Community Health Nursing.pdf

review - community health NURSING N.O.P COMMUNITY HEALTH NURSING COMMUNITY a group of people with common characteristics or interests living together within a territory or geographi...

review - community health NURSING N.O.P COMMUNITY HEALTH NURSING COMMUNITY a group of people with common characteristics or interests living together within a territory or geographical boundary POPULATION GROUP a group of people with common characteristics, developmental stages, or exposure to particular environmental factors, thus resulting in common health problems Examples: A group of pregnant women (referring to all pregnant women in the Philippines) Under 5 years old children (do not live in a certain location) COMMUNITY HEALTH NURSING Definition: the utilization of the nursing process in the different levels of clientele – individuals, families, According to Maglaya population groups and communities concerned with the promotion of health, prevention of disease and disability and rehabilitation Goal: Promotion and preservation of the health of populations ○ “The best health for the greatest number” Ex. OPV vaccine to prevent polio Nature of Practice: comprehensive, general, continual and not episodic Knowledge Base: from nursing and public health concepts Levels of Clientele: individuals – entry point families – unit of service population groups community as a whole – final object to uplift the condition DEFINITIONS PERSON PH enable every citizen to realize his birthright of health and longevity WINSLOW (Winslongevity) Philosophy of CHN is based on the worth and dignity of man SHETLAND (ShetlanDignity) CHN is a service rendered by a professional nurse (Req: BSN, RN) FREEMAN (NO need for MAN/masteral) Ultimate goal of CHN is promotion of optimum level of functioning (OLOF) JACOBSON (OL-OF 2Os) CHN for attainment of highest level of well-being and longevity HANLON (Hanlongevity) CONCEPTS IN COMMUNITY HEALTH NURSING Health promotion is the primary focus of CHN practice ○ Promotive – taking care the well-being of a healthy individual in holistic approach, generally walang tinutukoy na sakit Exercise Stress Management Proper nutrition ○ Preventive – specific, may tinutukoy na sakit BCG vaccination - prevent from bacilli MMR vaccination - to protect against measles, mumps, and rubella Isolation/Quarantine Community health nurses are generalist Community health nursing is based on recognized means of communities, families, groups, and individuals ○ Problems as identified by the family ○ Importante pa din ang assessment, it involves the families’ participation Family is the unit of service Health education is the primary responsibility of the community health nurse ○ Final goal of HE: behavioral change towards health Ultimate Goal of CHN: Raise the level of health of the citizenry isaiah 41:10 COMMUNITY HEALTH NURSING | 11 review - community health NURSING N.O.P THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM DEPARTMENT OF HEALTH (DOH) – lead agency of health in the country Vision: OLD 2008 “The leader, staunch advocate and model in promoting HEALTH for ALL in the Philippines” 2030 “A GLOBAL LEADER for attaining better health outcomes, competetive and responsive health care system, and equitable health financing” ○ 2015-2030 – SDG ○ President Noynoy: Universal Health Care / Kalusugang Pangkalahatan NEW Vision by 2040 “Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040” Mission: OLD “Guarantee Equitable, Sustainable and Quality Health for all Filipinos especially the poor” NEW Mission (2016-2022) PREP “To lead the country in the development of a Productive, Resilient, Equitable, and People-centered health system” ○ Presendient Duterte: Duterte Health Agenda PRIMARY HEALTH CARE Definition: basic fundamental of essential health care made available for the people adopted through LOI 949 under Marcos Underlying theme: “Health in the Hands of the People by 2020” History: First International Conference on Primary Health Care / ALMA ATA DECLARATION 1979 Alma Ata, USSr (Almaty, Kazakhstan) September 6-12, 1978 Sponsored by WHO and UNICEF In Southeast Asia, the Philippines is the first to implement primary health care Astana Declaration October 25-28, 2018 4 PILLARS in PHC (MAPS) M Multi-sectoral linkages Types: - health sector + other sectors a. Intra-sectoral linkaging – within the health sector - we need networking, Ex. Lucena Health Office in Cooperation with Candaleria Municipal Health Office collaboration, cooperation, Ex. Philippine Dental Association in cooperation with Philippine Medical Association b. Inter-sectoral linkaging – from the health sector, going out Ex. DOH in cooperation with DOLE along with the DILG and PAGCOR A Appropriate Technology a. Scientifically sound – follow processes to prove that technology is safe and effective Ex. Herbal Medicines / alternative medicines ○ Studied by the DOH in cooperation with DOST, in cooperation with PITAHC b. Indigenous – native or locally available c. Culturally appropriate Ex. Herbal medicine is culturally appropriate instead of acupuncture P Participation of the people active participation most important S Support mechanism made community must work hand-in-hand with another community available isaiah 41:10 COMMUNITY HEALTH NURSING | 12 review - community health NURSING N.O.P 8 ELEMENTS / COMPONENTS OF PHC (ELEMENTS) E Education for Health Most important The best time to educate a person is when the person is still healthy Teacher must be flexible and can easily adapt L Locally Endemic Disease Epidemiology: Control Endemic – constantly present but in low frequencies (laging may kaso pero konti lang) ○ Ex. Trangkaso ○ Ex. Dengue Epidemic – sudden outbreak but in high frequencies Pandemic – spread through regions, countries, and continents Sporadic – on and off (walang sinusunod na oras kung kelan lilitaw o mawawala) ○ Ex. Meningococcemia Cyclical – nahuhulaan kung kelan lalabas ang disease ○ Ex. Leptospirosis – tuwing umuulan nangyayari E Expanded Program on 13 Immunizeable Disease: Immunization 1. BCG – TB and leprosy 8. OPV IPV – polio 2. Hepatitis B 9. Rotavax – rotavirus 3. Penta Vax 10. Pneumococcal Conjugate – Pneumonia 4. Diphtheria 11. Measles 5. Pertussis 12. Mumps 6. Tetanus 13. Rubella 7. HIB M Maternal and Child Health and Prenatal Care of Mothers Family Planning Postpartum care Planned parenthood Artificial and natural means of family planning E Essential Drugs 50 drugs that must be available in each pharmacy (may generic form dapat) ○ Ex. Antibiotics, TB, antihypertensive, oral hypoglycemic, meds for COPD N Nutrition Proper nutrition as guided by Nutritional Guideline for Filipinos T Treatment