Community Health Nursing.pdf

Unit One Opportunities and Challenges of Community Health Nursing Public Health: Is science and art of preventing disease, prolonged life and health and efficiency, through organized community. Community health definition:...

Unit One Opportunities and Challenges of Community Health Nursing Public Health: Is science and art of preventing disease, prolonged life and health and efficiency, through organized community. Community health definition: Is the identification of the need and the protection and improvement the collective heath with in a geographically defining area. E.G of Health Need: 1- Immunization 2- Nutrition 3- School program 4- Environment protection 5- Accident prevention Definition of Community: Collection of people who share some important feature of their live. Three primary criteria are useful for identifying community: 1- Geographic 2- Common interest 3- Health problem Geographic Community Community often is defined by its geographic boundaries - city. Town or neighborhood is a geographic community. Common interest Community Agencies to promote change, stop violence, develop smoke free environment, air pollution water pollution. Community of solution Group of people who come together to solve a problem that affects all of them. 1  E.G: water pollution problem may involve several countries whose agencies and personnel must work together to control up stream water supply or waste disposal... etc The concept of health Health (WHO) Is state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Health … illness continuum The health continuum a range of degree from optimal health one end of the spectrum to total disability or death at the other end Components of community health practice Six basic components: 1- Health promotion 2- Rehabilitation 3- Evaluation 4- Research 5- Treatment of disorder 6- Health prevention of health problem 1. Health promotion It is all effort that seek to move people closer to optimal health and wellbeing OR higher level of wellness. A. health education. Health promotion program includes B. Nutrition. C. Stop smoking. D. Exercise E. Alcohol and drug abused 2. Health prevention Mean: anticipating and averting problem OR discovery of problem as early as possible to minimize potential disability and impairment. It is practice on three level in community 1- primary prevention 2  2- Secondary prevention 3- Tertiary prevention 1-primary prevention  It include measure taken to keep illness OR injuries from occurring e.g.: encouraging Elderly people to use safety devices e.g.: hand rails on steps, teaching young  Adult healthy life style. 2-Secondary prevention  Early diagnosis  Prompt treatment  Efforts to detect and treat existing health problem at earliest.  Secondary prevention attempted to discover a health problem at appoint when intervention may lead to its control or eradication. 3-Tertiary Prevention Rehabilitation  Attempts to reduce the extent and severity of a health problem to its lowest possible level so as to minimize disability and restore OR preserve function. 3-Treatment of disorders It focuses on the illness end of the continuum and is the remedial aspect of community health practice. This occurs by three method: 1- Direct service to people with health problem. 4- Rehabilitation 2- Indirect service that helps people to obtain treatment. 3- Development of program to correct unhealthy condition. 5- Evaluation Effort to reduce disability as much as possible restore function. Is the process by which that practice is analyzed, judged and 6-Research improved according to established goals and standards. Is systematic investigation to discover facts, solve problem and explore improved methods of health service. 3 Characteristics of community health nursing 1- It is field of nursing, knowledge, skills 2- It combines public health with nursing 3- it is population focused (health problem) 4- It emphasize prevention, health promotion and wellness. 5- It promotes client responsibility and self-care. What is healthy Community 1- Collaborate effectively in identifying needs and problems. 2- A chive a working consciousness on goal and priorities. 3- Agree on ways and means to implement the greed upon goals. 4- Collaborate effectively to take the required action. Community health nursing definition  Synthesis of nursing practice and public health practice applied to promoting and preserving the health of population. National standards of community health Nursing 1. Nursing practice is a direct service, goals directed and adaptable to the need of the individual. Family and community during health and illness 2. CHN is a synthesis of nursing practice and public health practice to promoting and preserving the health of population the nature of this practice is general and comprehensive it is not limited to a particular age OR diagnostic group. It is continuing not episodic 3. The nurse actions acknowledge the need for comprehensive health planning, recognize the utilize dynamic force which influence changes. 4. In CHN practice the consumer is the client OR pt. consumer includes individual, group OR community, as a whole 4 5. Standard focus on practice rather than on the practitioner. they provides mean for determining the quality of nursing which a consumer receives regardless of whether such as services are provided socially by a professional nurse. 6. The Standard of nursing practice apply to nursing in variety of setting. 7. The dominant responsibility is to the population as a whole, therefore nursing directed to individual families OR groups contribute to the health of the total population. 8. Health promotion, health education and heath maintain, coordination and continuity of care are utilized as holistic approach to the family, group and community. Community health nursing (CHN) identified by Standard  The nurse applies theoretical concepts as a basis for decision in practice.  The nurse systematically collects data that comprehensive and accurate.  The nurse analyze data collected about the community, family and individual to determine diagnosis.  The nurse develops plans at each level of prevention which specify nursing actions unique to client needs.  The nurse guided by the plan intervention to promote Maintain or restore health, prevent illness and affect rehabilitation  The nurse evaluates responses of the community family and individual to interventions in order to determine progress toward goal achievement and to revise the data base diagnosed and plan.  The nurse participates in peer review and other means of evaluation to assure quality of nursing practice. 5  The nurse collaborate with other health care provider, professionals and community representatives in assessing planning implementing and evaluating programs for community health.  The nurse contributes to theory and practice in community health nursing through research 6  Unit Two Evolution of community health nursing Historical development of community health nursing Roles and setting for CHN Evolution of community health nursing Four general stages mark the development of public health C.H.N 1- Early stage - early home care stage 2- District nursing stage 3- Public health nursing stage 4- Community health nursing stage 1. Early home care nursing Sick people were tended at home by focus of this females 1837 Farrar care before 1800s to reduce suffering and promote healing it began with religions groups focus on sick poor individuals and emphasis on curative it is lay and religious orders 2 District nursing-mid 1800- Formal organization of visiting nursing 1859, William Roth bone on 1900 English philanthropist convinced of the value of home nursing, he employed Mary Robinson the nurse who had carried for his wife to visit the sick poor in their home and teach him proper hygiene to prevent illness 3. Public health nursing District nursing hand broadened it focuses to include and Welfare of the 1900-1970 general public not just the poor, Robert Koch's demonstrate that TB is comm. - unlikable led the john Hopkins hospital to hire nurse. 4. Community health They based on community nursing education.B.S and master degree and nursing 1970 to the nurse specialist it focus on population, services emphasis's on health present promo- ion, illness prevention many kinds of institution independent practiced 7  Societal influences on the development of community health nursing 1- Advanced technology 2- Progress in causal thinking e.g.: epidemiological studies, researches 3- Changes in education 4- Change the role of women Factors influence the roles played by C.H.N: 1- Policy of the organization that nurse is affiliated 2- Consumer perception of nursing. 3- socio-cultural norms 4- Political and legal restriction. 