Health Education for Respiratory Therapy PDF 2023-2024

RES104 HEALTH EDUCATION FOR RESPIRATORY THERAPY TINGCO FS 2023-2024 Hope OU...

RES104 HEALTH EDUCATION FOR RESPIRATORY THERAPY TINGCO FS 2023-2024 Hope OUTLINE PRELIMS ○ While faith is the foundation on which hope rests, I. Concept of Man hope nourishes faith. II. Human Rights ○ It is a vital factor in the health care setting in III. Concepts of Health and Illness determining the patients prognosis or illness, state IV. Health Care Delivery System of being and acceptance of the dying process V. Assessment Charity ○ Love of man for his fellowmen. It enables him to overcome frustration because of love for one CONCEPT OF MAN another without complaint. ○ Charity allows the nurse to assist the patient in overcoming one crisis after another. APPROACHES ○ Charity allows one to give up his own pleasure while serving another without even thinking of the sacrifice ATOMISTIC APPROACH it entrails Anatomist = studies the structure of the cell and its components study - more detailed MAN AS A BIOLOGICAL BEING Physiologist = determines its function immunologist hematologist - - Man is a living organism who from birth is destined to die. Specialist = study the more in depth of cell As he lives, he has to contend continually with the forces in Views man as an organism composed of different organ his environment, be it friendly or hostile. systems, each system composed of organs and each organ In the micro and microcosms of life, man responds to composed of tissue cells environmental stimuli or a particular unit be it solitary cell, a Scientific Byrne and Thompson component organism , or a member of a conglomerate of - call this HOLISMC Or TOTAL individuals HOLISTIC APPROACH The environment influenced man’s behavior as an individual Stimuli in the environment provide necessary forces to enable Systems: man to demonstrate, consciously or unconsciously, the nature 1. Subordinate system of his responses and the subsequent quality of his cells, organ systems that are found within relationship with his environment the individual Provides a fundamental framework on which one can base his self perception or observation of the total behavior of man in Important in carrying out daily life activities relation to society which are vital to survival The holistic view traces the patterns of man’s relationship with Man’s feeling of well-being each day other being in the suprasystem of society depends on the condition on various organ Views man as a whole organism with interrelated and system interconnected parts functioning to produce behavior 2. Super ordinate system unacceptable or acceptable to him or society family, community, and society Sociological relationships provides the necessary framework of IMPORTANCE: Atomistic and Holistic approaches are useful in the relationships planning of care of the individual during illness or its prevention. Cell ○ The cell is the basic unit or building blocks of approximately structure of all forms of plant and animal life. 100 TRILLION CELLS MOTIVATION ○ The human body is composed of trillions of cells. [ May come either from natural or supernatural forces (ex. love ○ Each of these cells carries out precise and of parents) natural specialized functions that interweave harmoniously Other type of motivation may be supernatural, wherein one with the activities and functions of other cells in the transcends pain and suffering to a higher place in the hope of body non-material reward (ex. concept of purgatory, heaven, and hell) supernatural Stoic patients may mask their true feeling in order to satisfy ORGANISMIC BEHAVIOR inner feelings of mortification to atone for real or imagined Refers to those observable features and actions that reflect mistakes man’s functioning as a unified whole within the environment in which he exists. SPIRITUAL VIRTUES Reflects the dynamic changes that occur in him as a result of alterations he has made or has met me his internal or external Even if human reason makes man skeptical and faithless his environment spiritual nature makes him overcome his skepticism and sets Mind and body operates as a whole; body structures conform him back to the right paths of thinking to the purpose for which each part was made Faith Beliefs by Bryne and Thompson: ○ The unquestioning belief in someone or in 1. Man normally responds as a unified whole something or the complete trust and confidence or ➔ His mind and body operates as whole;’ reliance one places in a person or thing neither one stand alone ○ Patients come to the hospital or seek medical ➔ His body structures conform to the treatment because they believed that to do so will purpose for which each part was made prolong their lives even temporarily 2. Man as a whole is different from and more than the sum of his component part  ANALOGY OF WATER and Its COMPONENT I parts Water may is help to illustrate this not the same as its parts ↳ than his parts like ➔ In elements: they have different sets of Gives him the power of conscious and man is more , water is a whole , yet it's more than hydrogen and Oxygen (components) characteristics and predictable responses deliberate action or self control in initiating, > each element alone will but combined water support combustion ➔ As a human organism composed of sustaining, or terminating human activity as they are used to extinguished fire various systems is something more than just the addition of his parts NEEDS Need = essential to the emotional and physiologic health and MAN AS A SYSTEM survival of humans; something that is desirable, useful, and Whole which functions as a whole by virtue of the necessary interdependence of its parts. All people strive to meet basic needs at any given time It has common or unifying boundaries with interrelated and Absence of need = illness interdependent parts. Presence of needs = prevent or signals health It is composed of subsystems. Each is designed to carry out Meeting of unmet need restores health an activity which in turn is necessary for achieving the general purpose of the system. ABRAHAM MASLOW’S HIERARCHY OF NEEDS System Types: Humans have the urge to grow and attain