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 --> 00:00:46.989 fast. Welcome to the emergency room. Welcome 00:00:46.989 --> 00:00:50.869 back to the Deep Dive. Today we are wading into 00:00:50.869 --> 00:00:53.170 waters that, let's be honest, terrify a lot of 00:00:53.170 --> 00:00:56.179 people. A significant portion of the parents 00:00:56.179 --> 00:00:58.119 listening right now are probably nodding their 00:00:58.119 --> 00:01:00.140 heads. So, absolutely. But it's not just parents. 00:01:00.259 --> 00:01:01.979 It's nursing students, too. We're looking at 00:01:01.979 --> 00:01:05.420 that specific window from, what, roughly 11 to 00:01:05.420 --> 00:01:09.280 20 years old? Adolescents. And in clinical settings, 00:01:09.599 --> 00:01:12.659 this demographic often gets a bad rap. They're 00:01:12.659 --> 00:01:17.019 seen as difficult, moody. Non -compliant. Or 00:01:17.019 --> 00:01:18.700 just impossible to get a straight answer from. 00:01:18.939 --> 00:01:21.180 Exactly. It's such a huge shift. You know, you 00:01:21.180 --> 00:01:23.659 spin a rotation in pediatrics dealing with toddlers 00:01:23.659 --> 00:01:25.980 who are excited to show you their toys. Or even 00:01:25.980 --> 00:01:28.319 school -aged kids who, for the most part, still 00:01:28.319 --> 00:01:30.439 see adults as authority figures to be pleased. 00:01:30.540 --> 00:01:33.239 Right. And then suddenly you walk into a room 00:01:33.239 --> 00:01:36.480 and you're facing a 15 -year -old who is just 00:01:36.480 --> 00:01:40.609 silent. or rolling their eyes, or actively challenging 00:01:40.609 --> 00:01:42.469 everything you say. It can feel like walking 00:01:42.469 --> 00:01:44.769 through a minefield. It really, really does. 00:01:45.170 --> 00:01:47.049 But looking at the stack of sources for today, 00:01:47.510 --> 00:01:50.189 we've pulled the core textbook chapters on growth 00:01:50.189 --> 00:01:53.909 and development, the new 2025 CDC immunization 00:01:53.909 --> 00:01:56.390 schedules, and the current pain assessment protocols. 00:01:57.450 --> 00:01:59.950 It seems like the secret to navigating this, 00:02:00.230 --> 00:02:02.329 especially for the NCLAX or pediatric boards, 00:02:02.750 --> 00:02:05.090 isn't just memorizing a list of hormones. Oh, 00:02:05.129 --> 00:02:07.489 absolutely not. If you try to memorize every 00:02:07.489 --> 00:02:09.569 physiological change in isolation, you're just 00:02:09.569 --> 00:02:11.409 going to drown in data. You'll never get a handle 00:02:11.409 --> 00:02:13.710 on it. So what's the approach? We need to apply 00:02:13.710 --> 00:02:15.969 the 80 -20 rule here. The 80 -20 rule? Yeah, 00:02:16.030 --> 00:02:18.490 focus on the 20 % of developmental concepts that 00:02:18.490 --> 00:02:21.830 explain 80 % of the clinical problems. The whole 00:02:21.830 --> 00:02:25.150 mission of this deep dive is to understand the 00:02:25.150 --> 00:02:27.750 core engine that's driving the adolescent. OK. 00:02:27.909 --> 00:02:29.830 Because if you understand that engine, you can 00:02:29.830 --> 00:02:31.689 predict the behavior, you can predict the safety 00:02:31.689 --> 00:02:33.689 risks, and you can predict the correct answers 00:02:33.689 --> 00:02:36.199 on the exam. So what is that engine? What's the 00:02:36.199 --> 00:02:38.840 core concept? It's a collision. A high speed 00:02:38.840 --> 00:02:41.460 collision between a rapidly maturing, basically 00:02:41.460 --> 00:02:44.840 adult size body and a brain that is desperate 00:02:44.840 --> 00:02:48.360 for identity but lacks the brakes to keep it 00:02:48.360 --> 00:02:51.020 safe. So like a hardware versus software problem? 00:02:51.120 --> 00:02:53.419 That's the perfect analogy. The hardware gets 00:02:53.419 --> 00:02:55.740 a massive upgrade. but the software is still 00:02:55.740 --> 00:02:58.900 buggy. I like that framework. So what we're doing 00:02:58.900 --> 00:03:02.120 here is building a kind of survival guide. We 00:03:02.120 --> 00:03:04.719 want to move the listener from just asking, what 00:03:04.719 --> 00:03:07.699 is the normal blood pressure, to how do I actually 00:03:07.699 --> 00:03:09.939 get this person to listen to me so I can keep 00:03:09.939 --> 00:03:12.590 them alive? That's it. That is the ultimate goal. 00:03:12.889 --> 00:03:15.030 All right, let's dive in. Let's start with the 00:03:15.030 --> 00:03:17.770 big picture theme. The outline here calls this 00:03:17.770 --> 00:03:20.330 the central conflict. We're transitioning from 00:03:20.330 --> 00:03:22.810 childhood to adulthood, but what's the fundamental 00:03:22.810 --> 00:03:25.550 shift that's actually happening? Okay, so think 00:03:25.550 --> 00:03:27.289 back to the school -aged child we talked about 00:03:27.289 --> 00:03:30.310 before. For a 10 -year -old who is the center 00:03:30.310 --> 00:03:33.789 of their universe, who holds all the truth. The 00:03:33.789 --> 00:03:36.949 parents. Maybe teacher. It's the adults. Adults 00:03:36.949 --> 00:03:39.710 are the authority. Right. In adolescence, that 00:03:39.710 --> 00:03:43.270 center of gravity shifts violently. The biological 00:03:43.270 --> 00:03:45.289 and psychological imperative is independence. 