5- The community health nurses own values and ability to adapt to changing health need. Roles and setting for community health nursing practice 1) Care provides or clinician The nurse ensure that health service are provided not just to  Three clinician emphasize are useful individual and family but also to a group and population to consider here nursing still designed for a special need of client it emphases on holism health promotion and skill expansion. A-Holistic practice It means considering the broad range of Inter acting need that affect the collective health of the client, comprehensive and total care of the client in all area physical, emotional social, spiritual and economical 1. Health promotion 2. Health prevention B-Focus on wellness Or health promotion Immunization, family planning, cholesterol, screening.... Etc. C-Expanded skills  Necessary skills, like skill in observation, listening communication, counseling Recently environment and community, wide 8 2) Educator role consideration such problem caused by pollution, violence, crime drug abuse  It is useful in promoting the public health for two reasons: 1. A community client are not ill and can act on health information. 2. The educator role Is significant and a wider audience can be reached it should reach all people not only small group. 3) Advocate role The issue of client's right is important in health care. Every pt. or client has the right to receive just equal and humane treatment. Two goals in client advocacy: Advocacy goals 1. One is to help client gain greater in depend- end or Self- determination. CHN acts as an advocated for the client by showing them what services are available 2. Second goal to make the system more responsive and relevant to the need of client by calling attention to inadequate, inaccessible or unjust care. The advocated role in corporate four Advocacy action Characteristic action: 1. Being assertive 2. Taking risks 3. Communicating and negotiating well. 4. Identifying recourses and obtaining result. The management process like nursing process, planning, organizing 4) Manager role problem solving 9 Management Function A- planning By sets the goals and direction for the organization or project. Planning mean include defining goals and objective to coordinate activity for implementing and evaluation. B-Organizer Deciding the task to be taken and done, who will do them, how to group the tasks. C- As leader Act as persuading and motivated people, direct activity resolving conflict, coordinate mean bringing people and activity to gather so that they function in harmony. D-Nurses as controller and evaluation Is to control and evaluate project or program. Monitors plan and ensure that it stays on course and realize that plan may not proceeded as intended 1. Decision making. 2. Transferring of information Management behavior 3. Engaging in inter personal relationship Three basic management skill: Management skill 1. Human skill. 2. Conceptual skill. 3. Technical skill. 5) Collaborator role CHN seldom practice in isolation, they must work with people including client, nurse, physician, teacher Etc. The leader ship focuses on effecting change, influence people to 6) Leadership role think and be having differently 10 7) Researcher role CHN involve in systemic investigation collection and analysis data for solving problem. Research process involve the following steps: 1.Identify an area of interest 2.Specify research question 3.Review the literature 4.Identify a conceptual from work 5.Select a research design 6. Collect and analyze data. 7.Interpret data and result 8.Communicate and finding Setting for community health care practice: 1- Home 2- Ambulatory service 3- School 4- Occupational health setting 5- Residential institutions 11  Unit Three The Community as a Client Dimension of the community as client Three feature of community: 1- Location 2- Population. 3-Social system Location variable consist Serve as basis for measuring incidence of wellness and illness and determine spread of disease 1- Boundary of community Where the community is located, what is boundary, large and A. Community health implications small community Atlas, maps telephone book public library B. Community assessment question Use of health service depends on availability and accessibility C. Information sources Injury, death, floods, earthquake, volcanoes 2- Location of health service..e.g.: what is the average temperature? What are the extremes? 3- Geographic features What climatic feature affects health and fitness? 4- Climate extreme temperature Poisonous plants and disease carrying animals can affect community health plants and animals offer recourses as well as 5- Flora and Fauna dangers All human influence on environment housing, dams, farming 6-Human made environment type of industry, chemical waste, air pollution. 12  Population variable consist Number of people influence number and size of health care institutions size affect homogeneity of the A) Size: population need e.g..: urban, suburban or rural ↑ Density ↑ stress, or density affects the availability of B) Density health services. It determines type of health need, what is the age mostly C) Composition over 65 or younger, sex male more or female. Rapidly growing community place excessive demands on D) Rate of growth or decline health services marked decline in population may signal a poorly functioning community. E) Cultural differences Health need vary among sub cultural and ethnic population Utilization of health service varies with culture F) Social class Class difference influences the utilization and cost of health services, income level, educational level, occupation It affects continuity of care and availability of service to G) Mobility highly mobile population. e.g. migrant workers 1.Health system 2. family system Social system variables 3.Economic system 4.Educational system 5.Religions system 6.Welfare system 7.Political system 8.Legal system 9.Recreational system 13  Each system must fulfill its function for the healthy community collaboration among these system to Identify goal and problem affect health Types of community needs assessment The Nursing process applied to the community as client: Nursing assessment of the community: - Assessment is the first step of the nursing process, Assessment for nurses means collecting and evaluating information about a community health status to discover. Assessment involves two major activities: 1. Collection of data. 2. Analysis and interpretation of data.  It is difficult to determine the type of assessment needs in advance the decision will be facilitated by understanding several different types of community assessment: 1- Familiarization or Windshield It involve Studying data already available on the community and survey gathering a certain amount first hand data to gain a working knowledge of the community.This type of assessment is needed whenever the community health nurse works with families, groups. 2- Problem oriented assessment It began with a single problem and assesses the community in terms of the problem. The problem oriented assessment is commonly used when formalization is not sufficient and a comprehensive assessment is has expensive 3- Community sub system assessment CHN focuses on a single dimension of community life. Community subsystem assessment can be a useful way for a team to conduct a more thorough community assessment. 14  Seek to discover all relevant community health information; it 4-Comprehensive assessment began with a review of existing studies and all the data presently available. It focuses on the strengths and capacities of community rather 5-Community Assets Assessment than its problem. Based on a model developed, Assets assessment begins with what is present in the community, the capacities and skills of community members. In community health nursing practice, there is (10) Essentials services listed below: 1. Monitor health states to identify health assessment with vital statistics and rise profiles 2. Diagnose and investigate health problem and health hazards in the community. e.g.: Epidemiologic surveillance system. Inform, educate and empower people about health issues. 3. Mobilize community partnerships and actions to identify and slow health problems e.g.: convening and facilitating community group to promote health. 4. Develop policies and plans that support individual and leadership development. 5. Enforce laws and regulation that protect and ensure safely. e.g.: enforcement at sanitary codes. 6. Link people to needed health services and ensure the provision at health care when otherwise unavailable 7. Ensure competent public health and personal health care workforce. 8. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 9. Research for new insights and innovative solutions to health problem 15 Community assessment method Type of assessment depends on variables and needs and the goal to achieve and the resources available. 1. Surveys 2. Focus group 3. Community focus or town hall meeting 4. Descriptive Epidemiologic studies 1-Survey A survey assessment method in which sees of question is used to collect data for analysis for a specific group or data. Phases of survey method: A-phase one Planning phase 1. Determine what information is needed and why 2. Determine data to be collected 3. Select population, e.g.: city, household individual 4, Select surrey method or instrument. e.g.: interviews, Telephone calls, questioners 5. Determine sampling.size percentage B-phase two Data collection phase 1. Identify and train data Collectors 2. Pretest and adjust instrument 3. Supervise actual collection including plans C-phase three Data analysis and presentation phase 1. Organize data for Analysis 2. Apply statistical Method 3. Determine relationship and significance of analysis 4. Report results 16 2-Descriptive epidemiological studies  It examines the amount and distribution of a disease OR Health condition in a population  It is useful to identify individual at risk when, where the condition might occur 3-Town Hall meeting This method used to elicit public opinion on a variety of issues. Chain of causation… 1. Reservoir  Where causal agent can live and multiply  Example: malaria 2. Portal of Exit  How the agent gets in to a host  Example: mosquito bite 17 3. Mode of transmission  How agent travels from one system to another  Example: body of the Anopheles mosquito 4. Agent  Causative factor contributing to the health problem  Example: 4 different types of protozoa that cause malaria 5. Portal of entry  How the agent gets in to a host  Example: mosquito bite 6. Host 1. Human 2. Now becomes a reservoir 3. Sets up another cycle. 4. Chain of causation of infectious disease 18  Unit Four Epidemiology in community health care Epidemiology: Definition "Is the study of determinants and distribution of health disease and injuries in human population" The ultimate goals of Epidemiology are: 1. Determine the scale and nature of human health problems 2. Identify solution to prevent disease and improve the health of entire population. 3. Epidemiology offers community health nurses a specific methodology for assessing the health of aggregates 4. Furthermore it provides a frame of reference for investigating and improving clinical practice in any setting. An epidemic: Refer to disease occurrence that clearly exceeds the normal or expected frequency in a community region in past epidemic of cholera. Pandemic: is a worldwide distribution disease for example AIDS acquired immunodeficiency syndrome. Epidemiologic Triad Agent: The true cause of a health problem OR Disease without which it cannot occur. 19 Its presence OR absence can cause a disease Presence = bacterium = TB Absence = Fe = anemia Agent are either infectious (communicable) OR noninfectious (non communicable) Agent factors include 5 types: Physical: 1- Genetically transmitted 2- Mechanical e.g. automobile 3- Material e.g. rockslide 4- Atmospheric e.g. ultraviolet radiation Biological: 1- Bacteria 2- Viruses 3- Fungi 4- Protozoa Chemical: 1- Liquids 2- Gas 3- Solids Nutrient: Essential dietary components that can produce illness condition if they deficient or are taken in excess e.g. excess of vitamins A can be toxic. Psychological: Events producing stress that lead to health problems. Host The host is a Susceptible human or animal who harbor and nourish a disease- causing agent. 20  Host physical factors Host life style factor Psychological factor 1. Age... is the single most important!! 1. habits 1. Such as out 2. Gender/sex 2. personal hygiene 2. look and respond to 3. Ethnicity/Race 3. use of water 3. stress 4. previous disease history 4. Occupation 5. Immunity levels 5. Socio-economic status 6. Genetic influences Environment Referee to all external factors surrounding the host which may influence the vulnerability OR resistance. Factors include both physical and psychosocial Physical Environmental factors psychosocial Environmental factors 1. Geography Refer to social 2. climate / weather Cultural 3. water & food supply Economical 4. shelter/safety of buildings Condition that affect health such as 5. work conditions access to health care culture health practice Communicable disease definition: Is one that can be transmitted from one person to another caused by agent that is infectious and transmitted from a source or reservoir to the susceptible host? Why it is important for CHN to know about communicable disease Communicable disease are responsible for high morbidity among varies age and population groups 2- To prevent and control communicable disease 3- To decrease morbidity and mortality 4- To prevent and decrease resistant of bacteria and viruses to drugs 5- To prevent chronic disease and cancer 21 Infection  The entry and development or multiplication of an infectious agent in the body of man or animal it also implies that the host response in some way to the invading agent six characteristic of an infectious agent. 1. Infectivity 2. Pathogenicity 3. Virulence 4. Toxicity 5. Invasiveness 6. Antigenicity Control strategies of vector born disease 1. Educates the population of insect by spraying and insecticides to kill mosquitoes 2. Treating the natural habits of vector to reduce population density 3. Use of mosquito nets or screened windows to control malaria 4. Educating public about preventive and protection measure Primary prevention: 1-Education 2-Immunization Education By using mass media 4 major roles of the media 1. Use of media as primary change agent, community, increase knowledge about education program Communicable disease and prevention measure 2. Increase participation in preventive services 3. Disease prevention massage 22 Immunization:  Is the most effective and rapidly applicable measure for the protection of the susceptible host at relatively low cost. Immunization may be: 1- Natural 2- Acquired Vaccine: are one of the most effective methods of preventing and controlling communicable diseases Immunity: ability of the host to resist a particular infectious agent. Passive immunity  Short term resistant that is acquired either naturally or artificially.  Newborn through maternal antibody transfer have natural passive immunity is attained that last 6month.  Artificial passive immunity is attained through inoculation with vaccine that gives temporary resistance.  It is used to provide passive immunity against certain infectious diseases or modify severity for example rubella, varicella-zoster. Active immunity  Long term and sometime lifelong resistance the acquired naturally or artificially.  Naturally acquired active immunity comes through host infection that is a person who contacts a disease often develops long lasting antibodies that provide immunity against future exposure.  Artificially acquired active immunity is attained through vaccine inoculation such as polio, small pox, diphtheria. 23 Passive immunity differs from active immunity in the following aspects: (A)- Immunity is rapidly established. (B)-immunity produced is only temporary. (C) - There is no education of the reticule- endothelial system (D) Is employed when a susceptible person has been exposed to the risk of infection (e.g.: measles) and there is not sufficient time left to induce active immunity. The concept of Herd immunity:  Is the immunity possessed by the total population against a specific disease, it provides an immunological barrier to the spread of disease in the human herd.  