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2. APPRENTICE NURSING
*Extends from the founding of religious orders in the 6th century through the
crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established by
pastor Fliedner and his wife.
*Period of on the job training- desired of person to be trained
3. EDUCATED NURSING
*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas in London.
First program of formal education for nurses started.
4. CONTEMPORARY NURSING
*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes occurs.
INTUITIVE NURSING
*Cause of illness was believed to be the invasion of the victims body by an evil
spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural power.
*Believed in medicine man (shaman or witch doctor) that had the power to heal
by using white magic.
They made use of hypnosis, charms, dances, incantations, purgatives,
massage,fire, water, herbs or other vegetations and even animals.
*Performing a trephine
Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
Goal of this therapy is to drive the evil spirit from the victims body.
*Nurses role was instinctive directive toward comforting, practicing midwifery
and being wet nurse to a child.
*Act performed without training and direction.
Babylonia
*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time
Egypt
*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of 250
recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged physicians
was Imhotep.
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses 5th book is a midwife and wet nurse.
Palestine
*The Hebrews book of genesis emphazised the teachings of Judaism regarding
hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-cleanliness
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.
China
*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of
treating wounds, infection and muscular afflictions.
*Chan Chun Ching Chinese Hippocrates.
*Emperor Shen Nung said to be the father of Chinese medicine and the
inventor of acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the sick
will fall to the female members of the household.
India
*First recorded reference to the nurses taking care of patients on the writings of
shushurutu.
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals throughout
India where nurses were employed.
Greece
*Made contribution in the area aesthetic arts and clinical medicine, but nursing
was the task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we associate
the Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine insisted that magic and philosophical
theories had no place in medicine.
*The work of women was restricted to the household. Where mistress of the
mansion gave nursing care to the sick slaves.
Rome
*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine First aid, field ambulance service and hospitals for
wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used in
medicine ever since.
APPRENTICE NURSING
*Religious orders of Christian Church played a major role in this kind of nursing.
Nursing Saints
* St. Hildegarde a Benedictine abbess in Germany, actually prescribed cures in
her 2 books on medicine and natural history.
* St. Francis and Clara took vows of poverty, obedience, service and chastity
and took care of the sick and the afflicted; founders of the Franciscan Order and
the Order of the Poor Clares respectively.
* St. Elizabeth of Hungary the patroness of nurses; built a hospital for the sick
and the needy.
* St. Catherine of Siena the 1st lady with a lamp; became a tertiary of St.
Dominic and engaged in works of mercy among the sick and of the Church.
The Reformation
* St. Vincent de Paul set up the first program of social service in France and
organized the Community of the Sisters of Charity. His 1st superior and co-
founder was Louise de Gras (nee de Marillac).
England
* June 15, 1860 marked the day when 15 probationers entered St. Thomas
Hospital in London to establish the Nightingale system of Nursing, founded
by Florence Nightingale (May 12, 1820). Among the highlights in her life are the
following:
- At age of 31, obtained parental consent to enter the Deaconess School at
Kaisserwerth.
- Had 3 months training at Kaisserwerth; later superintendent of the
Establishment for Gentlewomen During Illness (1853) during which time she
initiated the policy of admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women at
Scutari in the Crimea upon the request of Sir Sidney Herbert, Minister of War in
England. At first their work is not accepted because it consisted of cleaning the
area, thus reducing the infections, clothing for the men, writing letters to their
families; their work served as inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital
in London believed that schools should be self-supporting; that schools of nursing
should have decent living quarters for their student; that they should have paid
nurse instructors; that the school should correlate theory to practice and these
students should be taught the why not just how in nursing.
- 2 books written Note on Nursing and Notes on Hospital, contain many
timely portions applicable in the 1970s as they were in 1859.
United States
* At the time that Florence Nightingale was opening her school in London; the U.S
was on the brink of the civil war. However though the country was in a condition of
chaos, nursing had many supporters and the needs to train nurses were
recognized.
- Linda Richards is the first graduate nurse in the U.S completed her training at
the New England Hospital for Women and Children in Boston, Massachusetts,
patterned after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan
the Bellevue Training School for Nurse in the New York City , the Connecticut
training. School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel
Hampton Robb as its 1st principal and the person most influential in directing the
development of nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization
was lad:
1. The Associated Alumnae, later known as the American Nurses
Association was begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses,
later known as the National League for Nursing Education, also began.
- During the Spanish American War (1898 1899) nurse were concerned with
the care of the wounded as well as care of those inflected with malaria and yellow
fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in
the search for control yellow fever.
* 1913 1937
- a standard curriculum for schools of nursing was prepared by the National
League for Nursing Education.
- the practice of nursing was gradually infiltrated with educational objectives.
* Worl War I (1917 1918)
- Private duty nurses were now nursing in the hospitals rather than in homes.
- Opening of more nursing schools as a result of the construction of more
hospitals.
- Increase demand for public health nurse for preventice aspects of care.
- Awareness of the need for military ranking among nurses for which a bill was
later introduced and passed.
Julia Stimson was the first woman to hold rank of major.
CONTEMPORARY NURSING
* Creation of United Nations in San Francisco California in 1945.
2 folds purpose are:
- International peace and international security with provisions for equal justice,
Machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic progress.
*Fray Juan Clemente was one of the 1st members of the Mission of the Order of
St. Francis in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he filled
with various medical remedies.
- Performed both the function of a physician and those of a nurse.
*Persons who really did nursing care of the sick were religious group (called
hospitallers) but they were assisted by Filipino attendants.
*In the early development of nursing, the work of the nurse and those of the
physician were not clearly defined.
* The Filipino Red Cross had its own constitution approved by the revolutionary
government. This was founded on February 17, 1899 with Dona Hilaria
Aguinaldo as president and Dona Sabina Herrera as secretary.
22. St. Rita Hospital and School of Midwifery (1956) and Nursing (1960)
1. Nursing Leaders
Florence Nightingale (1820-1910)
-recognized as nursings first scientist-theorist for her work, Notes on
Nursing: What It is, and What It is Not
-considered the founder of modern nursing.