00:03:45.750 --> 00:03:47.689 They're moving from a solar system where parents 00:03:47.689 --> 00:03:50.189 are the sun to a new one where peers are the 00:03:50.189 --> 00:03:52.370 sun. Is that just them being difficult? Or is 00:03:52.370 --> 00:03:54.310 this something that's hardwired? It's developmental 00:03:54.310 --> 00:03:56.509 survival. It has to happen. They have to detach 00:03:56.509 --> 00:03:59.400 to become functioning adults. Yeah. But... This 00:03:59.400 --> 00:04:02.300 is where that hardware software analogy really 00:04:02.300 --> 00:04:05.539 kicks in and explains the chaos. OK, break that 00:04:05.539 --> 00:04:08.419 down for me. The body is the hardware. Exactly. 00:04:08.740 --> 00:04:11.599 Puberty hits, and the hardware gets this massive, 00:04:11.639 --> 00:04:13.500 incredible upgrade. They get bigger, stronger, 00:04:13.759 --> 00:04:15.840 faster. They start to look like adults in the 00:04:15.840 --> 00:04:18.420 mirror. But the software. But the software, the 00:04:18.420 --> 00:04:20.660 brain, and specifically the judgment centers 00:04:20.660 --> 00:04:23.379 in the prefrontal cortex, is still running an 00:04:23.379 --> 00:04:26.459 older operating system. It's buggy. It's not 00:04:26.459 --> 00:04:28.699 fully compatible with the new horsepower of the 00:04:28.699 --> 00:04:30.939 body. That totally explains the disconnect. It 00:04:30.939 --> 00:04:33.819 explains why a kid who can solve a complex calculus 00:04:33.819 --> 00:04:36.800 problem in class, which is super high -level 00:04:36.800 --> 00:04:39.620 cognitive processing, will get in a car five 00:04:39.620 --> 00:04:41.980 minutes later and text while driving Eddie miles 00:04:41.980 --> 00:04:44.620 an hour. Yes. The raw intelligence is there, 00:04:44.860 --> 00:04:47.480 but the impulse control, the long -term consequence 00:04:47.480 --> 00:04:51.509 analysis, it's lagging way behind. And that drive 00:04:51.509 --> 00:04:54.230 for independence combined with that lag, it explains 00:04:54.230 --> 00:04:56.250 almost everything from why they skip breakfast 00:04:56.250 --> 00:04:58.769 to why they experiment with drugs. Okay, so let's 00:04:58.769 --> 00:05:01.430 dig into that hardware upgrade first, the physical 00:05:01.430 --> 00:05:05.370 stuff. For the exams, I know knowing the timing 00:05:05.370 --> 00:05:07.970 of puberty is critical, especially telling the 00:05:07.970 --> 00:05:10.430 difference between males and females. It's very 00:05:10.430 --> 00:05:13.009 distinct and it trips people up all the time. 00:05:13.370 --> 00:05:15.949 The general rule is females start the process 00:05:15.949 --> 00:05:19.699 significantly earlier. Biologically, females 00:05:19.699 --> 00:05:22.620 enter puberty usually around 9 to 10 years old. 00:05:22.819 --> 00:05:24.959 And what's the first clinical marker? What are 00:05:24.959 --> 00:05:27.560 we looking for? The larch. That's the medical 00:05:27.560 --> 00:05:29.699 term for breast budding. That's usually the first 00:05:29.699 --> 00:05:32.240 sign of ovarian activity. OK, the larch. Following 00:05:32.240 --> 00:05:34.699 that, you'll see adrenarch pupa care growth. 00:05:35.600 --> 00:05:38.639 But the big milestone everyone focuses on, parents 00:05:38.639 --> 00:05:42.199 and students alike, is monarch. the first period. 00:05:42.439 --> 00:05:44.000 But that's not the start of the process, right? 00:05:44.019 --> 00:05:45.959 That comes later in the sequence. Much later. 00:05:46.480 --> 00:05:48.720 Menarche typically happens about two to two and 00:05:48.720 --> 00:05:50.579 a half years after breast development begins. 00:05:50.980 --> 00:05:52.839 So the average age is somewhere around 12 or 00:05:52.839 --> 00:05:55.379 12 and a half. You know, there's a specific note 00:05:55.379 --> 00:05:57.879 in the source material about height and menstruation 00:05:57.879 --> 00:05:59.779 that really stood out. It feels like a classic 00:05:59.779 --> 00:06:02.100 exam trap. It is the number one misconception. 00:06:02.199 --> 00:06:04.459 I hear it all the time. Parents think, oh, she 00:06:04.459 --> 00:06:06.600 got her period. She's finally growing up. She's 00:06:06.600 --> 00:06:08.420 going to shoot up like a beanstalk. But it's 00:06:08.420 --> 00:06:10.740 the opposite. It's the exact opposite signal. 00:06:10.860 --> 00:06:14.279 Menarche signals the end phase of the growth 00:06:14.279 --> 00:06:16.800 spurt. So once the period starts, the growing 00:06:16.800 --> 00:06:20.300 is almost done. Their linear growth. So their 00:06:20.300 --> 00:06:23.519 height, it slows down dramatically. They typically 00:06:23.519 --> 00:06:25.639 stop growing about two to two and a half years 00:06:25.639 --> 00:06:28.420 after Menarche starts. They might only gain another 00:06:28.420 --> 00:06:31.100 inch or two. That's it. That is such a crucial 00:06:31.100 --> 00:06:33.860 piece of anticipatory guidance for a nurse. If 00:06:33.860 --> 00:06:36.500 you have a 13 year old patient who just started 00:06:36.500 --> 00:06:38.600 her period and she's worried she's too short. 00:06:39.259 --> 00:06:41.339 You have to manage those expectations. You do. 00:06:41.360 --> 00:06:43.839 You have to be honest and say, you're not going 00:06:43.839 --> 00:06:46.120 to grow another six inches. Now, contrast that 00:06:46.120 --> 00:06:48.379 with males. They're the late bloomers. Right. 