Community Health Nursing Notes

COMMUNITY HEALTH NURSING OVERVIEW  Public /Community Health Nursing is the synthesis of nursing practice and public CHN health practice. “The ut...

COMMUNITY HEALTH NURSING OVERVIEW  Public /Community Health Nursing is the synthesis of nursing practice and public CHN health practice. “The utilization of the nursing process in the different  Major goal of CHN: levels of clientele – individuals, families, population ✓ preserve the health of the community and groups and communities, prevention of disease and surrounding population by focusing on disability and rehabilitation” – Maglaya – health promotion and health A science of Public Health combined with Public maintenance of individual, family and Health Nursing Skills and Social Assistance with the group within the community. goal of raising the level of health of the citizenry, to ✓ PHN is associated with health and raise optimum level of functioning of the citizenry. identification of population at risk rather -WHO- than episodic response to patient demand. Public Health  Mission of Public Health: According to C.E. Winslow ✓ is SOCIAL JUSTICE that entitles all people ▪ Is the science and art of: to basic necessities, such as adequate 1. preventing disease, income and health protection and 2. prolonging life, and accepts burdens to make it possible. 3. promoting health and efficiency through ✓ PHN is associated with health and organized community effort for: identification of population at risk rather i. sanitation of the environment, than episodic response to patient ii. Control communicable infections demand. iii. Education of the individual in personal hygiene Salient Features of CHN ✘ Theoretical basis for practice: Knowledge and Principles of CHN skills from the sciences of public health and nursing. ✘ The family is the unit of care. ✘ Setting/place of practice and activities: health ✘ The community is the patient in CHN. centers, clinics, homes, schools and places of work. ✘ The goal of improving community health is realized ✘ Objectives: through multi-disciplinary effort. ▪ promote and maintain health ✘ There are 4 levels of clientele in CHN practice. ▪ restoration of the sick to health and ✘ The practice of CHN is affected by the changes in rehabilitation society in general and the developments of the ▪ to enhance the capabilities of individuals, fields in particular. ▪ families, population groups and the ✘ CHN is part of the community health system, community which in turn is part of the larger human services ▪ to take care of their own health and cope with system. health problems. ✘ Patients and levels of clientele: individual, families, Basic Concepts of CHN population group at risk, community.  Primary focus is health promotion and ✘ Perspective and orientation when establishing disease prevention. priorities for care:  Practice extends from individual to family, ▪ health of the total population or community population group and community. as a whole.  CHNurses are generalists. ▪ the greatest good for the greatest number  Contact with client continues through time rather than solely the needs of an individual and all types of health care. patient or family.  Nature of practice require application of ✘ Range of service provided: health promotion, concepts of various sciences. disease prevention, curative and rehabilitation  Implicit in CHN is the nursing process. nursing service. ✘ Emphasis of care: health promotion and 9. error of refraction; maintenance and disease prevention. 10. otitis media ✘ Types of clients: well and the sick = Elderly CLIENTS OF CHN Leading causes of morbidity among older person:  INDIVIDUAL 1. Influenza; ▪ people who consult at the health center and 2. Respiratory problems (TB, Bronchitis, Pneumonia); receive health services. 3. Cardiovascular problem (hypertension & disease ▪ seen during home visits, school health of the heart); consultation, workplace visit-conference & 4. Malignant neoplasms other community-based activities. 5. Accidents ▪ “entry point” in working with the whole family. = Community  FAMILY - is a group of people sharing common geographic ▪ number of person joined together by bonds of boundaries and/or common values and interests. marriage, blood or adoption. - functions within a particular sociocultural context. ▪ ”basic unit of care” in CHN locus of decision making on health matters. THEORETICAL MODELS IN CHN ▪ 6 health tasks: 1. recognizing interruptions of health and Definition of Health development ✘ WHO = “ a state of complete physical, mental, and 2. seeking health care social well-being and not merely the absence of 3. managing health and non-health crises disease or infirmity.” 