-developed the Nightingale Training School of Nurses, which operated in
1860. The scchool served as a model for other training schools. Its
graduates traveled to other countries to manage hospitals and institute
nurse-training programs.
-Nightingales vision of nursing, which include public health and healt
promotion roles for nurses, was only partially addressed in the early days of
nursing. The focus tended to be on developing the profession within
hospitals.
Clara Barton (1812-1921)
-organized the American Red Cross, which linked with the International
Red Cross when the U.S Congress ratified the Geneva Convention in 1882.
Lilian Wald (1867-1941)
-considered the founder of Public Health Nursing.
Lavinia L. Dock (1858-1956)
-active in the protest movement for womens right that resulted in the U.S
Constitution amendment in 1920, allowing women to vote.
Margaret Sanger (1879-1966)
-a nurse activist; considered the founder of planned Parenthood, was
imprisoned for opening the first birth control information clinic in Baltimore in
1916.
Lydia Hall
-developed the Care, Core, and Cure Theory
-Goal: To Care, and Cure Cores disease.
-Care for the patients BODY. Cure the DISEASE. Treat the PERSON ( or
patient) as the Core.
B. Nursing as a Profession
NURSING AS A PROFESSION
Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its memebers and make it possible to practice effectively.
Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well as a
basic liberal foundation.
2. A profession has a theoretical body of knowledge leaing to defined skills,
abilities and norms.
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profesion has a code of ethics for practice.
NURSING
- is a desciplined involved in the delivery of health care to the society.
- is a helping profession.
- is service-oriented to maintain health and well-being of people.
- is an art and science.
Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as
physiological, psychological, and sociological organism.
4. Nursing is committed to promoting individual, family, community, and national
health goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to
color, creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
Roles of a Professional
1. Caregiver/Care provider
- the traditional and most essential role.
- functions as nurturer, comforter, provider.
- mothering actions of the nurse.
- provides direct care and promotes comfort of client.
- activities involves knowledge and sensitivity to what matters and what is
important to clients.
- show concern for client welfare and acceptance of the client as a person.
2. Teacher
- provides information and helps the client to learn or acquire new knowledge and
technical skills.
- encourages compliance with prescribed therapy.
Promotes healthy lifestyle.
- interprets information to the client.
3. Counselor
- helps client to recognize and cope with stressful psychologic or social problems;
to develop an improve interpersonal relationships and to promote personal growth.
- Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.
4. Change agent
- initiate changes or assist clients to make modifications in themselves or in the
system of care.
5. Client advocate
- involves concern for and actions in behalf of the client to bring about a change.
- promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
- provides explanation in clients ;anguage and support clients decisions.
6. Manager
- makes decisions, coordinates activities of others, allocate resource evaluate care
and personnel.
- plans, give direction, develop staff, monitor operations, give the reward fairly and
represent both staff and administrations as needed.
7. Researcher
- participates in identifying significant researchable problems.
- participates in scientific investigation and must be a consumer of research
findings.
-must be aware of the research process, language of research, a sensitive to
issues related to protecting the rights of human subjects.
1. Clinical Specialists
- is a nurse who has completed a masters degree in specialty and has
considerable clinical expertise in that specialty. She provides expert care to
individuals, participates in education health care professionals and ancillary, acts
as a clinical consultant and participates in research.
2. Nurse Practitioner
-is a nurse who has completed either as a certificate program or a masters degree
in a specialty and is also cerified by the appropriate specialty organization. She is
skilled at making nursing assessments, performing P.E., counselling, teaching and
treating minor and self-limiting illness.
3. Nurse-Midwife
- a nurse who has completed a program in midwifery; provides prenatal and
postnatal care and delivers babies to woman with uncomplicated pregnancies.
4. Nurse Anesthetist
- a nurse who completed the course of study in an anesthesia school and carries
out pre-operative status of clients.
5. Nurse Educator
- a nurse usually with advanced degree, who beaches in clinical or educational
settings, teaches theoretical knowledge, clinical skills and conduct research.
6. Nurse Entrepreneur -
- a nurse who has an advanced degree, and manages health-related business.
7. Nurse Administrator
- a nurse who functions at various levels of management in health settings;
responsible for the management and administration of resources and personnel
involved in giving patient care.
Fields and Opportunities in Nursing
Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an amalgam
of activities
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying
III. Theories
*Group of related concepts that proposes actions that guide practice. May be
broad but limited only to particular aspects
Middle-range Theories
*The least abstract level because they include specific details in nursing practice
like population, condition and location.
C. HEALTH EDUCATION
1. Assess the learning needs of the patient and family.
2. Develops health education plan based on assessed and anticipated needs.
3. Develops learning materials for health education.
4. Implements the healtheducation plan.
5. Evaluates the outcome of health education.
D. LEGAL RESPONSIBILITY
1. Adheres to practice in accordance with the nursing law and other relevant
legislation including contracts, informed consent.
2. Adheres to organizational policies and procedures, local and national.
3. Documents care rendered to patients.
E. Ethico-Moral Responsibility
1. Respects the rights of individuals/groups.
2.Accepts responsibility and accountability for own decisions and actions.
3. Adheres to the national and international code pf ethics for nurses.
G. Quality Improvement
1. Utilizes data for quality improvement
2. Participtaes in nursing audits and rounds.
3. Identifies and reports variances.
4. Recommends solutions to identified causes of the problems.
5. Recommends improvement of systems and processes.
H. Reasearch
1. Utilizes varied methods of inquiry in solving problems.
2. Recommends actions for implementation.
3. Disseminates results of research findings.
4. Applies research findings in nursing practice.
I. Record Management
1. Maintains accurate and updated documentation of patient care.
2. Records outcome of patient care.
3. Observes legal imperatives in record keeping.
4. Maintains an effective recording and reporing system.
J. Communication
1. Utilizes effective communication in relating with clients, members with the team
and the public in general.
2. Utilizes effective communicationin therapeutic use of self to meet the needs of
clients.