00:06:48.600 --> 00:06:50.720 They usually start around 10 to 11 years old. 00:06:51.019 --> 00:06:54.939 And for them, the first sign is testicular enlargement, 00:06:55.459 --> 00:06:57.800 what we call tanner stage two. But their actual 00:06:57.800 --> 00:07:00.300 height velocity, that big growth spurt, is much 00:07:00.300 --> 00:07:02.259 later. How much later are we talking? It could 00:07:02.259 --> 00:07:04.139 be anywhere from 10 and a half to 16. It's a 00:07:04.139 --> 00:07:06.560 much wider window. And because they start their 00:07:06.560 --> 00:07:08.819 growth spurt later, and they grow for a longer 00:07:08.819 --> 00:07:11.180 period before their growth plates close, they 00:07:11.180 --> 00:07:13.519 tend to end up taller. And speaking of growth 00:07:13.519 --> 00:07:17.040 plates, the epiphyses, that's the physical mechanism 00:07:17.040 --> 00:07:19.399 here, right? Yes, that's what's happening. The 00:07:19.399 --> 00:07:22.079 surge in sex hormones like estrogen and testosterone 00:07:22.079 --> 00:07:25.060 that drives all these changes eventually signals 00:07:25.060 --> 00:07:27.639 those plates at the ends of the long bones to 00:07:27.639 --> 00:07:30.819 fuse. And once they close, the game is over. 00:07:31.279 --> 00:07:33.600 That's your adult height. That's your adult height. 00:07:33.959 --> 00:07:36.100 No more growing. And along with the height, we 00:07:36.100 --> 00:07:39.240 see these massive changes in their organs. The 00:07:39.240 --> 00:07:41.699 heart and lungs especially. The heart's size 00:07:41.699 --> 00:07:44.500 and strength basically doubled during adolescence. 00:07:45.060 --> 00:07:47.519 The lungs increase in diameter and length. This 00:07:47.519 --> 00:07:50.240 is why you see athletic performance just skyrocket 00:07:50.240 --> 00:07:52.540 in late adolescence. So you've got maximum endurance. 00:07:52.860 --> 00:07:55.759 Maximum endurance. And coordination is finally 00:07:55.759 --> 00:07:58.480 dialing in after that awkward sort of puppy dog 00:07:58.480 --> 00:08:00.180 phase where their limbs are all over the place. 00:08:00.420 --> 00:08:03.139 Which leads us directly to vital signs. Because 00:08:03.139 --> 00:08:05.180 their hearts are bigger and stronger, they don't 00:08:05.180 --> 00:08:07.399 need to beat as fast as a toddler's heart does. 00:08:07.600 --> 00:08:11.279 Exactly. For a nurse, an adolescent is effectively 00:08:11.279 --> 00:08:14.240 an adult when it comes to vitals. You were looking 00:08:14.240 --> 00:08:16.680 for a heart rate between 50 and 100 beats per 00:08:16.680 --> 00:08:20.939 minute. Respirations, 16 to 20. Blood pressure 00:08:20.939 --> 00:08:24.019 should be systolic under 120. Diastolic under 00:08:24.019 --> 00:08:27.620 80. So if you see a resting heart rate of 110 00:08:27.620 --> 00:08:30.779 in a 16 -year -old, you don't just document normal 00:08:30.779 --> 00:08:33.519 for age. No, that is tachycardia. You need to 00:08:33.519 --> 00:08:35.299 investigate that. What about pain assessment? 00:08:35.379 --> 00:08:37.440 Are we still pulling out the smiley faces scale? 00:08:37.720 --> 00:08:40.399 Please, please do not use the faces scale on 00:08:40.399 --> 00:08:43.700 a cognitively intact 17 -year -old. It can feel 00:08:43.700 --> 00:08:45.919 really demeaning, and they are so sensitive to 00:08:45.919 --> 00:08:48.139 being treated like children. So what do we use? 00:08:48.409 --> 00:08:50.769 They can think abstractly now. They can quantify 00:08:50.769 --> 00:08:54.149 their pain, use the numeric scale, 0 to 10. It's 00:08:54.149 --> 00:08:56.269 simple. It's respectful. Unless, of course, they're 00:08:56.269 --> 00:08:58.529 non -communicating or have a cognitive delay. 00:08:58.889 --> 00:09:01.269 In that specific case, you would revert back 00:09:01.269 --> 00:09:04.169 to an observational tool like FLACC. But for 00:09:04.169 --> 00:09:06.269 your standard adolescent, you just ask them to 00:09:06.269 --> 00:09:08.789 rate it. OK, so that covers the can -do. They 00:09:08.789 --> 00:09:11.190 can run fast. They have adult vitals. They can 00:09:11.190 --> 00:09:13.350 articulate pain. But now let's talk about the 00:09:13.350 --> 00:09:16.759 trap. What can they not do yet? This is the neurological 00:09:16.759 --> 00:09:18.860 piece. This is the software problem. We mentioned 00:09:18.860 --> 00:09:21.360 the myelin sheath is growing. That's the insulation 00:09:21.360 --> 00:09:23.940 on the nerves that makes processing faster. So 00:09:23.940 --> 00:09:27.039 they think really fast. But the prefrontal cortex 00:09:27.039 --> 00:09:30.840 is the bottleneck. CEO of the brain. Exactly. 