Founda_Chapter12 (PDF)

BY: HANZZEL E. BISA-PASTERA, RM **TABLE OF CONTENTS** Chapter I - Introduction to the Course Chapter II - Health and Illness A. B. C. D. E. F. Chapter III - Health Care Process A. 1. 2. 3. 4. B. 1. C. 1. 1. 2. 3. 2. 4. 5. 6. 7. 8. 3. 9. 3.1.1 Principles...

BY: HANZZEL E. BISA-PASTERA, RM **TABLE OF CONTENTS** Chapter I - Introduction to the Course Chapter II - Health and Illness A. B. C. D. E. F. Chapter III - Health Care Process A. 1. 2. 3. 4. B. 1. C. 1. 1. 2. 3. 2. 4. 5. 6. 7. 8. 3. 9. 3.1.1 Principles of Nutrition 3.1.2 Nutrients 3.1.3 Dietary guidelines 3.1.4 Types of Diet 3.2 Elimination 3.2.1 Bowel Elimination 3.2.2 Urinary Elimination 4\. Maintaining Respiration of Patients 4.1 Oxygen Therapy 4.2 Suctioning 5\. Drug Administration A. Classification of Drugs B. Factor Influencing Drug Action C. Effects of Drugs D. Common Abbreviations E. Types of Medication Order F. Parts of Drug Order G. 10 R's of Drug Administration H. Route of Drug Administration I. Drugs and Solution **SKILLS LABORATORY** 1. Physical Examination 2. Vital Signs Taking A. B. C. D. 3. Body Mechanics A. B. 4. Bed Making A. B. 5. Hygiene A. B. C. D. E. 6. Heat and Cold Application A. B. C. D. 7. Nutrition 8. Elimination A. 9. Drug Administration A. B. C. D. References: Udan, Josie RN MAN Mastering Fundamentals of Nursing: Concepts and Clinical Application, Educational Publishing House Kozier, Barbara, et al., Fundamentals of Nursing: Concepts, Process and Practice, Pearson Education, South Asia PTE. LTD **Chapter I - INTRODUCTION TO THE COURSE** Course Title: Foundation of Midwifery Practice Course Code: M-100 Course Credit: 7 Units (4 units lecture, 3 Clinical Practicum) Placement: First Year, Second Semester Pre-requisite: Introduction to Health Care C0 Requisite: Anatomy and Physiology Course Description: The course provides the student with the basic/necessary knowledge, skills and acceptable attitudes in the care of individuals and families through the use of the health care process. The health care process includes assessment, planning, implementation and evaluation of patient care. It specifically includes the application of skills in comfort, preventive, therapeutic measures and patient safety practices in the clinical areas. The course culminates with the students having achieved the basic competencies of value-laden health care practitioners. **Program Outcomes:** At the end of the program, the graduates of Bachelor of Science of Midwifery should be able to: 1. Demonstrate requisite knowledge and skills on obstetrics, neonatology, the social sciences, public health, and ethics that forms the basis of high quality, culturally relevant, and appropriate care for women, newborns, and childbearing families. 2. Provide high quality, culturally sensitive health education and services to all in any community setting. In order to promote healthy family life, planned pregnancies, and positive parenting. 3. Provide high quality antepartum, intrapartum, and postpartum care to maximize health during pregnancy, labor and delivery, and postpartum period that include early detection, emergency management, and referral of complicated conditions of mothers and newborns. 3.1 Conduct health assessment of the woman and fetus for promotion of health and well-being, detection of complications during pregnancy, and care of women with an unexpected pregnancy. 3.2 Assess and provide care to women during labor that facilitates physiological processes and a safe birth, the immediate care of the newborn infant, and detection of complications in mother or infant. 3.3 Provide continuing health assessment of mother and infant, health education, support for breastfeeding, detection of complications, and provision of family planning services. 4. Accept own accountabilities as a health professionals, the relationships with women and other care providers, and care activities that apply to all aspects of midwifery practice. 5. Demonstrate effective interpersonal communication with women and families, health care teams, and community groups. 6. Adhere to jurisdictional laws, regulatory requirements, and codes of conduct for midwifery practice. 7. Recognize conditions outside midwifery scope of practice and refer appropriately. **Course Intended Learning Outcomes:** At the end of the course, given relevant simulated situations the learners should be able to: 1. Assess patient's condition. 2. Provide appropriate interventions based on the identified problems of the patient. 3. Utilize health care process in the care of patients. **CHAPTER II - HEALTH AND ILLNESS** A. **DIMENSION OD WELLNESS** WELLNESS - is a state of well-being. Engaging in attitudes and behaviors that enhance quality of life and maximize personal potential. It is an active process of becoming aware of and making choices toward a higher level of well being. **Basic aspects of Wellness:** a. Self-responsibility - obligation to be healthy b. An ultimate goal c. A dynamic d. Growing process e. Daily nutrition making in the areas of nutrition, stress management, physical fitness, preventive health care, and emotional health f. The whole being of an individual **Seven Components of Wellness**  1. Physical wellness - is the ability to carry out tasks, achieve fitness, maintain adequate nutrition and body fat, avoid abusing drugs and alcohol or tobacco products, and generally practice positive lifestyle habits.  