CA1. CHN. Community Health Nursing 1. Family health nursing and malnutrition 2.

Community health nursing and DM Family health nursing and malnutrition 1. Malnutrition in the Philippines a. Based on the 2010 Millenium Development Goals (MDG) Progress Report i. Only 4 out of every 10 Filipino households have per capita energy intake that meets the recommended intake ii. From 2005 to 2008, there was a significant increase in the proportion of underweight children aged 0-5 from 24.6 % to 26.2 % iii. Iron and iodine deficiency remain as public health problem among infants, children, and pregnant women iv. Cause of hunger and malnutrition 1. Poverty 2. Rising food prices 3. Poor dietary diversity 4. Lack of access to potable drinking water and sanitation 5. Poor health status 6. Laziness 7. Ignorance b. Why does malnutrition have a great impact on the infants, toddlers, preschoolers and pregnant women? It affects the overall development of the child. It is one of the reasons why it is hard to educate the poor families because when we try to trace back from moms pregnancy, she is already malnourished. The development of their brains wouldnt be that complete. c. Facts from the 2001 nationwide nutrition survey by the Food and Nutrition Research Institute of DOST i. UNDERWEIGHT 1. Lowest proportion is seen among infants 2. Prevalence rises up to 3x reaching 35.6% when the child turns 1 year and 35.2% at age two, then slightly decreasing at each

age level (due to weaning; another one is that they are left eating unsupervised due to the number of children.) 3. At age 3-5 years the prevalence range from 32-33% ii. UNDERHEIGHT 1. Prevalence significantly increases from 7.9% among infants to more than 29% among children aging 1-2 years old 2. This continues to rise as age increases up to 40% at age five years (due to the parents teaching them farming, plus the malnutrition) iii. THINNEST 1. Most affected are the 1 year old children at 14.3% prevalence (because they already start to walk and spend too much energy and become active, and without proper nutrition, they become thin) d. Causes of Malnutrition r/t feeding Practices i. Non-breast feeding and early weaning ii. Dependence on artificial feeding iii. Absence of adequate complementary feeding iv. Lack of or inadequate skill of managing diarrhea at home. e. The Philippine DOH Nutrition Program i. Goal: to improve quality of life of Filipinos through better nutrition, improved health and increased productivity. ii. Objectives: 1. Reduction in the proportion of Filipino households with intake below 100% of the dietary energy requirement from 53.2% to 44%. 2. Reduction in: a. Underweight among pre-school children b. Stunting among pre-school children c. Chronic energy deficiency among pregnant women d. Iron deficiency among children 6 months to 5 years old pregnant, and lactating mothers e. Prevalence of overweight, obesity and noncommunicable diseases

Reduction in the prevalence of iron deficiency disorder among lactating mothers g. Elimination of moderate and severe IDD among preschool children and pregnant women 3. Strategies: a. Food-based interventions for sustained improvements in nutritional status b. Life-cycle approach with strategic attention to 0-3 years old children, adolescent females and pregnant/ lactating mothers. c. Effective complementation of nutrition interventions with other services. d. Geographical focus to needier areas. 4. Programs and projects a. Micronutrient supplementation i. The twice-a-year distribution of Vitamin A. capsules through the Araw ng Sangkap Pinoy (asap), known as the Garantisadong Pambata (GP), or child health week is the approach adopted to provide micronutrient supplements to 6-71 months old preschoolers on a nationwide scale. b. Food fortification i. The Food Fortification Act of 2000 provides the mandatory fortification of staples, namely: flour with iron and Vitamin A, cooking oil and refined sugar with Vitamin A, and rice with iron, and the voluntary fortification of processed foods through the Sangkap Pinoy seal. c. Essential Maternal and Child Health Service Package i. This ensures the right of the child to survival, development, protection, and participation. It includes the delivery of essential maternal and hicld health and nutrition package of services

f.

that will ensure the right of survival, development, protection, and participation as follows: 1. Breast feeding 2. Complementary feeding (foods, veggies, farm products available at home) 3. Micronutrient supplementation (6 months old, Vit.a) d. Nutrition information, communication, and education i. These include the promotion for nutritional guidelines for Filipinos and other nutrition key messages and training of health workers. e. Home, School, and Community Food Production i. It includes establishment of kitchens, gardens in homes, schools and in communities in urban and rural areas to serve as source of additional food for the home and establishment of demonstration centres and nurseries and distribution of planting materials. f. Food assistance includes center-based complementary feeding for wasted/stunted children and pregnant women delivering neonates with low birth weight. These may be done in schools. Rice distribution is done in schools through the efforts of local government units. Food discounts were provided through Tindahan Natin Program. g. Livelihood assistance is done by provision of credit and livelihood opportunities to poor households, especially those with malnourished children through linkage with lending and financial institutions. Functional literacy helps in this endeavor. Ex: 4Ps and ALS( alternative learning systems)

