Growth and Development of Adolescent

Introduction
Puberty
Definition
Types of Development
Health problems of adolescent
Health problem related to sexuality
Eating disorders
Serious health problem of adolescent
Bibliography

1. child health nursing Growth and development of adolescent . Presented By- Miss . Alisha Parker MSc Nursing Vijay Singh Mohite Patil College of Nursing and Medical Research Institute, Akluj .

2. Introduction : Growth : growth is a process of physical maturation result is an increase in size of body and various organ , occur by multiplication of cell and increase intracellular substance. Development : development is the process of functional and physiological maturation of individual characterized by progressive increase in skill and capacity to function. Adolescence : Adolescence is a period of transition between childhood and adulthood , a time of rapid physical , cognitive , social and emotional maturation as boy prepare for manhood and girl prepared for womanhood.

3. Puberty : puberty refers to maturational , hormonal and growth process that occurs when the reproductive organs begin to function and the secondary sexual characteristics develop. This process divided into 3 stages : 1 .Pre pubescence (early adolescence) : In this stage the child develop preliminary physical changes that add sexual maturity. Girls : 10 – 12 years Boys 12 – 14 years.

4. 2 .Puberty : (middle adolescence) It is the when the girl begin to menstruate and boy to produce spermatozoa. Girls: 12 – 14 years Boys: 14 – 16 years 3 .Post pubescent (late adolescence) It is the period in which skeletal growth is completed and reproductive function become fairly established , somatic growth is completed and individual is psychologically mature, capable of becoming a contributing member of society. Girls: 14-18 years Boys:16-20 years

5. Types of development in adolescent child Biological development Psychological development Intellectual development Social development Spiritual development Psychosexual development Moral development

6. 1 . Biological development : 1. Hormonal Changes in puberty. 2.Sexual maturation. 3.Physical Growth.

7. The physical change in puberty are result of hormonal activity by CNS. The physical change are increased physical growth and in appearance and development of sexual characteristics. Primary sex characteristics are external and internal organs that carried out reproductive functions { eg. Ovaries, breast , uterus , penis} Secondary sex characteristics are changes that occur throughout body as result of hormonal changes{ eg voice alterations , development of facial and pubertal hair , fat deposit.}

8. A . Hormonal change in puberty The event of puberty are caused by hormonal influence and controlled by anterior pituitary in response to stimulus from hypothalamus. Stimulus of gonad function is to produce and release Gamates and secretion of appropriate hormones. The ovaries ,testis and secrete adrenal sex hormones like estrogen , progesterone and testosterone. Estrogen is a feminizing hormone found low during childhood secreted more until age of 11 years. It remains high at maximum level throughout the reproductive life of female.

9. Androgen is a masculinizing hormone found low in childhood and gradually increased upto 7 -9 years of age in both sexes then upto 15 years in boys . With beginning of testicular function the level of androgen mainly testosterone in male increased that in female and continues to increased till maturity is attained.

10. B. sexual maturation Sexual maturation in girls – Breast changes - appearance of breast buds occurs between 9 to 13 1/2 years of age. Pubic hair growth – after 2 – 6 months of breast changes hair growth starts on monspubis. Menarche – age is 10 1/2 to 15 years with average age being 12 year. Ovulation and regular menstrual periods occurs 6 -14 months after menarche.

11. Sexual maturations in boys - Enlargement of testicles by thinning , reddening and increased looseness of scrotum. Occurs between 9 – 14 years. Pubic hair – early puberty is characterized by initial appearance of pubic hair. Penile enlargement begins and testicular enlargement and pubic hair growth continue through mid puberty. Gynecomastia are common in midpuberty and disappears within 2 years. The spurt in height and weight is seen towards end of midpuberty. By late puberty definite increase in length and width of penis , testicular enlargement and first ejaculation occurs. Axillaries hairs develops and facial hair over anterior neck, final voice changes occurs secondary to growth of larynx.