E.X: when an infection disease is introduced in to a “virgin" population - that is population with a very low or immunity - the attack and case fatality rates tend to be very high Contraindications to vaccination 1. Anaphylactic reaction to vaccine 2. Moderate or severe illness with or without fever 3. Encephalopathy within 7 days of administrative of previous dose of DPT 4. Infection with HIV know altered immunodeficiency e.g. immunosuppressive therapy 5. Pregnancy 6. Anaphylactic reaction to egg ingestion and to neomycin 7. Fever> or = 40.5 c 24 Precaution for immunization: 1. Seizures 2. Fever 3. Shock 4. Pregnancy Adult immunization: 1. Occupational exposure to blood, blood produce or other potentially contaminated body fluids E.G (hepatitis B vaccine) 2. All persons should receive tetanus vaccine every 10 year unless they have experienced major and /or contaminated wounds 3. Individual should receive a single booster of (TT) tetanus taxied on the day of injury if more than 5 year passed since their last (TT) dose 4. Pneumonia and influenza vaccines 5. Condition of high risk chromic respiratory disease D.M heart disease Incubation period Incubation period: "The interval from receipt of infection to the time of onset of clinical illness." Mode of transmission 1- Horizontally: Refers to person-to-person spread of infection through one OR more of the following four roles: A-Direct/indirect contact: E.g. sexually transmitted diseases are spread by direct sexual contact enterobisasis B-common vehicle Refers to transportation of the infection agent from an infected host to susceptible host via water food, milk, blood, serum, or plasma. E.g. hepatitis A: can be transmitted through contaminated food or water 25 C-Airborne:  Legionellosis and TB are both spread via contaminated droplets in the air. D-Vector borne:  Vectors can be arthropods, such as ticks and mosquitoes, or other invertebrates, such as snail, that can transmit the infectious agent by or depositing the infective material near the host. 2-Vertically  Refers to passing the infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal a birth.e.g. Transplancental transmission of HIV and syphilis. Cholera  Cholera is a water borne disease caused by the bacterium Vibrio cholera, which is typically ingested by drinking contaminated water, or by eating improperly cooked fish, especially shellfish. Epidemiology Susceptibility:  Recent epidemiologic research suggests that a person's susceptibility to cholera (and other diarrheas) is affected by their blood type.  Those with type O blood are the most susceptible. Those with type AB are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B. Transmission  Cholera is then transmitted through ingestion of feces contaminated with the bacterium. The contamination usually occurs when untreated sewage is released into waterways or into groundwater, affecting the water supply, any foods washed in the water. Symptoms  Symptoms include those of general GI tract upset, including profuse diarrhea. Symptoms also include terrible muscle cramps. 26 Prevention  Although cholera can be life-threatening, it is easily prevented. In the United States and Western Europe, because of advanced water and sanitation systems.  Simple sanitation is usually sufficient to stop an epidemic. There are several points along the transmission path at which the spread may be halted: 1- Sickbed: Proper disposal and treatment of waste produced by cholera victims. 2- Sewage: Treatment of general sewage before it enters the waterways. 3- Sources: Warnings about cholera contamination posted around contaminated water sources. 4- Sterilization: Boiling, filtering, and chlorination of water before use. Treatment  Treatment typically consists of aggressive rehydration and replacement of electrolytes, since the death rate is generally high due to the serious dehydration caused by the illness.  Tetracycline antibiotics may have a role in reducing the duration and severity of cholera, although drug-resistance is occurring. And their effects on overall mortality are questioned. Measles  Measles, also called rubella, is a highly contagious - but rare - respiratory infection that's caused by a virus. It causes a total body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Signs and symptoms  While measles is probably best known for the full body rash that it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and watery red eyes. Another marker of measles is koplik's spots, small red spots with blue- white centers that appear inside the mouth. 27 Prevention  Infants are generally protected from measles for 6 to 8 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations.  For most kids, the measles vaccine is part of the measles - mumps - rubella immunizations (MMR) given at 12 to 15 months of age and again at 4 to 6 years of age.  Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, the vaccine may be given when a child is 9 months old, followed by the usual MMR immunization at 12-15 months. Transmission  Measles is a highly contagious airborne pathogen which spreads primarily via the respiratory system.  The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Complications  Complications with measles are relatively common, ranging from relatively common and less serious diarrhea, to pneumonia and encephalitis.Complications are usually more severe amongst adults who catch the virus. Treatment  The symptom of measles usually lasts for about 2 weeks. It is highly contagious, and 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person. Tuberculosis  Tuberculosis is the most common cause of infection- related death worldwide WHO declared TB to be a global public emergency  A mycobacterium Tuberculosis is a causative organism it is usually affects the lung but can also affect other parts of the body such as brain, kidney, or spine 28   TB bacteria become active if the immune system cannot stop them from growing the active bacteria multiply in the body and cause TB disease  Is mainly transmitted by exposure to tubercle bacilli in airborne droplets from persons with pulmonary Tuberculosis during talking, coughing, or sneezing. High risk group 1. Children less than 3 years 2. Adolescents 3. Young adults 4. Old aged 5. Immunosuppression 6. Substance abuse 7. D.M 8. Sever kidney disease Mode of transmission Droplet infection, airborne infection Symptoms of pulmonary TB 1. Non-productive cough 2. Fever 3. Hemoptysis 4. Chest pains 5. Weight loss 6. Night sweats 7. Anorexia 8. Atelectasis Incubation period; (4 to 12 The most critical period for development of clinical disease as the first (6 - 12 weeks) months after infection) 5% of those initially infected may develop pulmonary Tuberculosis OR extra pulmonary involvement. 5% of those initially infected becomes latent and may be reactivated later in life. 29 Diagnosis The screening tests tuberculin skin reactors with pulmonary symptoms PPD purified protein derivative should be injected in 0.1ml intradermal on to the test should be read in 48-72 hrs. measuring the amount of duration Confirmatory tests include: 1- stained sputum smears 2- other blood fluids 3- demonstration of the acid - fast bacilli 4- Culture of the tubercle bacilli for definitive diagnosis. The appropriate multiple combination of antimicrobial drugs; Treatment isoniazide (INH) Rifampcin (RIF) streptomycin Treatment failure is due to: Poor compliance to taking medication. Development of drug resistance. Prevention 1. Periodic screening for all aged PPD 2. BCG vaccination 3. Public education focusing on high risk population Human immunodeficiency virus  HIV infection is caused by a retrovirus that attacks body's immune system two type have been identified type 1 and type 2 HIV causes immunological deficiencies that leave the host susceptible to opportunistic infections and cancers. A-Transmission 1- Exposure to blood 2- Semen 3- Vaginal secretions 4- Breast milk 30  5- Sexual contact 6- Involving the exchange of body fluids 7- Prenatal transmission from an infected mother to her Fetus during pregnancy 8- Needle and syringe sharing HIV is not transmitted through 1- Causal contact 2- Insects 3- Coughing 4- Sneezing 5- Sharing office equipment 6- Sitting next to or eating with someone who has HIV infection. Prevention  The CHN serves as an educator about the modes of transmission, as well as a role model for how to behave toward and provide supportive care for those with HIV infection.  Counselling to prevent further spread of disease AIDS in the community The CHN teaches families and significant others about:  Personal care and hygiene  correct medication administration  Universal precautions to ensure infection control  Healthy life style behaviors (such as adequate rest, balanced nutrition and exercise). Because of impaired immunity children with HIV infection are most likely to get childhood diseases and suffer from serious squeals Therefore:  DPT (diphtheria - pertussis - tetanus)  IPV (inactivated - polio -virus)  MMR (measles - mumps - rubella)  Vaccines should be given at regularly scheduled times for children infected with HIV 31 Sexual transmitted disease STDS Complication of STDs is 1- Pelvic inflammatory disease 2- sterility 3- Ectopic pregnancy 4- Blindness 5- Cancer 6- Fetal and infant death 7- Birth defects 8- Mental retardation Community health Nursing Role in Preventing Sexual transmitted disease (STDS) 1- Primary prevention  Assessing for risk behavior and providing relevant intervention through education on how to change risky behaviors. 2- Secondary prevention  It includes the early identification and treatment of STDs as well as follows up with sex and drug using partners to prevent further spread.  In general client teaching and counseling should include preventing reinfection with a curable, STDs, managing symptoms, and preventing the infection of others with chronic STDs 3- Tertiary prevention  Can apply to many of chronic STDs, such as HSV, HIV and untreated syphilis.  