4. providing nursing care to the sick, disabled ✘ MURRAY= “ a state of well-being in which the and dependent member person is able to use purposeful, adaptive responses 5. maintaining a home environment and processes physically, mentally, emotionally, conducive to good health personal spiritually and socially. development ✘ PENDER = “actualization of inherent and acquired 6. maintaining a reciprocal relationship with human potential through goaldirected behavior, the community & health institutions. competent self-care, and satisfying relationship with others.  POPULATION GROUP “AGGREGATE” ✘ OREM = “ a state of person that is characterized by ▪ Group of people who share common soundness or wholeness of developed human characteristics, development stage or structures and of bodily and mental functioning. common exposure to particular environment factors, & consequently common health Models of Health problems. ✘ MEDICAL MODEL (M.B. BELLOC AND L. ▪ ex. Group: children, elderly, community BRESLOW) ”Health is the state of being free of signs or = Children symptoms of disease.” 10 leading ailments/defects among school children = This means that if MAN’s systems, organs are 1. dental caries; functioning and does not manifest any abnormality 2. intestinal helminthiasis; as it responds to the demand of the environment 3. colds; (Internal or External) then he is considered healthy. 4. pediculosis; ✘ HEALTH – ILLNESS CONTINUUM (Mc Cann/Flynn 5. upper respiratory tract infection; and Heffon) 6. enlarged glands; ”Health is a constantly changing state.” 7. tinea flava 8. protein – energy malnutrition; = because of the various factors present in the others, and so we have to define what is acceptable environment and as MAN interacts with it, his health and not acceptable in a particular society. status changes and it will not remain the same. = Socio Economic – refers to the production ✘ ROLE PERFORMANCE MODEL (Parson) activities, distribution and consumption of goods of ”Health is the ability to perform all those roles from an individual. which one has been socialized.” = a person is therefore considered healthy if he THEORETICAL MODELS IN HEALTH performs all the expectations imposed on him especially on health activities. PRECEDE-PROCEED MODEL ✘ HIGH LEVEL WELLNESS (Dunn) PRECEDE which stands for predisposing, reinforcing, ”Functioning to ones maximum potential while enabling constructs in educational diagnosis and maintaining balance and purposeful direction in the evaluation is used for community diagnosis. environment” PROCEED stands for policy, regulatory, and = MAN to be considered healthy has to maintain a organizational constructs in education & continuous balance within the environment he is environmental development, is a model for functioning. implementing and evaluating programs based on ✘ WORLD HEALTH ORGANIZATION (WHO) PRECEDE. ”Health is the state of complete physical, mental, social well being and not merely the absence of disease” = MAN to be considered healthy has to posses a functional body system, can think rationally, and should interact with society effectively and it is not just the absence of any abnormality in this body system. ✘ NEEDS – FULFILLMENT MODEL ”Health is a state in which needs are being sufficiently met that allow an individual to function Health Promotion Model successfully in life with the ability to achieve the It defines health as a positive dynamic state not highest potential ” merely the absence of disease. Health promotion is = MAN to be considered healthy has to satisfy his directed at increasing a client’s level of well-being. needs not just being happy of what is happening around him. Core Concepts: 1. Individual Characteristics and Experiences: Factors Affecting Health Prior Related Behavior: Past behaviors influence current health choices. If someone ✘ INTERNAL FACTORS has a history of regular exercise, they're more = Heredity or Genetics – transmission of traits from likely to continue this behavior. parents to offspring. Personal Factors: These include biological = Coping Mechanism – determines how individual (age, gender), psychological (self-esteem, handle activities related to maintenance and motivation), and socio-cultural (ethnic promotion of good health. background, education level) factors. 