WEBVTT 00:00:06.059 --> 00:00:09.800 Welcome to the bed. We'll go ahead and give you 00:00:09.800 --> 00:00:12.580 the story. This is all going to happen super 00:00:12.580 --> 00:00:47.990 fast. Welcome to the emergency room. Today we 00:00:47.990 --> 00:00:51.409 are stepping into the storm. Hey, that's one 00:00:51.409 --> 00:00:53.250 way to put it. It really is the only way to describe 00:00:53.250 --> 00:00:56.070 it. We are tackling one of the most dynamic, 00:00:56.329 --> 00:01:01.240 chaotic and biologically aggressive periods of 00:01:01.240 --> 00:01:02.960 human development. You're talking about adolescence. 00:01:03.359 --> 00:01:05.799 Exactly. That shaky bridge between childhood 00:01:05.799 --> 00:01:08.799 and adulthood spanning roughly ages 11 to 20. 00:01:09.049 --> 00:01:11.049 It was a bridge, but if we're being honest, it 00:01:11.049 --> 00:01:12.650 feels like a bridge that's being built while 00:01:12.650 --> 00:01:14.769 someone is sprinting across it. In the dark. 00:01:14.890 --> 00:01:17.989 In the dark, yeah. You have these massive physiological 00:01:17.989 --> 00:01:20.689 changes, a desperate, sometimes frantic search 00:01:20.689 --> 00:01:23.709 for identity, and a brain that is literally rewiring 00:01:23.709 --> 00:01:26.290 itself in real time. It's a fascinating mess. 00:01:26.430 --> 00:01:29.049 And for our listeners today, specifically the 00:01:29.049 --> 00:01:31.349 nursing students and the pros gearing up for 00:01:31.349 --> 00:01:34.469 the NCLEX or those intense clinical rotations, 00:01:35.010 --> 00:01:37.109 this isn't just a trip down memory lane to our 00:01:37.109 --> 00:01:39.900 own awkward high school years. No, no. We have 00:01:39.900 --> 00:01:42.659 a very specific mission. We are conducting a 00:01:42.659 --> 00:01:46.620 high yield, exam focused review. Exactly. We've 00:01:46.620 --> 00:01:50.099 pulled from the 2025 CDC immunization schedule, 00:01:50.620 --> 00:01:53.060 the gold standard charts for pediatric vital 00:01:53.060 --> 00:01:55.200 signs, and, you know, the heavy -hitting chapters 00:01:55.200 --> 00:01:57.640 on adolescent growth and development. Our goal 00:01:57.640 --> 00:02:00.099 here is to apply the Pareto Principle. The famous 00:02:00.099 --> 00:02:02.939 80 -20 rule. Right. We want to identify the 20 00:02:02.939 --> 00:02:06.000 % of the information, the absolute core concepts 00:02:06.000 --> 00:02:09.060 that will help you answer 80 % of the exam questions 00:02:09.060 --> 00:02:11.500 and, frankly, keep your patients safe when you're 00:02:11.500 --> 00:02:13.479 on the floor. And that's so important because 00:02:13.479 --> 00:02:15.729 the role of the nurse really shifts here. It 00:02:15.729 --> 00:02:18.129 totally does. You aren't just managing the parent 00:02:18.129 --> 00:02:20.490 anymore like you would with a toddler or an infant. 00:02:20.569 --> 00:02:23.310 Right. You are empowering a patient who looks 00:02:23.310 --> 00:02:26.129 like an adult but is still very much under construction. 00:02:26.310 --> 00:02:28.569 So let's dive right into the numbers. Let's start 00:02:28.569 --> 00:02:31.330 there. Segment one is our baseline. Vital signs 00:02:31.330 --> 00:02:33.629 and pain assessment. The fundamentals. The fundamentals. 00:02:34.030 --> 00:02:36.349 When you walk into a room to assess a 15 year 00:02:36.349 --> 00:02:39.129 old, the landscape has changed significantly 00:02:39.129 --> 00:02:41.250 from early pediatrics. What are we expecting? 00:02:41.560 --> 00:02:44.340 The general rule of thumb, and if you need a 00:02:44.340 --> 00:02:46.039 mental anchor to keep you grounded during an 00:02:46.039 --> 00:02:49.919 exam, this is it, is that by late adolescence, 00:02:50.060 --> 00:02:52.960 so usually age 13 and up, the vital signs align 00:02:52.960 --> 00:02:55.699 very closely with adult norms. Okay, so they're 00:02:55.699 --> 00:02:58.500 basically adults, physiologically speaking. Pretty 00:02:58.500 --> 00:03:01.419 much. The physiology has matured enough to resemble 00:03:01.419 --> 00:03:04.960 a full -grown adult. which is a relief in some 00:03:04.960 --> 00:03:07.719 ways, less memorization. So we're done with the 00:03:07.719 --> 00:03:10.139 rapid -fire heart rates of infancy. Oh, long 00:03:10.139 --> 00:03:13.319 gone. We are. If we look at the charts, the heart 00:03:13.319 --> 00:03:16.800 rate for an adolescent, say ages 13 to 18, it 00:03:16.800 --> 00:03:19.919 settles into that familiar adult range of 50 00:03:19.919 --> 00:03:22.340 to 100 beats per minute. And what's the why behind 00:03:22.340 --> 00:03:24.780 that? Why does it slow down so much from, say, 00:03:24.879 --> 00:03:26.979 a two -year -old? It's all about efficiency. 00:03:27.319 --> 00:03:29.300 The heart muscle itself is larger. It's stronger. 00:03:29.340 --> 00:03:31.259 So the stroke volume, the amount of blood pumped 00:03:31.259 --> 00:03:33.419 with each beat is much more efficient. It just 00:03:33.419 --> 00:03:35.800 doesn't need to beat as fast to perfuse the body. 00:03:36.000 --> 00:03:38.000 Makes sense. And respirations follow the same 00:03:38.000 --> 00:03:40.560 trend. They do. They slow down, too. We're looking 00:03:40.560 --> 00:03:43.560 at a pretty calm 16 to 20 breaths per minute. 00:03:43.919 --> 00:03:46.800 Yeah. Now, compare that to a toddler who might 00:03:46.800 --> 00:03:49.819 be breathing at 24 to 40 times a minute. It's 00:03:49.819 --> 00:03:52.460 a significant drop. But, you know, there is one 00:03:52.460 --> 00:03:54.199 number that trends in the opposite direction. 00:03:54.340 --> 00:03:57.520 It goes up. blood pressure. Right. Correct. And 00:03:57.520 --> 00:03:59.960 it's really important for your clinical practice 00:03:59.960 --> 00:04:01.960 to understand the why here, not just memorize 00:04:01.960 --> 00:04:03.819 the number. So what's happening? As the child 00:04:03.819 --> 00:04:06.240 grows into an adolescent, two things happen. 