For viral STDs, much of this effort focuses on managing symptoms and psychosocial support regarding future interpersonal relation.  Much of the effort in tertiary prevention focuses on clients with AIDS whom return home and is unable to provide care for themselves because of progressing illness. 32  Example on STDs 1-Gonorrhea Causative agent------ gonococcus bacteria Neisseria Gonorrhea Sign and symptom In men ------ purulent discharge from penis Accompanied by painful urination Incubation period within 2-7days after infecting Exposure in women Symptoms include 1- Inflammation and erythema around the opening of the urethra 2- A very purulent urethral discharge 3- Dysuria or painful urination Some men remain asymptomatic or ignore early manifestation and thus are open to further complication which include 1- Inguinal lymphadenitis 2- Urethral structure 3- Local abscess formation and inflammation of other structure e.g. epididymitis, prostatitis 4- Skin lesion 2-Syphilis Causative agent is traponemia palladium Incubation period 10-90 days average 21days 1- Primary syphilis: (1-6months commonly 6-8 weeks) After 3 weeks of exposure to infection a primary lesion chancre is a firm or painless ulcer often on the pain vagina or rectum it persist for 4-6 weeks and then head without treatment 33 2- Secondary syphilis: Development of secondary skin eruption this symmetric reddish-pink non-itchy rash on the on sols of feet's pa of hands 3-Tertiary syphilis: From one year after the initial infection till 10 years late period sever systemic Involvement e.g. joint deformity and Neurological complication, cardiovascular syphilis lead to disability and death 3-chlamedia Caused by Chlamydia trachomatis Symptoms: Are sign of complication as pelvic inflammatory disease, ectopic pregnancy, infertility pneumonia for infant? It is important to remember  STDs affect men and woman of all background and economic levels and they are most among teenagers and young adult nearly 25years  The incidence is rising in last few decades young people become sexually active earlier and marriage late, divorce is more common  The symptom may be confused with other symptoms and the person may pass the disease and complicated more CHN role 1- Case finding 2- Education 3- Identifying high risk people e.g. international travelers 34 Vector borne Diseases  They Are diseases transmitted by vectors, usually insects, either biologically OR mechanically.  The biologic transmission: the vectors is necessary for the developmental stage of the infection agent (e.g.: mosquitoes that carry malaria)  Mechanical transmission: occur when an insect simply contacts the infectious agent with its legs or mouth parts and carries it to the host that may contaminate food or cooking utensils.  Malaria and dengue fever: carried by mosquitoes is carried by fleas of wild Rodents. 35  Unit Five Environmental Health and safety Food born and Waterborne Diseases  Food borne illness OR "food poisoning" often categorized as food infection OR food intoxication. Food infection: results from bacterial parasitic infection of food. (e.g.: salmonellosis – Hepatitis trichinosis). Food intoxication: results from toxins produced: bacterial growth, chemical contaminants, and a variety disease-producing substances found naturally in certain food 1- Salmonellosis It is a bacterial disease characterized by a sudden onset of 1. Headache 2. Diarrhea 3. Nausea Incubation period: (48 hours) The rate of infection is highest among infants and small children. Outbreaks occur commonly in 1. Restaurants 2. Hospitals 3. Nursing home 4. Institution for children Transmission Is ingestion of food derived from in infected animal or contaminated by feces of an infected animal or person. Meat, poultry and egg are the foods most often associated with reservoir: Salmonellosis out breaks. Animal are the common reservoir for the various Salmonella serotypes, Carriers: although infected humans also may fill this role. 36  2- Escherichia Coli  It belongs to enter hemorrhagic category E. coli serotypes which produce a strong cytotoxic that can cause a potentially fatal hemorrhagic colitis.  Undercooked hamburger has been implicated in several outbreaks, as less commonly have roast beef, unpasteurized milk and apple cider, and municipal water. Symptoms: 1. Bloody diarrhea 2. Abdominal cramps 3. Infrequently fever Ten Golden Rules for Safe Food Preparation 1. Choose food processed for safety 2. Cook- food thoroughly 3. Eat cooked food immediately 4. Store cooked food carefully 5. Reheat cooked foods thoroughly 6. Avoid contact between raw foods and cooked foods 7. Wash hands repeatedly 8. Keep all kitchen surfaces meticulously 9. Protect food from insects, rodents and other animals 10. Use pure water. 37 Sources of water pollution: Principal sources of water pollution are: 1. Industrial discharge of chemical wastes and byproducts. 2. Discharge of poorly-treated or untreated sewage. 3. Surface runoff containing pesticides. 4. Slash and burn farming practice, which is often an element within shifting cultivation agricultural systems. 5. Surface runoff containing spilled petroleum products. 6. Surface runoff form construction sites, farms, or paved and other impervious surfaces e.g. silt 7. Discharge of contaminated and/or heated water used for industrial processes. Some inorganic water pollutants include: 1- Heavy metals including acid mine drainage. 2- Acidity caused by industrial discharges (especially sulfurdioxide from power plants). 3- Chemical waste as industrial by products. 38  Unit Six Family Assessment Health families demonstrate six important characteristic: 1- There is a facilitative process of interaction among family member.  Healthy family are interaction regular, communicate, their patterns of varied and supportive active communication is necessary for a family to carry out basic function to demonstration affection, acceptance and affiliation. 2) They enhance individual member development.  Healthy families are responsive to their individual members needs and provide the freedom and support necessary to promote each members growth. And increase competence, self- reliance social skills. Intellectual growth and over all capacity for self-management among family members. 3) Their role relationships are structured effectively.  Healthy family structures their role relationship to meet changing family need over time in a stable social context.  Some families may establish member roles and tasks such as workable patterns though out the life of the family. 4) They actively attempt to care with problems. 5) They have a healthy home environment and life style. 6) They establish regular links with the broader community. 39 Family Function Every family performs certain basic functions such as: 1. Affection, security, identity, affiliation 2. Socialization and control. 3. To a achieve economic survival. 4. To provide physical protection to individual member. 5. To pass on the religions faith. 6. To educate it’s young. 7. To confer status. Fifteen traits of a healthy family 1. The family communicate and listen healthy spouses complement one another. 2. Family member affirm and support one another. 3. The Family teaches respect for individual member and another's. 4. The Family develops a sense of trust between and among its own members. 5. The Family has a sense of humor and play, the family Recognize it needs to play. 6. The Family exhibits a sense of shared responsibility. 7. Teaches right and wrong. 8. The Family has a shared religions care and respect Religions differences. 9. The Family member respect the privacy of one another 10. The Family member values service to other within and outside the family unit. 10. The Family fosters family table time and conversation and encourage expression of individual feeling. 11. The Family shares leisure time and values Opportunities to spend time together. 40  12. Family has a balance of interaction among its member. 13. Family admits and seeks help with problem that cannot Solved among its member. 14. There is a strong sense of family in which rituals and Traditional a bound and there is often an identifiable Locus either person or place for activity. Assessment tools: 1. Ecomap is a diagram of the connection between a family and other systems in its ecological environment. 2. Genogram display families information graphically in the way that provide a quick view of complex family pattern 3. Sculpture Tool for gathering data: 1. Questioners 2. Checklist 3. Interview 4. Videotaping family interaction 5. Structured observation. 6. Analysis of life changing events. Guideline for family health assessment: 1. Focus on the family not the member 2. Utilize assessment question 3. Allow adequate time for data collection. 