2. Behavior-Specific Cognitions and Affect: ✘ EXTERNAL FACTORS Perceived Benefits of Action: Beliefs about = Political (leadership) – how he/she manages and the positive outcomes of a behavior can involves other people in decision making. motivate people to engage in healthy = Culture (values, beliefs, attitudes & customs) – behaviors. understand that there are practices which would be normal in a particular society and viewed negative by  Perceived Barriers to Action : These are KEY CONCEPTS the obstacles that hinder individuals from Health Policy: engaging in a behavior. Policies can create environments that either Perceived Self Efficacy : Confidence in support or hinder healthy lifestyles. one’s ability to take action and persist in that Effective health policies can provide the action. necessary resources and opportunities for 3. Behavioral Outcomes: people to make healthy choices. Commitment to a Plan of Action : planning Environmental Influences: and strategizing how to achieve the desired The environment plays a significant role in health behavior. shaping health behaviors. Health Promoting Behavior: This is the goal Changes in the environment, such as or outcome of HPM. The aim of health improved access to healthy foods or safer promoting behavior is the attainment of neighborhoods, can lead to better health positive health outcomes. outcomes. Social learning theory The Philippine Health Care Delivery System It is based on the belief that learning takes place in is an organized plan of services. a social context; people learn from one another and rendering health care services to the people. learning is promoted by modeling or observing other totality of all policies, infrastructure, facilities, people. equipment, products, human resources and It assumes that all personas are thinking beings that services that address the health needs are capable of making decisions and acting problems and concerns for all people. according to expected consequences of their behavior. Significant Milestone The environment affects learning but learning ✓ The DOH remains to be the national outcomes depend on the learner’s individual government’s biggest health care provider. characteristics. ✓ The DOH exercises regulatory powers over health facilities and products. The theory highlights four main processes: ✓ The DOH takes the lead in formulation of 1. Attention: Observing and focusing on the policies and standards related to health behavior being modeled. facilities, health products and health human 2. Retention: Remembering the behavior resources. observed. ✓ It provides the LGU the necessary support in 3. Reproduction: Ability to replicate the managing their local health system. behavior. 4. Motivation: Having a good reason to DOH VISSION: imitate the behavior. “The DOH is the champion for health for all in the Philippines” MILIO’S FRAMEWORK FOR PREVENTION Focuses on the role of community and environmental DOH MISSION: factors in health and disease prevention. “Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to The framework highlights how policy and lead the quest for excellence in health” environmental changes can lead to healthier behaviors. It emphasizes the need for structural DOH CORE VALUES: changes in society to promote health and prevent The DOH adheres to the highest values of work as it disease. pursues its vision for the organization. 1. Integrity 2. Excellence 3. Compassion and respect for human dignity Tertiary – care involved highly specialized care. 4. Commitment o Subspecialist MD 5. Professionalism o Advanced Practice Registered Nurses (APRN) 6. Stewardship of the environment The direction being pursued by the DOH is guided Devolution of health services by the: One of the most significant laws that radically Millennium Development Goals changed the landscape of the health care delivery in Medium – Term Philippines the country is RA 7160 or more commonly known as Development Plan the Local Government Code. Health Sector Reform Agenda FOURmula One The code AIMS to: Transform local government units National Objectives for Health into self – reliant communities and active partners in the attainment of national goals through a more Millennium development goals (mdg) responsive and accountable local government ✘ On September 6 to 8, 2000, world leaders structure instituted through a system of on the UN General Assembly participate in decentralization. Millennium Summit. The result of the summit was a resolution entitled United Nations Millennium Declaration. ✘ In this declaration, the world leaders recognized their collective responsibility to uphold the principles of human dignity, equality and equity at the global level The declaration expressed the commitment of the 191 member states, including the Philippines, to reduce extreme poverty and achieve seven other targets- now called the Millennium Development Goals (MDGs) by the year 2015. Medium – term Philippine development plan ✘ MTPDP 2004 – 2010 spells out the priority strategies to meet the basic needs of the poor. Types of Health Care Personnel The following health priorities were identified: Primary – is