NUR304 Community Health Nursing Lecture 3 Student Version PDF

NUR 304 Community Health Nursing Dr Margaret Pau Associate Professor of Practice Saint Francis University  Lecture Three Comprehensive assessment in home care nursing and management of common medical conditions at home - Cardiovascular disease - Respiratory disease - Diabeti...

NUR 304 Community Health Nursing Dr Margaret Pau Associate Professor of Practice Saint Francis University  Lecture Three Comprehensive assessment in home care nursing and management of common medical conditions at home - Cardiovascular disease - Respiratory disease - Diabetic Mellitus - Others Learning outcome Upon completion of the lecture, students will be able to Understand the importance of comprehensive assessment in home care nursing Discuss ways to perform comprehensive assessment Identify the health care needs of clients with specific conditions in home care setting Understand the social, cultural, economical and environmental issues which influence the clients’ health in the home care setting Identify the intervention and treatment plan for management of different specific condition in home care nursing Comprehensive Assessment in Community Care Comprehensive Assessment To assess all aspects of physical, mental and social wellbeing of clients. To identify the health care needs of individuals, require additional support. Establishing whether clients are safe and able to cope at home. To integrate comprehensive assessment findings into the care plan and implement appropriate care for client. Allow clients to participate in their own care by engaging them in the assessment process.  The ultimate goal of a comprehensive assessment is to manage the client’s health at home for longer period of time and to prevent unnecessary hospital admission and hospital service utilization Source of Information Guiding Principles for Assessment Demographic characteristics sex, age, family background Physical health health history, mobility, ADL, present health problems Mental health psychological state, behavioral risk Socioeconomic characteristics financial status, neighborhood relationship Environmental health infectious disease outbreak Important issues / follow up appointment Comprehensive Assessment at First Home Visit Initial Assessment Focused Assessment Initial Assessment General assessment- Disease Mobility vital signs, conscious Management level, mental status, cognation Pain Fall Communication Medication Psychological Social Nutrition Elimination Skin General Condition Vital signs : BP, Temp, PR / AR, RR, SpO2 Conscious level: Alert / Response to pain / Response to voice / Unresponsive Mental state: Orientated / Disorientated / Restless / Confused / Apathetic / others Cognition: Abbreviated Mental Test (AMT) Non-assessable Not applicable Abbreviated Mental Test (AMT) Questions Score (please circle: 0=incorrect answer, 1=correct answer) 1. Age (+/-5years) 0/1 請問你今年幾多歲? 2. Time (to nearest hour, or am/pm/night) 0/1 請問依家幾多點 (上午、下午或晚上)? 3. Address for recall at end of test: 42 Shanghai Street (after 5 minutes) 0/1 依家我會講一個地址，講完之後，請你重複兩次。 然後記住佢，問完其他問題之後，我會叫你再講番俾我聽： 上海街42號 4. Year (+/-1year) 0/1 請問今年是新曆幾多年? 5. Place name type of place sufficient (park, market, clinic, home) 0/1 請問呢度地方叫甚麼名? 6. Recognition of two persons (doctor, nurse, daughter, etc) 0/1 (隨便指著兩個人: 醫生、護士或女兒) 請問佢係邊個? 7. Date of Birth (day and month) 0/1 請講出你幾時生日? 8. Date of Mid-Autumn Festival (Date in Chinese Calendar) 0/1 請問中秋節是舊曆幾月幾號? 9. Name of present Governor/Chinese leader 0/1 請問現任特區首長/中國領導人係邊個? 10. Count 20 to 1 backwards (demonstrate by counting 10 to 1) 0/1 請你倒數數目字由20至1 Communication Vision : Normal, Blurred Language / Dialect Speech: Clear / Slurring Hearing : Left ear – normal / loud voice/ hearing aids Right ear – normal / loud voice/ hearing aids Communication Aids: Communication chart / Sign language Pain Mobility Independent / ambulatory with aids / chairbound / bedbound Muscle strength : upper limbs / lower limbs Walking aids : stick / quadripod / tripod / frame / rollator / crutch /wheelchair Assisted by ___ person(s) Balance and gait Barthel Index (BI) : ___ /20 Modified Functional Ambulatory Category (MFAC) Barthel Index Score 0 Score 1 Score 2 Score 3 Bowels Incontinent Occasional Accident Continent Bladder Incontinent Occasional Accident Continent Grooming Needs Help Independent Toileting Dependent Needs some Help Independent