00:04:07.060 --> 00:04:09.879 Muscle mass increases dramatically, and the size 00:04:09.879 --> 00:04:12.460 of the entire vascular bed, all the arteries 00:04:12.460 --> 00:04:15.280 and veins, it just gets bigger. Yeah. It's a 00:04:15.280 --> 00:04:17.240 larger system. Like going from a small town's 00:04:17.240 --> 00:04:19.720 plumbing. to a CITES. That's a great analogy. 00:04:20.120 --> 00:04:22.480 To pump blood through that larger, more complex 00:04:22.480 --> 00:04:24.779 system, the pressure naturally has to go up. 00:04:25.120 --> 00:04:27.339 So for an adolescent, we want the systolic to 00:04:27.339 --> 00:04:30.019 be less than 120 and the diastolic less than 00:04:30.019 --> 00:04:33.980 80. So basically standard healthy adult limits, 00:04:34.160 --> 00:04:36.420 no special charts to memorize there. Precisely. 00:04:36.639 --> 00:04:38.439 And here's the clinical pearl, the high yield 00:04:38.439 --> 00:04:41.379 takeaway. OK. If you see a systolic over 120 00:04:41.379 --> 00:04:44.620 in a calm teenager, that warrants rechecking. 00:04:44.800 --> 00:04:47.800 Do not just assume it's white coat syndrome or 00:04:47.800 --> 00:04:49.879 stress from the visit. You really have to investigate. 00:04:50.160 --> 00:04:53.459 You have to. Hypertension in adolescence is becoming 00:04:53.459 --> 00:04:57.480 increasingly common due to diet, lack of exercise, 00:04:57.639 --> 00:04:59.879 all the modern lifestyle factors. Treating a 00:04:59.879 --> 00:05:02.220 high reading as a red flag is absolutely crucial. 00:05:02.319 --> 00:05:04.420 And what about temperature? Anything special 00:05:04.420 --> 00:05:07.579 there? Not really. The mean is around 36 .6 degrees 00:05:07.579 --> 00:05:11.439 Celsius or 97 .9 degrees Fahrenheit. Pretty standard 00:05:11.439 --> 00:05:14.290 stuff. OK, so that's the vitals. Pretty straightforward. 00:05:14.589 --> 00:05:17.230 Let's unpack pain assessment. This is always 00:05:17.230 --> 00:05:19.730 a tricky one on exams because you have to pick 00:05:19.730 --> 00:05:22.709 the right scale for the right cognitive level. 00:05:22.879 --> 00:05:25.240 It is, but for this demographic, it's actually 00:05:25.240 --> 00:05:27.720 simpler than with younger kids. The gold standard, 00:05:27.879 --> 00:05:29.800 the one you should reach for first, your default, 00:05:30.060 --> 00:05:32.360 is the numeric scale. The zero to ten scale. 00:05:32.540 --> 00:05:34.939 The zero to ten scale. If the patient is five 00:05:34.939 --> 00:05:37.459 years or older, and certainly by adolescence, 00:05:37.560 --> 00:05:39.819 they have the cognitive capacity to understand 00:05:39.819 --> 00:05:42.199 that abstract concept and rate their pain from 00:05:42.199 --> 00:05:44.300 zero to ten. Can we trust them? I mean, what 00:05:44.300 --> 00:05:46.540 if a kid is on their phone laughing with a friend 00:05:46.540 --> 00:05:48.899 but tells you their pain is a nine? We trust 00:05:48.899 --> 00:05:51.540 them. Self -report is the most reliable indicator 00:05:51.540 --> 00:05:54.300 of pain, period. That's a big one. I cannot stress 00:05:54.300 --> 00:05:57.319 this enough for the exam and for practice. If 00:05:57.319 --> 00:05:59.500 a 16 -year -old is playing on their phone but 00:05:59.500 --> 00:06:02.040 tells you their pain is an 8 out of 10, you treat 00:06:02.040 --> 00:06:04.279 the pain as an 8. So you ignore the behavior. 00:06:04.540 --> 00:06:07.000 You don't judge the behavior. You treat the report. 00:06:07.230 --> 00:06:09.449 That phone could be their only coping mechanism, 00:06:09.790 --> 00:06:11.930 their only distraction from that 8 out of 10 00:06:11.930 --> 00:06:15.110 pain. Document the behavior? Sure. But treat 00:06:15.110 --> 00:06:17.269 the number they give you. That's a fantastic 00:06:17.269 --> 00:06:20.050 point. But what if you have an adolescent with, 00:06:20.050 --> 00:06:23.089 say, a cognitive impairment or maybe a severe 00:06:23.089 --> 00:06:25.519 language barrier? Then you have to adapt. Of 00:06:25.519 --> 00:06:27.699 course, you might fall back on the faces scale, 00:06:27.879 --> 00:06:30.279 the one with the six cartoon faces. That's still 00:06:30.279 --> 00:06:32.180 valid for ages three and up, and if they have 00:06:32.180 --> 00:06:34.040 trouble with numbers or just prefer it, it's 00:06:34.040 --> 00:06:36.560 a great tool. And if they're completely non -communicating. 00:06:37.199 --> 00:06:39.319 Then you're moving to an observational checklist. 00:06:39.800 --> 00:06:43.579 Often it's the FLACC scale face, legs, activity, 00:06:43.839 --> 00:06:46.300 cry, consolability adapted for older children. 00:06:46.660 --> 00:06:48.939 You observe them for a set period, usually about 00:06:48.939 --> 00:06:51.600 10 minutes, and score them based on what you 00:06:51.600 --> 00:06:54.540 see. but for your typical neurotypical 16 -year 00:06:54.540 --> 00:06:57.439 -old. Just ask them the number. Don't overcomplicate 00:06:57.439 --> 00:06:59.319 it. Give them the agency to report their own 00:06:59.319 --> 00:07:02.259 experience. Got it. 010 is the way to go. Let's 00:07:02.259 --> 00:07:05.079 move to segment two. This is the big one. Puberty 00:07:05.079 --> 00:07:07.699 and physical development. The biological sequence. 00:07:08.019 --> 00:07:11.399 Yes. And I feel like exams love to ask about 00:07:11.399 --> 00:07:14.339 what happens first. They absolutely do. And this 00:07:14.339 --> 00:07:17.100 is where you need to separate. the boys from 00:07:17.100 --> 00:07:19.720 the girls, literally. The timelines are different, 00:07:19.800 --> 00:07:22.439 the markers are different, and the social implications 00:07:22.439 --> 00:07:25.800 are really different. It all starts in the brain, 00:07:25.939 --> 00:07:28.360 though, right? Always. It's a hormonal cascade. 00:07:28.899 --> 00:07:30.959 The hypothalamus wakes up and starts releasing 00:07:30.959 --> 00:07:33.699 GnRH, that's gonadotropin -releasing hormone. 00:07:33.899 --> 00:07:35.920 And that's the starting pistol. That is the starting 00:07:35.920 --> 00:07:38.240 pistol. It tells the pituitary gland, hey, time 00:07:38.240 --> 00:07:41.199 to go. And the pituitary releases FSH and LH 00:07:41.199 --> 00:07:43.319 follicle stimulating hormone and luteinizing 00:07:43.319 --> 00:07:45.660 hormone. Which then travel down to the gonads. 