the first point of contact for patients and a.) reduction of the cost of medicines; provides care to minor and simple cases. b.) expansion of health insurance particularly o Midwife for indigents through premium subsidy; o CHW c.)strengthening national and local health o BNS systems through the implementation of the Secondary – care provided by specialists and Health Sector Reform Agenda; includes more specialized medical services. d.) improvement of health care management o PHN systems; o MHO e.) improvement of health and productivity;  f.) establishment of drug treatment and (3). Improve the accessibility and availability of rehabilitation centers and the expansion of basic and essential health care for all; existing ones. (4). Improve health systems performance at the national and local levels. Health sector reform agenda (hsra) ✘ The DOH come up with the HSRA 1999-2004 that ✘ PRINCIPLES: included the following reforms: (1). Fostering a strong and healthy nation; o provide fiscal autonomy to government (2.). Enhancing the performance of the health hospitals; o secure funding for priority public health sector; programs; (3). Ensuring universal access to quality health care; o promote development of local health (4). Improving macro-economic and social systems and ensure its effective conditions for better health gains. performance; o strengthen the capacities of health regulatory Referral system agencies; Intersectoral Linkages: o expand the coverage of the National Health o Primary Health Care forms an integral part Insurance Program. of the health system and over-all social and economic development of the community FOURmula one for health (f1) o Necessary to unify health efforts within the ✘ 3 goals: health organization itself o Implies o better health outcomes; o more responsive health systems; integration of health plans with the plan for o equitable health care financing; the total community development ✘ Elements of the strategy: o Sector most closely related to health: o health financing; o Agriculture o Education o health regulation; o Public works o health service delivery; o Local government o good governance o Social welfare o Population control National objectives for health (noh) o Private sector ✘ VISION: “Health For All Filipinos” Intrasectoral Linkages ✘ MISSION: o Within health sector – acceptance of “Ensure Accessibility & Quality of Health Care to primary health care necessitates the Improve the Quality of Life of All Filipinos, Especially restructuring of the health system to the Poor” broaden health coverage and make health ✘ GOALS: service available to all (1). Better health Outcomes; (2). More responsive health system; o Primary health care is the hub of the health (3). More equitable health care financing system National objectives for health (noh) Role and Functions of a PHN ✘ OBJECTIVES: Health Service Provider: (1). Secure increased , better and sustained ✘ Carries out health services contributing the investment in health; prevention of illness, early treatment of illness and (2.). Assure the quality and affordability of health rehabilitation, implementation of guidelines related goods and services; to health as well as following policies on health for residence mainly to minimize the effects of illness health promotion. and disability Facilitator: Hospice home care: ✘ Helps plan a comprehensive health program with ✘ homecare rendered to the terminally ill; palliative the people. assists people to establish and find care is particularly important. means of achieving their own goals. EntrepreNurse: Health Counselor: ✘ A project initiated by the DOLE in collaboration ✘ Serves as a catalyst of change encourage with the BON in the Phil. , DOH, PNA, and other verbalization of problems. Help people look at stakeholders to promote nurse entrepreneurship by themselves see the nature of their discontent and introducing home health care industry in the Phil. barriers to their problems and provide health counseling including emotional support to Faith Community Nursing or Parish Nursing: individuals, family, population group and ✘ art and science of nursing combined with community. spiritual care; provision of holistic care to members of the faith community. Co Researcher: ✘ Provides the community with stimulation SCHOOL HEALTH NURSING necessary for a wider or more complex study R.A. 124 in 1947 problems. Enforce community to do prompt and An act to provide for medical inspection of children intelligent reporting of epidemiological enrolled in private schools, colleges and universities investigation of diseases. Suggest areas for research. Provide them with technical assistance in The practice of school nursing includes the