their highest level 1. Closed system potential Bryne and Thompson ➔ Self-sufficient, totally isolated from other Needs at one level must be first met before the next level can uses Buckley’s systems. & verbal life-threatening , non-verbal , supportive positive negative or , or be met definition of a system ➔ It does not allow outside stimuli in any form which describes it as penetrating its boundaries. “whole functions as a ➔ It does not allow anything from within it to whole by virtue of the go beyond its boundaries. interdependence of its ➔ Life sustaining elements cannot enter, parts.” uses its reserves for energy; eventually ↓ fails to function and disintegrates RESERVE ENERGY 2. Open system , ➔ Exchanges matter, energy or information Man is an open system with the environment needs ➔ It is directly affected by events or changes Self- in other systems. ➔ A person is viewed as a living behavior needs system. The metabolic, the growth and the total processes of living are involved in the and INPUT > energy - interchange of energy, matter or , matter or information Whic information among parts of the living taken is by system needs a OUTPUT > organism organism, and between the living organism from the passes - into the and its environment environment and security needs THE ENERGY-MATTER EXCHANGE OF MAN Man, as a unified whole, interacts constantly with his environment needs MAN AS A PSYCHO-SOCIAL BEING Man is unique, irreplaceable individual, a one-time being being in this world (even twins are unique) Characteristics of a Man: 1. Alike yet unalike 2. Shows limited and unlimited nature HUMAN RIGHTS 3. Creature of contradiction 4. Maturity with core of immaturity 5. Rational being yet irrational at times CIVIL AND POLITICAL RIGHTS Rational side = makes him merciful, kind, and compassionate 1. Right to life, liberty, and security of a person Irrational side: makes him commit acts 2. Right to freedom from slavery and servitude against another man 3. Right to freedom from torture or cruel, inhuman or degrading treatment or punishment 4. Right to recognition as a person before the law MAN AS A SPIRITUAL BEING 5. Right to equal protection of the law The unity of man in body, mind, and spirit 6. Right to effective remedy for violation of human rights Man needs the essential freedom of the human spirit; to 7. Right to freedom from arbitrary arrest, detention, or exile] achieve this he continuously struggles for it 8. Right to fair trial and public hearing by an independent and Man believes that his life is governed by a power greater than impartial tribunal he. He pays obedience to this supreme being/power 9. Right to presumption of innocence until guilt has been proven regularly/irregularly; the frequency depends on man’s whims, 10. Right to debarment from conviction for an act which was not a caprices or feelings of despair whenever hit by adversity penal offense at the time it was committed Man’s Spiritual Nature: 11. Right to freedom of movement and residence, including the 1. Intellect right to leave any country and to return to one’s country Allows man to look for truth 12. Right to nationality Helps him perceive and understand his 13. Right to contract a marriage and find a family surroundings 14. Right to own property 2. Will 15. Right to freedom of thought and conscience Expresses man’s own wishes, desires, or 16. Right to freedom of opinion and expression longing to do what he has set his mind to do 17. Right to participation in the government of one’s country 18. Right to equal access to public service in one's country  ECONOMIC, SOCIAL AND CULTURAL RIGHTS ○ Illness is the presence of signs and symptoms of 1. Right to social security disease 2. Right to work and free choice of employment 2. Health-Illness Continuum (McCann/Flynn and Heffron, 1984) 3. Right to equal pay for equal work ○ Health is a constantly changing state with high level 4. Right to just and and favorable remuneration ensuring the of wellness and death being on opposite ends of a existence of human dignity graduated scale or continuum 5. Right to form and join trade unions 3. Role-Performance Model (Parsons, 1958) 6. Right to rest and leisure ○ Health is the ability to perform all those roles from 7. Right to standard living adequate for health and well-being which one has socialized 8. Right to security in the vent of unemployment, sickness, 4. High-Level Wellness (Dunn, 1961) disability, widowhood, old age, or other circumstances beyond ○ High level wellness refers to functioning to one’s one’s control maximum potential while maintaining balance and 9. Right to protection of motherhood and childhood purposeful in the environment 10. Right to education, with parents having prior right to choose ○ Concepts in Dunn’s High-Level Wellness includes their children's type of education i. Totalitarity 11. Right to participation in the cultural life of one’s community ii. Uniqueness 12. Right to protection of the moral and material interest resulting iii. Energy from one’s authorship of scientific, literary, or artistic iv. Inner and outer world productions v. Self integration 5. World Health Organization (WHO, 1947) ○ Health is the state of complete physical, mental, PATIENT’S BILL OF RIGHTS social well-being and not merely the absence or 1. The patient has the right to considerate and respectful care, infirmity irrespective of socio-economic status 6. Wellness Education Model (John Travis) 2. The patient has the right to obtain from his physician complete ○ Travis is a wellness oriented physical who focused current information concerning his diagnosis, treatment, and his approach on concepts of wellness education prognosis in terms the patient can reasonably be expected to 7. Holistic Model of Health Care understand ○ The concept of holism is based on the idea that it is 3. The patient has the right to receive from his physician more fruitful to study human being as a whole than information necessary to give informed consent consent prior to study its separate parts to the start of any procedure and or treatment 8. Needs-Fulfillment Model 4. The patient has the right to refuse treatment life giving ○ Health is a state in