of communicable diseases and common illnesses S Safe water and sanitation LEVELS OF PHC WORKERS 1. Village / Barangay Health trained community health workers, health auxillary volunteer, traditional birth attendance, Workers healer no license or considered volunteers Infirmary ○ Barangay Health Station ○ Puericulture Center (lying-in) ○ Community Hospital ○ School Clinic ○ Private practitioner 2. Intermediate Level Health general medical practitioners (doctors) , public health nurse, rural sanitary inspectors, Workers midwives ○ Emergency district hospital ○ OPD department of Provincial Hospital 3. First Line Hospital Personnel staff nurse, attending physician working health refferal facilities kapag malalaking establishments and may mga training ○ Chinese General Hospital and Philippine Center isaiah 41:10 COMMUNITY HEALTH NURSING | 13 review - community health NURSING N.O.P 1995 To increase the responsiveness as well as the accountability of local government units RA 7160 – Local Government ○ Provincial, Municipal, Barangay Code Devolution of Health Services we relieve the DOH central office of bulk ng trabaho DOH → RHU decentralized, binibigyan ng role ang local governments EO 106 DOH is still considered the leader of health 3 functions of DOH: (LEAd) 1. Leader – policy and regulatory making 2. Enabler and Capacity Builder – trainings of personnel in the locality 3. ADministrator of health services – All the program directors will still be on DOH LGU will be considered as DOH’s active partners ○ responsible for active implementation of programs 1999 Time of Erap to Gloria Arroyo Health Sector Reform Agenda Erap – Signed HSRA (Overriding goal of DOH) Arroyo – Formulate the strategy (FOURmula 1 for health) Strategy/Framework for Implementation of HSRA FOURMULA 1 for HEALTH Elements: 1. Health Financing National Health Insurance Program (PhilHealth) - to foster investment in health government-owned corporation that will take care of your health investments Assumption: All Filipinos are members TYPES OF PHILHEALTH MEMBERSHIP OLD F Formal (Employed) with contract O OFWs required to give contributions annually S Self-employed (Informal) without contract Ex. business owners, professionals like doctors and lawyers S Sponsored (NGOs) Non-government and Non-profit Organizations Ex. Red cross – as volunteer but give benefits I Indigent (DSWD) dot not pay contributions L Lifetime number of contributions S Senior Citizens once reached at 60 years old, automatically member na NOW Member Dependent 2. Health Regulation Sentrolng Sigla Movement (2000-2010) - to ensure quality and Quality Assurance Program (QAP) of the DOH affordability of health goods and To check kung ang ospital ay may quality assurance services ○ Ex. Kung standard ang size ng door, bintana, kung tama ang ginamit na materials, organization structure, how many nurses in 1 shift, what ratio isaiah 41:10 COMMUNITY HEALTH NURSING | 14 review - community health NURSING N.O.P 3. Health Service Delivery Inter-local Health System - to ensure accessibility and sharing of resources so that services will be accessible and available availability of essential health care Process of zoning Ex. Napunta sa ibang lugar para sa MRI, kapag nakabili, para mailapit sa tao, hindi lang isang lugar ang makikinabang, magiging mura kasi hindi naghahabol ng profit 4. Good Governance Local Health Boards - to enhance health system an advisory body to the LGU, do not create laws performance Composition: (5) Chairperson: Head of LGU Vice Chairperson: Health Officer / Doctor Representatives: 1. DOH (RN) 2. Council 3. NGO the one to decide if gusto magdagdag ng health personnel Ratio: Midwife – 1: 5,000 PHN – 1:10,000 Doctor – 1:20,000 2010-2015 Thrusts: AQUINO HEALTH AGENDA 1. Financial Risk Protection – protecting the people from risking their money in health 2. Responsive Health System – hindi na sa DOH, LGU na RA 11223 3. Better Health Outcomes – MDGs ChiMaMa [health-related goals] Universal Health Care Law 8 Millennium Development Goals (PEG-ChiMaMa-EnPa) 1. Poverty – eradicate poverty and hunger 2. Education – primary education 3. Gender – equality & empower women 4. Child – reduce child mortality (under 5 y/o) 5. Maternal – improve maternal health 6. Malaria – approach and control various diseases (dengue, HIV, and other diseases) 7. Environment – promote sustainability 8. Partnership – with the global community 2016 “All for Health towards Health for all” DUTERTE HEALTH AGENDA most current health agenda for the country SDG 3 (Good health and well-being) is the only health-related goal for SDG Goals: The health system we aspire for: 1. Financial protection 2. Better health outcomes 3. Responsiveness Technique: ACHIEVE CAMPAIGN isaiah 41:10 COMMUNITY HEALTH NURSING | 15 review - community health NURSING N.O.P LEVELS OF PREVENTION Primary Secondary Tertiary (pre-pathogenesis) (acute illness) (convalescence / terminal stage) 1. Promotion of General Health 1. Early detection / 1. Rehabilitation Examples: identification a. disability limitation Nutrition a. screening b. restoration of remaining Exercise based on risk factors function Healthy Lifestyle Ex. Pap smear is a Example: Stress Management screening test for undergoing physical therapy cervical cancer Chronic degenerative diseases: Ex. Obese patient will DM undergo testing for heart COPD disease Hypertension b. diagnostic procedures Kidney disease based on s/s Ex. pt has s/s of heart disease Testicular Exam: – descended – 15-35 years old BSE: – after menstruation period – menopausal: same day each month – 2 position: upright and lying with towel 2. Prevention of Specific Diseases 2. Prompt Treatment (acute 2. Palliation (Terminal State) (specific protection) illness) to give relief to common Examples: Examples: signs and symptoms for Vaccination antibiotic for infection comfort Isolation and Quarantine trauma care in pt with Example: ○ Quarantine – limitation of injury Cancer patient with pain movement during the suturing laceration medication incubation period managing pt with tumor ○ Isolation – limitation of movement during the period of communicability isaiah 41:10 COMMUNITY HEALTH NURSING | 16 review - community health NURSING N.O.P FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS) Health and Management Information System Field Health Service Information System – data in barangay, used in community setting Hospital Services Information System – accomplished by nurse supervisors Physical Resources Information System – inventory, includes supplies and equipment Financial Information System – track health budget Human Resources Information System – employed under the government of health