3. Utilizes formal and informal channels.
4. Responds to needs of individuals, families, groups and communities.
5. Uses appropriate information technology to facilitate communication.
2. Fields of Nursing
3. Roles and Functions
V. Legal Responsibility
A. Legal Aspects in the Practice of Nursing
B. The Philippine Nursing Law of 2002 (R.A 9173)
C. Related Laws Affecting the Practice of Nursing
IX. Research
A. Problem Identification
B. Ethics and Science of Research
C. The Scientific Approach
D. Research Process
E. Research Designs and Methodology
1. Qualitative
2. Quantitative
F. Utilization and Dissemination of Research Findings
X. Communication
A. Dynamics of Communication
B. Nurse-Client Relationship
C. Professional-Professional Relationship
D. Therapeutic Use of Self
E. Use of Information Technology
I. Safe and Quality Care, Health Education and Communication, Collaboration and
Team work
COMMUNITY HEALTH NURSING
HISTORY OF CHN
Date
1901 Act # 157 (Board of Health of the Philippines) ;
Act # 309 (Provincial and Municipal Boards of Health) were created.
1095 Board of Health was abolished; functions were transferred to the Bureau of
Health.
1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners
of present MHOs; male nurses performs the functions of doctors.
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario, 1st Filipino Nurse supervisor under Bureau of Health.
October 22, 1922 Filipino Nurses Organization (Philippines Nurses
Organization) was organized.
1923 Zamboanga General Hospital School of Nursing and Baguio General
Hospital were established; other government schools of nursing were organized
several years after.
1928 1st Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the first ciy health officer; Office of Nursing
was created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz
(assistant chief nurse)
December 8, 1941 Victims of World War II were treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release
of 31 Filipino Nurses in Bilibid Prison as Prisoners of War by the Japanese.
February 1946 Number of Nurses decreased from 556 308.
1948 First training center of the Bureau of Health was organized by the Pasay
City Health Department. Trinidad Gomez, Marcela Gabatin, Constancia Tuazon,
Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff.
1950 Rural Health Demonstration and Training Center was created.
1953 The first 81 Rural Health Units were organized.
1957 RA 1891 Ammended some sections of RA 1082 and created the eight
categories of Rural Health Unit causing an increase in the demand for the
community health personnel.
1958 1965 Division of Nursing was abolished (RA 977) and Reorganization
Act (EO 288)
1961 Annie Sand organized the National Nurses of DOH.
1967 Zenaida Nisce became the nursing program supervisor and consultant on
the six special diseases (TB, Leprosy, V.D., Cancer, Filariasis, and Mental Health
Illness).
1975 Scope of responsibility of nurses and midwives became wider due to
restructuring of the health care delivery system.
1976 1986 The need for Rural Health Practice Program was implemented.
1990 1992 Local Government Code of 1991 (RA 7160)
1993 1998 Office of Nursing did not materialize in spite of persistent
recommendation of the officers, board members, and advisers of the National
League of Nurses Inc.
January 1999 Nelia Hizon was positioned as the nursing adviser at the Office of
Public Health Services through Department Order # 29.
May 24, 1999 EO # 102, which redirects the functions and operations of DOH,
was signed by former President Joseph Estrada.
R.A 2382 Philippine Medical Act. This act defines the practice of medicine in the
country.
R.A 1082 Rural Health Act. It created the 1st 81 Rural Health Units.
- amended by R.A 1891; more physicians, dentists, nurses, midwives
and sanitary inspectors will live in the rural areas where they are assigned in order
to raise the health conditions of barrio people, hence help decrease the high
incidence of preventable diseases.
R.A 6425 Dangerous Drugs Act. It stipulates that the sale, administration,
delivery, distribution and transportation of prohibited drugs is punishable by law.
R.A 9165 The New Dangerous Draug Act of 2002.
P.D No. 651 requires that all Health Workers shall identify and encourage the
registration of all births within 30 days following delivery.
P.D No. 996 requires the compulsary immunization of all children below 8 years
of age against the 6 childhood immunizable diseases.
P.D No. 825 provides pernalty for improper disposal of garbage.
R.A 8749 Clean Air Act of 2000
P.D No. 856 Code of Sanitation. It provides for the control of all factors in mans
environment that affect health including the quality of water, food, milk, insects,
animal carriers, transmitters of disease, sanitary and recreation facilities, nilse,
pollution and control of nuisance.
R.A 6758 Standardizes the salary of government employees including the
nursing personnel.
R.A 6675 Generics Act of 1988 which promotes, requires and ensures the
production of an adequate supply, distribution, use and acceptance of drugs and
medicines identified by their generic name.
R.A 6713 Code of Conduct and Ethical Standards of Public Officials and
Employees. It is thepolicy of the state to promote high standards of ethics in public
office. Public officials and employeesshall at all times be accountable to the people
and shall discharges their duties with utmost responsibility, integrity, competence
and loyalty, act with patriotism and justice, lead modest lives uphold public interest
over personal interest.
R.A 7305 Magna Carta for Public Health Workers. This act aims: To promote
and improve the social and economic well-being of health workers, their living and
working conditions and terms of employment; to develop their skills and
capabilities in order that they will be more responsive and better equipped to
deliver health projects and programs; and to encouragethose with proper
qualifications and excellent abilities to join and remain in government service.
R.A 8423 Created the philippine Institute of Traditional and Alternative Health
Care.
P.D No. 965 requires applicants for marriage license to receive instructions on
family planning and responsible parenthood.
P.D No. 79 defines, objectives, duties, and functions of POPCOM.
R.A 4073 advocates home treatment for lepsrosy.
Letter of Instruction No. 949 legal basis of PHC dated october 19, 1979.
-- promotes development of health programs on the
community level.
R.A 3573 requires reporing of all cases of communicable diseases and
administration of prophylaxis.
Misnistry Circular No. 2 of 1986 includes AIDS as notifiable disease.
R.A 7875 National Health Insurance Act
R.A 7432 Senior Citizens Act
R.A 7719 National Blood Services Act
R.A 8172 Salt Iodization Act ( ASIN LAW)
R.A 7277 Magna Carta for PWDS, provides their rehabilitation, self-
development and self-reliance and integration into the mainstream of society.
*A.O No. 2005 0014 National Policies on Infant and Young Child Feeding:
1. All newborns be breastfeed within 1 hour after birth.
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond.
I. Definition of Terms
Community derived from a latin word communicas which means a group of
people.
- a group of people with common characteristics or interests living together within
a territory or geographical boundary.