Feeding Unable Needs Help Independent (food provided within reach) Transfer Unable to Sit Sit with one or two assistance Minor Help (verbal/physical) Independent Mobility Immobile Wheelchair Independent Walk with Help of one Person Independent Dressing Dependent Needs Help Independent Stairs Unable Needs Help Independent Bathing Dependent Independent Modified Functional Ambulatory Category (MFAC) Stage Category Definition I Lyer Patient who is unable to sit for 1 min without back and hand for support II Sitter Patient who is able to sit for 1 min without back and hand for support. Patient cannot walk , or requires help of two or more people III Dependent Patient requires firm continuous support from one person who helps walker carrying weight and with balance IV Assisted walker Patient needs continuous or intermittent support of one person to help with balance or coordination V Supervised Patient requires verbal supervision or standby help from one person without walker physical contact VI Indoor walker Patient can walk independently on level ground, but requires help on stairs, slopes, or uneven surfaces VII Outdoor walker Patient can walk independently anywhere Fall History of fall Number of fall occurred within recent 3 months No. of hospitalizations due to fall Nutrition Diet : normal diet / special diet Oral feeding : Self help / with assistance / feed by carer Tube feeding : nasogastric tube / PEG milk regime : type of milk, frequency, amount, no. of feed per day type and size of the tube, due date for change Knowledge and skill on feeding tube care regarding feeding technique, cleansing of feeding utensil, storage of milk, blockage / misplacement / slip out of the feeding tube Elimination - Urinary Normal / Frequent / Dysuria / Incontinence Use of aids : commode / diaper / urinal / bedpan Ileal conduit Percutaneous nephrostomy tube (PCN) Urinary catheter: urethral / suprapubic type and size of catheter due date for renewal Knowledge and skill on caring of Ileal conduit / PCN / urinary catheter amount and colour of urinary output management of blockage / slip out of catheter Elimination - Bowel Normal Constipation, use of laxatives Incontinence Diarrhoea Stoma : colour of stoma knowledge and skill on care of stoma change of colostomy bag Skin condition Intact / dry / fragile / odema Rash / skin redness : location Risk of developing pressure injury (Braden Scale) Pressure injury / wound : site / size / stages /amount and colour of discharge Knowledge and skill on skin care / wound care Braden Scale Sensory Moisture Activity Mobility Nutrition Friction & Perception Shear Completely Constantly Moist Bedfast Very Poor Problem Limited Completely Immobile Very Limited Very Moist Chair fast Very Limited Probably Potential Inadequate Problem Slightly Limited Occasionally Walk Slightly Adequate No Apparent Moist Occasionally Limited Problem No Impairment Rarely Moist Walk Frequently No Limitation Excellent Remark: < 9 = Very high risk; 10-12 = High risk; 13 - 14 = Moderate risk; 15 - 18 = Low risk Medication No of drug items Herbs / over-the-counter drugs Self help / by carer / by RCHE staff Storage of drugs Psychological & Spiritual Concerns and worries Emotional and behaviour problems Suicidal thoughts Social Marital status Family member, main carer, household member Accommodation Educational level Occupational history Financial status Use of community resources e.g. Home help service, Day care centre Disease Management Assessment and management of Specific Condition in the Community Cardiac Care Diabetic Care Respiratory Care Postnatal and Infant Care CNS visit for client with Cardiac Disease Common Types of Cardiovascular Disease Coronary heart disease - Ischemic heart disease (IHD) - Myocardial Infarction (MI) Congestive heart failure (CHF) Case One Mrs. Lee F/78, lives with her husband in a public estate Suffered from congestive heart failure (CHF) Referred CNS for cardiac care on discharge Home Care Plan for Different Diseases Consider the 10 Care Elements 1. Physical Status 2. Psycho-social status 3. Home environment Assessment 4. Medication Planning (Goal & Objectives) 5. Nutrition Intervention (Education, Advice) 6. Elimination Evaluation(Client & Carer Outcomes) 7. Hygiene 8. Activity & Exercises 9. Consultation, referral, follow up schedule 10. Community resources Focus History Past medical history e.g. previous angina, MI, chest or