which needs are being measures, to the extent permitted by law, and to be informed sufficiently met to allow an individual to function of the medical consequences of his actions successfully in life with the ability to achieve the 5. The patient has the right to every consideration of his privacy hughes possible potential concerning his own medical care program 6. The patient has the right to expect that all communication and records pertaining to his care should be treated as STAGES OF ILLNESS EXPERIENCE confidential 1. Stage 1: Symptoms Experience 7. The patient has the right within its capacity, a hospital which The person is aware that something is wrong must make reasonable response to request of patient for A person usually recognizes a physical sensation or services a limitation in functioning but does not suspect a 8. The patient has the right to obtain information as to any specific diagnosis relationships of the hospital to other health and education 2. Stage 2: Assumption of the Sick Role institutions in so far his care is concerned If symptoms persist and become severe, clients 9. The patient has the right to be advised if the hospital assume the sick role proposes to engage in or perform human experimentation At this point, the illness becomes a social affecting his care or treatment phenomenon, and sick people seek confirmation 10. The patient has the right to expect reasonable continuity of from their families and social groups that they are care; he has the right to know in advance the times and indeed ill places the physician will be available 3. Stage 3: Medical Care Contact 11. The patient has the right to examine and receive an If symptoms persist despite home remedies, explanation of his bill regardless of the source of payment becomes severe, or require emergency care, the 12. The patient has the right to know what hospital rules and person is motivated to seek professional health regulations apply to his conduct as a patient services In this stage the client seeks expert acknowledgement of the illness and treatment CONCEPTS OF HEALTH AND ILLNESS 4. Stage 4: Dependent Client Role The client depends on health care professionals for relief of symptoms HEALTH, WELLNESS, & ILLNESS The client accepts care, sympathy, and protection Health = state of complete physical, mental, and social from the demands and stresses of life well-being and not merely the absence of disease or infirmity 5. Stage 5: Recovery and Rehabilitation Wellness = an integrated method of functioning which is This stage can arrive suddenly such as when the oriented towards maximizing the potential of which the symptoms appeared individual is capable Gives up sick role and returns to former functioning Illness = a state in which someone’s needs are not sufficiently In the case of chronic illness, the final stage may met to allow the individual to have a sense of physical and involve an adjustment to prolonged reduction in psychosocial well-being health and functioning MODELS OF HEALTH Other people identify 3 stages of Illness 1. Medical Model (M.B. Belloc and Breslow, 1972) 1. Stage of Denial ○ Health is the state of being free of signs and 2. Stage of Acceptance symptoms of disease 3. Stage of Recovery  FACTORS CAUSING ILLNESS DESCRIBED AS 5. Sociocultural Dimension 1. Predisposing ○ Health practices and beliefs are strongly influenced 2. Contributory by a person’s economic level, lifestyle, family, and 3. Precipitating culture ○ The family and the culture to which the person LEVELS OF PREVENTION belong determine patterns of lying and values about 1. Primary Prevention health and illness that are often unalterable ○ Providing specific protection against disease to 6. Spiritual Dimension prevent its occurrence is the most desirable form of ○ Spiritual and religious beliefs and values are protection get vaccinated or wearing sunscreens to prevent sickness > - important components of the way the person 2. Secondary Prevention behaves in health and illness ○ Consists of organized, direct screening efforts or education of the public to promote early case finding PROMOTING ADAPTATION TO ILLNESS of an individual with disease so that prompt 1. Develop a meaning to illness intervention can be instituted to halt pathologic 2. Ascribe proper cause for illness processes and limit disability > catching disease early such as regular - 3. Make comparisons about other illness 3. Tertiary Prevention check ups 4. Have the necessary resources to cope with illness ↓ ○○ ItConsists begins in the period of recovery from illness of such activities as alread hada HEALTH CARE DELIVERY SYSTEM Consistent and appropriate administration disease and helping of medication to optimize therapeutic yourself to recover effects THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM Moving and positioning to prevent Health is a fundamental right of every individual complications of immobility Passive and active exercises to prevent DEPARTMENT OF HEALTH (DOH) disability and minimizing residual disability Helping clients learn to live productively Responsibilities: with limitations 1. Formulation and development of national health policies, guidelines, standards, and manual operation for health services and programs FACTORS AFFECTING HEALTH 2. Issuance of rules and regulations, licenses, and 1. Political accreditations ○ Involves one’s leadership, how he/she rules, 3. Promulgation of National health Standards, goals, manages, and involves other people in decision priorities, and indicators making political will can create health 4. Development of special health programs and Safety programs, while poor governance projects and advocacy for legislation on health Oppression may lead to oppression and lack of policies and programs Political will healthcare access. Function: empowerment ○ The primary function of the DOH is the promotion, 2. Cultural protection, preservation, or restoration of the health ○ Non-physical traits, beliefs, customs, shared by a of the people through the provision and delivery of group of people and passed from one generation to health services and through the regulation and the next some cultures might rely on traditional encouragement of providers of health goods and Practices medicine, while others might emphasize services. Beliefs modern healthcare. Vision: 3. Heredity ○ Health as a right. Health for all Filipinos by the year ○ The genetic transmission of traits from parents to Your genes, inherited from your parents, 2000 and health in the hands of the people by the offspring play a big role in your health. year 2022. 