sector Field Health Service Information NETWORK information (shared) it is intended to address the SHORT TERM needs of the DOH/LGU staff with managerial or supervisory function in facilities and program areas (yearly updated information) MONITORS health service delivery nationwide ○ BHS → RHU → PHO → CHD → DOH Components of FHSIS RECORDING TOOLS REPORTING FORMS ➔ Facility Based (hindi ipapasa, sa filing cabinet lang) ➔ Transmitted / submitted (document leave the office) ➔ Detailed Data (ITR is the most detailed) ➔ Summary Data ➔ Day-day ➔ Monthly / Quarterly / Annual ➔ Source: Services delivered to patients / clients ➔ Source: Dependent on records made 1. Individual Treatment Record (ITR) / Patient 1. Monthly Form Consulation Record (PCR) / Family Treatment Record a. M1 – Health Program foundation / building block of FHSIS b. M2 – Morbidity Disease (sakit) Accomplished by Midwife and Nurse This is the reporting form that the MIDWIFE fills Includes: up to report her accomplishment and morbidity a. Complaints / presenting symptoms disease from the first day to the last day of the b. Diagnosis month and submits to the NURSE at the RHU for c. Treatment given consolidation d. Patient profile Midwife → source document: ST → passed to Nurse (consolidate) → make MCT 2. Quarterly Form a. Q1 – Health Program b. Q2 – Morbidity Disease This is the official health report of the RHU for the quarter for which the NURSE is responsible and submits to Prov. FHSIS Coordinator for provincial consolidation at PHO. Nurse → source document: MCT → passed to FHSIS Coordinator (provincial office) FHSIS Coordinator → has many quarterly form from different RHU → make Output Report isaiah 41:10 COMMUNITY HEALTH NURSING | 17 review - community health NURSING N.O.P 2. Target Client List (TCL) 3. Annual Forms Plan and carry out patient care and service delivery to “Targets / Eligibles” a. A – BHS – Annual Form BHS Accomplished by Midwife and Nurse TCLs to be maintained are: It consists of data categorized under: a. Prenatal – TCL sa lahat ng buntis Demographic (Population) b. Post-partum – TCL sa lahat ng nanganak Environmental (Waste management) c. Family Planning Natality (Birth) d. Under 1 year old child – monitored for vaccination The MIDWIFE fills up the form and submits to the e. Sick Children NURSE for consolidation f. Nutrition g. TB register, Leprosy register, Malaria register, Filariasis register, Schistosomiasis register b. A1 – Vital Statistics [disease register] It consists of data categorized under: Demographic (Population) Environmental (Waste management) Natality (Birth) Mortality (nurse lang ay may access sa statistics ng mga namatay) This report is prepared by the NURSE and submitted to the PHO on an annual basis c. A2 – Morbidity 3. Summary Table (ST) a monthly with 12-month columns to record all Annual consolidation of Morbidity by age and relevant data in a monthly basis sex Accomplished by Rural Health Midwife (RHM) This report is prepared by the NURSE and Wala nang pangalan, numbers lang submilted to the PHO on an annual basis. hindi pwedeng ipasa, M1 and M2 dapat na based sa ST 2 parts: d. A3 – Mortality a. Health Program Accomplishments b. Morbidity Disease (5 registry is included) Annual consolidation of Mortality by age and sex Importance: This report is prepared by the NURSE and proof of accomplishmnent of CHS submitted to the PHO on an annual basis Source document to be reported in M1, M2 tool of RHMs to assess own accomplishments 4. Monthly Consolidation Table (MCT) / Output Table record of data per indicator by each RHM or BHS Accomplished by Public Health Nurse Reflects the activity in Rural Health Unit MIDWIFE NURSE Importance: Source document for the Q1, Q2 Recording: Recording: Serve as output table for RHU ITR ITR Compares TCL TCL ST MCT Reporting: Reporting: M1 Q1 M2 Q2 A-BHS A1, A2, A3 isaiah 41:10 COMMUNITY HEALTH NURSING | 18 review - community health NURSING N.O.P COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) a social development approach (for change) aims to transform the apathetic, individualistic and voiceless poor (focus on the poorest sector of the community) into dynamic, participatory, and politically responsive community PARTICULAR AIMS of COPAR S Self-reliance (best answer) transform people to become self-reliant, the government cannot take care all the poor people in the community A Active Participation M Mobilization of Resources use of community resources (budgeting, funding) should know how to take risks, like implementing fund raising E Empowerment of the people SIGNIFICANCE Health Resource Development Program (HRDP) developed by Philippine Center for Population Development and has undergone 3 cycles ○ the role of PCPD is to identify the poorest community in the Philippines COPAR is a strategy used by HRDP III in PHC delivery As applied to PHC, COPAR is considered as both STRUCTURE (CO) and PROCESS (PAR) PRINCIPLES People are OPEN to change People have the CAPACITY to change People are able to BRING ABOUT change COPAR based on the interest of the POOREST SECTORS of society COPAR should lead to a SELF-RELIANT community PROCESS 1. COPAR uses Action-Reflection-Action (intervention-eveluation-into another intervention) 2. COPAR utilizes Consciousness-Raising (paggising sa kamalayan ng tao, gradual approach) 3. COPAR is Participatory and Mass-based (Democratic leadership, decision making is bottom going up) 4. COPAR is Group-oriented not Leader-centered (walang pilitan to follow the leader) 5 PHASES I. Pre-entry / Preparatory – not yet in the community, still inside the institution and having preparation for COPAR II. Entry / Social Preparation – already in the community, prepare them III. Organization Bulding – Community Diagnosis, Community Organizing, Community mobilization / action IV. Sustenance and Strengthening Phase – sustainability of all programs; focus is to strengthen knowledge and resources V. Phase-out isaiah 41:10 COMMUNITY HEALTH NURSING | 30 review - community health NURSING N.O.P I. PRE-ENTRY / PREPARATORY ➔ Initial phase of the organizing process where the community organizer looks for community to serve Activities 1. Preparation of the Institution Practiced COPAR – Community Immersion Program (School) 2. Site / Area Selection Criteria: a. Safety and security – for the students b. Adjacent barangays – malapit sa ibang barangay c. Far flung areas – malayo sa center of economy/urban setting d. Economically depressed – communities na mahirap e. Population – cluster of 100-200 families f. Existing people’s organization – mga samahan ex. TODA g. Problems exist – to help people solve the problem priority h. Existing barangay health stations – extension of health services 3. Networking / Courtesy Calls asking permission from authorities, signature of the mayor in community 4. Preliminary Social earliest study of the community Investigation (PSI) Ocular (spot map) – identify BHS, geographical boundaries Team leaders are involved. 