- place where people under usual conditions are found.
COMPONENTS:
INDIVIDUAL PERCEPTIONS: Includes perceived
susceptivility,seriousness and threat. Seriousness of an illness.
MODIFYING FACTORS: Includes demographic variables, sociophysiologic
variables, structural variable, and cues to action. Susceptibility to an illness.
LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the
perceived barriers. Benefits of taking actions.
Males age 40-49 seafarers ratio: 1: 5 anal sex- wont get pregnant,
common in rural
Vaginal: 1: 1000
Females 20-29 Anal: 1: 200-----highest risk
PUBLIC HEALTH ( Dr. C.E. Winslow ) the science and art of preventing
disease, prolonging life, promoting health and efficiency through organized
community effort for the sanitation of the environment, control of communicable
diseases, the education of individuals in personal hygiene, the organization of
medical and nursing services for the early diagnosis and preventive treatment of
diseases and the development of social machinery to ensure everyone a standard
of living adequate for the maintenance of health, so organizing these benefits as to
enable every citizen to realize his birthright of birth and longevity.( Dr C.E
Winslow ).
Aims:
1. health promotion
2. disease prevention
3. management of factors affecting health.
INDIVIDUAL CLIENT: APPLIED STUDY: COMMUNITY AS CLIENT:
Anatomy Structure Demographic study of population
Physic Function Sociology
Pathos Malfunction Epidemiology study of disease
1. Virginia Henderson
- Assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness
2. Dorothea Orem
- Providing assistance to clients to achieve self-care towards optimum wellness.
Early years- fetus- 12 years/ younger adults- 12-24 years
Orem- self care, autonomy----independent patient
3. Florence Nightingale
- Placing an individual in an environment. that will promote optimum capacity for
self-reparative process
- individual capable of self-repair and there is something to repair in an individual.
COMMUNITY HEALTH NURSING
-Synthesis of public and nursing practice.
Concepts
1. The primary focus of community health nursing practice is on health promotion
and disease prevention.
Primary goal self reliance in health or enhanced capabilities.
Ultimate goal raise level of number of citizenry.
Philosophy of CHN Worth and dignity of man.
2. CHN practices to benefit the individual, family, special groups, and community
*CHN is integrated and comprehensive
3. Community Health Nurses are generalist in terms of their practice through life
but the whole community its full range of health problems and needs.
4. Community Health Nurses are generalist in terms of their practice through life
continuity in its full range of health problems and needs.
5. The nature of CHN practice requires that current knowledge derived from the
biological, social science, ecology, clinical nursing and community health
organizations be utilized.
6. Contact with the client and or family may continue over a long period of time
which includes all ages and all types of health care.
Levels of Health Care:
Primary Health Care: Management at the level of community
Secondary Health Care: Regional, District, Municipal, and Local Hospital
Tertiary Health Care: Sophisticated Medical Center Heart Center, KI
7. The dynamic process of assessing, planning, implementing and intervening
provide measurements of progress, evaluation and a continuum of the cycle until
the termination of nursing is implicit in the practice of Community Health Nursing.
Nursing Function:
Independent without supervision of MD
Collaborative in collaboration with other Health team
( interdisciplinary, intrasectoral )
Goal: To raise the level of citizenry by helping and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential
for high-level wellness. Nisce, et al
To elevate the level health of the multitude.
PHILOSOPHY OF CHN
*The philosophy of CHN is based on the worth and dignity of man.
PUBLIC HEALTH
1. WINSLOW
- The science & art of preventing disease, prolonging life, promoting health
& efficiency through
organized community effort
To enable each citizen to realize his birth right of health & longevity.
Major concepts:
1. Health promotion
2. Peoples participation towards self-reliance
2. HANLON
- Most effective goal towards total development and life of the individual &
his society
3. PURDOM
- Applies holism in early years of life, young, adults, mid year & later
- Prioritizes the survival of human being
PUBLIC HEALTH NURSING
(Cuevas, 2007)
-In the light of the changing national and global helath situation and the
acknowledgement that nursing is a significant contributor to health, the public
health nurse is strategically positioned to make a difference in the health outcomes
of individuals, families, and communities cared for.
Concepts
1. Science and Art of Preventing diseases, prolonging life, promoting health and
efficiency through organized community effort for the:
a. sanitation of the environment.
b. control of communicable diseases.
c. the education of individuals in personal hygiene.
d. organization of medical and nursing services for early diagnosis and preventive
treatment of disease, and the development of social machinery to ensure
everyone a standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his birthright of
health and longevity.
Determinants of Health
*Factors that can affect health
a. Income and social status - socioeconomic
b. Education - socioeconomic
c. Physical Environment - Environment
d. Employment and working conditions - socieconomic
e. Social support networks - socioeconomic
f. Culture, Customs and Traditions - Behavior
g. Genetics - Heredity
h. Personal Behavior and coping skills - Behavior
i. Health Services Health Care Delivery System
j. Gender Heredity
-ECOSYSTEM influence on OLOF ( Blum 1974 ).
PRINCIPLES
1. The need of the community is the basis of community health nursing.
2. The community health nurse must understand fully the objectives and policies of
the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of race, creed and socioeconomic
status.
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation of community health nursing
service.
7. Opportunities for continuing staff education programs for nurses must be
provided by the community health nurisng agency and the CHN as well.
8. The CHN makes use of available community health resources.
9. The CHN taps the already existing active organized groups in the community.
10. There must be provision for educative supervision in community health
nuraing.
11.There should be accurate recording and reporting in community health nursing.
12. Health teaching is the primary responsibility of the community health nurse.
STANDARDS IN CHN
I. Theory
Applies theoretical concepts as basisfor decisions in practice.
II. Data Collection
Gathering comprehensive, accurate data systematically.
III. Diagnosis
Analyzes collected data to determine the needs / health problems of Individual,
Family, Community.
IV. Planning
At each level of prevention, develops plans that specify nursing actions unique
to needs of clients.
V. Intervention
Guided by the plan, intervenes to promote, maintain or restore health, prevent
illness and institute rehabilitation.
VI. Evaluation
Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnose and plan.
VII. Quality Assurance and Professional Development
Participates in peer review and other means of evaluation to assure quality of
nursing practice.