00:09:31.019 --> 00:09:33.379 The part that handles judgment, impulse control, 00:09:33.519 --> 00:09:36.059 and long -term consequence analysis. It is not 00:09:36.059 --> 00:09:38.299 fully mature until the mid -20s. So they have 00:09:38.299 --> 00:09:41.080 a Ferrari engine. The body and bicycle breaks 00:09:41.080 --> 00:09:43.779 the brain. That is the perfect description. They 00:09:43.779 --> 00:09:46.539 literally cannot fully grasp the concept of, 00:09:46.860 --> 00:09:49.600 if I do this risky thing today, I might be paralyzed 00:09:49.600 --> 00:09:52.620 in 20 years. It's too abstract. They physically 00:09:52.620 --> 00:09:55.000 look like adults, which tricks us, the adults, 00:09:55.179 --> 00:09:57.659 into treating them like adults, but they lack 00:09:57.659 --> 00:10:00.399 the executive function to act like adults in 00:10:00.399 --> 00:10:03.750 high stress, high emotion situations. Which transitions 00:10:03.750 --> 00:10:06.169 us perfectly into how they think. We have to 00:10:06.169 --> 00:10:08.490 bring in Piaget. Piaget helps us understand the 00:10:08.490 --> 00:10:11.190 software itself. Adolescents are entering what 00:10:11.190 --> 00:10:14.070 he called the stage of formal operations. This 00:10:14.070 --> 00:10:17.169 is the big shift from concrete to abstract thinking. 00:10:17.450 --> 00:10:20.269 Yes. A younger, school -aged child thinks in 00:10:20.269 --> 00:10:22.710 very concrete terms. The stove is hot. Don't 00:10:22.710 --> 00:10:25.669 touch it. An adolescent can think abstractly. 00:10:25.990 --> 00:10:28.350 What is the nature of heat? What are the principles 00:10:28.350 --> 00:10:31.110 of thermodynamics? What if I modify the stove? 00:10:31.440 --> 00:10:34.039 They can think about the future, about hypotheticals, 00:10:34.100 --> 00:10:36.720 about what -if scenarios. They can scientifically 00:10:36.720 --> 00:10:39.779 problem solve. But, and this is a big but, there's 00:10:39.779 --> 00:10:42.100 a glitch in the software. A massive glitch. It's 00:10:42.100 --> 00:10:44.460 called adolescent egocentrism. Even though they 00:10:44.460 --> 00:10:46.899 have these new abstract thinking powers, they 00:10:46.899 --> 00:10:49.740 are hyper -focused on themselves. And this shows 00:10:49.740 --> 00:10:52.039 up in two very specific ways that are all over 00:10:52.039 --> 00:10:54.679 nursing exams. The imaginary audience and the 00:10:54.679 --> 00:10:56.419 personal fable. Okay, let's break those down. 00:10:56.460 --> 00:10:58.659 The imaginary audience. Is this the feeling that 00:10:58.659 --> 00:11:02.190 everyone is constantly looking at you? Yes. The 00:11:02.190 --> 00:11:05.549 teen walks into the school cafeteria and genuinely 00:11:05.549 --> 00:11:08.110 believes that every single person is looking 00:11:08.110 --> 00:11:10.490 at them scrutinizing their hair, their shoes, 00:11:10.669 --> 00:11:12.990 the pimple on their forehead. This is what leads 00:11:12.990 --> 00:11:15.750 to that agonizing self -consciousness. It's main 00:11:15.750 --> 00:11:18.309 character syndrome. It really is. They feel like 00:11:18.309 --> 00:11:21.809 they are on stage 24 -7 and the spotlight is 00:11:21.809 --> 00:11:24.269 always on them. And the second one, the personal 00:11:24.269 --> 00:11:26.820 fable. This one sounds more dangerous. Oh, it's 00:11:26.820 --> 00:11:29.679 deeply dangerous. The personal fable is the core 00:11:29.679 --> 00:11:32.659 belief that one's own thoughts, feelings, and 00:11:32.659 --> 00:11:35.019 experiences are completely unique and special. 00:11:35.220 --> 00:11:37.259 Like no one has ever felt love like this before. 00:11:37.419 --> 00:11:39.500 Or no one could possibly understand my pain. 00:11:40.659 --> 00:11:43.000 But the really dark side of it is the belief 00:11:43.000 --> 00:11:45.980 in invincibility. Bad things happen to other 00:11:45.980 --> 00:11:47.899 people. Other people get pregnant. Other people 00:11:47.899 --> 00:11:51.070 die in car crashes. Not me. I'm special. I'm 00:11:51.070 --> 00:11:53.490 different. Wow, that is a terrifying combination. 00:11:53.730 --> 00:11:56.549 You have a brain that is actively seeking sensation 00:11:56.549 --> 00:11:58.990 and novelty and a belief system that tells you, 00:11:59.110 --> 00:12:01.429 I cannot be hurt. And then you layer Erickson 00:12:01.429 --> 00:12:03.710 on top of that. OK, Erickson's stage for this 00:12:03.710 --> 00:12:06.909 age group, identity versus role confusion. Right. 00:12:07.429 --> 00:12:10.389 The primary number one developmental job of the 00:12:10.389 --> 00:12:13.889 teenager is to answer the question, who am I? 00:12:14.529 --> 00:12:17.190 Not who my parents say I am, not who my teachers 00:12:17.190 --> 00:12:20.240 think I am, but who I am. separate from the family 00:12:20.240 --> 00:12:23.039 unit. And to do that, they need a mirror. The 00:12:23.039 --> 00:12:25.279 peer group acts as that mirror. That's its function. 00:12:25.820 --> 00:12:27.820 They try on different identities, the goth kid, 00:12:27.980 --> 00:12:30.440 the jock, the theater kid, and they look to their 00:12:30.440 --> 00:12:33.009 peers to see if it fits. to get that reflection. 00:12:33.350 --> 00:12:35.230 So fitting in isn't just about being popular. 00:12:35.450 --> 00:12:38.070 No, it's not shallow. It is a developmental survival 00:12:38.070 --> 00:12:40.730 mechanism. They need it to build their identity. 