2. Social wellness - is the ability to interact successfully with people and within the environment of which each person is a part, to develop respect and tolerance for those with different opinions and beliefs.  3. Emotional wellness - is the ability to manage stress and express emotions appropriately.  4. Intellectual wellness - is the ability to learn and use information effectively.  5. Spiritual wellness - is the belief in some force that serves to unite human beings and provide meaning and purpose to life. It includes a person's own morals, values, and ethics. 6. Occupational wellness - is the ability to achieve balance between work and leisure time.  7. Environmental wellness - is the ability to promote health measures that improve the standard of living and quality of life in the community. B. **MODELS OF HEALTH AND ILLNESS** HEALTH- according to WHO, it is "a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity." **Six Model of Health and Illness** 1. Health-illness continuum (Human) - Degree of client wellness that exist at any point in time, ranging from an option wellness condition, with available energy at its maximum, to death which represent total energy depletion. 2. High-Level Wellness Model (Halbert Dunn) - It is oriented towards maximizing the health potential of an individual. This model requires the individual to maintain a continuum of balance and purposeful direction within the environment. (Able to share emotion, feelings, engage in daily check up) 3. Agent-Host-Environment Model (Levels) - The level of health of an individual or group depends on the dynamic relationship of the agent, host, and environment. According to the model the health and illness, Health is seen when all three elements are in balance and Illness is seen when one, two, or all three elements are not in balance. (Host - human, Agent - factors or stressors led to diseases, Environment - temperature, altitude,water, pollution,) Agent - any factor or stressors that can lead to illness or disease. Host - the person or persons who may not be susceptible to a particular illness or disease. Environment - consists of all factors outside of the host. 4. Health-Belief Model - it is proposed by Rosenstock and Becker and Maiman. This model addresses the relationship between a person's beliefs and behaviours. It helps to understand the factors influencing patient's perceptions, beliefs, and behaviour to plan the care. Three Components: a. Individual's perception of susceptibility to an illness. b. Individual's perception of the seriousness of the illness. c. The perceived benefits of taking the necessary preventive measures. 5. Evolutionary-Based Model - Illness and death serves as an evolutionary function. Evolutionary viability reflects the extent to which individual's function to promote survival and well-being. The model interrelates the following elements: a. Life events b. Lifestyle determination c. Evolutionary viability within the social context d. Control perception e. Viability emotions f. Health outcomes 6. Health Promotion Model - A "Complimentary counterpart model of health protection". Direction at increasing a client's level of well-being. Explain the reason for the client's participation health-promotion Behaviors. The model focuses on three functioned: a. It identifies factors (demographic and socially) enhance or decrease the participation in the health promotion. b. It organizes cues into pattern to explain likelihood of client's participation health promotion behaviors. c. It explain the reasons that individuals engage in health activities. C. **FACTORS AFFECTING HEALTH** +-----------------------------------+-----------------------------------+ | **FACTORS** | **HEALTH** | +-----------------------------------+-----------------------------------+ | 1. Behavioural | | +-----------------------------------+-----------------------------------+ | Obesity | Heart disease, Diabetes, certain | | | Cancers | +-----------------------------------+-----------------------------------+ | Smoking | Lung cancer, Emphysema, Heart | | | disease, Low birth weight infants | +-----------------------------------+-----------------------------------+ | High cholesterol diet | Arterioclerosis, Heart disease | +-----------------------------------+-----------------------------------+ | Moderate to heavy alcohol use | Cirrhosis, mouth cancers, | | | complications of pregnancy, low | | | birth weight infants | +-----------------------------------+-----------------------------------+ | Regular exercise | Reduce risk of heart disease | +-----------------------------------+-----------------------------------+ | 2. Mental/Emotional | | +-----------------------------------+-----------------------------------+ | Depression | Cancer | +-----------------------------------+-----------------------------------+ | Prolonged grief/ Bereavement | Early death from a variety of | | | causes | +-----------------------------------+-----------------------------------+ | Emotional well-being | Increased resistance to infection | +-----------------------------------+-----------------------------------+ | 3\. Social | | +-----------------------------------+-----------------------------------+ | Lack of close ties with others | Mental illness, respiratory | | | disease, complications of | | | pregnancy, early death from | | | numerous cause | +-----------------------------------+-----------------------------------+ | 4\. Spiritual | | +-----------------------------------+-----------------------------------+ | Fatalism | Underutilization of health | | | services | +-----------------------------------+-----------------------------------+ | Concept of sin | Stress of excessive guilt | +-----------------------------------+-----------------------------------+ | Worship, prayers, meditations | Decreases blood pressure, | | | decreased mental stress, | | | increased hardness | +-----------------------------------+-----------------------------------+ | 5\. Environmental | | +-----------------------------------+-----------------------------------+ | Air pollution (living near toxic | Mental illness, respiratory | | waste dumps) | disease, complications of | | | pregnancy, spontaneous abortion | +-----------------------------------+-----------------------------------+ | Pesticide exposure | Birth defects | +-----------------------------------+-----------------------------------+ | 6\. Economical/Political | | +-----------------------------------+-----------------------------------+ | Impoverished living condition | Nutritional disorders, heart | | | disease, diabetes, depression, | | | marital, instability | +-----------------------------------+-----------------------------------+ | Arrest, torture, execution for | Possible death | | political reasons | | +-----------------------------------+-----------------------------------+ | Political interference with | Communicable diseases, | | relief programs | malnutrition, possible death | +-----------------------------------+-----------------------------------+ | Oppression, racism | High blood pressure, heart | | | disease among ethic minorities | +-----------------------------------+-----------------------------------+ D. **Stages of Illness** ILLNESS - is a condition of being unhealthy in your body or mind. The state of disturbance in the normal functioning of the total human individual. **Stages of Illness or Illness Behavior (Edward Suchmann)** 1. Symptoms experience - The person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation in functioning but does not suspect a specific diagnosis. 2. Assumption of the sick role - If symptom persist and become severe, clients assume the sick role. At this point, the illness becomes a social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations. 3. Medical care contract - If symptoms persist despite the home remedies, become severe or require emergency care, the person is motivated to seek professional health services. In this stage the client seeks expert acknowledgement of the illness as well as the treatment. 4. Dependent client role - The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule. 5. Recovery and rehabilitation - This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage may involve in an adjustment to a prolong reduction in health and functioning. E. **Levels of Prevention** DISEASE - Alteration in body functions resulting in a reduction of capacities or shortening of the normal life span. WELL BEING - is a subjective perception of balance, harmony and vitality. It is also a state that can be described objectively, occurs in levels and can be plotted on a continuum. **Three Level of Prevention:** 1. Primary prevention - providing specific protection before the person gets the disease. It aims to prevent the disease from occurring and also reduces both the incidence and prevalence of a disease. Preventive measure consists of counselling, education and adaptation of specific health practices or changes in lifestyle. (Health promotion, Self protection) Behaviors Associated with Primary Prevention: a. Quit smoking b. Avoid/limit alcohol intake c. Exercise regularly d. Eat well-balanced diet e. Reduce fat and increase fiber in diet f. Take adequate fluids g. Avoid over exposure to sunlight h. Maintain ideal body weight i. Complete Immunization Program j. Wear hazard devices in work site 2. Secondary prevention - is used after the disease has occurred. The goal of secondary prevention is to find and treat disease early. It consist of organized, direction screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability, early diagnosis of a health problem can decrease that catastrophic effects that might otherwise result for the individual and the family from advanced illness and its many complication. ( Early diagnosis/detention/screening, Prompt treatment to disability) Behaviors Associated with Secondary Prevention: a. Have annual physical examination b. Regular Papanicolaou Test (Pap Smear) (cervical test) c. Sputum examination for tuberculosis d. Screening programs for hypertension, diabetes, glaucoma and STD (sexually transmitted disease). e. Breast cancer examination and mammography 3. Tertiary prevention - it begins early in the period of recovery from illness and consist of such activities as consistent and appropriate administration of medication to optimize therapeutic effects, moving and positioning to prevent complications of immobility and passive and active exercise to prevent disability. Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing residual disability and ad helping the client learn to live productively with limitation are the goals of tertiary prevention. Behaviors Associated with Tertiary Prevention: a. Self monitoring of blood glucose levels among diabetic patients b. Physical therapy after CVA (stroke); participation in cardiac Rehabilitation after MI (myocardial infarction or heart attack). c. Attending self-management education for diabetes d. Undergoing speech therapy after laryngectomy F. **Patient's Bill of Rights** 1. Right to Appropriate Medical Care and Humane Treatment - Every person has a right to health and medical care corresponding to his state of health, without any discrimination and within the limits of the resources, manpower and competence available for health and medical care at the relevant time. The patient has the right to appropriate health and medical care of good quality. In the course of such, his human dignity, convictions, integrity, individual needs and culture shall be respected. 2. Right to Informed Consent - The patient has a right to a clear, truthful and substantial explanation, in a manner and language understandable to the patient, of all proposed procedures, wherein the person who will perform the said procedure shall provide his name and credentials to the patient, possibilities of any risk of mortality or serious side effects, problems related to recuperation, and probability of success and reasonable risks  involved.  3. Right to Privacy and Confidentiality - The privacy of the patients must be assured at all stages of his treatment. The patient has the right to demand that all information, communication and records pertaining to his care be treated as confidential. Any health care provider or practitioner involved in the treatment  of a patient and all those who have legitimate access to the patient\'s record is not authorized to divulge any information to a third party who  has no concern with  the care and welfare of the patient without  his consent. 4. Right to  Information - The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain as to the existence of any professional relationship among individuals, by name who are treating him. 5. The Right to Choose Health Care Provider and Facility - The patient is free to choose the health care provider to serve  him as well as the facility except when he is under the care of a service facility or when public health and safety so demands or when the patient expressly waives this right in writing. 6. Right to Self-Determination - The  patient has the right to avail himself/herself of any recommended diagnostic and  treatment procedures. Any person of legal age and of sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers from the terminal phase of a terminal illness: Provided that 1. he/she is informed of the medical consequences of his/her choice; 2. he/she releases those involved in his/her care from any obligation relative to the consequences of his/her decision; 3. his/her decision will not prejudice public health and safety. 7. Right to Religious Belief - The patient  has the  right to refuse medical treatment or procedures which may be contrary to his religious beliefs, subject to the limitations described in the preceding subsection. 8. Right to Medical Records - The patient is entitled to a summary of his medical history and condition. He has the right to view the contents  of his medical records, except psychiatric notes and other incriminatory information obtained about third parties, with the attending physician explaining contents thereof. 9. Right to Leave - The patient has the right  to leave hospital or any other health care institution regardless of his physical condition. No patient shall be  detained against his /her will in any health care institution on the  sole  basis  of  his failure to  fully  settle  his  financial  obligations.  However, he/she shall only be allowed to leave the hospital provided appropriate arrangements have been made to settle the  unpaid  bills: Provided further, That  unpaid  bills of patients shall be considered as loss income by the hospital and health care provider/practitioner  and shall be  deducted from gross income as income loss only on that particular year. 10. Right to Refuse Participation In Medical Research - The patient has the right to be advised if the hospital proposes to engage on or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research projects. 11. Right to Correspondence and to Receive Visitors - The patient has the  right to communicate with relatives and other persons and to receive visitors subject to reasonable limits prescribed by the rules and regulations of the health care institution. 12. Right  to  Express Grievances - The patient has the  right to  express complaints and grievances about the care and  services received  without fear of discrimination or reprisal and to know about the disposition of such complaints. Such a system shall afford all parties concerned with the opportunity to settle amicably all grievances. 13. Right to be Informed of His Rights and Obligations as a Patient - The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.