Community Health Nursing 1 RLE Notes PDF

COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- Fundamental Concepts of CHN...

COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- Fundamental Concepts of CHN Most traditionally recognized or imagined. Defined or formed by both natural and HEALTH manmade boundaries and include barangays, A state of complete physical, mental, and social municipalities, cities, provinces, regions and well-being and not merely the absence of nations. disease or infirmity. (WHO,1958) May also be called territorial communities A state of well being in which the person is able 2. Phenomenological communities to use purposeful, adaptive responses and Refer to relational, interactive groups processes physically, mentally, emotionally, Place and setting is more abstract spiritually and socially. (Murray et al.,2009) People share a group perspective or identity Actualization of inherent and acquired human based on culture, values, history, interests and potential through goal-directed behavior, goals. Actualization of inherent and acquired human Ex: schools, colleges, universities; churches and potential through goal-directed mosques; various groups or organizations. behavior,competent self- care, and satisfying Described also as functional communities relationship with others”.(Pender et al.,2006) A community of solution A state of a person that is characterized by A collection of people who form a group soundness or wholeness of developed human specifically to address need or concern. Ex. structures and of bodily and mental Gawad Kalinga functioning. (Orem,2001) POPULATION COMMUNITY A group of people having common personal or A collection of people who interact with one environmental characteristics another and whose common interests or All of the people in a defined community characteristics form the basis for sense of unity or belonging. (Allender et al., 2009) AGGREGATES A group of people who share something in common and interact with one another, who Subgroups or subpopulation may exhibit a commitment with one another Have common characteristics or concerns and may share a geographic boundary. (Lundy (Clark,2008) and Janes, 2009) Ex: Age groups or groups undergoing similar A locality –based entity, composed of systems physiologic processes (pregnancy) of formal organizations reflecting society’s institutions, DETERMINANTS OF HEALTH AND informal groups DISEASE and aggregates. (Shuster and Goeppinger,2008) WHO Health Determinants A group or collection of locality-based 1. Social and Economic Environment individuals interacting in social units and 2. Physical Environment sharing common interests, characteristics, 3. Person’s individual characteristics and behaviors values, and/ or goals (Maurer & Smith, 2009) Determinants that are specifically mentioned 1. Income and social status Four (4) Defining Attributes of Community 2. Education 1. People 3. Physical environment 2. Place 4. Employment 3. Interaction 5. Social support networks 4. Common characteristics, interests or goals 6. Culture 7. Genetics Two Main Types of Communities 8. Personal behavior and coping skills 9. Health Services 1. Geopolitical communities 10. Gender 1 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- FUNCTION INDICATORS OF HEALTH AND 1. Health situation monitoring and analysis ILLNESS 2. Epidemiological surveillance/disease prevention and Commonly reported indicators: control 1. Life expectancy 3. Development of policies and planning in public 2. Infant mortality health 3. Maternal mortality 4. Strategic management of health systems and 4. Age-adjusted death rates services for population health gain 5. Disease incidence rates 5. Regulation and enforcement to protect public health 6. Human resources development and planning in public health DEFINITION AND FOCUS OF 7. Health promotion, social participation and PUBLIC HEALTH AND empowerment. COMMUNITY HEALTH 8. Ensuring the quality of personal and population- Public Health based health service ▪ The science and art of 9. Research, development and implementation of 1. Preventing disease innovative public health solutions 2. Prolonging life 3. Promoting health and efficiency PREVENTIVE APPROACH TO HEALTH Three primary functions of Public Health promotion-Health promotion and levels Health (Institute of Medicine of of prevention activities enhance resources USA,1988) directed at improving well –being Core public health functions Disease prevention-Activities protect people 1. Assessment from disease and the effects of disease Regular collection, analysis and information about health conditions, risks and resources in Three (3) Levels of Prevention a community. 