Assumes professional development.
Contributes to development of others.
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and evaluating
programs for community health.
IX. Research
Indulges in research to contribute to theory and practice in community health
nursing.
B. Levels of Care
LEVELS OF CARE/PREVENTION
PRIMARY
-Is devolved to the cities and the municipalities. It is health care provided by center
physicians, public health nurses, rural health midwives, barangay health workers,
traditional healers and others at the barangay health stations and rural health
units. The primary health facility is usually the first contact between the community
members and the other levels of health facility.
- activites that prevent a problem before it occurs. Example: Immunization.
SECONDARY
-Secondary care is given by physicians with basic health training. This is usually
given in health facilities and district hospitals and out-patient departments of
provincial hospitals. This serves as a referral center for the primary health
facilities. Secondary facilities are capable of performing minor surgeris and
perform some simple laboratory examinations.
- activities that provide early detection/diagnosis and treatment and Intervention.
Example: Breast self-examination, HIV screening, Operation timbang.
TERTIARY
-Is rendered by specialists in health facilities including medical centers as well as
regional and provincial hospitals, and specialized hospitals such as the Philippine
Heart Center. The tertiary health facility is the referral center for the secondary
care facilities. Complicated cases and intensive care requires tertiary care and all
these can be provided by the tertiary care facility.
- activities that correct a disease state and prevent it from further deteriorating.
Example: Teaching Insulin Administration in the home
C. Types of Clientele
TYPES OF CLIENTELE
INDIVIDUAL
- People who visits the health center.
- People who receives health services.
e.g., Prenatal Supervision
Well Child Follow ups.
Morbidity Service
Teaching Client on Insulin Administration
Basic approaches in looking at the individual:
1. atomistic the basic constituents of an individual, use concepts of biology which
in turn refers to essentialism --- behavior --- psychological --- human behavior is
dictated by experience.
2. holistic suprasystems sociological in nature social constructionism
nurture behavior
SEX --- a biological concept (male / female)
--- a sociological concept --- gender --- musculinity or femininity --- based
on culture.
--- on sexual orientation: attracted to Opposite sex heterosexual
Same sex homosexual
Both bisexual
MODELS:
Stages of Family Development by Evelyn Duvall
STAGE 1 The Beginning Family ( newly wed couples ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
family.
STAGE 4 The Family with School Age Children ( 6 -12 years old).
TASK: Reinforce the concept of Responsible Parenthood.
STAGE 6 Launching Center ( 1st Child will get married upto the last child ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
Family.
STRUCTURAL FUNCTIONAL
Initial Data Base
a. Family Structure and Characteristics
Nuclear basic family
Extended in-law relations, or grandparents relations
*members of household in relation to head
*demographic data ( sex male or female, age, civil status )
Live in = married/ common law WIFE
Male Patriarchal Female Matriarchal
*types and structure of family
*dominant members in health
*general family relationship
Assessment: Family
-Initial data base
-1st level assessment
-2nd level assessment
c. Environmental Factors
*housing- number of rooms for sleeping
*kind of neighborhood
*social health facilities available
*comm. And transportatx facilities
*Health Deficits:
-Instances of failure in health maintenance ( disease, disability, developmental lag
)
3 TYPES:
a. Disease / Illness URTI, marasmus, scabies, edema
b. Disabilities blindness, polio, colorblindness, deafness
c. Developmental Problem like mental retardation, gigantism, hormonal, dwarfism
COMMUNITY Patient
- Defined by geographic boundaries with certain identifiable characteristics, with
common values and interests.
POPULATION GROUPS-
-Aggregation of people who share common chaaracteristics, developmental stage
or common exposure to particular environmental factors thus resulting in common
health problems ( Clark, 1995: 5 ) e.g. children, elderly, women, workers, etc.
- Specialized Fields:
*COMMUNITY MENTAL HEALTH NURSING a unique process which includes
an integration of concepts from nursing, mental health, social psychology,
psychology, community networks, and the basic sciences.
Focus: Mental Health Promotion no need to identify disease, increase mental
wellness of people.
Nursing: Strengthening the support mechanism
Psychiatric Nursing-Focus: Mental Disease Prevention
Focus: Mental Disease Prevention identify disease and shorten disease process
The Philippine health care delivery system is composed of two sectors: (1) the
public sector, which largely financed through a tax-based budgeting system at
both national and local levels and where health care is generally given free at the
point of service and (2) the private sector (for profit and non-profit providers)
which is largely market-oriented and where health care is paid through user fees at
the point of service.
The public sector consists of the national and local government agencies
providing health services. At the national level, the Department of Health (DOH) is
mandated as the lead agency in health. It has a regional field office in every region
and maintains specialty hospitals, regional hospitals and medical centers. It also
maintains provincial health teams made up of DOH representatives to the local
health boards and personnel involved in communicable disease control,
specifically for malaria and schistosomiasis. Other national government agencies
providing health care services such as the Philippine General Hospital are also
part of this sector.
With the devolution of health services, the local health system is now run by Local
Government Units (LGUs). The provincial and district hospitals are under the
provincial government while the city/municipal government manages the health
centers/rural health units (RHUs) and barangay health stations (BHSs). In every
province, city or municipality, there is a local health board chaired by the local
chief executive. Its function is mainly to serve as advisory body to the local
executive and the sanggunian or local legislative council on health-related matters.
The private sector includes for-profit and non-profit health providers. Their
involvement in maintaining the peoples health is enormous. This includes
providing health services in clinics and hospitals, health insurance, manufacture of
medicines, vaccines, medical supplies, equipment, and other health and nutrition
products, research and development, human resource development and other
health-related services.
DEPARTMENT OF HEALTH
-Lead agency in the Health Sector
-Sets the goals for the nations health status
-Establishes PARTNERSHIP
DOH MANDATE
1. Formulation
2. Support
3. Issuance
4. Promulgation
5. Development
Roles of DOH:
1. Leadership in Health
*Serve as the national policy and regulatory institution.
*Provide leadership in the formulation, monitoring and evaluation of the national
health policies, plans and programs.
*Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and Capacity builder
*Innovate new strategies in health.
*Exercise oversight functions and monitoring and evaluation of national health
plans, program and policies.