12. C . Physical growth : Along with sexual maturation there is dramatic increases in growth. The 20 – 25 % of height achieved during puberty and most growth occurs during 2 – 3 years period adolescent growth spurt. The growth spurt begins earlier in girls between 10 years and 16 years in boys. The height of boys is 10 – 30 cm and gain weight 7 -30 kg. The growth spurt is slower in girl , gains weigh- 7 – 25kg and height 5 – 20 cm. Growth and height stops 2-2.1/2 year after menarche in girls and 18 to 20 years in boys.

13. The increase in size is acquired in characteristics sequence. Growth in length of extremities an neck. The hand and feet appear larger than normal in adolescence . Increase in hip and chest breadth takes place after few month then increase shoulder width. It is followed by increase in length of trunk and depth of chest. Due to hypertrophy of laryngeal mucosa an enlargement of larynx and vocal wides there are voice change of both boys and girls. Girls voice become slightly deeper and fuller. Boys voice shifts from deep to high tone in middle of sentence.

14. Growth of lean body mass especially of muscles occurs after bone growth spurts takes place steadily during adolescence. Lean body mass in both quantitatively and qualitatively greater than in boys than in females. Muscles become well developed in boys whenever in girls muscles mass is proportionate to general tissue growth. Non lean body mass i.e. fat mass is also increased. In boys there may be increased in cutaneous fat just before skeletal growth spurt. Later are variable amount of fat deposit to fill out and contour mature physique in pattern characteristics of the adolescent sex, especially in region over things , hips ,buttocks around breast tissue.

15. Hormonal influence during puberty causes acceleration in growth and maturation of skin and its structural appendages. Sebaceous gland become extremely active , especial those on genitalia and in “flush areas” of body’s i.e face , neck, shoulder, upper back, and chest. Heavy sweating appears more in girls than boys. Body hair assumes characteristic distribution patterns and changes texture during puberty. Due to gonadal and adrenal androgens hair coarsens darkens and lengthens at site related to secondary sexual characteristics. Pubic hair are more extensive in male than in females. Beard , mustache and body hair on chest, upward along the linear abs and other areas like back shoulder appear in male . Extremity hair also grows in both male and female but mores in males.

16. 4. Physiologic changes : The size and strength of heart , blood volume and systolic blood pressure increase where as pulse decrease. All the values of element of blood are increased. Respiratory volume and vital capacity are increased more in males than females. Increases in strength and size of muscles and increased level of cardiac , respiratory and metabolic functioning.

17. 2 .Psychological development : Developing a sense of identity: Erikson. Adolescence begins with onset of puberty and extended to relative physical and emotional stability. In this age of adolescent develops- A. Group identity B. Personal identity C. Sex role identity D. Emotionality

18. A. GROUP IDENTITY

19. Group identity : In early stage of adolescence teenagers find it essential to belong to a group from which they can derive status. Belonging to group, crowd helps the adolescence to difference between themselves and their peer. They dress as group dresses , wear make up , do hairstyle as group criteria. Language , music's and dance reflect culture that is exclusive to adult. When adolescent begins to try their fashion and interests, the style changes immediately. Conformity to peer group and non conformity to adult group provides teenagers with frame of reference for self assertion and rejection of identity of parents generations. To be different from group is unaccepted and alienated from group.

20. b.INDIVIDUAL IDENTITY

21. B. individual identity : As the adolescent establish identity within a group they also attempt to incorporate multiple body changes into concept of self. Body awareness is part of self awareness. Other people hold expectations for behavior of adolescent. Adolescent find it too easy to slip into the roles expected by others. Thus individuals may become what parent or other wish them to be based on premature decisions. Adolescent children get negative identity when society , community labels them with words such as failure , juvenile delinquent. Some adolescent accept and live to these labels with behavior that validate and strengthen them. The process of personal identity is time consuming and period of confusion , depression and discouragement. Determining an identity and place in world is critical and perilous feature of adolescent. Later positive identity emerges.

22. C.SEX ROLE IDENTITY

23. C . Sex role identity : During early adolescent the peer group begins to communicate expectations regarding heterosexual relationship. As development progressive adolescent encounter expectations for mature sex role behavior from both peer and adult.