00:07:46.240 --> 00:07:49.699 Exactly! And the gonads ovaries in females, tests 00:07:49.699 --> 00:07:52.759 in males, start pumping out estrogen and progesterone 00:07:52.759 --> 00:07:55.500 or testosterone. And that's when you start to 00:07:55.500 --> 00:07:57.680 see the visible signs. Okay, let's start with 00:07:57.680 --> 00:08:02.259 females. What is the absolute first high -yield, 00:08:02.600 --> 00:08:04.199 gotta -know -it -for -the -test sign a nurse 00:08:04.199 --> 00:08:07.759 should look for? It's called thelarch. T -H -E 00:08:07.759 --> 00:08:11.259 -L -A -R -C -H -E. Thelarch. That's breast -butting, 00:08:11.420 --> 00:08:14.920 a small, tender lump under the nipple. It typically 00:08:14.920 --> 00:08:18.259 happens between ages 9 and 11. This is the herald 00:08:18.259 --> 00:08:20.339 of puberty for girls. And menarche, the first 00:08:20.339 --> 00:08:22.639 period. That comes later. Right. And this is 00:08:22.639 --> 00:08:25.660 a super high yield timeline to memorize. Menarche 00:08:25.660 --> 00:08:28.899 usually occurs roughly 2 to 2 .5 years after 00:08:28.899 --> 00:08:31.399 breast development begins. The average age in 00:08:31.399 --> 00:08:34.639 the U .S. is around 12. So if a parent brings 00:08:34.639 --> 00:08:36.820 in their 10 -year -old who has started developing 00:08:36.820 --> 00:08:39.159 breasts, you can give them some anticipatory 00:08:39.159 --> 00:08:41.159 guidance. You can and you should. You can say 00:08:41.159 --> 00:08:43.080 this is perfectly normal and you can expect your 00:08:43.080 --> 00:08:45.279 period to start in about two years. It prepares 00:08:45.279 --> 00:08:47.399 them, reduces anxiety, and makes you look like 00:08:47.399 --> 00:08:49.600 a superstar. Is there a connection between getting 00:08:49.600 --> 00:08:52.220 your period and growing taller? I hear this question 00:08:52.220 --> 00:08:55.179 a lot. A huge one. And this is a classic exam 00:08:55.179 --> 00:08:57.879 trap. Once Menarche hits, the estrogen levels 00:08:57.879 --> 00:09:00.259 cause the growth plates, the epithelial plates 00:09:00.259 --> 00:09:02.759 in the long bones, to start to close. So the 00:09:02.759 --> 00:09:06.100 window for growth starts to shut. Exactly. Height 00:09:06.100 --> 00:09:09.480 growth usually ceases about two to 2 .5 years 00:09:09.480 --> 00:09:11.840 after that first period. They might get another 00:09:11.840 --> 00:09:14.159 inch or so, but the major growth spurt is over. 00:09:14.340 --> 00:09:16.399 So let's make that a clinical scenario. A mother 00:09:16.399 --> 00:09:19.179 asks, my 15 year old daughter started her period 00:09:19.179 --> 00:09:22.559 at 12. Will she get any taller? The evidence 00:09:22.559 --> 00:09:26.100 -based answer is likely no. She has probably 00:09:26.100 --> 00:09:28.259 reached her adult height. That can be a tough 00:09:28.259 --> 00:09:30.320 conversation if the expectations aren't managed, 00:09:30.600 --> 00:09:33.100 but physiologically, the window has closed. That's 00:09:33.100 --> 00:09:35.259 fascinating and incredibly useful. Now, what 00:09:35.259 --> 00:09:37.759 about the boys? Males mature later. The whole 00:09:37.759 --> 00:09:39.960 process is delayed by about two years compared 00:09:39.960 --> 00:09:43.059 to females. What's the very first sign for them? 00:09:43.440 --> 00:09:45.799 Testicular enlargement. This is considered tanner 00:09:45.799 --> 00:09:47.980 stage two. And that's not something a parent 00:09:47.980 --> 00:09:50.639 is likely to notice? Usually not. It's often 00:09:50.639 --> 00:09:52.539 subtle, but it's the first thing that happens 00:09:52.539 --> 00:09:55.379 and it precedes the big growth spurt. A provider 00:09:55.379 --> 00:09:57.860 will assess this during a well child check. And 00:09:57.860 --> 00:10:00.340 when does their growth spurt hit? Later than 00:10:00.340 --> 00:10:03.740 girls. Usually between 10 .5 and 16 years old, 00:10:03.799 --> 00:10:07.740 but it peaks much later around 13 .5 to 17 .5. 00:10:07.899 --> 00:10:10.990 Which creates that classic awkward middle school 00:10:10.990 --> 00:10:13.750 phase. The phase where all the girls are towering 00:10:13.750 --> 00:10:16.330 over the boys at the school dances. I remember 00:10:16.330 --> 00:10:19.590 that phase well. We all do. And then over one 00:10:19.590 --> 00:10:22.350 summer the boys shoot up and their voices drop. 00:10:22.850 --> 00:10:25.529 That voice deepening is from laryngeal growth. 00:10:25.799 --> 00:10:28.840 caused by testosterone. OK, there's one specific 00:10:28.840 --> 00:10:31.059 thing for boys that I know nurses need to be 00:10:31.059 --> 00:10:33.259 prepared to discuss. Nocturnal emissions. We 00:10:33.259 --> 00:10:36.820 had dreams. Yes. This is a normal physiological 00:10:36.820 --> 00:10:39.559 event that happens during late puberty. It's 00:10:39.559 --> 00:10:42.019 a sign the reproductive system is maturing. But 00:10:42.019 --> 00:10:45.100 it can be incredibly embarrassing for them. Extremely. 00:10:45.220 --> 00:10:47.539 And confusing. And they won't ask about it. That's 00:10:47.539 --> 00:10:50.559 why anticipatory guidance is key. During a checkup, 00:10:50.659 --> 00:10:52.440 you find a private moment and you tell them, 00:10:52.679 --> 00:10:54.279 hey, as you're growing, you might start waking 00:10:54.279 --> 00:10:56.379 up sometimes and notice your pajamas are wet. 00:10:56.940 --> 00:10:59.240 This is totally normal. It has a name. And it 00:10:59.240 --> 00:11:00.980 means your body is working the way it's supposed 00:11:00.980 --> 00:11:04.440 to. You normalize the biology before the biology 00:11:04.440 --> 00:11:07.179 happens. Exactly. You remove the shame and confusion 00:11:07.179 --> 00:11:09.379 before it even has a chance to set in. That's 00:11:09.379 --> 00:11:11.799 excellent nursing care. We also see skin changes 00:11:11.799 --> 00:11:13.399 across the board, right? This affects everyone. 