heart surgery Family history of cardiovascular disease Current medical problems e.g. HT, DM, Hyperlipidemia Medication history, drug allergy, current medication used Lifestyle: smoking, alcohol consumption, diet preference, exercise pattern Cardiovascular Assessment General appearance, e.g. color, clubbing fingers, tobacco staining Vital sign (BP /P /AR /Temp. /RR /SpO2 ) Body weight , Body Mass Index (BMI) Inspection scars over chest, any pacemaker jugular vein pressure Palpation Auscultation  Complaints from clients Chest pain: duration / nature / tightness / palpitation Difficulties in breathing : shortness of breath / paroxysmal nocturnal dyspnea / exertional dyspnoea Cough / hemoptysis Fatigue Cyanosis Syncope Odema (e.g. ankle odema) Psycho-social Status Assessment Patient lived with : Supported by : Patient / Carer’s attitude: co-operating / indifference/ resistant Emotional status Stress and anxiety Identify any suicidal risk Assessing stress relieving technique Risk Factor Assessment Family History health status of all first-degree relatives Use of alcohol, tobacco, and illicit substances quantity (eg, drinks per day) duration (eg, cigarette pack-years) of use  Physical Activity Types and amounts of physical activity engage on a daily and weekly basis Assessment of functional status with physical limitations the ability to complete activities of daily living (eg, bathing, dressing). Identify social determinants of health and other barriers to care (eg, education level, ability to afford medications). Drug Compliance and Use of Device Drug compliance : Good / Fair / Poor Drug administered by : Self/ Carer Compliance: Good / Fair /Poor Use of TNG Use of oxygen therapy: Yes / No amount, duration  Proper use of Nitroglycerin (TNG) Sublingual sit down and take one dose of TNG when an attack begins take under the tongue do not chew, crush or swallow When chest pain persists, repeat the dose by every 5-10 minutes until the pain subsided Maximum dose : 3 times If chest pain not relieved to AED  Patient Empowerment Improve patients' ability to manage their own health and illnesses Empowered patient with: Knowledge Skills Attitudes Self-awareness Ultimately, improve quality of life Empower Client On Physical care, self management skill Psycho-social support Effects, side effects , storage and compliance of medications Lifestyle modification - healthy diet stress management quit smoking and alcohol regular bowel habit exercise regime and its precaution  Maintain personal hygiene and avoid skin breakdown Maintain environmental hygiene – ventilation and avoid dust Ensure home safety Compliance to follow up and consultation Use of community support, e.g. refer to smoking cessation class Management of emergency  Educate self monitoring of blood pressure, pulse rate / apical rate and record down daily Educate self monitoring of body weight at least 2 times weekly advise to seek for medical consultation if body weight changes more than 1.5-2kg in 2 days Educate on symptoms control management dyspnea management chest pain management Oedema management Identify the risk factors, e.g. stress, obesity, HT, DM, Hyperlipidemia Educate on healthy lifestyles, e.g. diet, regular exercise, quit smoking Psycho-social Care Monitor emotional status Observe for any stress and anxiety Identify any suicidal risk Assessing stress relieving technique to reduce the psycho-social disturbance Reinforce on positive thinking and attitude Empower the knowledge and skills in disease management Stress Management Talk with family members/friends Relaxation skill Diversional therapies / Alternative therapies social gathering, music, meditation guided imagery deep breathing exercises Refer to social workers, counsellors if necessary Diet Advice Eat healthy dietary pattern that emphasizes on: A variety of fruits and vegetables Starchy foods: such as bread, rice, potatoes. Choose wholegrain varieties whenever possible Only small amounts of foods and drinks high in fats and /or sugar Limited saturated fat, trans fat, sodium, red meats, sugar- sweetened foods Compare food labels and select the leanest cuts available Choose DASH diet ( Dietary Approaches to Stop Hypertension) Eat less of the nutrient-poor foods Fluid Restriction According to Doctor’s prescription Monitor intake and output daily Monitor degree of ankle and foot oedema Exercises Advantages of regular exercises: reduction