4. Environment Mission: ○ The sum total of all the conditions and elements that ○ The mission of the DOH, in partnership with the make up the surrounding and influence the The surroundings you live in, including air quality, water, people to ensure equity, quality and access to health development of an individual housing, and access to parks or healthy food, affect your health. care 5. Socio-economic By making services available ○ Production activities, distribution of and consumption By arousing community awareness of goods of an individual Your financial situation affects your ability to access healthcare By mobilizing resources By promoting means to better health FACTORS AFFECTING HEALTH & ILLNESS 1. Physical Dimension BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT IN HEALTH ○ Genetic make-up, age, developmental level, race, 1. Universal access to basic health services must be ensured. and sex are all part of an individual’s physical 2. The health and nutrition of vulnerable groups must be dimension and strongly influence health status and prioritized. health practices 3. The epidemiological shift from infection to degenerative 2. Emotional Dimension disease must be managed. ○ How the mind and body interact to affect body 4. The performance of the health sector must be enhanced. function and tor respond to body condition also influences health PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS 3. Intellectual Dimension ○ It encompasses cognitive abilities, educational 1. Increasing investment for primary health care. background and past experiences 2. Development of national standards and objectives for health 4. Environmental Dimension 3. Assurance of the health care ○ The environment has many influences on health and 4. Support for local health system development. illness, housing, sanitation, climate, and pollution of 5. Support for frontline health workers. air, food, and water are aspects of environment dimensions  LEVELS OF HEALTH CARE FACILITIES Interviewing 1. Primary Level It is a planned communication or observation with a purpose ○ Rural health units, sub-centers, chest clinics, A process that the health worker applies in most phases of malaria eradication units, schistosomiasis control the health care process unit, League of Puericulture centers, tuberculosis clinic, and hospitals of the Philippine Medical Association TWO APPROACHES IN INTERVIEWING 2. Second Level 1. Direct Interview ○ smaller , non-departmentalized hospitals including It is highly structured and elicits specific information emergency and regional hospitals The health worker establishes the purpose of the 3. Third Level interview and controls the interview, at least at the ○ Highly technological and sophisticated services outset, by asking closed questions that call for a offered by medical centers and large hospitals specific amount of data It is frequently used to gather and to give information on a limited amount of time 2. Nondirective or Rapport Building Interview The health worker allows the client to control the purpose, subject matter, and pacing The health worker encourages communication by providing empathetic responses TYPES OF QUESTIONS 1. Neutral Question ○ Questions that client can answer without direction or pressure from the health worker 2. Leading Questions PYRAMIDAL HEALTH STRUCTURE ○ Direct the client’s answer ○ The phrasing suggests what answer is expected KINDS OF INTERVIEW QUESTIONS 1. Closed Questions ○ Used in directive interview ○ Restrictive and generally require only short answers and giving specific information 2. Open-ended Questions ○ Used in nondirective interview ○ Lead or invite clients to discover and explore their thought or feelings PLANNING THE INTERVIEW AND SETTING Time Place Seating arrangement Distance STAGES OF INTERVIEW ASSESSMENT 1. The Opening ○ Most important part of the interview, because what is ASSESSMENT said and done at that time sets the tone for the remainder of the interview First phase of healthcare process, involves data collection, ○ 2 Step Process organization, and validation i. Establishing rapport Must take place before a diagnosis can be made ii. Orientation Its purpose is to establish a database about a client’s health 2. The Body care needs ○ In this stage, the client communicates what he/she Steps: thinks, feels, knows and perceives in response to 1. Observing question from the health worker 2. Interviewing 3. The Closing 3. Examining ○ The health worker usually terminates the interview 4. Data Collection when the needed information has been obtained 5. Organizing Data 6. Validating Data 7. Recording Data EXAMINING Major method used in the physical assessment OBSERVING The physical exam is a systematic data-collection method that Occurs when the nurse/healthcare provider is in contact with uses observational skills to detect health problems the client or support person Developing the skills needed for physical assessment To observe is to gather data by using the 5 senses requires knowledge, practice, and time It is a conscious, deliberate skill that is developed only Techniques to conduct examination through effort and with an organized approach 1. Inspection Two Aspects 2. Palpation 1. Noticing the stimuli 3. Percussion 2. Selecting, organizing, and interpreting data 4. Auscultation  DATA COLLECTION The process of gathering information about the client’s health status DATA BASE (BASELINE DATA) 1. Health worker’s health history and physical assessment 2. Physician’s history and physical examination 3. Results of laboratory and diagnostic tests 4. Material contributed by other health personnel TYPES OF DATA 1. Subjective Data ○ Symptoms or covert data (from patient) 2. Objective Data ○ Signs or overt data (from observation) SOURCES