 a man travels the world over in search of what he needs, and returns home to find it George Moore FAMILY A unit of interacting persons related by ties of marriage, birth or adoption, whose central purpose is to create and maintain a common culture which promotes the physical, mental, emotional and social development of each fits members (Duval and Miller, 1985) Is emotionally involved with each other and they live in close geographical proximity (Friedman, 1981) Cooperates economically in the upbringing of children, most of whom share a common dwelling (Gough, 19986) Is the basic unit of society and the social institution that has the most marked effect on its members (Friedman, 1986) Engage in interrelated social positions, roles, and tasks, and shares a sense of affection and belonging (Murray & Zetner, 1997) Has a boundary w/c means other people can recognize its members. Changes in the Filipino family may have affected.. on how they perform the health tasks and its capacity to remain as the primary source of support to its members ( fr. Maglaya 2009) A family is an open and developing system of interacting personalities with a structure and process regulated by resources and stressors, and existing within the larger community.

3. As structure 4. Has certain basic functions a. Providing affection b. Providing security and acceptance c. Instilling identity and satisfaction d. Promoting affiliation and companionshiiop i. Providing socialization ii. Establishing controls 5. Moves through stages in its life cycle (newly married couple, childbearing, preschoolage, school-age, teenage, launching center, middle-aged, aging) Duval and Miller, 1985 WHAT ARE THE STEPS IN THE COMMUNITY HEALTH NURSING PROCESS? The Community Health Nursing Process 1. 2. 3. 4. Establishing a good working relationship Assessment or nursing diagnosis Planning Implementation a. Monitoring 5. Evaluation How will you go about in the care of the family? Family Nursing Assessment Data collection o Family structure, characteristics and dynamics o Socio-economic and cultural characteristics o Home and environment o Health status of each member o Values and practices on health promotion/maintenance and disease prevention o Total initial database (IDB) Data Gathering method: Observation Physical examination

Why choose a Family Perspective? 1. Prevents, generates, tolerates and corrects health problems among its members 2. Has a powerful influence on values, beliefs and practices on health and illness 3. A locus of decision-making in the use of manpower and economic support especially during illness and crisis 4. A dysfunction in one member may lead to added stress and depletion of resources for the family. Universal Characteeristics every family is 1. A small social system 2. Has its own cultural values and rules

Interview Record review Laboratory/diagnostic tests

Data analysis o Sorting the data for broad categories such as those related to thealth with the health status or practices of family members or data about home environment o Clustering of related cues to determine relationships between and among data o Distinguishing relevant from irrelevant data to decide what information is important o Identifying patterns such as physiologic function, developmental, nutritional/dietary, coping/adaptation or communicating patterns and lifestyle. o Comparing patterns with norms and standards of health, family functioning and assumption of health task o Interpreting results of comparisons to determine signs, symptoms or cues of specific wellness states, health deficit, health threats or foreseeable crisis point in their underlying causes or associated factors. o Making inferences or drawing conclusions about the reasons for the existence of the health condition or problems. Problem definition or nursing diagnosis

5. 6. 7. 8. 9.

Loss of job of bread earner: foreseeable crisis Regular exercise: wellness state Poor impulse control: foreseeable crisis Spiritual well being: wellness state Fare cost of the eldest child to Canada: stress points

Second level assessment Defines the nature or the type of nursing problems that the family encounters in the performance of the health tasks with respect to a given health condition or problem

Characteristics of a healthy family: the ability to perform the health tasks expected of a family: 1. Recognize the presence of wellness state or health condition or problem; 2. Make decisions about taking an appropriate health action to maintain wellness or manage the health problem; 3. Provide nursing care to the sick, disabled, dependent, or at risk member 4. Maintain a home environment conducive to health maintenance and personal development 5. Utilize community resources for health care. The following then results of your second level assessment: 1. malnutrition as a health deficit - inability to recognize the presence of malnutrition in dependent members due to lack of knowledge. - inability to decide about taking appropriate actions due to failure to comprehend the nature, magnitude of the problem - inability to provide adequate nursing to a member suffering from malnutrition due to: - lack of knowledge about the health condition

Two Major types of nursing assessment First level assessment: process whereby existing and potential health conditions or problems of the family are determined o Wellness states o Health threats o Health deficits o Stress points or foreseeable crisis

How Would you classify the following nursing problems? 1. 2. 3. 4. Malnutrition: health deficit Inadequate family income: foreseeable crisis Blindness: health deficit Family disunity: foreseeable crisis

2. Scabies as health deficit

3. 4. 5. 6. 7.

a. Inability to provide adequate nursing to a member suffering from scabies due to : i. Lack of knowledge about the health condition ii. Lack of knowledge on the nature and extent of nursing care needed iii. Inadequate resources for care Inability (assignment: what would be your second level assessment on these four) Threat for cross-infection from communicable disease case Inadequate family income as a health threat Inadequate living space as a health threat Improper garbage disposal as a health threat

8. Population groups vulnerable to malnutrition 9. Phil. DOH nutrition program 10. Review on the concept of family