24. D. EMOTIONALITY

25. D . Emotionality : Adolescent vacillate in their emotional state between considerable maturity an childlike behavior. One minute they are exuberant and enthusiastic the nearest movement they are depressed and withdrawn. Mood swings are common during this time. Because of mood swings adolescents are unstable, inconsistent and unpredictable. Little things cause emotional upheaval(violent or sudden change ) and depending on teenagers interpretations can mean a great deal. Teenagers can control their emotion in later adolescence they approach problems calmly and rationally. More mature emotions in later adolescent period.

26. 3 . Cognitive development : By Jean Piaget Cognitive thinking deals with capacity for abstract thinking. This stage is period of formal operation. The adolescent think beyond present. They can imagine a sequence of event that might occurs such as college and occupational possibilities, how things may change in future, such as relationship with parents , consequences of their actions. Adolescents can make use of assumptions while thinking . They can solve problem that require abstract thinking. In this age, they begin to consider both their own thinking and thinking of others. They wonder what opinion others have of them and they are able to imagine thoughts of others. They are able to understand and aware of others culture and communities have become norms and standards from their own, it becomes easier for them to accept members of other culture and behave in their own it these other culture and behave in their own culture in accepected manner.

27. 4.Psychosexual development : During adolescence the child passes through Freud’s Genital period of development from approximately 11-16 years. Puberty and adolescence are period during which there is great surge of genital sexual development. Masturbation and sexual fantasies are common in this period. Adolescent represent a critical time in developing sexuality. Hormonal, physical , cognitive and social changes that occur during adolescent have an impact of sexual development. Adolescent faces normal influence , physiological manifestations such as menstruation , ejaculation. Increase level of pubertal hormone contribute to increased level of sexual motivation among the boys and girls. Development of sexual identity becomes a part of adolescent identity.

28. For young adolescent the process sexual identity development involve forming close friend with same sex peer, with whom they may experiment sexually often to satisfy curiosity. During middle adolescent there is a shift from relationship with same sex peer to intimate relationship with member of opposite sex. Sexual activity is more common during middle adolescence. The relationship between love and sexual expressions is brought into focus during middle adolescent , hence adolescent find it hard to believe that sex can exist without love , therefore they view each relationship as real love.

29. 5 .Moral development: By Kohlberg The young adults merely accept the decision or point of view of adults, to gain autonomy from adult , they must substitute their own set of morals and values. When the old principles are challenged but new independent values have not yet emerged to take their place , young people search for moral code that preserves their personal integrity. It guides their behavior to face pressure to violate old beliefs. Late adolescence is characterized by serious questioning of exiting moral values and their relevance to society and individual. Adolescent can easily take role of others. They seriously question established moral code , of ten as result of observing that adult verbally ascribe code but do not follow stick to it.

30. 6 .Spiritual development : During adolescence the adolescent begin to question religious concept and benefits of childhood. He / she explores various religious affiliations and cultures. This may be period of conflict between parents and adolescent children. A young person without religious culture may be attracted to any new or different religious culture. Most teens search for ideal and spectaculate about illogical statements an conflicting ideologies. They tend to keep their thoughts private fearing that no will understand. They may reveal deep spiritual concerns. They need support and encouragement in their struggle for understanding and freedom to questions.

31. 7 .Social development : To achieve full maturity , adolescent should free themselves from parents domination and develop a self identity than a parental authority. This process is between both teenagers and their parents. 1.Relationship with Parents. 2.Relationship with Peer. 3.Best Friends

32. 1.RELATIONSHIP WITH PARENTS:

33. During adolescence the parent-child relationship changes from one of protection dependency to one of mutual affection and equality. Behaviors observed of adolescent is struggle for independence and external restriction. On one hand they are accepted as maturing preadults but other hand because of their unpredictability and insecurity in evaluating situations and make judgment they are bound to regulations an restrictions set by adults. Favorite topic of dispute include use of home telephone , internet , need of personal phone , dress , duties, homework, money, atmosphere, friendship, dating , relationship an other substance abuse and timing schedules.

34. They get away from theirs parents , stay less within their parents, home and family activities and spend more time with the peer group. Parent should guide adolescent , appropriate freedom and provide clear , consistent message regarding expectations. To gain adolescent trust , parents must respect his / her privacy and show honest and sincere interest in what adolescent believes and feels.