*Ensure the highest achievable standards of quality health care, promotion and
protection
3. Administrator of specific services
*Manage selected national health facilities and hospitals with modern and
advanced facilities.
*Administer direct services for emergent health concerns that require new
complicated technologies.
VISION:
Old: Health for all Filipinos
New: The Leader of health for all in the Philippines
New: The DOH is the leader, staunch advocate and model in promoting Health for
all in the Philippines.
New: A global leader for attaining better health outcomes, competetive and
responsive health care system, and equitable health financing by 2030.
MISSION:
-Old: Ensure accessability and quality of health care services to improve the
quality of life of all Filipinos, especially the poor.
-New:To guarantee equitable, sustainable and quality health for all Filipinos,
especially the poor, and to lead the quest for excellence in health.
PHILOSOPHY OF DOH:
-Quality is above Quantity!
PRINCIPLES OF DOH
P Performance of health sector must be enhanced.
U Universal Access to basic health services.
S Shifting from infectious to degenerative diseases must be managed.
H Health, and nutrition of vulnerable group must be prioritized.
STRATEGIES OF DOH
SAID!!!
S support the local health system and front line workers.
A assurance of health care for all.
I increase investment of PHC.
D development of national standards.
Roadmap for All Stakeholders in Health: National Objectives for Health 2005
2010.
National Objective for Health: sets the target and the critical indicators, current
strategies based on field experience, and laying down new avenues for improved
interventions.
E. PHC as a Strategy
PHC as a Strategy
*October 19, 1979 Letter of Instruction ( LOI 949 ), the legal basis of PHC was
signed by President Ferdinand E. Marcos, which adopted PHC as an approacch
toward the design, development and implementation of programs focusing on
health development at community level.
LOI 949 signed by President Marcon with an underlying theme: Health in the
hands of the People by 2020.
Rationale for Adopting PRIMARY HEALTH CARE:
*Magnitude of Health Problems.
*Inadequate and unequal distribution of health resources.
*Increasing cost of medical care.
*Isolation of health care activities from other development activities.
An improved state of health and quality of life for all people attained through SELF-
RELIANCE.
Concept of PHC
KEY STRATEGY TO ACHIEVE THE GOAL:
- charactterized by partnership and empowerment of the people that shall
permeate as the core strategy in the effective provision of essential health service
that are community based, accessible, acceptable and sustainable at a cost, which
the community and the government can afford.
MISSION:
*To strengthen the health care system by increasing opportunities and supporting
the conditions wherein people will manage their own health care.
4. SELF RELIANCE
HEALTH
- is not merely the absence of disease. Neither it is only a state of physical and
mental well being.
- Health being a soical phenomenon recognizes the interplay of political, socio
cultural and economic factors as its determinant.
- Good Health therefore, is manifested by the progressive improvements in the
living conditions and quality of life enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved quality of life for all.
-Development is mulit dimentional. It has a political, social, cultural, institutional
and environmental dimensions ( Gonzales 1994 ). Therefore, it is measured by the
ability of people to satisfy their basic needs.
7. SOCIAL MOBILIZATION =
- It enhances people participation or governance, support system provided by the
Government, networking and developing secondary leaders.
8. DECENTRALIZATION
Policies to abide:
1. Know indications
2. Know parts of plants with therapeutic value: roots, fruits, leaves
3. Know official procedure/preparation
Procedures/Preparations:
a. Decoction
Gather leaves & wash thoroughly, place in a container the washed
leaves & add water
Let it boil without cover to vaporize/steam to release toxic substance
& undesirable taste
Use extracts for washing
b. Poultice
Done by pounding or chewing leaves used by herbolaryo
Example: Akapulko leaves-when pounded, it releases extracts
coming out from the leaves contains enzyme (serves as anti-
inflammatory) then apply on affected skin or spewed it over skin
For treatment of skin diseases
c. Infusion
To prepare a tea (use lipton bag), keep standing for 15 minutes in a
cup of warm water where a brown solution is collected, pectin which
serves as an adsorbent and astringent
Used for diarrhea and for pneumonia so PHN discourages to buy
commercially prepared cough syrup expectorant: Nature of Cough
1) Dry mucolytic liquefy mucus
Example: Carbocisteine, Guafenesin
2) Productive expectorant irritants to the mucus gland
Example: Bromhexine (Bisolvon)
3) Non stop coughing antitussive
Example: Dextromethorpan (Robitussin) contains codeine
Robitussin AC contains atropine & codeine
d. Juice/Syrup
To prepare a papaya juice, use ripe papaya & mechanically mashed
then put inside a blender & add water
To produce it into a syrup, add sugar then heat to dissolve sugar &
mix it
For problems of constipation
Example: papaya, mango & caimito
e. Cream/Ointment-for topical use
Cream is water based & used for wet skin lesions
Ointment is oil based & used for dry lesions
Example: Akapulko Leaves
start with poultice (pound leaves) to turn it semi-solid
add flour to keep preparation pasty & make it adhere to skin
lesions
to make it into an ointment: add oil (mineral, baby or any oil-
serves as moisturizer) to the prepared cream to keep it lubricated
while being massage on the affected area
STEPS:
1. RELATING
- Establishing a working relationship. Results in positive outcomes such as good
quality of data, partnership in addressing identified health need and problems, and
satisfaction of the nurse and the client.
2. ASSESSMENT
- Data Collection, Data Analysis and Data Interpretation and Problem definition or
Nursing Diagnosis.
TWO TYPES OF ASSESSMENT
a. First Level Assessment Data on status / conditions of family household
members.
b. Second Level Assessment Data on family assumption of health tasks on
each problem identified in the First Level Assessment.
3. PLANNING
- Determination of how to assist client in resolving concerns related to restoration.
Maintenance or promotion of health.
- Establishment of priorities, set goals / objectives, selects strategies, describe
rationale.
4. IMPLEMENTATION
- The carring out of plan of care by client and nurse, make ongoing assessment,
update / revise plan, document responses.
5. EVALUATION
- A systematic, continuous process of comparing the clients response with written
goal and objective.