2. Policy development Use of information gathered during 1. Primary prevention assessment to develop local and state health Relates to activities directed at preventing a policies and to direct resources toward these problem before it occurs policies. Two elements: 3. Assurance a. General health promotion Focuses on the availability of necessary health b. Specific protection services throughout the community. Examples of Primary Prevention a. Promotion of good nutrition b. Provision of adequate shelter DIRECT SERVICES TO COMMUNITIES c. Encouraging regular exercise Two (2) Avenues 1. Environmental Health Services 2. Secondary prevention Protect the public from hazards e.g polluted Refers to early detection and prompt water, tainted food intervention during the period of early disease 2. Personal Health Care Services pathogenesis Immunization,FP,well infant and maternal Implemented after a problem has begun; before care,treatment prevalent health conditions, s&s appear communicable and non communicable Examples: a. Mammography ESSENTIAL PUBLIC HEALTH b. Blood pressure screening c. Newborn screening 2 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- d. Mass sputum examination (PTb) Is based on assessment of the populations’ health status 3.Tertiary prevention- Considers the broad determinants of health Correction and prevention of deterioration of a disease Emphasizes all levels of prevention state Intervenes with communities, systems, individuals Aims LEVELS OF CLIENTELE OF THE a. Reduce the effects of disease and injury COMMUNITY HEALTH NURSE b. Restore individuals to their optimal level of functioning Levels of clientele Examples: 1. Individual a. Teaching how to perform insulin injection 2. Family techniques and disease mgt to a patient with Diabetes 3. Group/aggregate b. Referring a patient with spinal cord injury for 4. Community occupational and physical therapy Family- basic unit of care Intervention Wheel DEFINITION AND FOCUS OF CHN, PHN AND Framework for community and public health nursing COMMUNITY –BASED NURSING practice 3 elements Community Health Nursing (CHN) 1. It is population –based The synthesis of nursing practice and public 2. Contains 3 levels of practice health practice applied to promoting and a. Community preserving the health of populations b. Systems (ANA,1980) c. Individual/family Public Health Nursing (PHN) 3. Identifies and defines 17 public health interventions A field of professional practice in nursing and in public health in which technical nursing, EMERGING FIELDS OF COMMUNITY HEALTH interpersonal and analytical and organizational NURSING IN THE PHILIPPINES skills are applied to problems of health Community- based Nursing Established and recognized fields of practice of Refers to “application of the nursing process in CHN caring for individuals, families and groups 1. Public Health where they live, work or go school or as they 2. Occupational Health move through the health care system (McEwen 3. School Health and Pullis,2008) Client HOME HEALTH CARE In CHN the primary client is the community; in Providing nursing care to individuals and community-based nsg are the individual and families in their own places of residence mainly the family to minimize the effects of illness and disability. Services In Community based nsg, largely direct, HOSPICE HOME CARE whereas in CHN servicers are both direct and A home care specifically rendered to a indirect. terminally ill to provide comfort. EntrepreNurse DISTINGUISHING FEATURES OF COMMUNITY A project initiated by the Department of labor and HEALTH NURSING PRACTICE Employment (DOLE) Population-focused approach and community health Aims: nursing interventions Population- focused practice 1. Reduce the cost of health care for the indigent (Minnesota DOH, 2003) population Focuses on the entire population 3 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- 2. Maximize employment opportunities for unemployed ▪ Identification and reporting of variances in nurses client care 3. Utilized the country’s unemployed human ▪ Recommendation of solutions to identified resources