5. Identifying Host Family Criteria: a. House is stategically located hindi masyadong malayo b. Should not belong to the rich segment c. Respected by both formal and informal leaders walang kaaway na brgy d. Neighbors are not hesitant to enter the house e. No member of the family moving out of the community family is intact at all times II. ENTRY / SOCIAL PREPARATION ➔ most crucial phase ➔ social preparation phase ➔ actual entry of the community organizer into the community Activities 1. Basic masses integration reside or live with the family for 6 months 2. Awareness raising “Ground work” – making them aware that there is a problem Ex. Making the mother realize that unsanitary preparation of foods is the cause of diarrhea of her children 3. Deepening Social Investigation Community assembly – forming a circle and the facilitator is in the center Sociogram – identify key persons 4. Core Group Formation identifying potential leaders in the community A potential leader is informal, poor, young, key person (willing for change) isaiah 41:10 COMMUNITY HEALTH NURSING | 31 review - community health NURSING N.O.P III. ORGANIZATION BUILDING ➔ formation of formal structures ➔ phase where organized leaders or groups are given training to develop skills in managing their own concerns A. Community Diagnosis / Study we diagnose to know if the community has underlying problem 1st level of Assessment (Community Profiling) Factors: 1. Demographic factors (something to do with the population) 2. Socio-economic (includes employment, level of education, source of income) 3. Socio-cultural factors (identified minority, katutubo, mangyan, practices, religions) 4. Health-related factors (health believers, practices in illness) 2nd level of Assessment (Family Interviews) Identification of Problems: 1. Family problems 2. Community problems PRIORITY SETTING Methods of Data Gathering: 1. Census a. De facto – actually present (actual na nakita at naabutan sa bahay) b. De jure – place of jurisdiction (ilan talaga ang members ng family) 2. Survey – representative of the whole 3. Interview – face-to-face activity (in-depth discussion) 4. Record review – available record of the community 5. Observation – must initially learn by the nurse Typology of Health Problems: Family 1. Health deficit – a gap between actual and achievable health status ○ disease and disability (priority) 2. Health threat – conditions that are conducive to disease, accident/failure to realize one’s potential ○ hazards 3. Foreseeable crisis / stress points – anticipated periods of unusable demand resulting to stress Community 1. Health status – morbidity or mortality in the community 3/3 2. Health resource – factors that directly affects healthcare delivery 2/3 ○ Health facility ○ Health personnel ○ Lack of equipments, supplies, medicines ○ Lack of health budget 3. Health-related – factors indirectly affecting healthcare delivery 1/3 ○ Lack of paved roads ○ Proximity of houses to facilities ○ Calamities and disasters COMMUNITY SETTING Score/priority Family Community 3 Nature of the Problem Nature of the Problem 4 Modifiability of the Problem Modifiability of the Problem 1 Severity of the Problem Magnitude of the Problem 1 Preventive Potential Preventive Potential 1 Salience Social concern B. Community Organization Activities: Rostering – general assembly and listing of official members Election of officers Delegation / Tasking Working for legal requirements – DTI SEC for fund raising Initiation of resource mobilization – bring money to organization Networking and collaboration C. Community Mobilization / Action isaiah 41:10 COMMUNITY HEALTH NURSING | 32 review - community health NURSING N.O.P IV. SUSTENANCE AND STRENGTHENING PHASE ➔ Conduct of mobilization on health development concerns (use resources of the community) ➔ Linkaging and networking ➔ Identification of secondary leaders ➔ Training of the organization for monitoring and implementing of community health programs ➔ Implementation of livelihood projects (cooperative) SEMINARS OUTPUTS Leadership Skills SALT Clustering Self awareness and leadership training Managerial Skills PIME Project Proposal Planning, Implementation, Monitoring, Evaluation Assessment Skills BHST Demonstration ex. Vital signs Basic Health Skills Training Common and simple AHST Demonstration Intervention Advanced Health Skills Training ex. home remedies, first aid Alternative medicine SHST Demonstration ex. herbal medicine Specialized Health Skills Training V. Phase Out ➔ phase whereby the community development workers or change agent leaves the self-sustaining people’s organization and looks for other areas to work with Activities: 1. Endorsement – inendorse ang head sa iba’t ibang authorities 2. Disengagement – the time for you to leave the current activities to community members, may nitrain na 3. Impact evaluation – to identify if there is improvement in the well-being of the community isaiah 41:10 COMMUNITY HEALTH NURSING | 33 review - community health NURSING N.O.P TRADITIONAL and ALTERNATIVE MEDICINE LEGAL BASIS RA 8423 "Traditional and Alternative Medicine Act (TAMA) of 1997" An act creating the "Philippine Institute of Traditional and Alternative Health Care” (PITAHC) ○ Agency that study alternative medicine, they test therapeutic use of every herbal medicine in cooperation with DOST ○ They are responsible for the creation of 10 herbal medicine called “SANTA LUBBY” To accelerate the development of traditional and alternative health care in the Philippines ○ They also studied chinese medicine which is acupressure and acupuncture ○ PITAHC also offer scholarship for those who wants to learn chinese medicine RA 6675 Generic Law of the Philippines as amended by RA 5902 RA 5902 Cheaper and Quality Medicine Act of 2004 EO 144 Botika ng Barangay Implemented in time of Arroyo Supporting RA 5902, in order for the community to avail cheaper medicine, it must be in the form of generics GMA50 Government program that authorize and operationalize Botika ng Barangay (BnB) kung napapatupad ba na generic talaga yung mga gamot Naglista ng mga pangalan ng gamot with suggested retail price Price ceiling is created – bawal lumagpas sa presyo provided by the government ○ Ex. Noon ay sobrang mahal ng antibiotic, nung nilagyan ng price ceiling napadami ang pagdistribute ng mga gamot through generics HERBAL PREPARATIONS Decoction Boiled in