00:12:40.970 --> 00:12:43.269 So let me see if I can connect these dots. Because 00:12:43.269 --> 00:12:45.830 they are seeking identity, which is Erickson's 00:12:45.830 --> 00:12:49.350 task, they rely heavily on their peers. And because 00:12:49.350 --> 00:12:52.049 they have the personal fable from Piaget, the 00:12:52.049 --> 00:12:54.570 invincibility, they will take massive risks to 00:12:54.570 --> 00:12:56.789 impress those peers because they genuinely believe 00:12:56.789 --> 00:12:59.299 they won't get hurt. You've just summarized the 00:12:59.299 --> 00:13:01.480 entire adolescent safety profile. That's the 00:13:01.480 --> 00:13:03.500 engine. That connection is everything. And it 00:13:03.500 --> 00:13:06.080 connects to why play changes so much, too, as 00:13:06.080 --> 00:13:08.779 nurses were not asking about Legos or dolls anymore. 00:13:09.240 --> 00:13:12.340 No, not at all. Play evolves into socialization. 00:13:12.460 --> 00:13:15.000 It's hanging out at the mall. It's group chats. 00:13:15.399 --> 00:13:17.539 It's structured activities like sports or clubs. 00:13:17.980 --> 00:13:20.279 The purpose of play now is to learn negotiation, 00:13:20.720 --> 00:13:23.580 hierarchy, and social roles outside of the family. 00:13:23.710 --> 00:13:26.049 And sports are a huge part of this for a lot 00:13:26.049 --> 00:13:28.370 of teens. Huge participation. And for the most 00:13:28.370 --> 00:13:30.870 part, it's very good. It's great for physical 00:13:30.870 --> 00:13:33.629 health, self -esteem, social acceptance. But 00:13:33.629 --> 00:13:35.909 again, that hardware -software issue comes right 00:13:35.909 --> 00:13:38.850 back up. How so? Overuse injuries are incredibly 00:13:38.850 --> 00:13:40.549 common because they push too hard. They don't 00:13:40.549 --> 00:13:42.889 listen to their bodies. And concussions are a 00:13:42.889 --> 00:13:45.450 major, major concern, especially with that invincible 00:13:45.450 --> 00:13:47.490 mindset. And then there's the digital playground. 00:13:47.840 --> 00:13:51.059 Screen time well the sources say 95 % of teens 00:13:51.059 --> 00:13:54.179 have access to a smartphone. It's a classic double 00:13:54.179 --> 00:13:55.879 -edged sword It connects them to their peers 00:13:55.879 --> 00:13:58.559 which is good for building identity, but it also 00:13:58.559 --> 00:14:02.000 exposes them to cyberbullying social comparison 00:14:02.000 --> 00:14:04.690 unrealistic body standards all of which could 00:14:04.690 --> 00:14:07.370 be terrible for identity. So as a nurse, when 00:14:07.370 --> 00:14:09.429 you're doing an assessment and you ask about 00:14:09.429 --> 00:14:11.590 activities, you aren't really asking about hobbies 00:14:11.590 --> 00:14:13.649 in the traditional sense. Not really. You're 00:14:13.649 --> 00:14:16.509 asking, who do you hang out with and what are 00:14:16.509 --> 00:14:19.590 you doing online? You are assessing their entire 00:14:19.590 --> 00:14:22.830 social ecosystem because that's where the real 00:14:22.830 --> 00:14:25.129 developmental work and the real risk is happening. 00:14:25.730 --> 00:14:28.549 OK, let's move to those risks. Section five. 00:14:29.149 --> 00:14:31.409 Because of everything we just talked about, the 00:14:31.409 --> 00:14:34.570 invincibility, the peer pressure, the underdeveloped 00:14:34.570 --> 00:14:37.129 judgment adolescence is a surprisingly dangerous 00:14:37.129 --> 00:14:39.490 time. It is. The mortality rate actually goes 00:14:39.490 --> 00:14:41.490 up from childhood. Yeah. And we talk about the 00:14:41.490 --> 00:14:44.009 big three killers for this age group. Number 00:14:44.009 --> 00:14:46.830 one is always unintentional injury and specifically 00:14:46.830 --> 00:14:50.169 motor vehicle crashes, MVCs. Far and away the 00:14:50.169 --> 00:14:52.220 leader. And just think about the why. You have 00:14:52.220 --> 00:14:54.320 a brand new driver, so there's inexperience. 00:14:54.639 --> 00:14:56.580 You had a car full of friends, which is pure 00:14:56.580 --> 00:14:58.700 distraction, and you top it off with a personal 00:14:58.700 --> 00:15:01.179 fable. I won't crash. I can handle this. I'm 00:15:01.179 --> 00:15:03.519 a good driver. It's a recipe for disaster. I 00:15:03.519 --> 00:15:05.480 saw a stat in the source material that said the 00:15:05.480 --> 00:15:08.019 risk of a fatal crash doubles with every teen 00:15:08.019 --> 00:15:11.220 passenger in the car. It does. It's not a linear 00:15:11.220 --> 00:15:14.629 increase. It's an exponential distraction. That's 00:15:14.629 --> 00:15:17.850 precisely why so many states now have graduated 00:15:17.850 --> 00:15:20.470 licensing laws that limit the number of teen 00:15:20.470 --> 00:15:23.509 passengers a new driver can have. It's a direct 00:15:23.509 --> 00:15:26.470 legislative response to this developmental reality. 00:15:26.600 --> 00:15:29.179 OK, so after car crashes, we have suicide and 00:15:29.179 --> 00:15:31.840 homicide. Yeah. Suicide is either the second 00:15:31.840 --> 00:15:33.899 or third leading cause of death, depending on 00:15:33.899 --> 00:15:36.580 the specific year's data. But it is a massive 00:15:36.580 --> 00:15:39.039 crisis. And the impulsivity of the adolescent 00:15:39.039 --> 00:15:41.639 brain is absolutely key here. Because a problem 00:15:41.639 --> 00:15:44.019 feels permanent. It feels permanent and totally 00:15:44.019 --> 00:15:46.200 unique. A breakup can feel like the absolute 00:15:46.200 --> 00:15:48.620 end of the world because of the personal fable. 