policies the conduct of research thru capability training. and standards of the DepEd and the standards of Participates in the planning for the study and the nursing profession. formulating procedures. Assists in the collection of data. Help interpret findings collectively. School Nursing aims to promote the health of school children and preventing health problems Health Educator: that would hinder their learning and performance ✘ Facilitates in the improvement of the health of of their developmental tasks. the people by employing various methods or acceptable, appropriate procedures to stimulate, SCHOOL HEALTH PROGRAM arouse and guide people to voluntarily adopt ✘ Health promotion for school personnel. healthful ways of living. Taking into consideration ✘ School – community projects and outreach the following aspects of health education: ✘ Nutrition and food safety o Information – provision of knowledge ✘ Physical education and recreation o Education – change in knowledge, attitude ✘ mental health, counselling & social supports and skills o Communication – exchange of information COMPONENTS OF SCHOOL HEALTH PROGRAM ✘ Health education Emerging Field of CHN in the Philippines ▪ activities are based on the identified educ. Home health care: Needs of the target population. ✘ this practice involves providing nursing care to ✘ Physical education individuals and families in their own places of  ▪ should focus on activities that children can ✘ is aimed at assessing workers in all occupations continue into their adult years, such as to cope with actual and potential stresses in walking, swimming, biking and jogging. relation to their work and work environment. It is ✘ Health services geared at helping workers attain and maintain ▪ focus on preventive services (health optimum level of physical and psychological screening), including health screening for functioning. completeness of immunization. ✘ Determinants Occupational nursing practice are ▪ emergency care government policies and standards (e.g. Dept. of ▪ management of acute & chronic health Labor and Employment, DOH, SSS, PhilHealth & conditions Employees Compensation Commission) ✘ Health screening ✘ Professional standards such as those ▪ appropriate referrals recommended by the (OHNAP) & (PNA) ▪ regular deworming ✘ Nutrition R.A. 1054 ▪ eating disorders Occupational Health Act. ▪ obesity -an occupational nurse must be employed when ▪ nutritional education programs there are 30 to 100 employees and the workplace is ✘ Counseling, psychological and social services more than 1 km. away from the nearest health ▪ Promotion of Mental health & reduction of center. threats to mental health are important to children and adolescents. ✘ Working conditions and rest periods ✘ Healthy school environment ▪ normal hours of work of any employee shall ▪ School nurses and other school personnel not exceed 8 hours a day. should be aware of risk factors and signs ▪ health personnel: 100 bed capacity that could indicate a tendency towards (hospital) 1,000, 000 pop. (city/municipality) violence. = 8hrs/day, for 5 days a week. = 6 days or 48 hrs. (inc. demand) 30% additional Healthy school environment compensation of their regular wage for work on DepEd Order No. 40, s. 2012 6th. day CHILD PROTECTION POLICY ✘ Health promotion for school staff ▪ Giving of workshops on exercise and nutrition. ▪ Screening for increased BP ▪ Establish weight management programs OCCUPATIONAL HEALTH NURSING ✘ Identify: ▪ Health Hazards – are the elements in the work environment that can cause work- related diseases to the worker. ▪ Safety Hazards – are the unsafe conditions or unsafe acts that significantly increase the risk of a worker to be injured. COMMUNITY HEALTH NURSING SUPPORT MECHANISM PRIMARY HEALTH CARE § There are 3 major entities: o People Essential and universal health care o Government Started in September 1978, through o Private sectors (NGO’s, Socio-civic the Alma Ata Conference. It was and Faith Groups) attended by different world health leaders to represent each nation. PILLARS / CORNERSTONES: Aside from the devolution, we use the primary health care approach. 