Water Consume within 24 hours Kailangan mabawasan ang volume ng initial water na ginamit, nagiging half ○ Ex. If 2 glasses/cup of water is used, magiging 1 glass/cup na lang If volume is half na → kahalo na ang remnants ng dahon → filter 2 Types: 1. Soft decoction – malalambot na part ng herbal plant (ex. usbong, sprouts, leaves) 2. Hard decoction – matitigas na part ng herbal plant (stems, ugat) Infusion Soaked in water (babad) Tea preparation Tincture Soaked in alcohol Use within 2 months (last longer than decoction) Poultice Pounded or crushed Used for fresh leaves Ex. Kapag tinulian, pinapanguya ng bayabas tapos tinatapal Powder Dried then grounded Can be compressed into tablets or encapsulated in soft gelatin capsules Ex. Lagundi and Sambong In community, you do not have time to do this, hindi na tinutuyo, diretso boil in water na Salad Eat the plant raw (Huhugasan lang at kakainin na) Ex. Ampalaya at pansit-pansitan Rolled then smoked Marijuana isaiah 41:10 COMMUNITY HEALTH NURSING | 38 review - community health NURSING N.O.P Recommendations in Herbal Preparation F Follow the accurate dose suggested O Only one kind of herb for each type of symptom Hindi pwedeng pagsabay sabayin at pakuluan ang mga herbal medicine because herb-herb interaction may occur ○ Ex. Maraming pwedeng inumin for pain like yerba buena, lagundi, pansit-pansitan C Clay pots are used when boiling Do not use metal pots because metallic content of cooking ware can interact with active component of the herb C Consult doctor if signs and symptoms persists If used 2 times or 3 times of herbs and no relief of symptom → consult the doctor U Use only part of the plant being advocated Some part of the plant is poisonous S Stop giving the herb in case of untoward reaction Allergic reaction may occur Common allergies occur if herbal preparation is poultice because it is directly applied in the skin H Harvest parts correctly A Avoid the use of insectisides in growing herbs Herbs will not be processed properly in laboratory, sa bahay lang ginagawa at hinuhugasan Insecticides might adhere to the plant R Remove the lid or cover while boiling at low heat In decoction, let it evaporate to decrease the volume and make if half If in high heat, therapeutic component ay mawawala din D Dispose of decoction after one day (24 hours) 10 HERBAL PLANTS (SANTA LUBBY) Preparation S Sambong Nature’s diuretic Leaves for decoction For edema and calculi After taking sambong, drink water Contraindicated: ○ for calculi to be removed ○ UTI kasi alkaline substance ○ < 7 years old Dosage of sambong leaves based on patient’s age: Bitter taste – allowed to take with sugar but 3 tablespoon (7-12 years old) TID drink immediately because sugar will increase 6 tablespoon ( > 13 years old) TID the chance of bacterial growth A Ampalaya Nature’s antidiuretic Leaves for salad For lowering sugar 1 cup of leaves BID Used for Type 2 DM only Sprouts for decoction Makiling variety – maliliit lang ang bunga Drink ⅓ of the boiled water TID (ampalayang ligaw / ampalayang gubat) 30 minutes before meals (like metformin / oral Not allowed to take with sugar because it hypoglycemic agents) removes the purpose of giving ampalaya isaiah 41:10 COMMUNITY HEALTH NURSING | 39 review - community health NURSING N.O.P N Niyug-niyugan N Nature’s antihelmintic Seeds for salad To remove intestinal worms wash → chew → taske like coconut flesh Indicated for ascariasis – roundworms, hindi Dosage: kayang tanggalin ang tapeworms 4-5 seeds (4-6 years old) Contraindicated: ○ iniiisa-isa ang pagbigay, at risk for aspiration ○ < 4 years old (risk for aspiration) 6-7 seed (7-12 years old) No harvest leaves 8-10 seeds ( > 13 years old) adult dosing Side Effects: ○ Abdominal cramps → anticipated effect of If still no worm come out during a bowel movement, niyug-niyugan → change in peristaltic you may use the same dosage after 1 week movement → nausea and vomiting (Twice pwede ulitin, if wala pa din, → go to health center) T Tsaang Gubat (Fukien Tea in english) Nature’s antipasmodic Leaves for decoction For stomach pains 1 ½ tablespoons (7-12 years old) not prepared infusion although it is a tea 3 tablespoons for ( > 13 years old) Contraindicated: ○ < 7 years old A Akapulko (scabicidal) Nature’s antifungal Ground leaves for poultice For fungal infection of the skin Apply on skin BID for 3 weeks Not used in candidiasis Ground leaves for decoction (no oral use) Only used for skin infection If allergic to poultice, wash BID for 3 weeks L Lagundi Nature’s Ani-pyretic and antitussive Leaves for decoction For fever cough and asthma Also used for scabies, joint pain Dosage according to patient’s age: Used as “aromatic bath” in postpartum women 1 ½ teablespoon (2-6 years old) pinakabata ○ for soothing and relaxing bath because of its 3 tablespoons (7-12 years old) aroma 6 tablespoons ( > 13 years old) ○ boil → 15 minutes infusion → used for bath ○ “Lagundi pangpaligo sa mga lumandi” U Ulasimang Bata (Pansit-pansitan) *CBQ* Nature’s antihyperuricemic Leafy tops as salad For lowering uric acid 1 cup TID Indicated for gout or rheumatism Leafy tops for decoction Has a very soft stem, natural sour taste (citrous) Boil 3 cups in 2 glasses of water; reduce to half volume; Drink ⅓ glass TID after meals B Bawang Antihypertensive and antihyperlipidimic 2-3 garlic bulbs for salad For lowering BP and Cholesterol TID with meals Para mawala ang halang, it can be crushed and soaked in vinegar Grilled or fried (still maintain its therapeutic use) isaiah 41:10 COMMUNITY HEALTH NURSING | 40 review - community health NURSING N.O.P B Bayabas Antidiarrheal Diarrhea – decoction Antimicrobial Wounds and scabies: Scabicidal Boil 1 or 2 handfuls or leafy tops For diarrhea, wound cleansing, gingivitis etc. Wash the wound with lukewarm water BID May pinakamaraming preparation Improvement will be noticed if natutuyo ang sugat Antipruritic effect Dizziness: ○ Can also be used for itchy skin Crumple the fresh tops and let it be inhaled by the person experiencing dizziness Swollen gums (Gingivitis) Boil one handful of leafy tops in a small pot with water Gargle with the lukewarm water BID Cleaning the vagina after giving birth: Boil one handful of leafy tops in a small pot with water Wash with the lukewarmwater as desired Y Yerba Buena (Peppermint) Nature’s analgesic Boil the freshly picked leaves in a pot filled with 2 glassess of For body aches, headaches, toothaches water until the pot is only left with half filled of water Commonly used for commercial products ○ Mint flavored candies has yerba buena if Divide into 2 portions. Drink 1 portion, and drink another 1 naturally produced except for those na portion after 3-4 