00:15:48.919 --> 00:15:51.399 No one has ever felt pain like this. If they 00:15:51.399 --> 00:15:53.460 have access to a lethal means like a firearm 00:15:53.460 --> 00:15:55.919 in that moment of high emotion and impulsivity, 00:15:55.879 --> 00:15:58.639 tragedy happens. The sources specifically call 00:15:58.639 --> 00:16:02.080 out the increased risk for the LGBTQ plus population. 00:16:02.419 --> 00:16:05.139 Yes, social marginalization, bullying, family 00:16:05.139 --> 00:16:07.840 rejection. These things significantly increase 00:16:07.840 --> 00:16:09.960 that risk and homicide unfortunately is also 00:16:09.960 --> 00:16:11.799 right there in the top three often involving 00:16:11.799 --> 00:16:13.899 firearms and gang related violence. And then 00:16:13.899 --> 00:16:16.360 we have substance abuse. The sources mention 00:16:16.360 --> 00:16:19.100 vaping as the new gateway. Vaping and smoking 00:16:19.100 --> 00:16:21.980 are huge. The stat is that 9 out of 10 adult 00:16:21.980 --> 00:16:24.639 smokers started before they were 18. If you can 00:16:24.639 --> 00:16:27.519 get a kid to age 20 without smoking, they probably 00:16:27.519 --> 00:16:30.299 never will. And the brain itself is more vulnerable. 00:16:30.639 --> 00:16:32.960 The developing brain is primed for addiction. 00:16:33.419 --> 00:16:35.740 It learns faster than an adult brain, which is 00:16:35.740 --> 00:16:37.700 great for school, but it also means it learns 00:16:37.700 --> 00:16:41.240 addiction faster too. So, anticipatory guidance. 00:16:41.720 --> 00:16:43.720 This is what the nurse needs to tell the parents 00:16:43.720 --> 00:16:46.779 and the team. It has to be specific and practical. 00:16:46.919 --> 00:16:50.019 It has to be. For cars. Seat belts are non -negotiable. 00:16:50.279 --> 00:16:52.940 No texting and driving, period. Limit night driving. 00:16:53.200 --> 00:16:55.659 Limit passengers. For firearms, they have to 00:16:55.659 --> 00:16:57.940 be removed from the home or, at the very least, 00:16:58.240 --> 00:17:00.799 locked in a safe with the ammunition locked separately. 00:17:01.480 --> 00:17:04.140 A depressed, impulsive teen cannot have easy 00:17:04.140 --> 00:17:06.410 access to a gun. And what about water safety? 00:17:06.529 --> 00:17:08.910 I feel like that's more of a toddler issue. You'd 00:17:08.910 --> 00:17:11.170 think so, but drowning is still a real risk. 00:17:11.430 --> 00:17:13.369 Not because they can't swim, but because they 00:17:13.369 --> 00:17:15.730 do things like swim drunk or dive into shallow 00:17:15.730 --> 00:17:17.869 water on a dare to show off for their friends. 00:17:18.289 --> 00:17:20.869 It's the hold my beer and watch this phenomenon. 00:17:20.990 --> 00:17:23.329 That is the personal fable in action. One hundred 00:17:23.329 --> 00:17:25.430 percent. Let's shift gears a bit to maintenance. 00:17:25.809 --> 00:17:29.170 Health promotion. Section six. The body is growing 00:17:29.170 --> 00:17:32.230 so fast it must need a ton of fuel. The caloric 00:17:32.230 --> 00:17:35.529 needs are sky high. During that peak growth spurt, 00:17:35.849 --> 00:17:38.009 an adolescent boy might need 2 ,800 calories 00:17:38.009 --> 00:17:40.509 or even more just to maintain their weight. Wow. 00:17:41.130 --> 00:17:43.309 And are there any specific nutrients we need 00:17:43.309 --> 00:17:45.890 to be focused on? Two big ones, calcium and iron. 00:17:46.430 --> 00:17:49.410 Calcium because almost half 45 % of your total 00:17:49.410 --> 00:17:52.009 adult skeletal mass is built during adolescence. 00:17:52.430 --> 00:17:54.910 If you don't bank that bone density now, you 00:17:54.910 --> 00:17:56.789 are setting yourself up for osteoporosis later 00:17:56.789 --> 00:18:00.539 in life. Okay, calcium. and iron. Iron is crucial. 00:18:00.720 --> 00:18:03.460 For males, it's for the massive expansion in 00:18:03.460 --> 00:18:06.539 muscle mass and blood volume. For females, it's 00:18:06.539 --> 00:18:09.079 to replace the losses from menstruation. Iron 00:18:09.079 --> 00:18:11.380 deficiency anemia is really common. But the reality 00:18:11.380 --> 00:18:13.859 of their diet is fast food. It is. You've got 00:18:13.859 --> 00:18:15.740 convenience plus independence. They have their 00:18:15.740 --> 00:18:17.779 own money. They have cars. They go to the drive 00:18:17.779 --> 00:18:20.099 -through with friends. So obesity is a major 00:18:20.099 --> 00:18:22.339 risk on the other side of the coin. And sleep. 00:18:22.859 --> 00:18:25.380 I feel like every parent I know complains their 00:18:25.380 --> 00:18:27.619 teen is lazy and sleeps all day on the weekends. 00:18:28.019 --> 00:18:31.180 They're not lazy. They are biologically jet lagged. 00:18:31.359 --> 00:18:34.480 It's real. There is a physiological shift in 00:18:34.480 --> 00:18:37.559 the circadian rhythm during puberty. Their body 00:18:37.559 --> 00:18:40.180 clock pushes sleep onset later. So they're becoming 00:18:40.180 --> 00:18:42.480 night owls. They are becoming night owls. They 00:18:42.480 --> 00:18:44.480 physically cannot fall asleep at 9 p .m. anymore. 