OF DATA 1. Primary Data ○ Client is the source of primary data and usually the best source 2. Secondary Data ○ Provide data that supplement and validate data obtained from the client ○ From support people ○ Client records i. Medical records ii. Record of therapies by other health professionals iii. Laboratory records 3. Healthcare professionals 4. Literature ○ Standard or norms against which to compare findings ○ Cultural and social health practices ○ Spiritual beliefs ○ Additional required assessment data ○ Health worker’s intervention and evaluation criteria relative to a client’s health problem ○ Information about medical diagnosis and prognosis ORGANIZING DATA To obtain data systematically, the nurse uses an organized assessment framework often referred to as a health history or health worker assessment VALIDATING DATA Validation is the act of “double-checking” or verifying data to confirm that they are accurate and factual RECORDING DATA To complete the assessment phaser, the health worker records the data Accurate documentation is essential should include all data collected about client’s health status Data are record in factual manner and not interpreted by the health care worker OUTLINE MIDTERMS I. Primary Health Care II. Health History PRIMARY HEALTH CARE UNIVERSAL DEFINITION  Essential care based on scientifically sound and sociologically programs whether as a service provider or acceptable methods and technology made universally beneficiary. accessible to individuals, families, and communities through ○ Empowerment of parents, families, and communities their full participation, at a cost they can afford at any given to make decisions on their health is really a desired stage of development ,and with the goal of self reliance and outcome. self determination B. Promoting and supporting community managed health care. ○ The vision of health in the hands of the people RATIONALE FOR PRIMARY HEALTH CARE brings the government closest to the people. ○ It necessitates a process of capacity-building of During the Alma Ata Conference in 1978, the World Health communities and organizations to plan, implement, Organization (WHO) declared its goal of “Health for All by the and evaluate health programs at their levels. Year 2000” and because of the deplorable health situation in ○ The DOH, in promoting community managed care the country, there is a need for the people to act on their own as a cornerstone to health, must maniferst support and to use whatever resources within their reach to solve their to community organizing and organizations health problems. Thus Primary Health was formulated. Establish sustainable mechanism for community manage financial schemes and identify and develop GOAL indigenous health resources. Self-reliance = the ability to stand on their own; C. Increasing efficiencies in the Health Sector self-sufficiency ○ The DOH will safeguard and strengthen the Health for all Filipinos by the year 2000, and health in the integration of health operations to maintain the hands of the people by the year 2020. quality of health care. ○ It will also evovle an appropriate organizational LEGAL BASIS structure responsive to devolution and Letter of Instruction (LOI) 949 was signed on October 19,1979 decentralization. by then President Ferdinand Marcos - one year after the First ○ Using appropriate technology will make the services International conference on Primary Health care that held in and the resources required for their delivery Alma Ata USSR on September 6-12, 1978 which was effective, affordable, accessible and culturally sponsored by the WHO and UNICEF acceptable. ○ the development of health human resources must correspond to the actual needs of the nation and the GENERAL PRINCIPLES OF PRIMARY HEALTH CARE policies it upholds such as Primary Health Care. 1. Health and Development Interrelated D. Advancing essential national health research ○ Health is not merely the absence of disease. ○ Essential national health research is an integrated ○ Neither is it only a state of physical and mental strategy for organizing and managing research well-being. using intersectoral, multidisciplinary and scientific ○ Health, being a social phenomenon, recognizes the approach to health programming and delivery interplay of political, sociocultural and economic factors as its determinants ○ Good health therefore, is manifested by the progressive improvements in the living conditions PRIMARY HEALTH CARE ELEMENTS and quality of life enjoyed by the community residents. EDUCATION FOR HEALTH ○ Development is a quest for an improved quality of Health education is potent methodology for information life for all. dissemination. ○ Development is multidimensional It promotes the partnership of both the family members and ○ It has political, economic, social, cultural, health workers in the promotion of health as well as institutional, and environmental prevention of illness. ○ Therefore, it is measured by the ability of people to It is a means of improving the health of the people by satisfy their basic needs. employing various methods of scientific procedures to show ○ Interrelationship of health and development the most healthful ways of living. 2. Essential Health Services must be accessible,available, acceptable, and affordable LOCALLY ENDEMIC DISEASE CONTROL ○ The health services should be present where the The control of locally endemic diseases focuses on the supposed recipients are. prevention of the occurrence of these disease ○ They should make use of the available resources Endemic diseases may have a low morbidity rate but since it that is found in the community, wherein the focus is continuously present in the community, prevention or would be more on promotion of health and control is necessary. prevention of illness. ○ Proverty illnbess cycle 3. Genuine people’s participation is essential LEPROSY CONTROL PROGRAM ○ People are the center, object,and subject of Leprosy also known as Hansen's disease is a chronic mild development. communicable disease caused by infection from ○ Thus, the success of any undertaking that aims at Mycobacterium leprae, a rod-shaped acid-fast bacillus. serving