-Determines progress and evaluate the implemented intervention as to:
1. Effectiveness
2. Efficiency
3. Adequacy
4. Acceptability
5. Appropriateness
I. NURSING ASSESSMENT
-Involves a set of actions by which the nurse measures the status of the family as
a client, their ability to maintain wellness, prevent and control or resolve problems
in order to achieve health and well being among its members.
2. Data Analysis
Steps:
1. Sorting of data for broad categories (such as those related with health
status or practices about home and environment).
2. Clustering of related cues to determine relationship among data.
3. Distinguishing relevant from irrelevant data. This will help in deciding what
information is pertinent to the situation at hand and what information is
immaterial.
4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication patterns.
5. Compare patterns with norms or standards of health, family functioning
and assumption of health tasks.
6. Interpreting results of comparisons to determine signs and symptoms or
cues of specific wellness state/s, health deficit/s, health threat/s,
foreseeable crises/stress point/s and their underlying causes or associated
factors.
7. Making conclusions about the reasons for the existence of the health
condition or problem, or risk for non-maintenance of wellness state/s which
can be attributed to non-performance of family tasks.
3. Problem Definition/Nursing Diagnosis
End result of 2 major types of assessment.
II. Inability to make decisions with respect to taking appropriate health action
due to:
A. Failure to comprehend the nature/ magnitude of the problem / condition
B. Low salience of the problem / condition
C. Feeling of confusion, helplessness and / or resignation brought by
perceived magnitudes / severity of the situation or problem, i.e., failure
to break down problems into manageable units of attacks
D. Lack of / or inadequate knowledge / insight as to alternative courses of
action to take
E. Inability to decide which action to take among the list of alternatives
F. Conflicting opinions among family members / significant others
regarding action to take
G. Lack of / or inadequate knowledge of community resources for care
H. Fear of consequence of action, specially:
social consequences
economic consequences
physical / psychological consequences
I. Negative attitude towards the health problem By negative attitude is
meant one that interferes with rational decision making
J. Inaccessibility of appropriate resources for care, specifically:
1. physical inaccessibility
2. cost constraints or economic / financial inaccessibility
K. Lack of trust / confidence in the health personnel / agency
L. Others, specify______________
II. PLANNING
- The step in the process which answers the following questions:
*What is to be done?
*How is to be done?
*When it is to be done?
-It is actually the phase wherein the health care provider formulates a care plan.
CRITERIA Weight
1. Nature of the problems Presented 1
Scale:
-Health deficit / Wellness 3
-Health threat 2
-Foreseeable crisis 1
2. Modifiability of the problem 2
Scale:
-Easily modifiable 2
-Partially modifiable 1
-Not modifiable 0
3. Preventive potential 1
Scale:
-High 3
-Moderate 2
-Low 1
4. Salience 1
Salience:
-A condition / problem needing Immediate 2
attention
*A condition / problem not needing 1
Immediate attention
*Not perceived as a problem or condition 0
needing change.
Goal
* It is a general statement of the condition or state to be brought about by
specific courses of action.
Objective
Refers to a more specific statement of desired outcome of care.
They specify the criteria by which the degree of effectiveness of care is to
be measured.
Types of Objective
1. Short term or Immediate Objective
Formulated for problem situation which require immediate attention &
results can be observed in a relatively short period of time.
They are accomplished with few HCP-family contacts & relatively less
resources.
2. Medium or Intermediate objective
Objectives which is not immediately achieved & is required to attain the
long ones.
3. Long Term or Ultimate Objective
This requires several HCP-family contacts & an investment of more
resources.
Typology of Interventions
1. Supplemental - the HCP is the direct provider of care.
2. Facilitative - HCP removes barriers to needed services.
3. Developmental - improves clients capacity.
III. Implementation
Actual doing of interventions to solve health problems.
IV. Evaluation
Determination whether goals / objectives are met.
Determination whether nursing care rendered to the family are effective.
Determines the resolution of the problem or the need to reassess, and
re-plan and re-implement nursing interventions.
According to Alfaro-LeFevre:
Types of Evaluation:
On-going Evaluation analysis during the implementation of the activity,
its relevance, efficiency and effectiveness.
Steps in Evaluation:
1. Decide what to Evaluate.
Determine relevance, progress, effectiveness, impact and efficiency
2. Design the Evaluation Plan
Quantitative a quantifiable means of evaluation which can be done
through numerical counting of the evaluation source.
Qualitative descriptive transcription of the outcome conducted
through interview to acquire an in-depth understanding of the
outcome.
3. Collect Relevant Data that will support the outcome
4. Analyze Data - What does the data mean?
5. Make Decisions
If interventions are effective, interventions done can be applied to
other client / group with the similar circumstances
If ineffective, give recommendations
6. Report / Give Feedbacks
Dimensions of Evaluation
1. Effectiveness focused on the attainment of the objectives.
2. Efficiency related to cost whether in terms on money, effort or
materials.
3. Appropriateness refer its ability to solve or correct the existing
problem, a question which involves professional judgment.
4. Adequacy pertains to its comprehensiveness.
Thermometer
Tape measure
Ruler
BP apparatus
Weighing scale
Checklist
Key Guide Questionnaires
Return Demonstrations
Methods of Evaluation
1. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises
1.1 Family Based Nursing Services (Family Health Nursing Process)
Nursing Assessment of Family:
First Level Assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance
and disease prevention
Second Level Assessment data include those that specify or describe the
familys realities, perceptions about and attitudes related to the assumption or
performance of family health tasks on each health condition or problem
identified during the first level assessment.
Developing the Nursing Care Plan
Steps in developing a family care plan:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. The plan of interventions
4. The plan for evaluating care
Implementing the Nursing Care Plan
During this phase the nurse encounters the realities in family nursing practice
which can motivate her to try out creative innovations or overwhelm her to
frustration or inaction. As the nurse practitioner works with clients she
experiences varying degrees of demands on her resources. A dynamic attitude
on personal and professional development is, therefore, necessary if she has
to face up to challenges of nursing practice.
Evaluation of Family Health Services.
2. Planning
- purpose is to act on determined needs of the community people.
3. Implementation
- purpose is to achieve the optimum level of health of the community people.
4. Evaluation-
- to determine the effectiveness of health care programs.