00:11:13.639 --> 00:11:16.860 Yes. This is where deodorant becomes non -negotiable. 00:11:17.039 --> 00:11:19.620 The apocrine glands, mostly in the armpits and 00:11:19.620 --> 00:11:22.639 groin, wake up. So you get body odor. And then 00:11:22.639 --> 00:11:25.240 there's the face. And then the face. The sebaceous 00:11:25.240 --> 00:11:27.539 glands go into overdrive, which gives us acne, 00:11:27.779 --> 00:11:30.360 face, back, shoulders. It can be anywhere. And 00:11:30.360 --> 00:11:33.179 we shouldn't dismiss acne as just cosmetic. Absolutely 00:11:33.179 --> 00:11:36.980 not. For a teen whose entire world revolves around 00:11:36.980 --> 00:11:39.700 pure acceptance and identity, severe acne can 00:11:39.700 --> 00:11:42.330 be a major psychosocial stressor. It can lead 00:11:42.330 --> 00:11:44.889 to depression and social isolation. So we take 00:11:44.889 --> 00:11:48.529 it seriously, we assess it, and we refer to dermatology 00:11:48.529 --> 00:11:50.929 when needed. OK, so we've got the body changing 00:11:50.929 --> 00:11:53.110 at a breakneck pace. Let's shift to the mind. 00:11:53.730 --> 00:11:56.789 Segment three, cognitive and psychosocial development. 00:11:57.370 --> 00:11:59.389 Who are the big theorists we need to know for 00:11:59.389 --> 00:12:01.889 our exams? You cannot pass a nursing exam without 00:12:01.889 --> 00:12:04.350 knowing Eric Erickson. Erickson, of course. For 00:12:04.350 --> 00:12:06.889 adolescents, the stage is identity versus role 00:12:06.889 --> 00:12:09.860 confusion. Who am I? That is the central question. 00:12:10.120 --> 00:12:13.019 Exactly. The primary developmental task is developing 00:12:13.019 --> 00:12:15.259 a sense of self that is separate from their parents. 00:12:15.559 --> 00:12:17.220 They're trying to figure out where they fit in 00:12:17.220 --> 00:12:19.820 the world, what they believe, who they want to 00:12:19.820 --> 00:12:21.879 be. And this doesn't happen all at once. It happens 00:12:21.879 --> 00:12:23.820 in phases, right? It does. We can break it down 00:12:23.820 --> 00:12:26.799 into early, middle, and late adolescence, and 00:12:26.799 --> 00:12:29.500 the focus shifts in each stage. So let's start 00:12:29.500 --> 00:12:32.440 with early adolescence, say 11 to 14. What's 00:12:32.440 --> 00:12:36.429 their main focus? The body. They are preoccupied 00:12:36.429 --> 00:12:39.049 with the physical changes of puberty. Am I normal? 00:12:39.269 --> 00:12:42.909 Am I growing too fast? Too slow? And critically, 00:12:43.269 --> 00:12:45.769 they are focused on conforming to peer norms. 00:12:46.129 --> 00:12:47.870 Fitting in. Fitting in is everything. They want 00:12:47.870 --> 00:12:50.750 to look, talk, and act exactly like their friends. 00:12:51.090 --> 00:12:53.169 Being different is the worst possible thing you 00:12:53.169 --> 00:12:56.029 could be at 13. Then what happens in middle adolescence? 00:12:56.210 --> 00:12:58.909 Middle adolescence. So ages 15 to 17, this is 00:12:58.909 --> 00:13:01.570 the peak of peer reliance. The peer group is 00:13:01.570 --> 00:13:04.009 more important than family for social and emotional. 00:13:03.980 --> 00:13:06.620 And this is also where we see the most conflict 00:13:06.620 --> 00:13:10.440 with parents. Yes, this is the struggle for emancipation. 00:13:10.899 --> 00:13:13.279 They are pushing boundaries, testing limits, 00:13:13.600 --> 00:13:15.879 trying to establish their independence. They're 00:13:15.879 --> 00:13:18.899 also exploring romantic interests and trying 00:13:18.899 --> 00:13:21.620 on different roles. You know, the athlete, the 00:13:21.620 --> 00:13:24.399 musician, the rebel, trying to see what fits 00:13:24.399 --> 00:13:26.820 their identity. It's a period of experimentation. 00:13:26.980 --> 00:13:29.360 A huge period of experimentation. They form a 00:13:29.360 --> 00:13:31.620 group identity first, and through that, they 00:13:31.620 --> 00:13:34.259 find their individual identity. And finally, 00:13:34.779 --> 00:13:38.539 late adolescence. 18 to 21. By now, emancipation 00:13:38.539 --> 00:13:41.019 is nearly complete. They've hopefully developed 00:13:41.019 --> 00:13:43.080 a more stable sense of self. They're thinking 00:13:43.080 --> 00:13:45.440 about realistic career goals. They have a more 00:13:45.440 --> 00:13:47.559 developed moral compass. And the relationship 00:13:47.559 --> 00:13:50.000 with parents often shifts from authority figure 00:13:50.000 --> 00:13:52.440 to something more like a partnership or mentorship. 00:13:52.700 --> 00:13:55.399 OK, so that's Erickson, identity versus role 00:13:55.399 --> 00:13:57.820 confusion. Now, what about Piaget? How are they 00:13:57.820 --> 00:14:00.779 thinking? They're entering the final stage, formal 00:14:00.779 --> 00:14:04.299 operations. Which means they can think abstractly. 00:14:04.360 --> 00:14:06.720 This is a huge leap. They can think about the 00:14:06.720 --> 00:14:09.500 future, about possibilities, about concepts like 00:14:09.500 --> 00:14:11.919 justice and morality. They're not just stuck 00:14:11.919 --> 00:14:14.600 in the concrete here and now like a younger child. 00:14:14.879 --> 00:14:17.659 They can hypothesize. But there's a huge catch, 00:14:17.799 --> 00:14:20.039 isn't there? Because we know teenagers don't 00:14:20.039 --> 00:14:22.159 always make the most logical forward -thinking 00:14:22.159 --> 00:14:25.259 decisions. That is the great paradox of the adolescent 00:14:25.259 --> 00:14:28.059 brain. They can use deductive reasoning, but 00:14:28.059 --> 00:14:30.799 it is often completely clouded by what developmental 00:14:30.799 --> 00:14:34.360 psychologist David Elkine called the invincibility 00:14:34.360 --> 00:14:37.200 fable. The invincibility fable. It's the deeply 00:14:37.200 --> 00:14:40.529 held egocentric belief that Bad things happen 00:14:40.529 --> 00:14:42.990 to other people, not me. I can text and drive. 00:14:43.169 --> 00:14:45.710 I won't crash. I can vape. I won't get addicted. 