in body weight reduction in blood pressure reduction in LDL and total cholesterol level increase in HDL cholesterol increase in insulin sensitivity increase in exercise tolerance Types of Exercises According to Doctor’s advice Stretching e.g. Tai Chi, Yoga Strengthening e.g. muscle tone training Aerobic e.g. swimming, fast walk For older adults: 30 minutes moderate intensity walk Gradually increase according to functional capacity Management of Emergency Advise to seek medical consultation if client with pain and discomfort tightness over chest, radiated to neck and shoulder, jaw, back chest pain not relieved by TNG increase shortness of breath, orthopnoea severe ankle odema, increased body weight activities intolerance CNS visit for client with Diabetic Mellitus Diabetes Mellitus Chronic disease of absolute or relative insulin deficiency or resistance Insulin transport glucose into the cells for use as energy and storage as glycogen stimulates protein synthesis and free fatty acid storage in the adipose tissues Insulin deficiency caused body tissues access to essential nutrient for fuel and storage  Type I absolute insufficiency usually before 30 usually thin and requires exogenous insulin and dietary management Type II usually after age 40 insulin resistance with varying degrees of insulin secretory often treated with dietary management and exercise and antidiabetic drugs Risk Factors for type I Unknown Genetic factors Autoimmune disease Viral infection Risk Factors for type II Obesity Family history of diabetes History of gestational diabetes Low high-density lipoprotein, high triglycerides Hypertension Age  Diabetes – Diagnostic Tests Fasting blood glucose level Glucose tolerance test Glycosylated hemoglobin test- HbA1c From Diabetes Hong Kong (2022) http://www.diabetes-hk.org/page/ch/%E8%AA%8D%E8%AD%98%E7%B3%96%E5%B0%BF%E7%97%85%20-%20%E8%A8%BA%E6%B2%BB Fasting blood Glucose level glucose (mmol/L) (mmol/L) ≥ 11.1 DM ≥ 7.0 [偶然或餐後2小時] ≥ 7.8 - 11.0 葡萄糖耐量異常 < 7.0 [口服葡萄糖耐量測試 (IGT) Pre DM OGTT] 空腹血糖異常 5.6 – 6.9 --- (IFG) Normal < 5.6 58 HbA1c Test Reflects average plasma glucose concentration over the previous 8 to 12 weeks Performed at anytime of the day and does not require any special preparation such as fasting Range Normal Pre-diabetes Diabetes < 42mmol/mol 42 – 47 mmol/mol 48 mmol/mol (6%) (6.0 - 6.4%) ( ≥ 6.5 % ) https://www.diabetes.co.uk/what-is-hba1c.html Case Study 2 Mrs. Wong F/70, lives with husband in a public housing estate suffered from Type II DM started insulin injection in recent hospitalization referred CNS for diabetic care on discharge Home Care Plan of Different Diseases Consider the 10 Care Elements 1. Physical Status 2. Psycho-social status 3. Home environment Assessment 4. Medication Planning (Goal & Objectives) 5. Nutrition Intervention (Education, Advice) 6. Elimination Evaluationt(Client & Carer Outcomes) 7. Hygiene 8. Activity & Exercises 9. Consultation, referral, follow up schedule 10. Community resources Focus History Family history Past/current medical history: H/T / CVD / DM Secondary causes, e.g. pregnancy / pancreatitis / Ca pancreas Drug History e.g. steroid-induced diabetes Current medication regime: e.g. oral hypoglycemic drugs, insulin injection Lifestyle: smoking, alcohol consumption, diet preference, habit of exercise Risk of stress Physical Examination General appearance (signs of complications) Home blood glucose monitoring (HBGM) Vital signs ( BP /P /HR / Temp/ RR ) Body Mass Index (BMI) Chief complaint - sweating, dizziness, dry mouth, weakness, polyuria Careful inspection of lower limbs Eye examination Cardiovascular examination Medication - Insulin Therapy Injected subcutaneously (sc) a protein that is destroyed in digestive tract Standardized in units for sc injection Rapid onset Short acting (regular) Intermediate acting (Lente) Slow onset, long acting (Protamine zinc or Ultralente) Continuous monitoring of blood glucose is necessary  Diet Advice Compliance to dietary prescription by Doctor / Dietitian Spare meals Modify fat intake Exchange diet Exercises Insulin may work better and improve diabetic control Maintain healthy body weight Reduce the cardiovascular risk Reduce stress Advice on Exercise Perform regular exercises (engage in at least 30 minutes of physical activity daily or advised by health care professionals Always inspect the feet before and after exercises Avoid exercises that