for health for the delivery of public problems r/t client care 8. Research ▪ Research based formulation of solutions to problems in client care COMPETENCY STANDARDS IN ▪ Dissemination and application of research COMMUNITY HEALTH NURSING findings 11 Key areas of responsibility 9. Record Management 1. Safe and quality nursing care ▪ Accurate and updated documentation of client ▪ Knowledge of health/illness status of the care while observing legal imperatives in record client keeping ▪ Sound decision making 10. Communication ▪ Comfort and privacy of the client ▪ Uses therapeutic communication techniques ▪ Priority setting based on client’s need for establishment of rapport ▪ Administration of medications and health ▪ Identifies verbal and nonverbal cues Therapeutics ▪ Responds to client’s needs while using formal ▪ Use of the nursing process and informal channels of communication and 2. Management of resources and environment appropriate technology ▪ Organization of workload 11. Collaboration and teamwork ▪ Use of financial resources for client care ▪ Establishment of collaborative relationship ▪ Mechanism to ensure proper functioning of with colleagues equipment HISTORY OF PUBLIC HEALTH AND PUBLIC ▪ Maintenance of a safe environment HEALTH NURSING IN THE PHILIPPINES 3. Health Education ▪ Assessment of client’s learning needs 1577- Franciscan Friar Juan Clemente opened a ▪ Development of a health education plan and medical dispensary in Intramuros for the indigent. learning materials 1690-Dominican Father Juan de Pergero worked ▪ Implementation and evaluation of the health toward installing a water system in an Juan del Monte education plan and Manila 4. Legal responsibility 1805-Smallpox vaccination was introduced by Dr. ▪ Adherence to the nursing law and other Francisco de Balmis relevant laws 1876-First medicos titulares were appointed by the 5. Ethico-moral responsibility Spanish Government ▪ Respect for the rights of the client 1888- a 2 year course consisting of fundamental ▪ Responsibility and accountability fopr own 1901-Created the Board of Health of the Philippine decisions and actions Islands (Act 157) ▪ Adherence to the international and national Fajardo Act of 1912 -created sanitary divisions codes of ethics for nurses 1915-Philippine General Hospital began 6. Personal and professional development 1947- DOH was reorganized into bureaus ▪ Identification of own learning needs 1954- congress pass RA 1082 or the Rural Health Act ▪ Pursuit of continuing education 1970- Philippine health care delivery system was ▪ Involvement in professional and civic restructured. Health care system are classified into activities primary, secondary and tertiary ▪ Projection of a professional image 1991-RA 7160 or the Local Government Code was ▪ Positive attitude toward change and criticism enacted ▪ Adherence to professional standard 1999-Health sector Reform agenda launched 7. Quality improvement 2010- Universal Health Care ▪ Data gathering for quality improvement ▪ Participation in nursing audits and rounds Control of Communicable Diseases 4 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- Symptoms: Fever, night sweats, persistent cough, COMMUNICABLE DISEASES bloody phlegm, chest pain or shortness of breath low illnesses caused by an infectious agent or its grade fever in late afternoon loss of appetite easy toxic products that is transmitted directly or fatigability night sweats dry cough then later indirectly to a person, animal, host or inanimate productive with hemoptysis chest pain environment Incubation Period: 4-6 weeks One of major public health problem in the Philippines Leading causes of morbidity Millenium Development Goal Globally, new HIV infections declined by 38% between 2001 and 2013. Existing cases of tuberculosis are declining, along with deaths among HIV-negative tuberculosis cases FUNCTION OF A PUBLIC HEALTH NURSE Report immediately to the Municipal Health Office any known case of notifiable disease Refer immediately to the nearest hospital Conduct a strong health education program directed toward prevention of an outbreak Assist on the diagnosis of the suspect based on the signs and symptoms (IMCI) Conduct epidemiological investigations as a Collection of sputum specimens means of contacting families’ case finding and 1. Motivate the presumptive TB patient to undergo individual as well as community health sputum exam ( DSSM). education 2. Explain the importance of the procedure and that of submitting two (2) sputum specimens. 