00:18:44.680 --> 00:18:46.960 Their body wants to sleep at 1 a .m. and wake 00:18:46.960 --> 00:18:50.140 up at 10 a .m. But school starts at 730 exactly 00:18:50.140 --> 00:18:53.619 so they are chronically profoundly sleep -deprived 00:18:53.619 --> 00:18:56.079 They need about nine hours a night. They're lucky 00:18:56.079 --> 00:18:58.880 if they get six and that affects everything mood 00:18:59.079 --> 00:19:01.420 grades, and especially driving safety. All right, 00:19:01.420 --> 00:19:03.779 let's talk about vaccines, the teen platform. 00:19:04.059 --> 00:19:06.460 We've got a clear checklist here from the 2025 00:19:06.460 --> 00:19:09.440 CDC schedule. Yep, that 11 to 12 year old visit 00:19:09.440 --> 00:19:12.240 is the golden hour for adolescent vaccines. There 00:19:12.240 --> 00:19:14.279 are three routine shots you absolutely need to 00:19:14.279 --> 00:19:16.539 know for your exams. Let's list them. First up 00:19:16.539 --> 00:19:19.680 is Tdap. This is the booster for tetanus, diphtheria, 00:19:19.839 --> 00:19:22.799 and pertussis rubincol. Okay, Tdap. Second is 00:19:22.799 --> 00:19:26.940 meningococcal, specifically the Menel ACWY vaccine. 00:19:27.259 --> 00:19:30.099 This protects against bacterial meningitis, which 00:19:30.099 --> 00:19:32.619 spreads really fast in crowds. Think college 00:19:32.619 --> 00:19:34.920 dorms or army barracks. Got it. And the third 00:19:34.920 --> 00:19:38.759 one? HPV. Human papillomavirus. Now this one 00:19:38.759 --> 00:19:41.119 can get some pushback from parents because it's 00:19:41.119 --> 00:19:43.819 associated with a sexually transmitted virus. 00:19:44.240 --> 00:19:46.720 How do you frame that conversation? You frame 00:19:46.720 --> 00:19:50.269 it accurately as cancer prevention. That is the 00:19:50.269 --> 00:19:53.130 medical reality. This vaccine prevents cervical 00:19:53.130 --> 00:19:56.309 cancer, throat cancer, anal cancers. It's a cancer 00:19:56.309 --> 00:19:58.210 vaccine. And there's a scheduling nuance there, 00:19:58.369 --> 00:20:00.829 right? Based on age. Yes. And this is a key detail 00:20:00.829 --> 00:20:03.130 for the listener. If they start the series before 00:20:03.130 --> 00:20:05.549 age 15, they only need two doses. If they start 00:20:05.549 --> 00:20:07.950 after 15, they need three. So starting at 11 00:20:07.950 --> 00:20:10.089 actually saves them a shot. What about for the 00:20:10.089 --> 00:20:14.670 older teens, say? 16 to 18. At 16, they get a 00:20:14.670 --> 00:20:17.690 booster dose of that MenAndyWY vaccine. But you 00:20:17.690 --> 00:20:19.750 also start talking about MenB, MenigoCocalB. 00:20:19.789 --> 00:20:21.930 It's a separate type. It's usually what we call 00:20:21.930 --> 00:20:24.609 shared clinical decision making, which means 00:20:24.609 --> 00:20:27.150 you discuss the risks and benefits with the family. 00:20:27.869 --> 00:20:30.710 But it's often given between 16 and 23, especially 00:20:30.710 --> 00:20:32.789 for kids heading off to college. And of course, 00:20:32.829 --> 00:20:35.450 the annual flu shot for everyone. OK, we've covered 00:20:35.450 --> 00:20:37.869 the body, the brain, the risks, the maintenance. 00:20:38.890 --> 00:20:41.720 Let's get to section seven. This is for the nursing 00:20:41.720 --> 00:20:44.660 students who are sweating over the NCLEX. How 00:20:44.660 --> 00:20:47.359 do we apply all this knowledge? You have to think 00:20:47.359 --> 00:20:49.859 like an exam writer. And what they are really 00:20:49.859 --> 00:20:53.000 testing, more often than not, is your understanding 00:20:53.000 --> 00:20:56.039 of privacy and communication. Give me the classic 00:20:56.039 --> 00:20:58.339 scenario. You walk into the exam room. There's 00:20:58.339 --> 00:21:00.900 a 16 -year -old and their mom. The teen looks 00:21:00.900 --> 00:21:03.759 nervous and isn't talking. What do you do? The 00:21:03.759 --> 00:21:05.619 answer on an exam is almost always going to be 00:21:05.619 --> 00:21:07.960 something like ask the parent to step out for 00:21:07.960 --> 00:21:10.680 part of the visit. You cannot get an honest history 00:21:10.680 --> 00:21:14.000 about sex, drugs, depression, or safety risks 00:21:14.000 --> 00:21:16.059 with a parent hovering over them. But how do 00:21:16.059 --> 00:21:18.259 you do that without offending the parents? You 00:21:18.259 --> 00:21:21.059 frame it as a standard of care. You say something 00:21:21.059 --> 00:21:23.059 like, it's our policy to spend a little time 00:21:23.059 --> 00:21:25.740 with all our teen patients alone, just to help 00:21:25.740 --> 00:21:27.519 them start taking ownership of their own health. 00:21:27.779 --> 00:21:30.720 You make it normal. And what about confidentiality? 