the people is dependent on the people’s It primarily affects the skin, the mucous membranes especially participation at all levels of decision making: those in the nose and the peripheral nervous system. planning, implementing, monitoring, and evaluating. Leprosy exacts a high physical and social toll, It can result in ○ Any understanding must be based on the people’s deformity and disability. In many societies people with leprosy needs and problems. have been made outcasts from their communities. Norwegian doctor, Dr. Gerhard Armaur Hansen first observed M. leprae as an acid-fast, alcohol-fast, strong gram-positive MAJOR STRATEGIES OF PRIMARY HEALTH CARE bacillus in tissue specimens from leprosy patients in 1873. A. Elevating health to a comprehensive and sustained national The following year, He proposed that the bacteria caused effort leprosy hence the name “Hansen's Disease” emerged. ○ Attaining health for all Filipinos will require expanding participation in health and health-related LEPROSY TRANSMISSION  M. leprae Infection occurs primarily in human beings. ○ Rifampicin and Dapsone given in 28 day researchers do not know exactly how the bacteria are monthly blister packs transmitted. For many years leprosy was believed to be ○ Treatment is completed when the patient transmitted through skin-to-skin contact. However experts has taken 6 packs within a maximum of 9 now consider this unlikely because M. leprae are not usually months. found on the skin surface. 3. MultiBacillary Regimen Most evidence suggests that people become infected by ○ Rifampicin, Clofazimine, and Dapsone inhaling the bacteria. With each cough or sneeze of an given in monthly blister packs. Treatment untreated Person With Leprosy (PWL) the bacilli are is completed when the patient has taken discharged as droplets. Prolonged, close contact With 12 packs within a maximum of 18 months. infectious persons is likely to increase the risk of transmission. EXPANDED PROGRAM ON IMMUNIZATION (EPI) LEPROSY SUSCEPTIBILITY This program exists to control the occurrence of preventable While a leprosy bacilli may be transmitted easily perhaps 95% illness especially among children. of people who are infected do not develop the disease. The DOH’s Araw ng Sangkap Pinoy is a response to this Cell-mediated immunity (CMI )or the body's ability to resist particular program. infection is the mechanism that protects against leprosy. Most Immunization on poliomyelitis, measles, tetanus, diphtheria, people who are exposed to M. leprae resist infection and and other deadly but preventable diseases are given by the develop immunity after this exposure. government and an ongoing program of the DOH. Only a few actually develop the disease. Symptoms of leprosy The EPI Was launched in July 1976 by the DOH in typically appear three to five years after infection. cooperation with WHO and UNICEF. The original objective was to reduce the morbidity and LEPROSY DIAGNOSIS mortality among infants and children by the 6 childhood and Diagnosis of leprosy is commonly based on clinical signs and immunizable diseases. symptoms. only in rare instances is there a need to use PD 996 (September 16, 1976) Provides for compulsory basic laboratory and other investigations to confirm a diagnosis of immunization for infants and children below 8 years of age. leprosy. a person should be regarded as having leprosy if he exhibits one or more of the following cardinal signs: MATERNAL AND CHILD HEALTH ○ Whitish (hypopigmented) or reddish patches of skin called skin lesions with loss of feeling The mother and the child are the most delicate members of ○ Damage to the peripheral nerves as demonstrated the community. by loss of sensation and weakness of the muscles of The maternal and infant mortality and morbidity rates are the hands, feet, and/or face. among the indicators of health of a particular community. ○ Skin smears that are positive for M. leprae. The protection of the mother and child to illnesses and other risks would ensure good health for the community. Maternal and Child Health refer to mother and child LEPROSY CLASSIFICATION ACCORDING TO WHO relationship to one another and consideration of the entire 1. Single Lesion Paucibacillary (PCB) family as well as a culture and socio-economic environment ○ Identified by only one leprosy lesion whose surface as framework of the patient. may either be normal, dry, or scaly with some Goals degree of loss of sensation. ○ To ensure that every expectant and nursing mother ○ Border may be ill-defined or well-defined and slit maintains good health, learns the art of childcare, skin smears are negative for M. leprae. has a normal delivery, and bears healthy children. 2. Paucibacillary (PB) ○ Maternal care consists of the care of the pregnant ○ Two to five infiltrated patches whose surface may be woman, her safe delivery her postnatal care, and normal, dry, or scaly with absence of hair growth. examination and care of her lactation. ○ There may either be partial or total loss of sensation. ○ That every child wherever possible lives and grows ○ Borders are well-defined and skin smears are up and a family unit with love and security, in healthy negative for M leprae. surroundings, receives adequate nourishment, ○ Peripheral nerves may be affected. health supervision, and efficient medical attention 3. MuluiBacillary (MB) and taught the elements of healthy living. ○ More than five macule, plaques, papules, or Activities infiltrated patches whose surface may be dry, 1. Prenatal care and prenatal check up smooth, and shiny. 2. Monitoring of pregnancy ○ Outer borders are vague sloping outwards and 3. Care during childbirth merging imperceptibly with surrounding skin. 4. Care of the newborn ○ More than one peripheral nerve is affected and skin 5. Breastfeeding smears are always positive for M leprae. 