1. Active Community Participation 2. Multi – Sectoral Approach CRITICAL POINTS OF PRIMARY HEALTH CARE 3. Equitable distribution of health resources 4. Appropriate Technology 1. Universal goal Use of appropriate technology Health for all RA 8423 – PITACC/TEMA 2. Goal of PHC-Philippines Use of indigenous resources available in Health for all and health in the hands of the community the people by year 2020 Philippine Institute of Traditional and 3. Mission: Alternative Health Care Let the people manage their Traditional and Alternative Medicines own healthcare (self-reliance) Act “use of herbal medications” To strengthen the health care system by increasing opportunities & supporting the Alma Ata Declaration listed essential health conditions wherein people will manage services using the acronym ELEMENTS their own health care. E- Education for health 4. Concept or strategy L- Locally endemic disease control Partnership E- Expanded program for immunization Empowerment of people M- Maternal & Child Health including responsible parenthood HISTORY OF PRIMARY HEALTH CARE E- Essential drugs N- Nutrition 1. First International Conference T- Treatment of communicable and non-communicable of PHC diseases When: September 6 to 12, S- Safe water and sanitation 1978 Where: Alma Ata, USSR Rationale (why there is a need of PHC) Goal: Health for all by year 2000 Magnitude of health problems. Inadequate and unequal distribution 2. PHC Adoption in the Philippines of health resources. o Legal basis: LOI 949 signed by Increasing cost of medical care. President Ferdinand Marcos last Isolation of health care activities from October 19, 1979 other developments. o The Philippines is the first in Asia to implement primary health care E L E M E N T S IN P H C approach. Health education KEY PRINCIPLES OF PHC o I – Information (input/theory) o E – Education (change of lifestyle) o C – Communication (transmission A – Accessible of information) A – Available A – Acceptable A – Affordable A – Attainable/Achievable  Locally Endemic Diseases Control 2. Hep B o Focuses on the prevention of the When: within 24 hours after birth, at birth/ first week of occurrence of continually present life diseases in a certain locality. (@birth – 6 weeks – 14 weeks) No. of doses: 3 doses, interval: Expanded Program on Immunization 6 weeks à 1st dose – 2nd dose - Launched: July 1976 8 weeks à 2nd dose – 3rd dose - Basis: Epidemiological Situation (increased cases of immunizable diseases) 0.5 ml IM Vastus Lateralis - Goal: Reduce the number of immunizable S/E: local soreness, NO fever diseases/cases MGT: warm compress, do not massage, continue Laws breastfeeding 1. PD 996 – compulsory immunization below 8 years old 3. DPT 2. RA 7846 – compulsory Hep B immunization When: 6 weeks (6th week-10th week-14th week) 3. RA 10152 – Mandatory Infant & Children Health No. of doses: 3 doses, interval: 4 weeks Immunization Act of 2011 0.5 ml IM Vastus Lateralis (upper outer thigh) (Note: Do not administer in Vastus Medialis because Give the meaning of the following acronyms: there is sciatic nerve) S/E: local soreness, fever, do not massage ü FIC (Note: ALL vaccines should not be massaged) ü CIC MGT: warm compress, antipyretics, continue ü CPAB breastfeeding, do not massage the site 5 Elements of EPI 4. OPV When: 6 weeks (6th week-10th week-14th week) 1. Surveillance 1-2 drops PO Mouth (Directly to tongue) 2. IEC S/E: no known SE 3. Cold Chain & Logistic Management MGT: Withhold breastfeeding for 30 minutes after 4. Assessment and Evaluation vaccination 5. Target Setting VACCINES 5. Measles When: 9 months old No. of doses: 1 dose only OLD VACCINES 0.5 ml SQ Deltoid S/E: local soreness, fever, mild rashes (expected, 1. BCG educate client not to worry because this will When: Any time after birth disappear 3-5 days after) For: Infant 0.05 ml ID Deltoid MGT: warm compress, antipyretics, continue School Entrants 0.1 ml ID Deltoid breastfeeding, do not massage the site S/E: local soreness, fever, Koch’s phenomenon, Wheal formation, permanent scar formation NEW VACCINE UPDATES: MGT: warm compress, antipyretics, continue BF, do not massage 1. Pentavaccine BCG 5 in 1 (Hep B, Diptheria, Pertussis, Tetanus, o Add 2 to 3 ml of diluent Haemophilus Influenza B) o Use 5 ml syringe When: 6 weeks (6th week-10th week-14th week) o Discard 4 hours after No. of doses: 3 doses, interval: 4 weeks 0.5 ml IM Vastus Lateralis S/E: local soreness, fever MGT: warm compress, antipyretics, continue breastfeeding, do not massage the site  2. Rota Vaccine MMR When: 6th week and 10th week (Before 34 weeks Vaccines that need to be consumed when diluted: old/ 8 months) BCG No. of doses: 2 doses, interval: minimum 4 weeks MMR 1.5 ml PO Mouth (in between gum & check) Vaccine given per orem: S/E: Mild allergic reaction OPV MGT: Benadryl/Antihistamine Vaccine (monodose): Pentavalent 3. MMR Vaccine (multidose): When: 12-15 months old Hepa B Measles/MMR 0.5 ml SQ Deltoid S/E: local soreness, fever, mild rashes MGT: warm compress, antipyretics, continue NATIONAL IMMUNIZATION PROGRAM (NIP) breastfeeding, do not massage the site Contraindications: Vitamin A is given with MMR, 200,000 IU 1. History of seizures/convulsions – for at 9 months Pentavalent Must be consumed within 4-6 hours; Pentavalent (5 in 1) - most common discard if it has not been consumed vaccine with adverse reaction which is Can be given as early as 6 months (if presence of convulsions there is an outbreak) Convulsions for more than 3 days is a sign of neurological condition > succeeding PNEUMOCOCCAL CONJUGATE VACCINE (PCV) doses are not given 3 doses (6, 10. 