35. 2.RELATIONSHIP WITH PEERS.

36. The majority of teenagers , peers assume a great role in adolescence. The peer group serves as a strong support to teenagers. Adolescent are usually socially and group minded. Early in adolescent period most of peer relations are with member of one own sex. Later they turn to heterosexual relationship. As heterosexual groups develop , activities such as playing volleyball or going to beach becomes important. In middle adolescent groups called crowds are focus of social activities. There is we feeling. Association with crowed allows the adolescent to loose parental ties. Dating pattern is started in middle adolescent period. As dating continues , egocentrism appear at this time , which is concern for self and not for dating partner.

37. 3. BEST FRIENDS:

38. Personal friendship develops between same sex adolescent. This relationship is closer or more in middle adolescence. Best friend is best audience to try out possible role and identities that adolescent wants to test. They try role together, provide support for each other, care for each other. Sense of intimacy grows with permanent relationship. the stability of same sex friendship is important link in progress towards intimate relationship in young adulthood.

39. Nutrition The nutritional need are closely related to increase in body mass, peak requirements occurs in the year of maximum growth during which the body mass double. The calorie and protein requirement during this time are higher than at almost any other time of life. Adolescent usually have sufficient intake of protein to meet their need except who limit their due to economic problems or to loose weight. There is substantial increases in need for mineral are like calcium for skeletal growth , iron for maximum expansion of muscle mass and blood pressure and zinc for both skeletal and bone structure. Girls with heavy menses are susptible to iron deficiency. Calcium intake in adolescent is important during adolescent to prevent osteoporosis.

40. Eating habits and behavior : According to recent scenario the children's interest, attitude are altered as increasing number of meals are eaten away from home. Their peers easily influence their eating habits. Pressure for time and commitment to activities adversely affect teenagers eating habits. Overeating or undereating during adolescent period presents special problems

41. SEX EDUCATION:

42. The development of primary and secondary sexual characteristics and increased sensitivity of the genitalia produce thoughts and fantasies about sexual relationship. Societal expectation push adolescent towards dating and their own sex drive urges them towards exploration. So the pubescent and adolescent have a great need for education about sexuality. The time and way in which education is given are both vitally important. Girls receive education at mean age of 13 years and boys at average of 15years. A large amount of knowledge relating to sex is acquired from peer , Television , magazines., movies etc. The responsibility for providing sex education has been assumed by parent , school , teachers such as planned parenthood federation of America and health professionals especially nurse. They should use simple terminology and language not street language. Sexuality education should consist of instruction concerning normal body function and should be present in straight forwarded manner using correct terminology. Young adolescent need reassurance that are the individual differences and that lags and spurt due normal.

43. Girls are concerned about irregular menstruation and atypical breast development. Boys are concerned about masturbation , nocturnal emission an atypical penile size. Teenagers needs to discus intercourse , alternative method of sexual satisfaction and how resist pressure, due to increase risk of sexually transmitted diseases especially HIV infection. The topic of safe sex especially use of condom essential. Accurate and unbiased information regarding sexual practices should be provided where adolescent feel comfortable asking questions without being degraded or feel uncomfortable. Adolescent need role model and life experiences with delayed gratification. They need problem solving experience and decision making skills so that they can anticipate the positive and negative outcomes of decision. With this type of assistance , teenagers can become sexually responsible adults.

44. Health problems of adolescent- DISORDER RELATED TO REPRODUCTIVE SYSTEM A . Amenorrhea B . Dysmenorrhea C . Vaginitis

45. A .Amenorrhea : Menarche or first menstrual period occurs relatively late in female pubertal development. When a adolescent girl is seen with complaint of absence of menses a careful history of timing of her pubertal development is to be taken. 1 .Primary amenorrhea : Absence of secondary sexual characteristics and no uterine bleeding by 14 -15 yrs or absence of uterine bleeding with secondary sexual characteristics by 16 years of age . The cause of primary amenorrhea may be atonic , hormonal , genetic or idiopathic.