causes stress to the feet (e.g. running) Monitor blood glucose levels before, during and after exercises to assess the need for extra food Extra carbohydrate is often needed after exercises Consult physician to reduce insulin dose prior to exercise Diabetic Foot Complications Neuropathy Ulcer Ischaemia Gangrene Infections Foot Care Educate client on daily checking and caring of feet at home Check the feet daily and alert for – sores / signs of infection / any changes, e.g. numbness Wash feet every day with lukewarm water and mild soap, dry thoroughly Apply skin lotion to soften skin Wear comfortable and well-fitting shoes and socks Avoid bare foot Stop smoking Refer podiatrist for foot problems e.g. corns Refer Prosthetic and Orthotics Department for special shoes wear if required Complications Directly related to duration and extent of abnormal blood glucose levels Hyperglycemia Hypoglycemia 70  Hyperglycaemia When blood glucose reaching 30 mmol/L Causes eating too much failing to take medications, especially during sick days or after surgery S/S extreme thirst, rapid heart beat if serious, lose consciousness or fall into coma Hypoglycemia More common with insulin replacement treatment Causes excess oral hypoglycemic drugs excess insulin in circulation glucose deficit in blood life-threatening or cause brain damage if untreated often following strenuous exercise dosage error vomiting skipping meal after taking insulin 72 S/S Impaired neurological function poor concentration, slurred speech, lack of coordination stimulate the sympathetic nervous system causing increased pulse, pale, moist skin, anxiety, tremors if untreated: loss of consciousness, seizures, death Patient Empowerment Stress the importance of strictly following the prescribed therapy Proper technique of insulin injection Proper technique of blood glucose monitoring Emphasize how blood glucose control affects long term health Discuss the diet, medications, exercise, hygiene How to prevent/ recognize/ manage hyperglycemia/hypoglycemia  Empower the client to care for his feet Wash daily Carefully dry between the toes Inspect for corns, redness, swelling, breaks in the skin Cut toenails straight Wear comfortable, non-constricting shoes Never walk barefoot Regular ophthalmologic examinations Describe the signs and symptoms of diabetic neuropathy Self Managemment Skill Monitoring of blood glucose (SMBG), blood pressure, pulse rate with record daily Medication management : insulin injection technique, drug compliance Monitor for early signs and symptoms of hypoglycaemia/ hyperglycaemia attack Management of hypoglycaemia / hyperglycaemia Early detection of DM complications e.g. poor eye vision, foot ulcer and preventive care Proper disposal of sharps for insulin injection Management of Diabetic Emergency Hypoglycemia give 15gm simple sugar, e.g. 15 gm glucose power / 150ml fruit juice Wait for 15 minutes Recheck blood glucose level If blood glucose < 4mmol/L, repeat. Seek medical advice if no improvement after treatment To AED if further deteriorates If blood glucose ≥ 4 mmol/L, give 10-15mg complex CHO, e.g. 2-3 pieces of biscuits (According to HA guideline) CNS visit for client with Respiratory Disease Common Types of Respiratory Disease Chronic Obstructive Pulmonary Disease (COPD) Tuberculosis (TB) Pneumonia  CNS visit to client with Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) Chronic progressive disease of the airways narrowed by inflammation with thickened and swollen walls increased mucus production distortion and loss of support of normal lung tissues leading to difficulty in getting air in and out of the lungs.  Generally includes “Chronic Bronchitis” and “Emphysema”. “Chronic Bronchitis” characterized by excessive mucus secretion, causing productive cough on most days for three months or more over two consecutive years. “Emphysema” characterized by the abnormal enlargement of the airways distal to the terminal bronchioles and destruction of their walls, leading to the trapping of air in the enlarged air sacs. Case Study 3 Mr. Wong M/78 lives with wife in a public housing estate suffered from COPD on long term oxygen therapy (LTOT) admitted to hospital due to exacerbation Referred CNS on discharge for pulmonary care Home Care Plan of Different Diseases Consider the 10 Care Elements 1. Physical Status 2. Psycho-social status 3. Home environment Assessment 4. Medication