3. Prepare the sputum cups and the Form 2a. NTP TUBERCULOSIS Laboratory Request Form. Label the body of the sputum Causative Agents: Mycobacterium tuberculosis, cup (i.e., not the lid), indicating patient’s complete Mycobacterium africanum, (from humans) name, and order of specimen collection (i.e., 1st, and Mycobacterium bovis (from cattle 2nd). Mode of Transmission: AIRBORNE DROPLET through 4. Demonstrate how to produce quality sputum. Mucus inhalation of coughing, singing or sneezing from the nose and throat, and saliva from the mouth are NOT good specimens. 5 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- DENGUE HEMORRHAGIC FEVER Is a mosquito borne infection found in tropical and subtropical regions around the world 4 Stereotypes: DENV-1, DENV-2, DENV-3, and DENV-4 Other Names: Hemorrhagic fever, Break bone, Dandy fever, Dengue Shock syndrom MALARIA is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. Mode of Transmission: vector female anopheles Common diagnostic tests: Tourniquet test (Rumpel test)=check presence of 20 or more petechiae in the arm, platelet count/ hematocrit Other Names: Nursing Management: Marsh fever Give Paracetamol every 4 hours Periodic fever Encourage oral intake of Oral Rehydration Solution King of Tropical Disease (ORS) Laboratory/ Diagnostic tests Avoid dark - colored foods 1 Travel history in a malaria -endemic area e.g. Palawan Instruct to bring to the hospital if with severe and Mindoro abdominal pain, persistent vomiting, lethargy or 2 Blood smear irritability, bleeding, black stools or coffee ground 3 Rapid Diagnostic test (RDT) – detect presence of vomiting, no urine more than 4 -6 hours specific malaria antigen Blood transfusion should be given as soon as severe Symptoms: Recurrent fever preceded by chills and bleeding is suspected or recognized profuse sweating Malaise Anemia Monitor laboratory results especially platelet and Prevention and Control hematocrit 1. MOSQUITO CONTROL 2. Zooprophylaxis – larvae-eating fish, farm animals should be kept near the house 3. Environmental methods – cleaning and irrigating canals 4. Screening of houses Treatment 1. CHLOROQUINE PHOSPHATE 250mg (all species except P. malariae) 6 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- 2. QUININE SULFATE 300mg./tab 3. TETRACYCLINE HCL 250mg/cap 4. QUINIDINE SULFATE 200mg durules QUINIDINE HYDROCHLORIDE 300mg/ml, 2ml QUINIDINE GLUCOLATE 80mg (50mg) 1 vial FILARIASIS Other names: Elephantiasis, Filarioidea infection Causative Agents: Wuchereria bancrofti, Burgia malay, Mode of Transmission: Bite of mosquito Vector: Aedes poecilus, Culex Quinquefaciatus Signs and Symptoms: CHILLS, FEVER, MYALGIA, LYMPHANGITIS and gradual thickening of the skin commonly affecting limbs, scrotum resulting in elephantiasis and hydrocele SCHISTOSOMIASIS Causative Agent: Schistosoma japonicum Schistosoma mansoni Schistosoma haematrobium Vector: ONCOMELANIA QUADRASI (snail) Mode of transmission: VEHICLE (water) INDIRECT (skin pores) LEPROSY Signs and Symptoms: Rash at site of Inoculation Leprosy is a chronic, progressive bacterial Prevention: infection caused by the MYCOBACTERIUM 1. Proper disposal or feces and urine LEPRAE. 2. Proper irrigation of all stagnant bodies of water It primarily affects the nerves of the extremities, 3. Prevent exposure to contaminated water (Wear the skin, the lining of the nose, and the upper rubber boots) respiratory tract. 4. Eradication of breeding places of snails THE MAIN SYMPTOMS 5. Use of molluscides numbness in the hands, arms, feet, and legs Laboratory: skin lesions The skin lesions result in decreased 1. COPT ( Cercum Ova Precipetin Test) 2. Kato Katz sensation to touch, temperature, or pain. techniqu Treatment: 1. Praziquantel ( Biltricide) 2. Oxamniquine (for S. mansoni and S. haematobium) LEPTOSPIROSIS INCUBATION PERIOD – 7-13 DAYS SIGNS AND SYMPTOMS 1. Septicemic – high , remittent fever 4-7 days, myalgia LABORATORY DIAGNOSTIC TEST Blood Culture Leptospira Agglutination Test (LAT) TREATMENT Penicillin or Tetracycline Symptomatic nursing management 7 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. -HIV infection progresses to AIDS when your CD4 T cell count dips below 200. VIRAL LOAD (HIV RNA) This test measures the amount of virus in your blood. After starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces your chances of opportunistic infection and other HIVrelated complications Treatment Currently, there's no cure for HIV/AIDS. 2020 – gene therapy, immunotherapy However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). SEXUALLY-TRANSMITTED DISEASES OTHER VIRAL DISEASES AIDS Diagnosis: CD4 T CELL COUNT 8 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- An Act Further Liberalizing the Treatment of Leprosy Sec. 1059. Confinement and treatment in sanitarium when necessary. -Whenever a person afflicted with leprosy shall have developed the disease to such stage as to require institutional treatment and the leprosy officer shall so certify, the said person shall forthwith be sent to a government operated sanitarium and be treated therein until such time as the Secretary of Health or his authorized representative decides that institutional treatment is no longer necessary." Republic Act 8504 Philippine AIDS prevention and control act of 1998 An act promulgating policies and prescribing measures for the prevention and control of hiv/aids in the philippines, instituting a MPOX nationwide hiv/aids program, establishing a Causative Agent: Mpox virus comprehensive hiv/aids monitoring system, MOT: Direct, respiratory Incubation 7-14 days Signs and strengthening the philippine national aids Symptoms: Early Symptoms: Fever, headache, muscle council, and for other purposes aches, and swollen lymph nodes. Republic Act 9482 Rash: A characteristic rash appears, typically starting on Anti- RABIES Act of 2007 the face and then spreading to other parts of the body. AN ACT PROVIDING FOR THE CONTROL AND It progresses through stages: macules, papules, ELIMINATION OF HUMAN AND ANIMAL vesicles, pustules, and scabs. Prevention: RABIES, PRESCRIBING PENALTIES FOR Avoid Contact: With infected individuals or animals. VIOLATION THEREOF AND APPROPRIATING Personal Protective Equipment (PPE): For healthcare FUNDS THEREFORE workers and those in close contact with patients. Hygiene: Regular hand washing and disinfection of surfaces LAWS GOVERNING CONTROL OF COMMUNICABLE Memorandum Circular 98- 155 DISEASES Pronounced the National Tuberculosis Control Republic Act 3573 Program as the highest priority public health Reporting of Communicable Diseases program of the LGUs Requires all individuals and health facilities to Presidential Proclamation No. 45 of 1992 report notifiable diseases to local and national Reaffirming the commitment to the Universal authorities Child and Mother Immunization goal by Category I (immediately notifiable) includes launching the Polio eradication Project, which acute flaccid paralysis, adverse event following aims to make the Philippines polio-free by 1995 immunization, anthrax, human avian influenza, Presidential Proclamation No. 1204 of 1998 measles, neonatal tetanus, paralytic shellfish Declaring the month of June of every year as poisoning, rabies and SARS (Severe Acute National Dengue Awareness month, and Respiratory Syndrome) formulation of the National Dengue Prevention Category II (Weekly notifiable) includes acute and Control Program to reduce morbidity and bloody diarrhea, bacterial meningitis, cholera, mortality dengue, diphtheria, influenza-like illness, Administrative Order No. 24 series of 199 leptospirosis, malaria REPUBLIC ACT No. 4073 9 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- The National Tuberculosis Control Program All through a seamless alignment of SHNP adopted Directly Observed Treatment, Short activities with other key school programs thus Course (DOTS) in the management of TB. the title: Communicable diseases remain to be one of the major INTEGRATED SCHOOL HEALTH AND NUTRITION public health concerns in the Philippines. PROGRAM. 1. Nurses must be knowledgeable about the different health programs and policies of the government to prevent and control these communicable diseases. 2. The public health nurse must work collaboratively with other health professionals in eliminating and eradicating communicable diseases in response to the Philippines’ commitment to the MDGs set to be achieved School Nursing Health and Education: ‘’TO LEARN EFFECTIVELY, DEVELOPMENT OF SCHOOL CHILDREN NEED GOOD HEALTH.’’ HEALTH PROGRAMS DepEd Order No.43,s.2011 -LONG TERM For the past 50 years, school health have evolved markedly. OBJECTIVES Expand Early Childhood care and Education Its components are : Improve quality of Education SCHOOL HEALTH SERVICES Provide learning and life skills to young people SCHOOL HEALTH EDUCATION and adults HEALTHY SCHOOL ENVIRONMENT Eradicate extreme poverty and hunger Reduce child mortality rate In Philippines, RA 124 IN 1947 was first created. Combat HIV/AIDS,malaria,and other diseases Ensure environmental sustainability Entitled: An Act to Provide for Medical Inspection of Children Enrolled in Private Schools, Colleges and In 1977, World Health Organization , added more Universities components in the School Health Program In 1991, REDESIGNED APPROACH IN SCHOOL HEALTH PROMOTION FOR SCHOOL HEALTH NURSING(RASHN), PERSONNEL Officially adopted the DepEd Memorandum No.37 SCHOOL COMMUNITY PROJECTS AND Academic performance of the pupils and the OUTREACH instructional outcomes are determined by the NUTRITION AND FOOD SAFETY quality of health school population and the community where they come from. PHYSICAL EDUCATION MENTAL HEALTH COUNSELLING AND SOCIAL In 2011, creation of DEPARTMENT OFEDUCATION Order SUPPORTS No. 43 Strengthening the School Health and Nutrition Programs for the achievement of the Education for 10 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- SCHOOL HEALTH GUARDIANS CLINIC- IN- CHARGES/ WELL/TRAINED TEACHERS PRIMARY Prevention Nutrition Education Immunization Safety Health Education SECONDARY Prevention Screenings PROFESSIONAL PERFORMANCE Case Finding Treatment Quality of Practice Home Visits Education Profession Practice Evaluation TERTIARY Prevention Collegiality Referral of student for substance abuse or Ethics behavior problems Research Prevention of complications and adverse Resource Utilization effects Leadership Faculty and staff Program Management Monitoring STANDARDS OF SCHOOL NURSING PRACTICE HEALTH EDUCATION Assessment Target population–Primary to Tertiary Learners Diagnosis and Staff Outcomes Clarification Culture sensitive and based on the identified Planning educational needs of the clients Implementation Health Concepts are integrated in the K-12 Coordination of Care Curriculum Health Teaching and Health Promotion Teachers and other School Evaluation Personnel are partners of School Nurses SCHOOL CLINIC ORGANIZATION The health concepts are introduced according Physician to the developmental level of school children. Dentist Nurse PHYSICAL EDUCATION Clinic/Teachers Provision of physical and social environment Establish policies that promote enjoyable,lifelong physical activity SCHOOL CLINIC ORGANIZATION Assess the physical activity patterns of young CLUSTER OF SCHOOLS people and refer them to physical activity SCHOOL VISITS programs HEALTH PROGRAMS FOR Training to enable teachers,coaches, recreation TEACHERS AND and health care staff and advocate for physical LEARNERS activity instruction programs 11 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- Provide a range of developmentally appropriate RISK FACTORS: community sports that are attractive to young Women people. Family Dysfunction History of Sexual Abuse SCREENING BINGE-EATING Detect early signs and symptoms of illness,disabilities and deviations from normal. Out of control and recurrent eating of large amount of food whether hungry or not. Annual Physical Examination RISK FACTORS Height and Weight Stress Management Low Self-Esteem Rapid Classroom Inspection Depression Genetics CARE OF THE ILL CHILD BULIMIA NERVOSA Identifying nutritional problems School based Feeding Program A serious, potentially life-threatening eating Gulayan sa Paaralan disorder. Healthy Food and Beverages in Schools Characterized by a cycle of bingeing and Dietary Counseling compensatory behaviors such as self-induced Deworming- prevents and eradicates vomiting designed to undo or compensate for helminthiasis the effects of binge eating. Weekly Iron Folic Acid Supplementation- RISK FACTORS address anemia and micronutrient deficiency Social isolation. Change in mood or personality. Refusing to eat in front of people. NUTRITIONAL DEFICIENCIES AND MENTAL Impulsive behaviors. DISORDERS Excessive or new substance or alcohol use. Obesity Striving for perfectionism. Anorexia nervosa Intense fear of weight gain. Bulimia nervosa Binge eating NUTRITION EDUCATION PROGRAM Prevention should concentrate on Eliminating misconceptions. Nutrition Education is essential and must include PARENTS, TEACHERS