00:14:45.929 --> 00:14:48.129 I can have unprotected sex. I won't get pregnant. 00:14:48.370 --> 00:14:50.470 Everyone else might, but I'm different. I'm special. 00:14:50.789 --> 00:14:53.509 Exactly. And that is what drives so much of the 00:14:53.509 --> 00:14:55.490 high -risk behavior we see. It's not that they 00:14:55.490 --> 00:14:58.169 don't understand the danger intellectually. It's 00:14:58.169 --> 00:15:00.950 that they don't believe it applies to them personally. 00:15:01.289 --> 00:15:04.490 And that brain science is so key. The prefrontal 00:15:04.490 --> 00:15:07.330 cortex, the judgment and impulse control center, 00:15:07.690 --> 00:15:09.820 it's just not fully developed. Yeah. It's the 00:15:09.820 --> 00:15:12.639 last part of the brain to mature, not fully online 00:15:12.639 --> 00:15:16.100 until the mid -20s, but the limbic system, the 00:15:16.100 --> 00:15:18.340 emotional reward -seeking part of the brain. 00:15:18.440 --> 00:15:21.399 That's firing on all cylinders, fueled by hormones. 00:15:21.559 --> 00:15:23.700 So you have a powerful engine with weak brakes. 00:15:24.159 --> 00:15:26.559 The perfect metaphor. A powerful engine, weak 00:15:26.559 --> 00:15:28.840 brakes, and a driver who thinks they're invincible. 00:15:29.080 --> 00:15:32.320 It's a recipe for, well, for adolescents. Which 00:15:32.320 --> 00:15:34.820 segues perfectly into our next segment because... 00:15:34.519 --> 00:15:37.700 One way we as nurses can act as external breaks 00:15:37.700 --> 00:15:40.139 is through preventative care. Absolutely. Segment 00:15:40.139 --> 00:15:42.960 four, the vaccine schedule. This is pure high 00:15:42.960 --> 00:15:45.179 yield. Got to know it for the exam material. 00:15:45.240 --> 00:15:48.480 It is. And the CDC 2025 schedule is very specific 00:15:48.480 --> 00:15:51.240 here. There are two major milestones for vaccines 00:15:51.240 --> 00:15:53.080 and adolescents that you absolutely have to know. 00:15:53.360 --> 00:15:55.379 Let's start with the first one, the 11 to 12 00:15:55.379 --> 00:15:57.740 year old visit. Right. I like to call this the 00:15:57.740 --> 00:15:59.860 three at 11. It helps you remember there are 00:15:59.860 --> 00:16:01.879 three routine shots they need at this visit. 00:16:02.059 --> 00:16:05.220 OK, what's number one? First, Tdap. This is a 00:16:05.220 --> 00:16:07.620 booster for tetanus, diphtheria, and pertussis, 00:16:07.779 --> 00:16:09.720 or whooping cough. Why do they need a booster? 00:16:09.960 --> 00:16:12.639 Didn't they get this as a baby? They did, but 00:16:12.639 --> 00:16:16.860 immunity wanes over time. And pertussis is particularly 00:16:16.860 --> 00:16:20.179 nasty. A teen might just get a bad cough, but 00:16:20.179 --> 00:16:22.159 they can pass it to a newborn baby who can't 00:16:22.159 --> 00:16:25.019 be vaccinated yet. And for a baby, pertussis 00:16:25.019 --> 00:16:27.059 can be deadly. So it's for community protection 00:16:27.059 --> 00:16:29.899 too? Hugely. And it's almost always required 00:16:29.899 --> 00:16:32.120 for middle school entry in most states, so it's 00:16:32.120 --> 00:16:34.279 a high -yield topic for that reason alone. OK, 00:16:34.399 --> 00:16:36.360 that's one. What's the second of the three at 00:16:36.360 --> 00:16:40.700 11? Menacewy. This is the first dose of the meningococcal 00:16:40.700 --> 00:16:42.720 conjugate vaccine. And what does that protect 00:16:42.720 --> 00:16:45.740 against? Bacterial meningitis, specifically types 00:16:45.740 --> 00:16:49.659 A, C, W, and Y. This is a devastating disease. 00:16:49.779 --> 00:16:51.840 It's an infection of the lining of the brain 00:16:51.840 --> 00:16:54.779 and spinal cord. It can kill within hours or 00:16:54.779 --> 00:16:57.059 leave survivors with deafness, brain damage, 00:16:57.120 --> 00:16:59.539 or amputated limbs. And it spreads easily in 00:16:59.539 --> 00:17:01.879 close quarters. Exactly. Think dorm rooms, summer 00:17:01.879 --> 00:17:04.420 camps, military barracks. This first dose at 00:17:04.420 --> 00:17:06.759 11 or 12 starts to build that protection. OK. 00:17:06.839 --> 00:17:09.529 Tdap and menonase C. What's the third shot at 00:17:09.529 --> 00:17:13.509 this visit? HPV human papillomavirus. The cancer 00:17:13.509 --> 00:17:15.890 prevention vaccine. That's what it is. It prevents 00:17:15.890 --> 00:17:18.950 the HPV strains that cause most cervical, anal, 00:17:19.269 --> 00:17:22.819 throat, and other types of cancers. Here is where 00:17:22.819 --> 00:17:24.700 it gets really interesting and really tricky 00:17:24.700 --> 00:17:28.140 for testing purposes. The dosing. The dosing. 00:17:28.380 --> 00:17:31.019 It depends entirely on the age they start the 00:17:31.019 --> 00:17:32.779 series. So let's break that down. This is the 00:17:32.779 --> 00:17:35.660 before 15 versus after 15 rule. Correct. High 00:17:35.660 --> 00:17:38.680 yield. Write a down fact. If the child starts 00:17:38.680 --> 00:17:41.819 the HPV series before their 15th birthday, they 00:17:41.819 --> 00:17:43.900 only need two doses. And the timing on those 00:17:43.900 --> 00:17:45.700 two. You give the first one today and the second 00:17:45.700 --> 00:17:48.039 one six to 12 months later. Simple. OK, but what 00:17:48.039 --> 00:17:50.400 if they wait? What if they start on or after 00:17:50.400 --> 00:17:52.779 their 15th birthday? Then they need three doses. 00:17:53.000 --> 00:17:56.319 The schedule is more packed, given at zero, then 00:17:56.319 --> 00:17:58.059 one to two months later, and then the final one 00:17:58.059 --> 00:18:00.759 at six months. So why the difference? Why do 00:18:00.759 --> 00:18:03.339 the younger kids get off easy with just two shots? 00:18:03.440 --> 00:18:06.240 It's all about the immune system. Younger adolescents, 00:18:06.319 --> 00:18:09.460 for whatever reason, mount a much stronger and 00:18:09.460 --> 00:18:12.380 more robust immune response to this particular 00:18:12.380 --> 00:18:14.539 vaccine. So they get more bang for their buck. 00:18:14.920 --> 00:18:17.599 Exactly. Two doses at age 11 are just as effective 00:18:17.599 --> 00:18:20.200 as three doses at age 16. The body just learns 00:18:20.200 --> 00:18:22.509 better when it's younger. That a great teaching 00:18:22.509 --> 00:18:25.170 point for parents who might be hesitant. If we 00:18:25.170 --> 00:18:27.950 do it now, it's one less shot for your child. 