hours if the pain still persist menthol Can also be used for dysmenorrhea, rheumatism, etc. Iba’t ibang klase ng sakit, pwedeng pagalingin Contraindicated for < 2 years old: Lagundi Contraindicated for < 4 years old: Niyugyugan Contraindicated for < 7 years old: Sambong and Tsaang Gubat Scabies: Akapulko (priority), Ampalaya, Bayabas Cleansing Bath for postpartum women: Bayabas Aromatic Bath postpartum women: Lagundi Given before meals: Ampalaya Given after meals: Ulasimang Bato (Pansit-pansitan) isaiah 41:10 COMMUNITY HEALTH NURSING | 41 review - community health NURSING N.O.P ACUPRESSURE AND ACUPUNCTURE Principles of Practice Acupressure is an ancient healing art using the fingers to gradually press key healing points (pressure points), which stimulate the body's natural self-curative abilities. ○ Chinese believe na without the use of medicine, kusang naghihilom ang katawan natin by pressing key healing point Acupressure is a technique for diagnosing and treating diseases based on energy imbalances healing points are mapped by Tsun (CUN) measurements. ○ Kaya nagkakasakit, hindi balance ang energy sa katawan ○ CUN measurements – para mahahanap ang mga key pressure points ○ 1 thumb width = 1 unit of CUN According to acupressure, a human's body has 14 meridians all over the body, that works as a transportation of Qi (life energy) into the whole body. ○ Qi flows in the entire body following the 14 regions in the body where life energy flows Ailments are often the result of a blockage that occurs in one of the meridians. Essentially, when Qis not able to flow naturally, a part of the body is no longer properly nourished. Acupressure helps to clear such blockages so Qi can flow freely once again. Botika ng Barangay (BnB) Refers to a drug outlet Managed by community organization (CO) / non-government organization (NGO) and / or the Local Government Unit (LGU) With a trained operator and a supervising pharmacist (2 individuals) Drug list area: 1. OTCs Antipyretics, Analgesics, Supplements 2. Antibiotics Cotrimoxazole and Amoxicillin 3. Medicines for COPD Bronchodilators (ex. salbutamol) 4. Medicines for Hypertension –dipines, –sartan, –prils, –olols 5. Medicine for Diabetes Oral Hypoglycemic Agents (OHAs), Insulin isaiah 41:10 COMMUNITY HEALTH NURSING | 42 review - community health NURSING N.O.P NUTRITIONAL PROGRAM NUTRIENTS MACROnutrients MICROnutrients Breakdown → production of heat energy → calories 1. Vitamins – organic molecules 1. Carbohydrates – polysaccharide →monosaccharide Water solubles 4 kcal/g ○ Vitamin B complex RDA: 50 % ○ Vitamin C 2. Protein → amino acids Fat solubles 4 kcal/g ○ Vitamin A, D, E, K RDA: 20 % 2. Mineral – inorganic molecules 3. Fats → fatty acids Iron 9 kcal/g Iodine RDA: 30 % Zinc Recommended Dietary Allowance: 2200 – 2400 kcal/day MACRONUTRIENTS DEFICIENCIES Kwashiorkor Lack of protein (severe protein malnutrition) Edema on both feet – press the foot of the child Common among 1-4 years old Marasmus Total Caloric malnutrition (lack of carbohydrates, protein, and fats) Visible severe wasting, baggy fats Common in children < 1 yr old Malnutrition Parameters: 1. Visible severe wasting (Baggy pants) Marasmus 2. Edema on both feet Kwashiorkor 3. Z-scores (Weight for Height) WFH -2 to 0 – normal positive – overweight (+1, +2, +3) above negative – underweight (-1,-2,-3) below anything below negative 3 (severe) -2 to -3 moderate 4. BBC (Weight for Age) WFA 2 regions: Between the curves – normal AUC [above the upper curve] – overweight BBC [below the bottom curve] – underweight 5. Mid-upper arm circumference Done in children > 6 months Normal: > 125 mm Moderate malnutrition: 115-125 mm Severe malnutrition: < 115 mm isaiah 41:10 COMMUNITY HEALTH NURSING | 45 review - community health NURSING N.O.P Malnutrition Complicated Severe Acute General danger signs Malnutrition Visible severe wasting (baggy pants) (C.SAM) Edema on both feet Pink Negative 3 or below on Z score BBC: underweight MUAC: < 115 mm Not feeding well Unable to finish Ready To Use Therapeutic Food (RUTF) Uncomplicated Severe Acute Visible severe wasting (baggy pants) Malnutrition (USAM) Edema on both feet Negative 3 or below on Z score BBC: underweight Yellow MUAC: < 115 mm No feeding problem Able to finish Ready To Use Therapeutic Food (RUTF) Moderate Acute Malnutrition No visible severe wasting (MAM) No edema on both feet Z score: between negative 2 MUAC: between 115-125 mm Green No Acute Malnutrition Wala sa 5 parameters Anemia Check palmar pallor: Severe anemia = Paper white Anemia = Tinged of pink No anemia = Rosy red isaiah 41:10 COMMUNITY HEALTH NURSING | 46 review - community health NURSING N.O.P MICRONUTRIENTS DEFICIENCIES 1. Vitamin A Deficiency Lack of vitamin A can result to: Problem in vision Growth retardation or growth impairment Compromised immune system Various problems especially night blindness XEROPHTHALMIA WHO Classification: XN Night blindness X1A Conjunctival xerosis (natutuyo ang conjunctiva) X1B Bitot spot X2 Corneal xerosis (natutuyo ang cornea→pwedeng lumambot) X3A Corneal ulceration / keratomalacia, involving < ⅓ of the cornea X3B Corneal ulceration / keratomalacia, involving > ⅓ of the cornea XS Corneal scar due to xeropthalmia XF Xeropthalmic fundus (can lead to total blindness because of scar formation) 2. Iron Deficiency Can lead to decrease production of RBC Normochromic – RBC maintained being red Hypochromic – namumutla ang RBC Microcytic – lumiliit ang RBC Causes: C Chronic blood loss (menstruation, parasitism in children can cause bleeding in GI) H High body requirements I Increased demand during pregnancy and lactation (9 months) Iron should be supplemented in 6 months during pregnancy (pre-natal) 3 months for breastfeeding (postpartum) L Low intake and absorption of iron rich foods (absorbed in acidic environment) L Lack of vitamin C in the diet (aids in iron absorption) P Parasitism (should regularly deworm the child) 3. Iodine Deficiency Cause: Goitrogenic foods is commonly found in mountainous regions like baguio ex. strawberry, cabbage, broccoli (lack iodine) Common in women isaiah 41:10 COMMUNITY HEALTH NURSING | 47 review - community health NURSING N.O.P STRATEGIES I. Micronutrient Supplementation – “Garantisadong pambata” (Araw ng sangkap pinoy); Patak sa bibig II. Food Fortification – Halo sa pagkain III. Dietary Diversification IV. Growth monitoring and Health Promotion I. MICRONUTRIENT SUPPLEMENTATION Strategies: Vitamin A Supplementation Case Dose Administration Healthy Baby 6-11 month 100,000 IU Once – 9 months soft gel capsule (blue) Kasi may binibigay ng vaccine like measles vaccine Healthy Baby 12-59 months 200,000 IU Every 6 months (1 year old to