00:21:30.859 --> 00:21:33.779 This is so tricky. The teen asks... You won't 00:21:33.779 --> 00:21:36.619 tell my mom what I say, right? You have to be 00:21:36.619 --> 00:21:39.680 honest, but you also have to build trust. The 00:21:39.680 --> 00:21:42.599 right answer is to say what we discuss here is 00:21:42.599 --> 00:21:45.400 private. I will not share it with your parents 00:21:45.400 --> 00:21:47.180 unless you tell me that you are going to hurt 00:21:47.180 --> 00:21:49.680 yourself, that someone else is hurting you, or 00:21:49.680 --> 00:21:51.519 that you are planning to hurt someone else. The 00:21:51.519 --> 00:21:55.319 harm exception. Right. Suicide, homicide, and 00:21:55.319 --> 00:21:58.559 abuse are mandatory reporting situations. You 00:21:58.559 --> 00:22:00.930 have to be clear about that boundary. But if 00:22:00.930 --> 00:22:02.609 they tell you they're sexually active or they 00:22:02.609 --> 00:22:05.289 tried alcohol at a party, you generally keep 00:22:05.289 --> 00:22:08.230 that private to maintain trust while, of course, 00:22:08.490 --> 00:22:10.569 counseling them on safety. So if an exam question 00:22:10.569 --> 00:22:13.130 says, a 15 -year -old asks for information on 00:22:13.130 --> 00:22:15.329 birth control, and the options are call the parents 00:22:15.329 --> 00:22:18.109 immediately, lecture them on abstinence, or provide 00:22:18.109 --> 00:22:21.349 the information. The answer is always provide 00:22:21.349 --> 00:22:24.529 the information. Do not lecture them. They will 00:22:24.529 --> 00:22:27.109 tune you out instantly. And do not break their 00:22:27.109 --> 00:22:29.309 trust by calling the parent immediately. The 00:22:29.309 --> 00:22:31.769 nursing boards will always favor patient advocacy 00:22:31.769 --> 00:22:34.309 and building a trusting therapeutic relationship. 00:22:34.509 --> 00:22:36.789 And watch out for distractors that use the wrong 00:22:36.789 --> 00:22:40.089 tools, like an option to use the FLACC scale 00:22:40.089 --> 00:22:42.410 on a teenager. That's an immediate wrong answer. 00:22:42.410 --> 00:22:43.970 You have to treat them as a partner in their 00:22:43.970 --> 00:22:47.250 care, not as a child. Okay, we have covered a 00:22:47.250 --> 00:22:49.289 massive amount of ground. Let's try to bring 00:22:49.289 --> 00:22:53.049 it all home with our 80 -20 summary box. If the 00:22:53.049 --> 00:22:55.450 listener remembers nothing else from this entire 00:22:55.450 --> 00:22:59.000 deep dive, what is the one thing? Remember the 00:22:59.000 --> 00:23:01.900 collision. The adolescent is a physically adult 00:23:01.900 --> 00:23:05.019 body driven by a peer -focused heart and an invincible 00:23:05.019 --> 00:23:07.359 mind. If you get that, you get almost everything 00:23:07.359 --> 00:23:10.059 else. And we have a mnemonic for this, SAFE. 00:23:10.200 --> 00:23:13.619 SAFE Teens. S is for sexuality and socialization. 00:23:13.920 --> 00:23:16.440 Everything is peer -driven. A is for accidents, 00:23:17.180 --> 00:23:19.680 specifically MVCs. They are the number one killer 00:23:19.680 --> 00:23:22.339 because of that invincibility. F is for future 00:23:22.339 --> 00:23:25.630 thinking. They have formal operations, but it's 00:23:25.630 --> 00:23:27.930 flawed by that egocentrism we talked about. Right, 00:23:27.930 --> 00:23:30.710 the personal fable. And E is for eating and exercise. 00:23:31.109 --> 00:23:33.670 High calories, iron, calcium, and the overused 00:23:33.670 --> 00:23:36.250 injuries that can come with sports. S -A -F -E. 00:23:36.269 --> 00:23:38.509 I love it. It's about pattern recognition, really. 00:23:38.730 --> 00:23:41.450 So if the exam question involves safety... You 00:23:41.450 --> 00:23:44.190 should immediately think invincibility, car crashes, 00:23:44.369 --> 00:23:47.309 risk taking. If the question involves communication... 00:23:47.309 --> 00:23:50.289 Think privacy and identity. Talk to them alone. 00:23:50.450 --> 00:23:52.970 And if the question is about growth... think 00:23:52.970 --> 00:23:56.069 sexual maturation. And remember that key fact, 00:23:56.670 --> 00:23:59.609 monarch, the first period, signals the end of 00:23:59.609 --> 00:24:02.150 the major growth spurt, not the beginning. That's 00:24:02.150 --> 00:24:04.329 amazing. You know, before we sign off, I was 00:24:04.329 --> 00:24:06.609 thinking about that personal fable concept, the 00:24:06.609 --> 00:24:09.910 idea that I am unique and bad things won't happen 00:24:09.910 --> 00:24:12.289 to me. It sticks with you, doesn't it? It really 00:24:12.289 --> 00:24:14.049 strikes me that this doesn't fully disappear 00:24:14.049 --> 00:24:16.990 when we turn 20. I look at nursing students or 00:24:16.990 --> 00:24:19.589 new grads working 12 -hour shifts, not eating, 00:24:19.750 --> 00:24:21.930 not sleeping, and thinking, I won't burn out. 00:24:21.970 --> 00:24:24.430 Burn out happens to other people. That is a profound 00:24:24.430 --> 00:24:27.589 connection. That's exactly right. We all carry 00:24:27.589 --> 00:24:29.690 a little bit of that adolescent invincibility 00:24:29.690 --> 00:24:32.089 with us. It can be a protective mechanism, but 00:24:32.089 --> 00:24:35.210 it can also be a major blinder. So to our listener, 00:24:35.710 --> 00:24:37.650 the next time you're dealing with that difficult 00:24:37.650 --> 00:24:40.450 teen patient, try to see them a little differently. 00:24:40.759 --> 00:24:43.799 Don't just see a rebel. See a person who is trying 00:24:43.799 --> 00:24:46.500 to figure out who they are, piloting a Ferrari 00:24:46.500 --> 00:24:48.980 with bicycle brakes, and just hoping to stay 00:24:48.980 --> 00:24:51.839 on the road. Well said. That's it for this deep 00:24:51.839 --> 00:24:54.039 dive. Thanks for listening, and we'll see you 00:24:54.039 --> 00:24:55.420 next time. Stay curious.