00:18:28.289 --> 00:18:30.670 Absolutely. It frames it as a clear benefit. 00:18:30.950 --> 00:18:33.250 You also emphasize that we give it now, long 00:18:33.250 --> 00:18:35.450 before they're ever sexually active, to build 00:18:35.450 --> 00:18:37.890 protection well in advance. OK, so that covers 00:18:37.890 --> 00:18:41.670 the 11, 12 year visit. Now, fast forward a few 00:18:41.670 --> 00:18:43.950 years, there's another key vaccine milestone. 00:18:44.009 --> 00:18:46.910 Yes, at age 16. This is the second milestone, 00:18:47.069 --> 00:18:49.190 often called the Sweet 16 booster. And what do 00:18:49.190 --> 00:18:51.069 they get then? They get their second booster 00:18:51.069 --> 00:18:54.730 dose of MENACWY. The meningitis vaccine again? 00:18:54.970 --> 00:18:57.809 Why a booster? Because that protection from the 00:18:57.809 --> 00:19:00.190 first dose starts to wane and their risk is about 00:19:00.190 --> 00:19:03.589 to spike. Ages 16 to 21 are the highest risk 00:19:03.589 --> 00:19:05.829 period for meningococcal disease. Because they're 00:19:05.829 --> 00:19:07.430 heading off to college? They're heading off to 00:19:07.430 --> 00:19:09.470 college, living in dorms, sharing drinks, you 00:19:09.470 --> 00:19:12.470 know, being teenagers. That booster is absolutely 00:19:12.470 --> 00:19:15.589 essential to bridge that high risk gap. Now, 00:19:15.589 --> 00:19:18.829 I see MenB on the schedule, too. For men in Jadis 00:19:18.829 --> 00:19:21.529 B, is that routine? This is a very common exam 00:19:21.529 --> 00:19:25.109 trap. Men A C W Y is routine for all adolescents. 00:19:25.490 --> 00:19:28.210 Men B is not. Okay, so what's the recommendation? 00:19:28.480 --> 00:19:30.720 It's based on something called shared clinical 00:19:30.720 --> 00:19:33.480 decision making for healthy adolescents age 16 00:19:33.480 --> 00:19:36.259 to 23. Meaning the nurse, the doctor, the patient, 00:19:36.380 --> 00:19:38.839 and the parents talk about it. Exactly. You discuss 00:19:38.839 --> 00:19:41.200 the risks and benefits. MenB is not as common 00:19:41.200 --> 00:19:43.240 as the other strains, but there have been outbreaks 00:19:43.240 --> 00:19:46.059 on college campuses, so it's not mandatory for 00:19:46.059 --> 00:19:48.400 everyone. But it is preferred for administration 00:19:48.400 --> 00:19:51.079 between 16 and 18 if the patient and provider 00:19:51.079 --> 00:19:54.559 decide the risk warrants it. Got it. So for the 00:19:54.559 --> 00:19:58.329 test, routine is MenACWI. Share decision as men 00:19:58.329 --> 00:20:02.009 be. You got it. And last thing on vaccines. Always 00:20:02.009 --> 00:20:04.269 check for catch up. Don't assume anything. Never 00:20:04.269 --> 00:20:05.950 assume they're up to date just because they made 00:20:05.950 --> 00:20:07.950 it to high school. Did they finish their three 00:20:07.950 --> 00:20:10.829 dose hep B series as a baby? Did they get two 00:20:10.829 --> 00:20:12.829 doses of varicella for chicken pox? Did they 00:20:12.829 --> 00:20:14.549 get their hep A series? If they missed those 00:20:14.549 --> 00:20:17.130 as kids, you catch them up now. Moving on to 00:20:17.130 --> 00:20:19.369 segment five, and this is a heavy one. Safety 00:20:19.369 --> 00:20:21.849 and mortality. We talked about the invincibility 00:20:21.849 --> 00:20:23.849 fable. What is actually killing adolescents? 00:20:24.119 --> 00:20:26.839 If you look at the CDC mortality data, it is 00:20:26.839 --> 00:20:29.819 tragic, but it is crystal clear. The number one 00:20:29.819 --> 00:20:32.700 cause of death for this age group is unintentional 00:20:32.700 --> 00:20:35.559 injury. And that's a broad category. It is. But 00:20:35.559 --> 00:20:38.380 the vast majority of that is one thing. Motor 00:20:38.380 --> 00:20:42.940 vehicle accidents? MVAs. Is it just inexperience? 00:20:43.200 --> 00:20:45.920 Speeding it's a combination. It's inexperience. 00:20:45.920 --> 00:20:49.079 It's speed. It's alcohol and it is Overwhelmingly 00:20:49.079 --> 00:20:51.799 distracted driving phone phones, of course But 00:20:51.799 --> 00:20:54.339 the single biggest risk factor even more than 00:20:54.339 --> 00:20:56.799 their own phone use is having other teens in 00:20:56.799 --> 00:21:00.099 the car the peer passengers Yes, the data is 00:21:00.099 --> 00:21:03.000 shocking the risk of a fatal crash increases 00:21:03.000 --> 00:21:06.059 Exponentially with each non -family peer passenger 00:21:06.059 --> 00:21:09.400 in the car with a teen driver. It's the ultimate 00:21:09.400 --> 00:21:12.240 distraction so the nursing guidance here is What? 00:21:12.359 --> 00:21:14.220 It's all about anticipatory guidance. You talk 00:21:14.220 --> 00:21:16.440 about seatbelts, no texting. But you also talk 00:21:16.440 --> 00:21:18.759 to the parents and the teen about graduated driver 00:21:18.759 --> 00:21:21.180 licensing rules. Most states have them. Rules 00:21:21.180 --> 00:21:23.180 that limit night driving or the number of passengers. 00:21:23.619 --> 00:21:25.640 Exactly. We enforce those rules because we know 00:21:25.640 --> 00:21:27.559 that passengers kill teen drivers. It's that 00:21:27.559 --> 00:21:30.339 simple. OK, that's number one. The next two causes 00:21:30.339 --> 00:21:34.599 are grim. They are homicide and suicide. According 00:21:34.599 --> 00:21:37.640 to our source text, homicide is the second leading 00:21:37.640 --> 00:21:40.200 cause of death for this age group, and it primarily 00:21:40.200 --> 00:21:43.309 involves firearms. What's the nurse's role there? 00:21:43.470 --> 00:21:45.809 It's assessment. You're screening for risks. 