6. EPI 7. Growth and development LEPROSY TREATMENT The drug of choice of the National Leprosy Control Program (NLCP) is the WHO recommended Multidrug Therapy (MDT). It is a combination of two or more of the following drugs: Rifampicin, Clofazimine, Dapsone, Ofloxacin, and ESSENTIAL DRUG) Minocycline. This focuses on the information campaign on the proper MDT is fast-acting and prevents the emergence of utilization and acquisitions of drugs. drug-resistant strains of M. leprae. Generics Act of the Philippines Drugs 1. Rifampicin - Ofloxacin - Minocycline (ROM) NUTRITION ○ Used to treat SLPB leprosy One of the basic needs of the family is food and if food is ○ Treatment give in a single dose properly prepared then one may be assured of a healthy ○ Two blister pack for adult family. ○ One for children There are many food resources found in our communities but 2. Paucibacillary Regimen because of faulty preparations, and lack of knowledge  regarding proper food planning; malnutrition is one of the Its performance is the primary vehicle by which rapport is problems that we have in our country. established between the practitioner and the client. Eye contact is important TREATMENT OF COMMUNICABLE DISEASE The health history not only records the problems of the client but also describes the client as a whole and in relation to his The disease spread by direct contact posed a great risk to social and physical environment. those who can be infected. Contains not only weaknesses and abnormalities but also the Tuberculosis as one of the communicable disease strengths that will support therapy and care. continuously occupies the top 10 causes of death Other important components of the history database are the perceptions of the client regarding his health, his illness and TUBERCULOSIS PROGRAM his past experience with the health delivery system. Tuberculosis is caused by Mycobacterium tuberculosis which Certain principles of history taking procedures can be transmitted via airborne droplets and direct invasion should be emphasized. through mucous membranes or breaks in the skin. The importance of privacy seems obvious, but this principle is The National Tuberculosis Control Program aims to vaccinate often violated in actual practice. with BCG the eligible population under the EPI. The practitioner must immediately note specific information, Identify at least 45% of the infectious cases annually and to such as dates, age, and so on, or he may forget. and to treat effectively and adequately all sputum cases for a Usually refers to subjective data period of six months with the use of Short Course Not just past events, but also current symptoms and situations Chemotherapy (SCC). Several different models ○ Medical SAFETY WATER SANITATION ○ Several nursing models Environmental sanitation is still a health problem in the Several different structures country. ○ History and Physical (H&P) - common in PH It is defined as the “study of all factors in man's environment ○ Functional Health Patterns which exercise or may exercise deleterious effect on his ○ PBA Neuman Assessment well-being and survival” The DOH through the Environmental Health Services has COMPLETE HEALTH HISTORY authority to act on all issues and concerns in environment and Biographical Information health under the guidelines of the Sanitation Code of the Source and Reliability Philippines. Reason for Seeking Care Major Environment Sanitation Programs: Present Health or History of Present Illness (HPI) 1. Water Supply Sanitation Program Past Health 2. Health and Sanitation Family History 3. Proper Excreta and Sewage Disposal Program Functional Assessment 4. Food Sanitation Program Perception of Health 5. Hospital Waste Management Program Review of Systems CARE ENHANCEMENT QUALITIES BIOGRAPHIC INFORMATION Caring is the antithesis of simply using the other person to DOB (Date of Birth) satisfy one's needs. Gender Mayeroff (1971) suggests that the meaning of caring is not to Race be confused with such meanings as wishing well, comforting and maintaining, or simply having an interest in what happens to another. REASON FOR SEEKING CARE Caring is helping another grow and actualize himself is a CHIEF COMPLAINT / PRESENTING PROBLEM process or her way of relating to someone that involves “Chest Pain for 2 hours” development mutual trust and deepening and qualitative “Feeling dizzy” after standing up transformation of relationship. “Follow up” is not a CC - dapat stated ang reason ng follow up to be a CC “3 mo F/U High Blood Pressure” is a CC. CARATIVE ELEMENTS “F/U N/O Diabetes 2” is a CC 1. Humanistic 2. Faith and hope 3. Sensitivity to others HISTORY OF PRESENT ILLNESS 4. Helping trust relationship Location 5. Ability to accept positive and negative expressions of feelings Quality or Character - “parang tinutusok” 6. Interpersonal teaching and learning abilities Quantity or Severity - “6/10 pain” 7. Personality type Duration - “3 days na” 8. Solid family background Setting -” tuwing yumuyuko” 9. Experience of having been love and ability to love Context - mas detailed 10. Spiritual life Modifying factors 11. Sense of humor Associated signs and symptoms 12. Relax attitude PAST MEDICAL HISTORY (PMH) 13. Open mindedness General State of Health 14. Quick decision making Past illness Chronic illness Injuries HEALTH HISTORY Chronic Illnesses Injuries and treatments – lingering effects Hospitalizations – including psychiatric HEALTH HISTORY Surgeries – procedure, date, hospital, surgeon Important part of health assessment. Active/Chronic Problems Allergies  ○ Environmental Religious beliefs, practices ○ Food Prayer or meditation ○ Drugs – See medication history below Substance use/abuse SEXUAL HX ○ Smoking/Tobacco Sexual drive as an indicator of overall health ○ Alcohol Perception of sexuality ○ CAGE screening Frequency and nature of sexual activity ○ Recreational drugs Age of first experience Exercise Sexual problems – anorgasmia, decreased libido, Nutrition dyspareunia Sleep Pattern STIs Risk behaviors MEDICATION HX (History) Sexual orientation Current medications Abuse/Rape ○ Dose Number of pregnancies, terminations ○ Frequency Trying to become pregnant ○ Reason LMP (Last Menstrual Period) ○ Adherence Menopause Vitamins ○ Herbal remedies/health supplements REVIEW OF SYSTEMS (ROS) Past medication (only related) A ROS is an inventory of the body system obtained through a ○ Dose series of questions seeking to identify signs and/or symptoms ○ Reason for taking which the patient may be experiencing