41  4. Assessment can be quantities as well as qualitative 5. Use family assessment tools with caution. Family Abused  Acts of family violence range from negligence to physical battering sexual abused.  Characteristic that seem statistically related to both wife and husband - beating are as follows:- 1. Husband employed part time or unemployed. 2. Family in come at or below poverty level. 3. Husband is a manual worker. 4. Husband is very dissatisfied with her family’s standard Of living. 5. The couple has two or more children. 6. The couple disagrees over how to raise or discipline children. 7. Either or both spouses grow up in a home where the father hit the mother. 8. The couple has been married less than 10 years. 9. The couple is aged 30 or under. 10. The family is non-minority. Violence toward children (child abuse):  The national center for child abuse and neglect has identified the following as signs of abuse in children: 1. Any injury in an infant under 12 month of age. 2. Gross or multiple injuries in a child at any age. 42  3. Repeated injuries or fracture illness stages of healing. 4. Intracranial injury. 5. Un expected weight loss 6. Severe malnutrition or failure especially very young child. 7. General disease or signs of genital trauma. Signs of Physical abuse Physical indicators:  Unexplained bruises and welts on the face, throat, upper arms, buttocks, thighs or lower back in unusual patterns or shapes which suggests the use of an instrument (belt buckle, electric cord) on an infant in various stages of healing that are seen after absences, weekends, or vacations.  Unexplained burns, cigarette burns, especially burns found on plams, soles of feet, abdomen, buttocks; immersion burns producing (stocking) or (glove) marks on hands and feet; (doughnut shaped) on buttocks or genital area.  Rope buns.  Infected burns indicating delay in treatment; burns in the shape of common household utensils or appliances. Behavioral indicators:  Behavioral extremes (withdrawal, aggression, regression, depression).  Inappropriate or excessive fear of parent or caretaker  Antisocial behavior such as substance abuse, truancy, running away, fear or going home.  Unbelievable or inconsistent explanation for injuries. 43   Lies unusually still while surveying surroundings (for infants).  unusual shyness, wariness of physical contact Sings of Sexual abuse Physical indicators:  Torn, stained or bloody underclothes.  Frequent, unexplained sore throats, yeast or Urinary infections.  Somatic complaints, including pain and irritation of the genitals.  Sexually transmitted diseases.  Bruises or bleeding from external genitalia, vagina and anal region.  Pregnancy. Behavioral indicators  The victim's disclosure of sexual abuse.  Regressive behaviors (thumb-sucking, bedwetting, fear of the dark).  Promiscuity or seductive behaviors.  Disturbed sleep patterns (recurrent nightmares).  Unusual and age- inappropriate interest in sexual matters. Avoidance of undressing or wearing extra layers of clothes.  Sudden decline in school performance, truancy.  Difficulty in walking or sitting. Signs of Emotional abuse Physical indicators:  Eating disorders, including obesity or anorexia. 44   Speech disorders (stuttering, stammering).  Developmental delays in the acquisition of speech or motor skills.  Weight or height level substantially below norm.  Flat or bald spots on head (infants).  Nervous disorders (rashes, hives, facial tics, stomach aches). Behavioral indicators:  Habit disorders (biting, rocking, head - banging). Cruel behavior, seeming to get pleasure from hurting children, adults or animals; seeming to get pleasure from inappropriate behaviors bedwetting, wetting, and being mistreated.  Age soiling)..Behavioral extremes, such as overly compliant demanding; withdrawn - aggressive; listless - excitable. Signs of Neglect Physical indicators:  Poor hygiene, including lice, scabies, severe or untreated diaper rash, bedsores, body odor.  Squinting.  Unsuitable clothing; missing key articles of clothing (underwear, socks, shoes); overdressed or underdressed for climate conditions.  Untreated injury or illness.  Lack of immunizations.  Indicators of prolonged exposure to elements (excessive sunburn, insect bites, colds).  Height and weight significantly below age level. Behavioral indicators:  Unusual school attendance. 45   Chronic absenteeism.  Chronic hunger, tiredness, or lethargy.  Begging for or collecting leftovers. Addiction Definition  Is defined as a compulsive use and impaired control over use of a substance, pre occupation with obtaining and using the drug, and continued use despite adverse consequences Etiology of addiction  There is no consensus about the causes of alcohol and drug addiction but there is possible factors such as physiologic, social psychological. Vulnerable substance abusing population 1) Biological variables  Family history.  Genetic predisposing.  Body chemistry.  Disease 2 Psychological variable:  Drug experimentation.  Maladaptive coping.  Stress relief.  Chronic pain.  Significant loss. Social activity.  Low self-esteem. 46 3 Socio cultural variable  Lack of knowledge.  Misleading information.  Advertising promotion.  Over prescribing.  Lack of quality control 4 Environmental variable  Dysfunctional family.  Abusive relationships.  Peer pressure.  Drug availability.  Public misconception. 47  Unit Seven School health nursing Definition A especially branch of professional nursing that serves the school-age population Health problem of school aged children 1. Accident and injury 2. Communicable diseases 3. Chronic diseases 4. Behavioral problems and learning disability 5. Head lice 6. Poor nutrition and dental health Health problem of adolescence 1. Emotional problems and teenage suicide 2. Violence 3. Substance abuse 4. Teenage pregnancy 5. Sexual transmitted diseases 6. Acne Components of school health: 1- School health services. 2- School health Education. 3- School health Environment. 4- Health promotion 5- Counseling. 6- School nutrition services 7- Physical health program 8- Family and community participation 48 1-School health services A- Basic care: e.g. ; ( answering questions about personal hygiene, Asthma, diabetes). 1- Primary care: e.g. monitoring immunization insulin injection). 2- Screening: (e.g.: assessment of vision, hearing) B-Specialized care: (e.g.: special health services for any one disabled). 2-School health education The prevision of health instruction is aimed of knowledge, attitudes and behavior that maintain and enhance wellness and prevent or minimize. Disease A-Philosophy  learning styles - learning strategies  Participation  Health environment (physical, social) B-Curriculum  Planned  Organized C- Personal  Develop, deliver and evaluate relevant programs D-Students 1. Physical environment 2. Social environment 3. Psychological environment E-evaluation F-System Theory  In put (Throughout)......out put  Feed back 49 3-School health environment 1. Physical environment  Geographic location  lightning  Noise  Safely 2. Psychological  Emotional and social condition  Interactions for students, activity 3. Cultural environment  Values  Beliefs  Language  Communication Screening in school health 1- For Screening tests consider: A-Sensitivity and specificity:  Sensitivity: if generated too many inappropriate referrals is (over sensitive) Specificity: specific for the disease B-cost-Benefit C-Acceptability: test as blood test or urine test 2-Type of screening test  Vision screening  Cardiac screening (B.P,Ht sound)  Throat screening  Hearing screening - The school health program will include planning for activity at all three levels of prevention, primary, secondary, tertiary 50 A-Primary prevention:  Immunization (e.g.: hepatitis A) o safety (safety education, hazards) o food and nutrition  Self-image (role model, problem solving) o coping skills (stress and coping) o interpersonal skills (communication) B-Secondary prevention:  Screening test  Referral  Counseling  Treatment (injury, medication) C-Tertiary prevention:  Prevention recurrence of acute condition  Preventing complication of chronic disease (D.M Disability Ht.diseases)  Preventing adverse effects of learning disabilities. Roles of CHN in school: 1- Promote health of children 2- Provide health assessment 3- Develop and implement health plan referral and counseling 4- Participate in health education program 5- Planes and implement school health protocols for child with special needs 1. Management 6- Participate in home visits to assess family of the student 7- develop procedure for crisis intervention 7- Assists in the control of communicable diseases 51  Unit Eight Home visit Definition: Is a formal call by a nurse on a client at the client’s place of residence for the purpose of providing nursing care Advantages  Convenient for the family  Client control of the setting.  