46. 2.Secondary amenorrhea : I t is defined as absence of menses for 6 month or at least three cycles after menstruation was previously established. Irregular menstrual cycle are common with first or two years of menarche. Girls with later onset of menarche will take longer to establish regular ovulatory cycle. Pregnancy is most common cause of secondary amenorrhea and should be ruled out in both types of amenorrhea even if adolescent denies sexual activity. Other cause can be stress , environmental changes , hypothyroidism , PCOD chronic illness, bulimia nervosa , ovarian disturbance , contraceptive steroids.

47. B. Dysmenorrhea : Most girls experiences cramping , abdominal pain , backache , leg ache but in few cases pain is intolerable and incapacitating Primary Dysmenorrhea - it is painful menses not related to any pelvic disease. Pain is related to ovulatory cycle , women may have level of prostaglandin an overproduction of vasopressin . Pain occurs at time of menstrual flow or hour before and continue for 48-72 hrs. Secondary Dysmenorrhea – It is defined as painful menses with pathologic condition such as salpingitis , congenital anomalies

48. C . Vaginitis : It may be due to forgotten tampon , chemical irritation like bubble bath , deodorant pads and tampons. Infectious Vaginitis can be caused by candida, fungi , trichomonas, protozoa, parasites or bacteria.

49. Health problem related to sexuality 1 . Adolescent pregnancy 2 . Sexual Transmitted Diseases(STD) 3 . Pelvic Inflammatory Disease(PID) 4 . Sexual assault ( rape )

50. 1 . Adolescent pregnancy : In the recent years teenage pregnancy rate has shown a conditional downward tend due to increase in use of condom and long term hormonal contraceptive methods among adolescent. The reduction in teen pregnancy is important national goal because of risk of negative outcome for both mother and child. Teenage girls and unborn infants are at greater risk for complications of both pregnancy and delivery. The most common complication are premature labor , Low birth weight baby,high neonatal mortality ,fetopelvic disproportion, iron deficiency anemia , prolonged labor. 2 . Sexually transmitted diseases : Sexually active adolescent are at risk of STD. Physiologically adolescent girls cervix is much more susceptible to HPV and Chlamydia infection. The rate of Chlamydia and Gonorrhea are highest among adolescent girls of 15-19 yrs and HPV in highest adolescent population.

51. 3 . Pelvic inflammatory diseases : It is a infection of upper genital tract ,( endometrium, fallopian tubes and ovaries) most common caused by sexually transmitted bacteria as Neisseria gonorrhea , Chlamydia trachoma and variety of anaerobic bacteria. PID causes fever , lower abdominal pain , UTI symptoms, nausea, malaise, diarrhea , constipation. Prevention is primary concern of health care professional . Contraceptive methods such as condoms is best protection for prevent STD and PID. 4 . Sexual assault : An adolescent girl is particularly vulnerable to sexual assault. Sexual assault victims are of all ages, ethnic groups and economic groups, children with physical or developmental disability are more vulnerable to sexual abuse than their peers.

52. Definition of SEXUAL ASSUALT- I t includes various types of forces or inappropriate sexual activity . It includes both physical and psychological coercion as well as touch , penetrate and other sexual contract. RAPE- Forced sexual intercourse that occurs by physical force or physiologic coercion, includes vaginal, anal or oral penetration of body parts or inanimate objects.

53. Eating disorder 1. Obesity 2. Anorexia nervosa 3 .Bulimia nervosa

54. 1.Obesity

55. 1.OBESITY Obesity is defined as an increases in body mass resulting from excessive accumulation of body fat relative to lean body mass. Overweight refers to state of weighing more than average for height and body mass. Body mass index measurement is recommended as most accurate method for screening children, adolescent for obesity. Obesity in adolescent has taken related to elevated blood cholesterol , high BP , respiratory disorder , orthopedic conditions. Common emotional consequence of obesity include poor body image , low self esteem , social isolation and feeling of depression and rejection.

56. BMI = weight in kg (height in cm)² Or weight in pound x 703 (height in inches) ² BMI is <18.5- Underweight BMI 18.5-24.9- Healthy. BMI 25-29.9 - Overweight The best approach to management of obesity Is preventive one. Early recognition and control measure before the adolescent gets to obese state. Diet modification is most important along with exercise.