or has experienced. ○ Reason for d/c (discontinue) (Medicare Guidelines, 1997) Allergies/ADR’s (Adverse Drug Reaction) ○ Drug ROS RULES ○ Reaction A system review should include all questions ○ Manifestation pertinent to that system Treatment Complete ROS – asks about all systems Date Problem pertinent ROS Repetitions An initial visit should include a complete ROS True allergies are inappropriate immune responses At least once a year, complete ROS update Hypersensitivity reactions ○ Type I - Vasoactive response CONSTITUTIONAL ○ Type II - cytotoxic – humoral antibodies Usual state of health ○ Type III - immune complex – activates complement Fever ○ Type IV - Cell mediated Chills Usual Weight HEALTH MAINTENANCE Changes in weight Health Promotion – Primary Prevention Weakness Disease Detection – Secondary Prevention Fatigue Disease Prevention – Primary/Secondary Prevention Sweats Immunizations Exposure to radiation or pollutants Frequency of physicals or routine care Sleeping habits Gynecological exams – Frequency and last Snoring Eye Sleep apnea Cholesterol Self breast and testicular exams EYES Seat belts, bike helmets Eyeglasses/contacts Efforts to change Current Vision ○ Cutting back on Tobacco/Alcohol Changes in vision ○ Diets Double vision Excessive tearing Dryness ENVIRONMENTAL HX Pain Occupation Last eye exam Nature of Work (Work setting – sun, office building) Photophobia (sensitivity to light) Exposure to hazardous materials and loud noises Unusual sensations Hobbies Redness Work related symptoms Discharge Travel history Infections Living near farms, mines, shipyards, factories Hx of glaucoma (group of eye diseases that can cause vision FAMILY HISTORY loss and blindness by damaging the optic nerve) Health status Cataracts (cloudy area in the lens of your eye) Diseases Injuries Hereditary and environmental factors EARS PSYCHOSOCIAL AND SPIRITUAL HISTORY Hearing impairment “Tell me about yourself” Use of hearing aid Upbringing Discharge Marital status, roommates Lightheadedness Perceptions of healthcare Pain Perceptions of and satisfaction with life Tinnitus (ringing or other noises in one or both of your ears) How has illness impacted life  Infections Appetite Surgeries Excessive hunger Excessive thirst NOSE Nausea Epistaxis (nosebleed) Vomiting Infections Diarrhea (NVD) Discharge Constipation Frequency of colds Dyspepsia (indigestion) Nasal obstruction Heartburn Congestion Reflux, waterbrash (gurp) History of injury Swallowing (dysphagia) Septal deviation (crooked nose, 1 smaller alae) Abd pain Sinus infections Change in stool color, caliber, consistency Hay fever (allergic rhinitis) Frequency of bowel movements (BM) Rhinorrhea (runny nose) Change in bowel habits Hematemesis (vomiting blood) MOUTH AND THROAT Rectal bleeding Dentition Hematochezia (bright red blood in stool) Last dental appointment Melena (black stool due to gastrointestinal bleeding) Condition of gums Laxative use Bleeding gums Antacid use Frequent sore gums Excessive belching Burning of tongue (dysglossia) Food intolerance Foul taste (dysgeusia) Halitosis (bad breath) Hoarseness Change in abd size Voice changes Hemorrhoids (swollen vein in retum/anus) , fissures Postnasal drip Infections Thrush Jaundice (yellowing of skin and sclera) Rectal pain RESPIRATORY Previous abdominal x-rays Hepatitis (inflammation of li9ver) Pain Liver disease Cough Gallbladder disease Pleurisy (inflammation of the lining of lungs) Pancreatic problems Dyspnea or SOB (shortness of breath) Sputum (saliva and mucus) Tuberculosis (contagious infection because of bacteria) GENITOURINARY (GU) GENERAL Asthma (chronic illness, airways narrow produce extra mucus) Frequency Bronchitis (bronchial tubes become inflamed and filled mucus) Urgency Hemoptysis (coughing up blood from lungs) Difficulty starting stream Wheezing (whistling sound while breathing = blocked airways) Incontinence (loss of bladder control) Last CXR (Chest Radiography) Polyuria (excessive urination volume) Last PPD (purified protein derivative; TB skin test) Oliguria (low urine output) Hx of BCG (bacilli Calmetter-Guerin) vaccine Dysuria (pain/discomfort during urination) Hematuria (blood in urine) CARDIOVASCULAR (CV) Proteinuria (elevated protein in urine) Nephrolithiasis (calculi; kidney stones) Chest pain Infections HTN (hypertension) Bed-wetting Palpitations Nocturia (nocturnal urinary frequency) DOE (dyspnea on exertion) Flank pain (below rib and above ilium) Orthopnea (shortness of breath that occurs while lying flat) Hx of retention Paroxysmal Nocturnal (red/brown/dark urine noticed during Urine color, odor late night or early morning) Dyspnea (shortness of breath) Hx of MI (myocardial infarction = heart attack) GENITOURINARY MALE Rheumatic fever (condition that can inflame or make the Penile lesions (abnormality in tissue) heart, joints, brain, and skin swell) Discharge Heart murmur (blowing, whooshing, or rasping sound heard ED (erectile dysfunction; unable to keep erection) during a heartbeat) Pain Valve problems Scrotal masses (lump) Last ECG (electrocardiogram; non-invasive test of electrical Hernias (tear in your muscle or tissue that allows part of your activity of heart) insides to bulge out) Other heart tests – stress, echo, etc. Frequency of intercourse Claudication (muscle pain due to lack of oxy; symptom of Ability to enjoy sexual relations PAD) Fertility problems Peripheral/dependent edema (due to fluid retention) Prostate problems Varicose veins Hx of STD (sexually transmitted diseases) and Tx (treatment) Thrombophlebitis Coolness of extremities GENITOURINARY FEMALE Loss of leg/toe hair Lesions on external genitalia Discoloration of extremities Itching Ulcers Discharge/odor Last Pap smear and result (collecting cells from cervix) GASTROINTESTINAL (GI) Dyspareunia (painful sexual intercourse) Frequency of intercourse  Contraceptive method – current and past, why, stop Behavioral changes Ability to enjoy sexual relations Hallucinations Fertility problems Confusion Hernias Depression Hx of STDs and Tx Hx of diethylstilbestrol exposure (given to prevent ENDOCRINE complications during pregnancy but post risks to breast Polydipsia (excessive thirst) cancer) Polyuri