When client is unable to travel.  Nurse identify minor health changes.  Nurse can see other factors influences client health. Disadvantages 1- High cost 2- Pre- visit preparation 3- Travel to & from the home 4- Time spent with family. 5- Post visit activities. 6- Paper work. 7- Making referrals. 8- Consulting, collaboration. Principles of Home Visiting 1. Home visiting should be made according to the need of the family. 2. Be sensitive to the members feeling and needs at the time of visiting. 3. Understand the other person’s point of view and accept useful suggestions made by the family. 4. Be sure of the scientific soundness of the subjects you discuss. 52  5. Use safe technical skills and nursing procedures. 6. Have a full understanding of your agency s policies. 6. Attain working knowledge of the community resources and use them wisely. 7. Collect background information about the client, home and the environment and make an objective analysis of the information as an initial step in home visiting. 8. Work with the client and family and plan jointly Home visiting Technique: 1. To provide family health services to prevent diseases, promote and maintain health the family member. 2. To carry out simple nursing care at home for the needy clients. 3. To provide treatment for minor ailments 4. To rehabilitate the sick and the disabled members of the family 5. To help the family to help themselves to maintain their health. Nurse Client Contact: Strategies & Technique Home visits Objectives: 1) List the purposes, advantages and disadvantages of home visit. A. Purposes of home visit B. A advantages and disadvantages of home visit 2) Describe the phases of home visits and activities Involved. A. Initiation phase B. Pre- visit phase C. In-home phase 53  D. Termination phase E. Post-visit phase 3 Describe the technique of home visiting. 4 Demonstrate correct bag technique 5 Identify the purpose of contracting. 6 Describe the phases of contracting. Equipment and logistics: 1- Prepare and keep ready all necessary equipment (s) in a home visiting kite \ bag To: A-assess new born B- Infant C- Child D-pregnant woman E-adult clients Refer to page on home visiting kite \ bag. 2- Keep ready all documents and records needed for home visiting and family assessment. 3- Obtain transport if needed as scheduled. 4- Make a survey and prepare a map of the area with: A- Details of topography B-Location of villages C-Population D-House numbers E-Different land marks 54  F-Roads phase Activity Initiation phase Clarity source of referral for visit. Clarity purpose of visit. Share information on reason and purpose of home visit with family. Pre-visit phase Initiate contact with family. Establish shared perception of purpose with family. Determine family s willingness for home visit. Review referral and family record. phase Activity In-home phase Introduction to self and professional identity. Establish nurse- client relationship. Implement nursing process. Termination phase Review visit with family and plan for future visit. Post-visit phase Record visit, plan for next visit 3- Weight the criteria.  In this step, the decision maker sets priorities OR ranks activities OR in order of importance from least important to most important as they relate to the specific situation.  Because the weighting is specific to the situation, an activity may be ranked as most important in one situation and of less importance in another situation. 4-Seek alternatives  In this step, the decision maker identifies all possible ways to meet the criteria. 55   In clinical situation, the alternatives may be selected from arrange of nursing interventions OR client care strategies. 5- Test alternatives  The nurse analyzes the alternatives to ensure that there is an objective rationale in relation to the established criteria for choosing one strategy over another. 56  Unit Nine Older Adults Aging In Place Care of the aged [Elderly]  The elderly population group poses a special challenge for community health nursing.  Old age should be regarded as a normal inevitable biological phenomenon.  The increasing life span has increased the number of old age.  Significant economic, environmental, and social change create a demand for greater protective and preventive services for older adult in addition to requiring adjustments in health care provision patterns. Definition  The elderly have been described as people who are 65 years or older. Factors affecting the health of the elderly 1- The ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging. A-Good health in the elderly means maintaining the maximum degree of physical, mental and social vigor of which one is capable. B- Good health mean being able to adapt, to continue to handle stress, and to be active and involved. 2- Good health is influenced by many factors such as: A- Personality traits B-life experience C-current physical health D-current societal supports. 3- A life style of health habits during the elderly years contributes to the well-being of older adults because the continuation of healthy habits and the addition of age. 57 4- Specific habits improve the quality and quantity of life. 5- Moderation in exercises, diet, environment, regular physical check-up and adherence to prescribed treatment regimens, also play an important role in maintaining the health elderly. Physical and psychosocial changes in aging process Physical as well as psychosocial or developmental changes accompany aging. The observed changes represent the cumulative and altered health status. Normal Changes in Aging Integumentary system. Hair and Nails 1. hair thin and gray 2.receding hairline 3. Thicker nails. Sight 1. Increased opacity of lens 2. grayish white corneal ring 3. less tearing 4. droopy eye lids 5. inability to focus on near objects Hearing 1. slight decline in hearing 2. especially for high frequency tones Touch 1. decreased differentiation of cold 2. heat 3. touch sensations Smell 1. diminished sense of smell 2. prominent on protruding nose Taste 1. diminished taste bud sensations 2. less saliva 3. dry mouth 58  Skin 1. Wrinkles 2. Thinning 3. drier 4. easily bruised 5. decreased perspiration 6. spotty pigmentation Musculoskeletal system: 1. Flabby muscles 2. Less energy and more frequent fatigue 3. Slower and shorter gait 4. Less swinging on arms 5. Stooped posture 6. Loss of height 7. Some rubbing of articular - cartilage in joints 8. Stiffening of joints Cardiovascular - Respiratory system: 1. Lessened vital capacity 2. Decreased chest movement 3. Slower pulse 4. Increased systolic and decreased diastolic pressures 5. Poor reaction to increased and sustained on heart activity Gastrointestinal - Genitourinary system: 1. decreased motility of gastrointestinal system (organ) function 2. Less secretion of digestive enzymes and acid secretions 3. Slower emptying of stomach 59 4. Decreased filtering ability of urinary system 5. Polyuria 6. Drier vaginal mucosa 7. Enlarged prostate glands Nervous system: 1) Atrophy of brain cells 2) Slower reflexes Mental changes: 1) Impaired memory 2) Rigidity of out look Emotional Problems: 1) Failure to adapt leading to withdrawal 2) Depression 3) Weariness of life Psychosocial Aspects of Aging: Coping with retirement Managing time Realignment of relationships Maintaining self-esteem Coping with loss and grief Abuse of the elderly 60 Coping with retirement 1. The ability to successfully adjust to retirement is affected by health status, income, number of situational changes and quality of personal relationships. 2. The ability to manage time effectively, flexibility ability to relinquish the work routine, and anticipation and realistic expectation of retirernent are other factors. 3. The two aspects of adjustment to retirement are how effectively, the retiree learns to restructure time and quality of personal relationships. Realignment of relationships  Retirees must often consider their relationships between themselves and significant others including spouse, family and neighbors.  Family relationships represent one of the challenges of this period.  Family relationships after retirement are the relationships between aging parents and their adult children.  The parent who - has always helped the family member now needs assistance with feeding bathing, dressing and mobility must rely on the adult children. Maintaining Self-Esteem Self-esteem is crucial in the later years of life. Elderly people must often modify the criteria they use to evaluate themselves to reflect their changed position Health Services for the Elderly Population Community health service system for the elderly. 