00:21:46.049 --> 00:21:48.609 Is there gang involvement? Are there weapons 00:21:48.609 --> 00:21:51.250 in the home? Is the child being bullied or showing 00:21:51.250 --> 00:21:53.730 signs of aggression? It's about identifying risk 00:21:53.730 --> 00:21:56.490 and connecting families with resources. And suicide 00:21:56.490 --> 00:21:59.490 is third. Correct for the 10 -19 demographic. 00:21:59.829 --> 00:22:02.049 Though we all know that anecdotally and from 00:22:02.049 --> 00:22:05.049 the news, those rates are trending sharply upward. 00:22:05.609 --> 00:22:08.190 As nurses, we are on the front lines and we must 00:22:08.190 --> 00:22:10.289 assess for this. What does that assessment look 00:22:10.289 --> 00:22:13.019 like? It feels... uncomfortable to ask about. 00:22:13.299 --> 00:22:15.720 It can be, but you have to push past the discomfort. 00:22:15.859 --> 00:22:18.599 You have to ask directly. You cannot use euphemisms 00:22:18.599 --> 00:22:20.740 like, are you feeling sad? You have to say, have 00:22:20.740 --> 00:22:22.500 you had any thoughts about hurting yourself or 00:22:22.500 --> 00:22:25.400 ending your life? Just be direct. Be direct. 00:22:25.779 --> 00:22:28.160 It does not put the idea in their head. It opens 00:22:28.160 --> 00:22:30.559 the door for them to talk. You look for red flags, 00:22:31.000 --> 00:22:33.400 a sudden drop in school performance, withdrawal 00:22:33.400 --> 00:22:35.819 from activities they used to love, giving away 00:22:35.819 --> 00:22:38.700 prize possessions, drastic mood swings. And we 00:22:38.700 --> 00:22:41.380 know certain populations are even higher risk. 00:22:41.539 --> 00:22:45.460 Yes. We know that LGBTQ plus youth are at a significantly 00:22:45.460 --> 00:22:48.420 higher risk, often due to social stigma, family 00:22:48.420 --> 00:22:51.480 rejection and isolation. It's our job to create 00:22:51.480 --> 00:22:54.019 a safe, affirming space for them to talk. OK, 00:22:54.039 --> 00:22:57.000 let's talk about substances. Vaping and e -cigarettes 00:22:57.000 --> 00:22:58.980 seem to be everywhere. It is the new epidemic 00:22:58.980 --> 00:23:01.539 for this generation. And the marketing is so 00:23:01.539 --> 00:23:04.400 insidious, making it look harmless and fun. But 00:23:04.400 --> 00:23:07.619 it's not. It is not. Nicotine is a neurotoxin, 00:23:07.700 --> 00:23:10.220 and it profoundly affects the developing adolescent 00:23:10.220 --> 00:23:12.539 brain, specifically the parts responsible for 00:23:12.539 --> 00:23:15.500 attention, learning, and impulse control. It 00:23:15.500 --> 00:23:17.839 literally primes the brain for a lifetime of 00:23:17.839 --> 00:23:19.880 addiction. And there's the old standby alcohol. 00:23:20.180 --> 00:23:22.880 Alcohol, of course. The big risk there is binge 00:23:22.880 --> 00:23:25.099 drinking. Again, that prefrontal cortex isn't 00:23:25.099 --> 00:23:27.019 working well, so they don't have that off switch. 00:23:27.339 --> 00:23:29.480 So how do you talk to a 16 -year -old about this? 00:23:30.059 --> 00:23:31.960 Telling them you'll get liver failure when you're 00:23:31.960 --> 00:23:35.109 50? Doesn't seem to work. No, because they are 00:23:35.109 --> 00:23:37.670 invincible. Remember, 50 is a million years away. 00:23:37.809 --> 00:23:40.609 You have to focus on the immediate socially relevant 00:23:40.609 --> 00:23:43.470 consequences. Like what? Vaping gives you bad 00:23:43.470 --> 00:23:46.269 breath and stains your teeth. Alcohol makes you 00:23:46.269 --> 00:23:48.289 lose control and do something embarrassing in 00:23:48.289 --> 00:23:50.130 front of your friends that could end up on social 00:23:50.130 --> 00:23:53.670 media forever. You appeal to their vanity and 00:23:53.670 --> 00:23:56.150 their social standing. That works far better 00:23:56.150 --> 00:23:58.230 than long term scare tactics for this age group. 00:23:58.349 --> 00:24:01.130 That is a brilliant tip. Leverage the peer pressure 00:24:01.130 --> 00:24:03.750 for good. Let's lighten it up a bit with segment 00:24:03.750 --> 00:24:06.210 six, health promotion and the nice -to -know 00:24:06.210 --> 00:24:10.170 details. Let's talk food. Nutrition is huge because 00:24:10.170 --> 00:24:12.470 they are in a period of growth second only to 00:24:12.470 --> 00:24:14.849 infancy. They need increased calories, they need 00:24:14.849 --> 00:24:17.329 increased protein for all that new muscle. And 00:24:17.329 --> 00:24:19.890 any specific minerals? Two are absolutely critical, 00:24:20.150 --> 00:24:22.930 calcium and iron. Okay, why calcium? Bone density. 00:24:23.609 --> 00:24:26.990 About 45 % of a person's total skeletal mass 00:24:26.990 --> 00:24:30.000 is added during adolescence. This is the one 00:24:30.000 --> 00:24:32.599 and only window they have to build strong bones 00:24:32.599 --> 00:24:35.700 for life. If they don't get enough calcium now, 00:24:35.859 --> 00:24:38.380 their risk for osteoporosis later in life is 00:24:38.380 --> 00:24:41.200 much, much higher. And iron. For two different 00:24:41.200 --> 00:24:44.019 reasons. For females, it's because of menstruation. 00:24:44.500 --> 00:24:46.940 They are losing iron -rich blood every single 00:24:46.940 --> 00:24:49.380 month. They're at high risk for iron deficiency 00:24:49.380 --> 00:24:51.880 anemia. And for males. For males, it's because 00:24:51.880 --> 00:24:54.619 of the massive increase in muscle mass. Muscle 00:24:54.619 --> 00:24:57.460 requires iron to function properly. So both sexes 00:24:57.460 --> 00:25:00.279 need more, but for different physiological reasons. 00:25:00.500 --> 00:25:02.720 What about sleep? I feel like every teen is famous 00:25:02.720 --> 00:25:05.759 for sleeping in until noon on Saturdays. And 00:25:05.759 --> 00:25:08.240 biologically, they need to. Their circadian rhythm 00:25:08.240 --> 00:25:10.819 actually shifts during puberty. It's a real documented 00:25:10.819 --> 00:25:13.099 phenomenon called a sleep phase delay. Their 00:25:13.099 --> 00:25:15.180 brains don't start producing melatonin until 00:25:15.180 --> 00:25:16.900 later at night. So they naturally want to stay 00:25:16.900 --> 00:25:19.259 up later and sleep later. Yes, but school starts 00:25:19.259 --> 00:25:22.539 at 7 .30 a .m. So there's a huge mismatch. They 00:25:22.539 --> 00:25:25.140 still need, on average, about nine hours a night. 