serve as positive role model.
      2. Teach rules of safety for water sports.
      3. Wants to earn money but still needs guidance: advocate safe job, reasonable hours.
      4. Refer to Tables 5-7 and 5-8 for additional information on safety and infection control.