and the CHILD. OBESITY ACTIVITIES Major health concern Parent -Teacher Orientation Not an eating disorder Health Talks May result to social and impairment in quality Nutrition Counselling of life Height and Weight Assessment Risk Factors include: Reduced access and affordability of nutritious Counseling, Psychological and Social food Services Decreased Physical Activity Cultural and Genetic Influences Promotion of Mental health and reduction or removal of threats Nurses as and CONFIDANTE COUNSELOR. ANOREXIA NERVOSA It is a severely restricted intake of food based on an EXTREME FEAR OF WEIGHT GAIN. 12 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- ADVANTAGES OF HOME VISIT To find out needs of individual, family and community in relation to health, socio- economic and cultural aspects. To provide domiciliary midwifery as care for pregnant, delivery, and puerperal mother and infant. FAMILY AND COMMUNITY To give care to the sick, to a postpartum INVOLVEMENT mother and her newborn with the view teach a School nurses are asked to provide health content to responsible family member to give subsequent families,parents and communities. care To assess the living condition of the patient and Act as.... his family and their health practices in order to RESOURCE OF HEALTH RELATED PROBLEMS provide the appropriate health teachings. HEALTH CONSULTANT To provide basic health services for minor ailments. (i.e. injury, boils, abrasions). To COMMUNITY RELATED ACTIVITIES provide counseling on family Develop Healthy Eating Habits in the Home planning,immunization, nutrition. Develop Physical Activity Program To give health teaching regarding the Working with media and legislators to sustain prevention and control of diseases health education advocacy To establish a close relationship between the nurses and the public for promotion of health. HOME VISIT To make use of an inter-referral system and to promote the utilization of community services. Provides an excellent opportunity to implement DEFINITION OF HOME VISIT the nursing care Render services at their own surrounding and at A home visit is one of the essential parts of the their convenience. community health services. Promotes good understanding between the community health nurse and the family. Home visiting means visiting the family at their place to Helps to observe family practices.Helps CHN assess the health need, to provide services such as and family member to modify the way of their preventive, promotive, curative or rehabilitative service care. at their door steps.It is a backbone of community health services. PRINCIPLES OF HOME VISIT A home visit is defined as the process of Based on need.Collect information before home providing the nursing care to patients at their visiting doorsteps. It requires technical skills, Use safe technical skills resourcefulness, judgment, relationships Be kind and courteously..Defined as providing the services to family at Planned and purposeful their door steps to maintain the health and to Regular.Flexibility in approach. reduce the mortality and morbidity in the family. Voluntarity and convenient To obtain information for family assessment. To get acquainted with the family. To begin a relationship of continuing assistance inthe family health and health related needs. 13 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- cause more than 70% of deaths in children under 5 years of age. ▪ There are feasible and effective ways that health workers in health centers can care for children with these illnesses and prevent most of these deaths. ▪ WHO & UNICEF used updated technical findings to describe management of these illnesses in a set of integrated guidelines ▪ It is an integrated approach to child’s health that focuses on the well-being of the whole child. ▪ It is a case management process and strategy for a FREQUENCY OF HOME VISIT first – level facility such as a health center to achieve a significant reduction in the number of deaths from Frequency of home visits depend upon communicable diseases in children > 5 Extend of health needs Extend of health ▪ Aims to reduce death, illness and disability, and to problems promote improved growth and development among Need felt by the family children under (5) five years of age. Family's ability to deal or cope with health ▪ It includes both preventive and curative problems elements that are implemented by families and Family's regularity in home visit. communities as well as by health facilities. PROBLEMS DURING HOME VISIT HOW IMCI STARTED Consume lots of time and energy. ▪ 1995 – IMCI was developed by WHO _ UNICEF to all Unforeseen events. developing countries. Non-acceptance by the family. ▪ 1997 – IMCI was brought to the Philippines thru the Problem of local language. Department of Health – Region I, III, X, XI (funded by Role confusion.