Planning (Goal & Objectives) 5. Nutrition Intervention (Education, Advice) 6. Elimination Evaluationt(Client & Carer Outcomes) 7. Hygiene 8. Activity & Exercises 9. Consultation, referral, follow up schedule 10. Community resources Focused History Family history of Pulmonary disease Past medical history e.g. asthma, pneumonia, TB, chest injury, chest, chest or heart operation Current health problem: e.g. COPD exacerbation Medication history /drug allergy Current medication regime Lifestyle: smoking, alcohol consumption, diet preference, habit of exercise Occupational history Influenza vaccination / Covid-19 vaccination Physical Examination General appearance Vital signs: BP / P /HR / RR / SpO2 / Temp. Body weight Chief complaint Cough: Dry / productive Difficulty in breathing Associated with pain Duration  Cyanosis : No / Yes Cough: No / Yes (seldom / occasional / frequent) Productive / Non-productive Sputum: Colour : Whitish / Yellowish / Greenish / Blood-stained Amount: NA / Increased / Decreased / Same as before Consistency: Loose / Viscous  Chest sound: Clear / Crepitation / Rhonchi / Wheeze Exercise tolerance: As usual / Decreased Signs and symptoms of Chest infection No / Yes COPD exacerbation No / Yes Other signs Ankle oedema No / Yes Muscle wasting No / Yes Inspection Clubbing, nicotine stain Peripheral cyanosis Shape of chest, breathing pattern Scars, prominent veins Palpation Tracheal deviation, chest expansion Percussion Resonant, hyper-resonant, tympanic, dull Auscultation Breath sounds, adventitious sounds, vocal resonance Assess Compliance on Drug Therapy and Use of Device Drug compliance : Good / Fair / Poor Drug administered by : __________ Standby drug for COPD exacerbation: No / Yes Inhaled bronchodilator : No / Yes Inhaled Steroid: No / Yes Use of inhaler device : Aerochamber (with mask / without mask) Use of home oxygen therapy: No / Yes: ____L/min ____hours /day Compliance: Good / Fair /Poor Home Care Management of COPD Four components of patient empowerment Ability to assess and monitor the disease Risk factor reduction Manage stable COPD Self manage of COPD exacerbation Patient Empowerment Physical care: self management skill Psycho-social support, develop coping skill Medication management importance of good drug compliance proper storage and use of drugs Breathing technique: Purse-lip respiration Energy conservation technique  Knowledge and skill on use of inhaler and home oxygen therapy Remind to rinse the mouth after using steroid inhaler Lifestyle modification Quit smoking and alcohol consumption Healthy diet Stress management Regular bowel habit, use of bronchodilator before elimination  Avoid risk factors Environmental tobacco smoking Occupational dust Indoor air pollution, chemical irritants Outdoor air pollution e.g. dust  Maintain personal hygiene Maintain environmental hygiene and good ventilation, avoid dusting and respiratory irritants Ensure home safety, proper placement and operation of oxygen concentrator when use Regular exercise, energy saving technique Compliance to follow up in COPD Clinic as scheduled, consult PT / OT / Dietitian Use of community support e.g refer to smoking cessation class, Community Rehabilitation Network (CRN) Influenza and Covid-19 vaccination Self Management Skill Self monitoring of body temperature, BP/P with record Identify risk factors Self monitor early signs and symptoms of chest infection Symptoms control management Exacerbation management Medication and Use of Devices Identify Identify problems with medication regime Provide Provide education on the purpose and administration od medications Explain Explain the effects and side effects of drugs Teach Teach the proper use of inhaled bronchodilators and spacer Explain Explain the importance and safety use of oxygen concentrator Instruct Instruct to perform proper disinfection of devices Manage Manage mechanical ventilator support, e.g. home Bipap Signs and Symptoms of COPD Exacerbation Increased shortness of breath (SOB) Burning or tightness in the chest + / - fever Cough with yellowish viscous sputum Palpitations Activity intolerance CNS visit to client with Tuberculosis (TB) Pulmonary TB Tuberculosis Caused by tubercle bacillus or Mycobacterium tuberculosis or Mycobacterium tuberculosis Usually affects the lungs Mode of transmission: Airborne  Signs and symptoms: Coughing that lasts three or more weeks Purulent sputum