00:25:25.500 --> 00:25:28.099 Which basically no teenager gets. Almost none. 00:25:28.279 --> 00:25:31.220 And chronic sleep deprivation impacts everything. 00:25:31.660 --> 00:25:34.019 Their mood, their school performance, their risk 00:25:34.019 --> 00:25:36.119 -taking behavior, their immune system. So what's 00:25:36.119 --> 00:25:39.000 the nurse's role here? Encouraging sleep hygiene. 00:25:39.660 --> 00:25:42.700 Number one rule. No screens in the bedroom. That's 00:25:42.700 --> 00:25:45.359 a tough song. It is, but it's critical. The blue 00:25:45.359 --> 00:25:48.240 light from phones and tablets suppresses melatonin 00:25:48.240 --> 00:25:50.539 production, making it even harder for them to 00:25:50.539 --> 00:25:53.819 fall asleep. So consistent bedtimes, a cool, 00:25:54.019 --> 00:25:57.730 dark room, and no phones. Great advice. Okay, 00:25:57.849 --> 00:26:00.250 let's hit our final segment. Second seven, common 00:26:00.250 --> 00:26:02.630 exam traps and clinical pearls. These are the 00:26:02.630 --> 00:26:04.650 things that trip students up every time. Trap 00:26:04.650 --> 00:26:07.369 number one, and it's a big one, confidentiality. 00:26:07.589 --> 00:26:09.769 Ah, the parent in the room problem. Exactly. 00:26:09.930 --> 00:26:13.049 The rule is this. You must, at some point during 00:26:13.049 --> 00:26:15.390 the visit, interview the adolescent without the 00:26:15.390 --> 00:26:17.769 parent present. You need to ask about sensitive 00:26:17.769 --> 00:26:20.869 topics, sexuality, drugs, alcohol, mental health. 00:26:21.309 --> 00:26:23.569 They will not be honest with mom or dad sitting 00:26:23.569 --> 00:26:25.710 there. But there's a limit to that confidentiality. 00:26:25.769 --> 00:26:29.190 Yes. And this is the key. If they disclose that 00:26:29.190 --> 00:26:31.089 they are a danger to themselves or to someone 00:26:31.089 --> 00:26:34.589 else, if their suicidal or homicidal confidentiality 00:26:34.589 --> 00:26:37.269 must be breached to ensure safety, you have to 00:26:37.269 --> 00:26:39.890 tell the parent and get them help. Safety always 00:26:39.890 --> 00:26:42.190 trumps privacy in that case. OK, trap number 00:26:42.190 --> 00:26:44.809 two. Growth cessation. We talked about it, but 00:26:44.809 --> 00:26:47.730 it bears repeating. Don't expect a 16 year old 00:26:47.730 --> 00:26:50.190 female to grow much taller if she had menarche 00:26:50.190 --> 00:26:53.250 at 12. The growth plates are likely closed. Don't 00:26:53.250 --> 00:26:56.579 give false hope. Trap number three. HPV dosing. 00:26:56.900 --> 00:26:58.779 I see students miss this all the time. Just burn 00:26:58.779 --> 00:27:01.319 it into your brain. Before 15 equals two doses, 00:27:01.759 --> 00:27:05.119 after 15 equals three doses. It is a simple cutoff, 00:27:05.359 --> 00:27:11.250 but it's so easy to forget under pressure. Remember, 00:27:11.349 --> 00:27:14.130 Menace CWY is routine for everyone. MenB is a 00:27:14.130 --> 00:27:16.690 shared decision, risk -based conversation. Do 00:27:16.690 --> 00:27:18.789 not get them swapped on the test. They will absolutely 00:27:18.789 --> 00:27:20.950 try to trick you on that. So if you remember 00:27:20.950 --> 00:27:23.309 nothing else from this entire deep dive, what's 00:27:23.309 --> 00:27:24.930 the one thing you want our listeners to take 00:27:24.930 --> 00:27:27.230 away? If you remember nothing else, remember 00:27:27.230 --> 00:27:30.809 this. The adolescent brain has a powerful engine 00:27:30.809 --> 00:27:34.630 but very weak brakes. Their emotional, reward 00:27:34.630 --> 00:27:37.109 -seeking limbic system is fully developed, but 00:27:37.109 --> 00:27:39.970 their prefrontal cortex, the center for judgment, 00:27:40.329 --> 00:27:43.309 impulse control, and long -term planning is still 00:27:43.309 --> 00:27:45.990 under major construction until their mid -20s. 00:27:46.150 --> 00:27:48.349 So what does this all mean? We've covered the 00:27:48.349 --> 00:27:50.490 numbers, the hormones, the risks, the shots. 00:27:51.029 --> 00:27:53.200 How do we tie it all together? Adolescence is 00:27:53.200 --> 00:27:55.960 a perfect storm. You have the rapid physical 00:27:55.960 --> 00:27:58.740 growth of an infant, the emerging hormonal drive 00:27:58.740 --> 00:28:01.339 of an adult, and the dangerous risk -taking behavior 00:28:01.339 --> 00:28:04.000 driven by that invincibility fable. And it all 00:28:04.000 --> 00:28:05.900 comes back to that brain development. That prefrontal 00:28:05.900 --> 00:28:09.019 cortex just isn't online yet. Exactly. The emotional 00:28:09.019 --> 00:28:11.720 center, the amygdala, is fully firing. But the 00:28:11.720 --> 00:28:14.400 control center, the CEO of the brain, is lagging 00:28:14.400 --> 00:28:17.019 way behind. So as a nurse, you have a unique 00:28:17.019 --> 00:28:20.210 role. What's that? You act as the external prefrontal 00:28:20.210 --> 00:28:22.089 cortex. I love that. We provide the judgment 00:28:22.089 --> 00:28:25.130 they don't have yet. Yes. Through our anticipatory 00:28:25.130 --> 00:28:28.089 guidance, we are the ones saying, wear your seatbelt. 00:28:28.549 --> 00:28:30.670 We give them the vaccines to protect them from 00:28:30.670 --> 00:28:33.230 future harm they can't conceptualize. We screen 00:28:33.230 --> 00:28:35.690 for depression they might not recognize. We guide 00:28:35.690 --> 00:28:38.509 them safely across that very shaky, very stormy 00:28:38.509 --> 00:28:40.930 bridge to adulthood. And that wraps up our deep 00:28:40.930 --> 00:28:43.539 dive into adolescent nursing care. Check the 00:28:43.539 --> 00:28:45.539 show notes for the vaccine tables and the vital 00:28:45.539 --> 00:28:47.819 signs chart we talked about. Good luck on your 00:28:47.819 --> 00:28:51.640 exams, and remember, treat the patient, not just 00:28:51.640 --> 00:28:53.339 the parent. And stay curious.