before 5 years old) soft gel capsule (red) First dose given is at 12 months old with MMR vaccine Sick Child with Measles Dose according to Age Upon diagnosis regardless of last dose Measles can suffer from eye complications Sick child with Severe Pneumonia, Dose according to Age Upon diagnosis except if given less than 4 weeks before Persistent Diarrhea, Severe Malnutrition (single dosing) diagnosis Sick Child with Xerophthalmia Dose according to age 3 doses Chu-Chu-Chu (Today, Tomorrow, 2 weeks) Pregnant women 10,000 IU tablet / capsule Twice a week starting 2nd trimester (twice a week) Contraindicated in 1st trimester because teratogenic Pregnant woman with xeropthalmia 10,000 IU tablet / capsule Upon diagnosis taken daily for 1 month Postpartum Woman 200,000 IU Once 4 weeks after delivery Strategies: Iron Supplementation Case Dose Administration Child 6-11 month 15 mg elemental iron / 0.6 ml drops Daily for 3 month Child 12-59 months 30 mg elemental iron / 5 mL syrup Daily for 3 month Child 5-12 years old 30-60 mg elemental iron / 5 mL syrup Daily for 3 month Pregnant woman 60 mg elemental iron / 400ug folic acid Daily at least 6 months in pregnancy Post-partum Woman 60 mg elemental iron / 400ug folic acid Daily for 3 months after delivery Strategies: Iodine Supplementation Case Dose Administration Pregnant woman 200 mg capsule 2 capsule single dose Lactating woman 200 mg capsule 2 capsule single dose Supplementation only in areas with no salt iodization RA 8172 – Asin Law of 1995 → no more need for supplementation isaiah 41:10 COMMUNITY HEALTH NURSING | 48 review - community health NURSING N.O.P II. FOOD FORTIFICATION (RA 8976) Strategies: Food fortification “FOS-A FR-I” 1. Mandatory fortification of staples (lahat ng food products, dapat malagyan ng micronutrients) Rice Iron Flour Vitamin A and Iron Sugar Vitamin A Edible oil Vitamin A 2. Voluntary – “FOS-A FR-I” Flour, Oil, Sugar Vitamin A Flour and Rice Iron III. DIET DIVERSIFICATION Strategies: Diet Diversification 1. A variety of food Go, Grow, Glow Balanced diet 2. Breastfeeding Can breastfeed beyond 2 years old Exclusive breastfeeding Complementary Feeding less than 6 months Breastfeeding w/ complimentary food: 6 months -2 y/o at least 8-12 times a day ➔ Cereal-based (lugaw) on-demand (24/7) Should include: no water breaks Iodized salt Can give supplements if Edible oil prescribed by pediatrician Mashed fruits and vegetables Dried protein ○ flaked fish ○ dilis ○ pulverized shrimp Frequency of complementary feeding 6 - 9 months 9 - 12 months 12 months - 2 y/o 2 y/o - 5 y/o ½ cup ½ cup ¾ cups 1 full cup 2-3 times a day 3-4 times a day 3-4 times a day 3-4 times a day 1-2x provide snacks isaiah 41:10 COMMUNITY HEALTH NURSING | 49 review - community health NURSING N.O.P BREASTFEEDING D Do not delay E Exclusive breastfeeding for children < 6 months D Dietary compliment starts at 6 months E Excluding milk formulas U Utilize both breast T To prevent breast engorgement (mastitis can occur) O Observe proper latching Chin should touch the breast and approach the lower aspect of the areola Lower lip is approximated in the lower areola Lips must be turned outward Upper areola is more visible than the lower areola Unlatched/detached: pataas, automatic aalis kasi natatakpan and ilong N No noise when sucking G Give proper nutrition to the mother 3. (Tree) Fruits and vegetables 4. Four sources of protein 1. meat 2. poultry 3. fish 4. legumes 5. Calcium Teeth and bones 6. Safe and sanitary preparation and handling of food 7. Iodine salt (iodize) 8. Reduce consumption of fat, sugar, and salt 9. Weight monitoring 10. Exercise and healthy lifestyle isaiah 41:10 COMMUNITY HEALTH NURSING | 50 review - community health NURSING N.O.P IV. HEALTH PROMOTION Strategies: Health Promotion 8 Gateway Behaviors: 1. Magpasuso 2. Magpabakuna 3. Mag-bitamina act 4. Magpurga 5. Magsipilyo 6. Maghugas ng kamay 7. Gumamit ng palikuran 8. Huwag manigarilyo isaiah 41:10 COMMUNITY HEALTH NURSING | 51 review - community health NURSING N.O.P *CBQ* RA 11223 – Universal Healthcare Law 2019 “All for Health towards Health for all” 3 Guarantees: 1. All life stages and triple burden (first 1000 days) ○ All life stages: Covers health programs that encompasses health care services given to pregnant women, newborns, infants, adolescence, children, adults, elderly ○ Triple burden of disease: Communicable disease Non-communicable disease (heart disease, COPD, cancer, diabetes) & Malnutrition Diseases of rapid urban industrialization (mental health burden, industries) First 1000 days – RA 11148 ○ 9 months x 30 days per month = 270 ; 365 days in a year x 2 years from the baby is born = 730 270 + 730 = 1000 Maternal Newborn and Child Health and Nutrition (MNCHN) Strategy “Kalusugan at Nutrisyon ng Mag-Nanay” Expanded breastfeeding act – RA 10028 (old RA 7600) IMCI strategy Expanded Newborn Screening – RA 9288 National Immunization Program – RA 10152 isaiah 41:10 COMMUNITY HEALTH NURSING | 54 review - community health NURSING N.O.P MATERNAL AND NEWBORN CHILD HEALTH AND NUTRITION INTEGRATED MNCHN STRATEGY MNCHN “Kalusugan at Nutrisyon ng Mag-nanay” 2 of the MDGS calls for the reduction of child mortality and improvement of maternal health MDG: 4. Child – reduce child mortality (under 5 y/o) 5. Maternal – improve maternal health Targets: 1. Reduce Maternal Mortality Rate (MMR) from 209 to 52 deaths per 100,000 live births ○ Pagkamatay ng nanay in regards to pregnancy and child delivery ○ Childbearing women: 14 - 44 years old 2. Reduce Neonatal Mortality Rate (NMR) from 13 deaths to 10 per 1000 live births ○ Mga namamatay na sanggol during the first 28 days (neonatal) Problems leading to maternal and newborn deaths 3 DELAYS: First delay Second delay Third delay delays at home delays on the way delays at the facility Financial – no enough money Proximity – malayo ang bahay sa Lack of equipments Knowledge deficit – do not know when health center Lack of supplies will go to health center Transportation – walang masakyan Lack of medicines Lack of companion Lack of personnel 4 Pillar of safe motherhood: 1. Proper pre/postnatal care 4 visits for prenatal care: 2 visits for postpartum: 1. 1st visit: 1st trimester 1. After a week from delivery 2. 2nd visit: 2nd trimester 2. After a month from delivery 3. 3rd visit: 8 months 4. 