14 weeks) Less than 3 days - pertussis is not given 0.5 ml (pertussis is an antitoxin) IM 2. Clinical AIDS – infant BCG Protect children from meningitis 3. Immunosuppression Multidose (5 doses/vial) Not a Contraindication: Healthy children aged 2-5 years old may be 1. Fever up to 38.5°C given: 2. Simple or mild acute respiratory infection o 1 dose of PCV 13, or 3. Simple diarrhea without dehydration o 2 doses of PCV BCG at least 8 weeks apart 4. Malnutrition (it is indication for immunization) Given to protect the child against Old Vaccines pneumonia which may cause meningitis BCG brought about by pneumococcal DPT organism HepB Multidose: 1 vial is equivalent to 5 doses OPV No need to dilute prior to administration Measles Updated Vaccines Vaccines that cause fever: ROTA BCG Penta Pentavalent MMR IPV PCV Measles/MMR MATERNAL HEALTH PROGRAM Vaccines that do not cause fever: Hepa B RA 9173 – states that the practice of nursing includes but OPV not limited to “nursing care during conception, labor, Vaccines that cause Local Tenderness: delivery, infancy…As independent nurse practitioners, BCG nurses are primarily responsible for the promotion of Hepa B health, prevention of illness.” This sets the basis for the Pentavalent practice of the nurse on maternal care. IPV PCV Home Base Maternal Record Measles/MMR - Shall be used in rendering prenatal care as a Vaccines that need to be diluted: guide in the identification of risk factors, danger BCG signs and do appropriate measures.  - Recommended Schedule for Healthy Pregnancy TETANUS TOXOID IMMUNIZATIONS Prenatal visits: Ø 4-28 weeks: 1 prenatal visit every month Protects the mother and the baby Ø 28 – 36 weeks: 1 prenatal visit every 2 against tetanus weeks Fully Immunized Mother (FIM) Ø 36 – 40 weeks: 1 prenatal visit every week o 5 TT 3 doses of DPT = 2 doses of TT Provides artificial active immunity – mother PRENATAL CHECKUP Provides natural passive immunity – baby Age For determining the amount of TT to LMP be requested: 3.5% of the population Family History Fundic Height Dosage: 0.5mL IM Leopold’s Maneuver Given at the non-dominant hand, Blood Pressure Deltoid Region Tetanus Toxoid Immunization May cause tenderness at injection site, give Laboratory Tests compress o CBC – Anemia o Glucose tolerance test – 24th to Schedule of tetanus toxoid and diphtheria as 28th week AOG per AO#15 § If with history of DM o Blood typing – ABO Rh Incompatibility o UA – Proteinuria, UTI, STI’s Benedict’s Test: test for sugar in the urine; test for diabetes Heat test tube with 5 cc of benedicts solution (blue) in the burner then add 3-5 gtts of urine (amber yellow then heat again. Observe for the change in MICRONUTRIENT SUPPLEMENTATION color IRON SUPPLEMENTATION Blue – (-) sugar in urine Given at 1st trimester Green – trace of sugar in urine [+1, +] Iron deficiency – can cause neural tube defects Yellow - trace of sugar in urine [+2, ++] Anemia -presence of pallor, N = 11g/dL Orange- more traces of sugar in urine [+3, +++] Brick red- surely diabetic [+4,++++] Acetic Acid Test test for albumin in urine; test for pregnancy induced HPN Collect urine in test tube, heat it in burner then add 3-5gtts acetic solution (clear white). Observe for change in color: a. If it remains clear: (-) CHON or albumin in urine b. If it turns cloudy: (+) = proteinuria Side effects of Iron Supplements Constipation Black or discoloration of stools Metallic taste Should be taken with Vitamin C to enhance absorption VITAMIN A SUPPLEMENTATION Given at 2nd trimester (due to its teratogenic effects) Plant sources: carotene Animal sources: Retinol Vitamin A Deficiency – can cause congenital problems Do not give vitamin A to a woman taking multivitamins Blue – 100,000 IU Red – 200,000 IU POST PARTUM Ø postpartum check for conditions such as bleeding or infection. Ø Micronutrient supplementation à Iron and folate (60mg./400 mcg) once a day for 3 months or 90 tablets à Vitamin A 200,000 IU within 4 weeks after delivery Counseling on nutrition, child care, family planning, and other available services EO No. 51 or Milk Code o Prohibits the advertising, promotion, marketing of bottle feeding as equivalent or superior to breastfeeding. RA 7600 or Rooming – In and Breastfeeding Act Newborns must be put into the breast of the mother immediately after birth and roomed -in within 30 minutes after NSVD and within 3-4 hours after caesarian delivery