57. 2.ANOREXIA NERVOSA

58. 2 . Anorexia nervosa : It is a eating disorder characterized by refused to eat food to maintain a minimal normal body weight and by severe weight loss in absence of obvious physical cause. Approximately 5% of adolescent females in US have anorexia nervosa. It begins at age of 13yrs but occurs as early as 10 yrs and as late as 25 years. Individual with anorexia nervosa are described as perfectionists, academically have high achievers. They have high energy levels , marked emaciations. Patient with anorexia nervosa may eventually develop bulimia.

59. 3.Bulimia nervosa

60. 3 . Bulimia nervosa : Bulimia nervosa refers to an eating disorder. It is observed in older adolescent girls and young women. Males with bulimia nervosa are less common. They have average or slightly more average weight. It is characterized by repeated episode of binge eating followed by inappropriate compensatory behavior such as self induced vomiting, misuse of laxatives , diuretics, excessive exercise, fasting.

61. Binge behavior consists of secretive consumption of large amount of high calorie food during brief time(less than 2 hours). Characterized by weight control methods by purging, It is followed by self depreciating thoughts, depressed mood and awakeness that eating pattern is abnormal.

62. Serious health problem of adolescent 1 . Substance abuse 2 . Alcohol 3 . Drugs 4 . Suicide

63. 1 . Substance abuse :

64. National and statewide survey indicate that despite a steady increases in incidence of adolescents using tobacco, marijuana between 12-18yr of age,it is been reported that 51% of American youth have tried illegal drugs by time of high school graduations. Most drug use begin with experimentation. It become part of drug centered lifestyle. Adolescent use drug for curiosity. They fall into category of experimentees , compulsive users, , recreational users .They use drugs such as marijuana , cocaine , alcohol etc.

65. 2 . Alcohol ( ethanol ) :

66. Alcohol drinking is likely to begins in middle school years and increases with age by 18 yrs of age. 80% – 90% of adolescent have tried alcohol. Ethanol is a depressant that reduces inhibitor against aggressive and sexual acting out. Through abrupt withdrawal physical and psychological symptoms are seen especially of brain and liver cell. The most effect is seen on CNS which includes changes in cognitive and autonomic function such as judgment , memory , learning activity , ability intellectual capacities. Young alcoholics rely on substance as defense against depression , anxiety , fear and anger.

67. 3. DRUG ABUSE A.Tobacco

68. It is used for cigarette smoking. Although the number of adults and adolescent smokers declined in recent years, but still it is considered the chief avoidable cause of death. Because of its addictive nature , smoking begins in childhood and adolescent results in lifetime habits with increases morbidity and early mortality. Cigarettes are considered to be gateway drugs and teenagers who smoke are 11.4 times more likely to use illicit Drug. Teenagers smoking is due to imitations of adult behavior , peers , movies and advertisement, desire to control weight especially females.

69. B . Cocaine :

70. Cocaine is available in two forms ; water soluble cocaine hydrochloride , which is administered by “snorting” or IV injections and non soluble alkaloid cocaine is used for smoking. It is smoked in either waste pipes or mentholated cigarette. The use of cocaine is increased in recent years because of its availability and affordability .Its association with person in glamorous occupational, peer pressure and its reputations as sexually enhancing drugs. Cocaine creates a sense of euphoria. The withdrawal does not produce dramatic symptoms like other withdrawal substance. The effects are commonly seen in depression , including lack of energy and motivation , irritation , appetite changes , psychomotor retardation and irregular sleep patterns.

71. C . Narcotics :

72. Narcotics drug includes opiates such as heroin and morphine and opioids such as hydromorphine , hydrocodone , fentanyl , meperidine and codeine. These drugs produced a state of euphoria by removing painful feelings and creating a pleasurable experience and sense of success accompanied by clouding of unconscious and dreamlike state. Physical signs of narcotics abuse include constricted pupils , respiratory depression , cyanosis. Needle marks may be visible on the arms or legs in chronic users .