· United States Agency for International Development Unsafe situation for health workers [USAID]) ▪ 2001 – Integration of IMCI to Nursing & Midwifery ROLES AND RESPONSIBILITIES OF A CHN DURING Curriculum (attended by the Academe from different HOME VISIT Nursing & Midwifery schools) She need to respect for life, dignity and rights of people, and serve them all without regard to race, PARTICIPATING AGENCIES religion, color, age, sex, politics or social status. ▪ DOH – Lead Agency She should value the customs and spiritual beliefs of ▪ Commission on Higher Education Department (CHED) people. ▪ Association of Deans of Philippines College of Nursing She should not pass on personal information except (ADPCN) to the right person.She should keep up a high standard ▪ Association of Philippine School of Midwifery of work and personal conduct. (APSOM) She should maintain a good relationship and ▪ Professional Regulation Commission (PRC) Cooperation with coworkers in the health team, and community. IMCI Components of Strategy INTEGRATED MANAGEMENT OF CHILDHOOD ▪ Improving case management skills of health workers ILLNESS ▪ Improving the health systems to deliver IMCI ▪ Improving family and community practices. IMCI ▪ Pneumonia, diarrhea, dengue hemorrhagic fever, Who are the children covered malaria, measles and malnutrition by IMCI protocol? 14 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- ▪ Describe what to do when a child returns to the health ▪ Sick children birth up to 2 months (Sick Young Infant) center by arrangement for a follow-up visit. ▪ Sick children 2 months up to 5 years old (Young Child) 1. Ask the mother what is the problem of the child. 2. Check for General Danger Signs (GDS): Strategies/Principles of IMCI ▪ A general danger sign is present if the child ▪ The children and infants are then assessed for main is/has: symptoms. For sick children, the main symptoms ▪ C – onvulsion include: cough or difficulty breathing, diarrhea, fever ▪ U – nable to feed, drink, or breastfeed and ear infection. For sick young infants, local bacterial ▪ V –omits everything infection, diarrhea and jaundice. ▪ A – bnormally sleepy/difficult to awaken ▪ All sick children are routinely assessed for (lethargic or unconscious) nutritional immunization and deworming status and for other problems. REMEMBER: 1 Danger Sign = Severe ▪ Only a limited number of clinical signs are used. ▪ A combination of individual signs leads to a child 3. Assess Main Symptoms classification within one or more symptom groups ▪ Cough / DOB rather than a diagnosis. ▪ Diarrhea ▪ IMCI management procedures use limited number of ▪ Fever essential drugs and encourage active participation of ▪ Ear Problem caretakers in the treatment of children. ▪ Anemia ▪ Counseling of caretakers on home care, correct ▪ Malnutrition feeding and giving of fluids and when to return to clinic is an essential component of IMCI. The IMCI Case Management Process 1. Assess and classify ▪ Taking a history and doing a physical examination ▪ Making a decision on the severity of the illness. 2. Identify appropriate treatment ▪ The charts recommend appropriate treatment for each classification 3. Treat/refer ASSESS AND CLASSIFY DIARRHEA ▪ Giving treatment in health center, prescribing drugs or other treatments to be given at home, and also teaching the mother how to carry out the treatments. 4. Counsel ▪ Includes assessing how the child is fed and telling her about the foods and fluids to give the child and when to bring back to the health center 5. Follow-up 15 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- ASSESS AND CLASSIFY FEVER ASSESS AND CLASSIFY EAR PROBLEM 16 COMMUNITY HEALTH NURSING 1 Comprehensive Examination —------------------------------------------------------------------------------------------------------------------------------------------- ASSESS AND CLASSIFY MALNUTRITION AND ASSESS AND CLASSIFY POSSIBLE BACTERIAL ANEMIA INFECTION 17