contains blood Chest pain, or pain with breathing of coughing Unintentional weight lost Fever Fatigue Loss of appetite Night sweats Chills Medications The TB & Chest Service of the Department of Health provides treatment to patients free of charge. Usual course of drug treatment lasts 6 months: Four drugs in the first 2 months isoniazid, rifampicin, pyrazinamide, ethambutol Two drugs in the subsequent 4 months isoniazid, rifampicin  The drugs are taken either daily or three times per week Given under direct observation (DOT, directly observed treatment) by health-care staff Great majority of patients can be considered as non-infectious after 2 weeks of effective drug treatment If the treatment is taken irregularly, there may be serious consequences: - the TB germs become resistant to the drugs - the disease cannot be cured - the disease can be spread to others - DEATH Common Side Effects - nausea and vomiting - decrease in appetite - fever - dizziness - ringing sensation in the ears (tinnitus) - blurring of vision - skin itchiness and skin rash Directly Observed Therapy (DOT) the standard of care for treatment of all forms of active TB disease increases the number of patients cured and completing treatment increasing the likelihood that the patient’s bacterial load, especially the number of live bacteria in the patient’s respiratory specimens, will decrease over time. https://www.dhs.wisconsin.gov/tb/nurse-care-management.htm Education Stay at home Don’t go to work or school during the first few weeks of treatment for active TB Cover the mouth Use tissue to cover the mouth when sneeze or cough. Put the tissue in a bag, seal up and disposed properly in rubbish bin Maintain good room ventilation Don’t close all windows and door Wear mask wear a surgical mask during the first three weeks of drug treatment when going out Complete the whole course of drug treatment Do not self stop treatment or skip dose CNS visit for Postnatal and infant Care Maternal Assessment Vital signs: BP/ P/ RR / Temp. General appearances – Anaemia Emotional status: anxiety, depression, postnatal blue Breast examination : engorgement, any sore nipple Uterus involution  Lochia : colour, amount, any foul smelling Personal hygiene Dietary intake Wound condition Compliance to perform postnatal exercise Postnatal Care Dietary advice : well balanced diet, avoid ginger Management of breast engorgement, sore nipple Breast feeding technique Wound care – episiotomy, caesarean section (LSCS)wound Genital hygiene Observe for post-partum haemorrhage and management Postnatal exercises Family planning Baby Assessment Vital signs: RR, Temp. General appearance: active / dull / colour / pallor / jaundice Feeding : breast feed / bottle feed / amount of intake Umbilical cord : cord on / off, any blood stain or abnormal discharge Buttock: any skin redness, sore buttock Baby safety Sterilization of feeding bottles Technique of baby bath and cord care Immunization record Baby Care Observe for jaundice Management of jaundice Baby feeding technique: Breast feeding/bottle feeding Sterilization of feeding bottles Cord care: clean cord with warm water at least once daily after bathing observe amount, colour of discharge Skin care: observe any redness of buttock and apply baby lotion to buttock after cleansing References Association of Hong Kong Diabetes Nurse. (2014). AHKDN Insulin Injection guideline. Retrieved from http://ahkdn.com/wp-content/uploads/2017/11/AHKDN-Insulin-Injection-guidelin_2014.pdf Clinical practice guidelines for developing a Diabetic Mellitus comprehensive care plan -2015, American Association of Clinical Endocrinologists and American College of Endocrinology, Endocrine Practice Vol 21 (Suppl. 1), April 2015 Department of Health. (2022). Health Topics. Retrieved from Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Retrieved from http://goldcopd.org. Hong Kong Lung Foundation. (2018).COPD Hong Kong GOLD. Retrieved from http://hklf.org/index/education-information/copd-hong-kong-gold Javis, C. (2016). Physical examination & health assessment (7th ed.). Elsevier: St. Louis. Mosby.MO. The American Heart Association’s Diet and Lifestyle Recommendations. (2017). Retrieved from http://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle- recommendations Tuberculosis & Chest Service. (2022) Information on Tuberculosis. Retrieved from https://www.info.gov.hk/tb_chest/en/index_1.htm END