73. D. Central nervous system depressant : ROHYPNOL -FLUNITRAZEPAM

74. CNS depressant include variety of hypotonic drugs that produce physical dependence and withdrawal symptoms on abrupt discontinuation. They create a feeling of relaxation and sleepiness but impair general functioning. Drugs in this includes barbiturates , non barbiturates and alcohol. Flunitrazepam Rohypnol known as the date rape drug is a recent hypnotic drug used by adolescent. Many women report being raped after unknowingly being given Rohypnol in drink. Rohypnol is 10 times more powerful than diazepam (valium ) It produced prolonged sedation, a feeling of well being and short term memory loss.

75. E . Central nervous system Stimulant - Methamphetamine

76. Amphetamine and cocaine do not produce strong physical dependence and can be withdrawn without much damage. However psychologic dependence is strong and acute intoxication can lead to violent aggressive behavior or psychotic episodes characterized by paranoia , uncontrollable agitation and restlessness. When combined with barbiturates, the euphoric affect are particularly addictive. Methamphetamine can be snorted , injected , swallowed or smoked and produces burst of energy in its users along with intense alternating attacks of boldness and paranoia. It provides excitement far more immense than caused by cocaine. The drug with the street names crank , meth and crystal is inexpensive.

77. F . Mild altering drugs : marijuana, hasish

78. Hallucinogens are the drugs that provides vivid hallucination and euphoria. These drugs do not produce physical dependence and they can be abruptly withdrawn without ill effect. Cannabis ( marijuana , hashish ) and lysergic acid diethylamide (LSD).

79. 4.SUICIDE

80. Suicide is defined as the deliberate act of self injury with the intent that the injury results in death. Suicidal attempts is intended to cause injury or death. The term parasuicide is used to refer behaviors ranging from gestures to serious attempts to kill oneself. Recent result shows that 8.4% of students nation wide had attempted suicide at least once during 12 month preceding survey. Suicide is the 3 rd leading cause of death during teenage years The causes of suicide are mainly psychiatric disorder , substance abuse ( alcohol more than 50% of suicidal family issues , lack of support , emotional disturbance and isolation within the family. Firearms are most commonly used instrument in committing for both male and female .Other methods are hanging , overdose, strangulation.

81. Nursing care management related to therapeutic management Nurses who have contact with children and adolescent are in an excellent position to provide information about substance abuse and to serve as patient advocates. 1. Exercising overdose or withdrawal symptoms. 2. Manifesting bizarre behavior or confusion secondary to drug ingestions. 3.Worried that they are or will become addicted. 4. Worried about a friend, family members who is addicted. 5.It is necessary to asses for possible trauma sustained while the pt. was under the influence of the drug.

82. Nurses should be alert for any physical or behavioral clues that indicate onset of withdrawal or effects of drugs. School nurses or community nurses play essential role in identifying children, adolescents and family with substance abuse family. School nurse may be the first to identify a child who has ingested a particular drug by child's erratic behavior in class.

83. REHABILITATION-It involves fostering healthy interdependent relationship with caring and supportive adults. Person working with trouble youth must be prepared for tendency to relapse. FAMILY SUPPORT PREVENTION-Nurses play important role in education efforts as well as in individual observation ,assessment and therapy related to substance abuse. Health compromising behaviors are often inter connected and have common antecedents . Peer pressure is the common tool and can be used effectively in substance abuse prevention.

84. SUICIDE-Nurses play pivotal role in reducing adolescent suicide. Care includes early recognition, management, and prevention. Peers are excellent source of information about potential suicide attempt. Confidentiality is essential part of adolescent counseling

85. Bibliography 1. Marilyn j . Hockenberry David Wilson Wongs Essential of pediatric nursing 8 th edition , page no 514-571 2 . Dorothy R Marlow Barbara A Redding A textbook of pediatric nursing 6 th edition , page no 1114 – 1168 3 . Mukesh Agarwal A textbook of pediatrics 2 nd edition , page no ; 352 – 359

86. 4. A Parthasarathy Piyush Gupta MKC Nair IAP textbook of Pediatrics 5 th edition , page no ; 844- 853 5 . OP Ghai , Vinod k Paul , Arvind Bagge Ghai essential pediatrics 7 th edition , page no : 42 – 46