4th visit: 9 months 2. Proper neonatal care EINC (unang yakap) Time Bound Non-time bound Breastfeeding (first hour of life) Eye prophylaxis Skin-to-skin contact Immunization ID in ankle Foot printing 3. Clean and safe delivery Skilled birth attendance (licensed to attend at births) 4. Family planning Natural Family Planning Methods Artificial Family Planning Methods Condom is together with spermicide NO latex to latex isaiah 41:10 COMMUNITY HEALTH NURSING | 55 review - community health NURSING N.O.P MNCHN CONCEPTS Ensure all women and newborns have skilled care Care is to be provided by a skilled birth attendant: ○ Midwife ○ Nurse ○ Doctor ➔ Hilot is traditional birth attendants, they can assist in skilled birth attendants to prepare the client, they are not allowed to deliver All pregnant women are at risk of complications Home deliveries has distinct disadvantages The best intrapartum care is deliver in a health facility ○ Birthing homes ○ Lying-in ○ Hospital MNCHN Core Service Package EmONC APPROACH Basic services Comprehensive services Pre-pregnancy Prenatal Childbirth Post-partum Post-natal 3 TIER OF SERVICE: 1 TIER Community health providers Birthing homes 2 TIER Basic Emergency, Obstetric, Newborn Care (BEmONC) District Hospitals 3 TIR Comprehensive Emergency, Obstetric, Newborn Care (CEmONC) Provincial Hospital isaiah 41:10 COMMUNITY HEALTH NURSING | 56 review - community health NURSING N.O.P I. PRE-PREGNANCY PACKAGE Micronutrient supplementation: ○ Vitamin A 8 Essential Services (BMD) ○ Iron ○ Folic acid Birth planning ○ Calcium – for teeth kasi nakakabungi Saan balak manganak ○ Zinc – to boost immune system Magkano ang magagastos ○ Iodine – 200mg B Sino ang kasama kapag manganganak Body measurement Oral Health height and weight, BMI Tetanus toxoid immunization – TT1 to TT5 Blood pressure taking ○ First pregnancy requirement: TT1, TT2 to identify if developed PIH Health promotion Blood tests ○ Healthy lifestyle (no alcohol, no smoking) to screen for gestational diabetes Screening for STI – social hygiene clinic, possibility of the mother having HIV Micronutrients supplements Family Planning Vitamin A Iron – 60 mg Education of adolescents and young adults Disease prevention and management M Folic acid – 400 mcg ○ prevent neural tube defects Maternal immunization TT 2 = received 1 month before EDC Malaria Prophylaxis Chloroquine ○ to protect from malaria Deworming D For parasitism isaiah 41:10 COMMUNITY HEALTH NURSING | 57 review - community health NURSING N.O.P II. CHILDBIRTH PACKAGE Follow the EINC: Within 30 seconds Objective: ➔ To stimulate breathing and provide warmth Activities: 1. Put on double gloves 2. Dry thoroughly 3. Remove wet cloth 4. Quick check of newborn breathing 5. Suction only if needed – routine suctioning is no longer practiced After Through Drying Objective: ➔ To provide warmth, bonding, prevents infection, hypoglycemia Activities: 1. Put prone on chest / Abdomen (skin-to-skin contact / kangaroo care) 1. Cover with blanket and bonnet 2. Place ID on ankle 3. Do not remove vernix – spread, do not remove, has thermoregulatory function 4. Do not separate Up to 3 minutes post delivery Objective: ➔ To reduce incidence of anemia Activities: 1. Remove 1st set of gloves 2. Clamp and cut cord after cord pulsations (1-3 minutes) 3. Do not milk cord 4. Give oxytocin 10 mg to mother – administered at the 3rd stage of labor to facilitate expulsion of placenta Within 90 minutes of age: Objective: ➔ To facilitate initiation of breastfeeding through sustained contact ○ do not delay breastfeeding (first hour of life or 60 minutes) Activities: 1. Leave the newborn in skin to skin contact 2. Observe newborn for feeding cues – proper latching 3. Counsel on positioning and attachment 4. Do eye care injections after 1st breastfeed – immunization, eye prophylaxis PARTOGRAPH Monitor progress of labor under active phase 3 Phases of 2nd Stage of Labor Latent 0-3 cm Active 4-7 cm Transitional 8-10 cm Normal Progress of labor: 1cm / hr anything beyond is slow progress 1st diagonal line: Alert line 2nd diagonal line: Action line Below: number of hours Side: centimeters isaiah 41:10 COMMUNITY HEALTH NURSING | 58 review - community health NURSING N.O.P III. POSTPARTUM PACKAGE Postpartum check up Micronutrient supplementation ○ Vitamin A – 200,0000 IU single dose Counseling on proper breastfeeding and family planning ○ Lactational Amenorrhea Method (LAM) 3 requisite to use LAM: Amenorrheic < 6 months Exclusive breastfed Prevention and management of other diseases IV. POSTNATAL PACKAGE Delayed bathing – after 6 hours of life, non-time bound Initiation of breastfeeding Vitamin K injection – 1 mg, for blood clotting, sterile GI tract Immunization at birth BCG Hepa B Pentavaccine OPV Rotavax PCV Measles MMR ID IM IM Oral Oral IM 9 months 12-15 Right upper arm 6 weeks 6 weeks 6 weeks months form a scar 10 weeks 10 weeks 10 weeks 14 weeks 14 weeks 14 weeks Fully Immunized Child (FIC) Status Completely Immunized Child (CIC) status Before 12 months Before 24 months 1 dose of BCG 3 doses DPT 3 doses of Hepa B 3 doses of OPV 1 dose of Measles Newborn Screening – RA 9288 Eye prophylaxis – opthalmic neonatorum Cord care – use boiled water Birth registration isaiah 41:10 COMMUNITY HEALTH NURSING | 59 review - community health NURSING N.O.P CRITICAL EMERGENCY INTERVENTIONS BEmONC: CEmONC: Parenteral administration of of A-S-O drug Cesarean section ○ Antibiotics – Sepsis Blood transfusion ○ Anticonvulsant – Magnesium sulfate / Large volume provider of surgical family planning Diazepam method, IUD ○ Antihypertensive – PIH ○ Female: Bilateral Tubal ligation ○ Steroids – preterm, for LS ratio (lung ○ Male: Vasectomy surfactant) ○ Oxytocin – to aid in uterine contractions Assisted vaginal delivery (forceps delivery) ○ cephalopelvic disproportions Manual removal of retained placental products Intravenous fluid administration Newborn resuscitation Treatment of neonatal sepsis Oxygen support for the newborn Support mechanisms MNCHN Human resource: Community-based women’s health Team (c-WHT) ○ MW + BHWs EmONC Team (ET) ○ Basic 1 doctor, 1 nurse, 1 midwife ○ Comprehensive 1 OB, 1 pediatrician, 1 anesthesiologist, 3 nurses, 3 midwife, 1 medical technician Itinerant Team (IT) ○ Information dissemination ○ lead by the nurse Social Hygiene Clinic Team (ST) ○ addresses STDs ○ 1 doctor, 1 nurse, 1 midwife Methylergometrin (Methergine) – do not give until the child is inside, given upon delivery isaiah 41:10 COMMUNITY HEALTH NURSING | 60 review - community health NURSING N.O.P NEWBORN SCREENING BASIC 6 NEWBORN SCREENING DISORDERS MANAGEMENT GOLDEN PERIOD Endocrine Disorders: 1. Congenital Hypothyroidism Decreased production of T3 and T4 ⬇ Levothyroxine 4 weeks Biologic crisis: Myxedema coma 2. Congenital Adrenal Decreased production of corticosteroids Hormonal 2 weeks Hyperplasia ⬇ Replacement shortest: Addisonian crisis (Steroids) life-threatening Amino acids disorders: 3. Phenylketonuria (PKU) Problem with metabolizing phenylalanine ⬇ Can form ketones in blood (ketosis) ?