1.Comprehensiveness 2.Coordination 3.Accessibility 4.Quality 61 Comprehensiveness  An effective community health service delivery system for the elderly should be Comprehensiveness.  Some of the programs are: limited health screening or selected activities.  Gaps as duplication of services result from poor community wide planning.  A comprehensive set of services should provide Following:  Health care services (disease prevention early Diagnosis and treatment and rehabilitation)  Health education including preparation for retirement.  Recreation and activity program.  Adult day care program. Coordination:  Often older person go from one to other. There should be coordinated community - wide assessment and planning.  Many elderly people need a range of services – dietary guidance, eye care, foot carem dental care, and social assistance, as well as, routine medical care. And these are best provided at one center. Accessibility:  Too often services for the elderly are not conveniently, located OR are prohibitive in cost.  Some communities are considering multi – service community centers to bring programs and services for the elderly closer to home. Quality:  Finally, the effective system for the elderly promotes quality programs.  By that it is meant service that truly addresses the needs and concerns of the elderly.  Evaluation of the quality of a community s services for the elderly is closely tied to their assessed needs. 62   Planning for quality of community s services depends on having adequate and accurate current data.  Periodic need assessment is a necessity to ensure updated information and quality services. Implications for Community Health Nursing (Role of Nurse in the care of the elderly)  Community health nurses need to be proactive, designing interventions that maximize nursing resources and provide the greatest benefit to elderly clients.  Many of the elderly population’s health problems can be prevented and their health promoted.  Nurses must analyze and capitalize on the elderly strength, not to focus only on their problems, as the goal is to enable the older people to thrive, not merely to survive.  Change to a healthier life style is one of the most important preventive measures the nurse can emphasize.  Examples include stopping smoking, eating regular and well balanced meals, exercising regularly, keeping weight within normal body weight with normal for body build, getting proper rest and maintaining a healthy emotional outlook.  Educating the elderly about their health conditions and use of their medications is another important way to prevent problems. Health Needs of the Elderly  Aging is a normal irreversible physiological process  Aging in itself is not a problem.  Certain people do experience some problems associated with aging.  Many of these problems can be prevented. 63   The elderly are more likely than younger person to suffer from multiple, chronic and often disabling conditions.  The leading causes of death among population aged 65 and over are heart diseases, cancer, stroke, pneumonia, chronic obstructive pulmonary diseases and diabetes  The most frequent problems experienced by the older Population in the community are: a- Arthritis b- Reduced vision c- Hearing loss d- Heart conditions and hypertension. Depression  It is a difficult problem of the aged, loss of spouse, loss of friends, economic problems, physical disease and disability, loneliness, OR drug side effects I can make an elderly person feel that life holds meaning. Social and emotional with drawl often occurs. Some other specific health needs of the elderly include: 1- Need For Good Nutrition:  Need to maintain weight by eating low fat moderate carbohydrate and high protein diet, adding fiber and bulk in the diet can avoid use of laxatives.  Eating should be pleasurable experience, preferably taking place in the company of other people. 2- Older People Need Exercise:  Physical activity and movement contribute to quality of intellectual and Physical performance. 64   Exercise for the older people may occur with such activities as home - making chores, gardening, hobbies OR recreation and sports.  Often such activities are done in company with people meeting the social and emotional needs as well. 3- Need For Economic Security:  Fearing the potential cost of major illness and not wanting to be a burden on the family OR friends many conserve their limited resources by eating cheaply, sparingly using the health resources. 4- Need For Independence:  Elderly need to make their own decisions and manage their own lives.  Need for independence can, also help meet the need for self-respect and dignity.  The elderly need to have their ideas and suggestions heard and acted upon and to be addressed by their preferred names in a respectful tone of voice. 5- Need For Companionship And Social Interaction:  The company of other people and of the household for expression very important. Aningful Activity  Some kind of active role in the community is essential for mental health satisfaction and self-esteem. Community Health Perspective  In-general we can divide nursing service to the elderly on to two approaches.  One approach emphasizes the science of geriatrics m the other the science of gerontology.  Geriatrics is the study of diseases of old age, while gerontology studies the broader phenomena of aging itself.  Geriatric nursing in the past has been oriented primarily toward care of the sick aged.  Gerontological nursing a broader practice, concentrates on preventing illness and promoting health of older adults 65  Unit Ten Promoting and protecting the health of maternal, pre- natal, infant population  Women are more likely to have acute and chronic women have a longer life expectancy than men. Conditions that require them to use health services more than men. The three major causes of mortality in woman are: 1.Heart disease 2.Cancer 3.Cerebrovascular disease. The three major chronic conditions women experience are: 1. Heart conditions 2. Arthritis 3. Hypertension. Heathy people 2000 identifies several ,objectives for improving maternal and infant health during the childbearing years including: - Increasing prenatal care - Reducing complications of pregnancy. - Decreasing low birth weight. - Decreasing infant mortality rate. - Improving preconception counseling. Definition of reproductive health (WHO): - Is state of complete physical mental and social wellbeing and not merely the absence of disease OR infirmity in all matters related to the reproductive system in its function and process. 66 Elements of reproductive health: Safe motherhood: 1.Antenatal 2.Safe delivery 3. Postnatal  Infant and child health  Family planning services  Health information, education, communication. Counseling.  Early detection of reproductive system cancer.  Early detection and management of STDS, HIV infection.  Management of reproductive morbidities.  Management of infertility Preconception assessment should include discussion of a women’s family, medical, reproductive, nutritional, and a social history E.g.: exposure to tobacco and alcohol may be detected. Education; about the effects of these on the fetus can be explored and effects aimed at decreasing exposure can be taken. Prenatal care  Prenatal care is a variable strongly associated with improved birth out comes important concepts of sexuality marriage and parenthood;  Sexuality; A Childs sex education is going on all the time. She must be educated about body changes, where babies come from, changes of puberty. 67   Marriage and parenthood: marriage can provide companionship, a guaranteed sexual outlet, domestic service and the opportunity for joint parenthood.  Preparing for parenthood: preparing for health pregnancy, prevent any reproductive disaster before happening. Pre-conception \ premarital counseling; 1- Diet: Bread and cereals: Whole grain cereals and bread Provide carbohydrate fiber, minerals and vitamins.  Fresh fruits and vegetables, especially for folic acid  Protein foods ;( meat, fish, eggs).  Dairy products; fresh milk contains vitamins and fatty acid which are destroyed by process such as drying and sterilization. A well balanced diet should contain sufficient vitamins and minerals for daily requirement.  Consider taking a folic acid supplement (0,4mg\day) and vitamin D supplement (if covered) during reproductive life. 2- weight:  Pre-pregnancy weight can have an important bearing on pregnancy outcome. If the women is underweight there is evidence of an association with fetal abnormality and low birth weight. The overweight women increase risk of complication of pregnancy hypertension and risk to her own health. -Use the body mass index as a guide: - Less than 20- underweight - 20-27 Desirable - 27-30 Moderate obesity - Over 30 severe obesity 68