3 elements : structural , process & measurable outcome or objective
4 Tools/ Instruments for Data Collection:
1. Nursing history subjective
2. PE- Objective
3. Lab- Objective
4. Process recording- objective (analyzed by RN)
NURSING PROCEDURES
Clinic visit
- patient visits the Health center to avail of the services there to offered by the
facility primarily for consultation on matters that ailed them physically.
-Process of checking the clients health condition in a medical clinic.
PURPOSE: (C.U.R.E)
-Consult about signs and symptoms of illness.
-Utilize service of a health agency.
-Render some treatment procedures.
-Evaluate through some diagnostic procedures
III. Triaging
1. Manage program-based cases (like the IMCI)
2. Refer all non-program based cases to the physician
3. Provide first aid treatment to emergency cases and refer to the next
level when necessary
VII. Prescription/dispensing
1. Give proper instructions on drug intake
Home visit
- family nurse contact which allows the health worker to assess the home and
family situations in order to provide the necessary nursing care and health related
activities.
- a professional face to face contact made by the nurse with a patient or the
family to provide necessary health care activities and to further attain the
objectives of the agency.
-PRIORITY during HOME VISITS: Newborn (First), Post-Partum, Pregnant
Mother, Morbid Individual (Last).
Bag Technique: tool by which the nurse, during her visit will enable her to perform
a nursing procedure with ease and deftness, to save time and effort
- a tool making of the public health bag through which the nurse during the home
visit can perform nursing procedures with ease and deftness saving time and effort
with the end in view of rendering effective nursing care.
SOLUTION:
1. Benedicts Solution For sugar detection
2. Acetic Acid For Albumin Detection
3. Zephiram Solution Soaking Solution
4. Alcohol, Betadine
5. Ammonia
-Placed waste paper bag outside of work area to prevent contamination of clean
area.
-RATIONALE IN THE USE OF PHN BAG :
*Technique during home visit
- It helps render effective nursing care.
Intravenous Therapy
- Insertion of a needle or catheter into a vein to provide medication and fluids
based on physicians written prescription
- Can be done only by nurses accredited by ANSAP(Association of Nursing
Service Administration of the Philippine.)
- INDICATIONS:
*Maintenance /Correction of dehydration in patient unable to tolerate adequate
volume of oral fluid medications
*Parenteral Nutrition
*Administration of Drugs
*Blood Transfusion
- CONTRAINDICATIONS:
*Administration of irritant fluids / drugs through peripheral access (e.g., Sodium
Chloride, Hypertonic Potassium Chloride).
Specimen Collection
-URINE Sterile Bottle, Midstream Collection
-FECES Clean Container, Small amount of feces only.
-SPUTUM NPO midnight first collection early AM then submit at the health
center immediately, then second collection following day early in the AM then
submit at the health center then collect the third sputum; instruct the patient to take
a deep breath four times then cough out.
PLANNER / PROGRAMMER
1. Identifies needs, priorities, and problems of individuals, families, and
communities.
2. Formulates municipal health plan in the absence of medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and
circular for the concerned staff personnel.
4. Provides technical assistance to rural health midwives in health matters.
MANAGER / SUPERVISOR
1. Formulates individual, family, group, and community centered plan.
2. Interprets and implements programs, policies, memoranda, and circulars.
3. Organizes work force, resources, equipment, and supplies at local level.
4. Provides technical and administrative support to Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and meetings to different RHMs and gives
feedback on accomplishments.
COMMUNITY ORGANIZER
1. Motivates and enhances community participation in terms of planning,
organizing, implementing, and evaluating health services
2. Initiates and participates in community development activities.
COORDINATOR OF SERVICES
1. Coordinates with individuals, families, and groups for health related services
provided by various members of the health team.
2. Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health.
HEALTH MONITOR
1. Detects deviation from health of individuals, families, groups, and communities
through contracts / visits with them.
ROLE MODEL
1. Provides good example of healthful living to the members of the community.
CHANGE AGENT
1. Motivates changes in health behavior in individuals, families, groups, and
communities that also include lifestyle in order to promote and maintain health.
RESEARCHER
1. Participates in the conduct of survey studies and researches on nursing and
health related subjects.
2. Coordinates with government and non government organization in the
implementation of studies / research.
CHN NOTES:
1. Primary Goal in CHN Self-reliance in health
2. Ultimate Goal in CHN Raise the level of health of the citizenry
3. Unit of care - Family
4. Levels of Clientele Individual, Family, Special Population & Community
5. Primary Focus Health Promotion & Disease Prevention
6. Philosophy Of CHN Uphold the worth & dignity of man
7. Theoretical Bases of CHN Practice Theories & Principles of Nursing & Public
Health
8. CHN as : People-oriented, comprehensive & integrated, focus on
health
I. Community Organizing
COMMUNITY ORGANIZING
Maglaya DOH
Preparatory Phase Community Analysis
Organizational Phase Design and Initiation
Education and training Implementation
Collaboration Phase Program Maintenance Consolidation
Phase Out Dissemination Reassessment
Phases of CO:
1. SOCIAL INVESTIGATION
Preliminary Investigation
- done before entry to community
- secondary data sources are utilized
- baseline information from secondary data sources (e.g. Records
Review)
Deepening Social Investigation
- continuous appraisal of community situation through primary data
sources
2. ENTRY low-key or low-profile approach
Upon entry, start the following:
a. Deepening Social Investigation
b. Social Preparation
c. Community Integration
3. SOCIAL PREPARATION tampering the grounds for setting up health
programs
PRE-ENTRY
1. Site selection
2. Preliminary Social Investigation
ENTRY
1. Social preparation
2. Community integration
3. Deepening social investigation
ORGANIZATION FORMATION PHASE
1. Small group formation
2. Election of CHW (women; middle-aged; married)
3. Organizational meetings - to clarify matters
TRAINING PHASE
1. Training needs assessment COMMUNITY DIAGNOSIS
2. Curriculum development based on problems identified
3. Actual training
4. Training evaluation
SERVICES PHASE
1. Community clinics
2. Other services
LEADERSHIP FORMATION PHASE
1. Core group formation
2. Advanced training
CONSOLIDATION PHASE
1. Evaluation session
2. Staff development
SUSTENANCE AND MAINTENANCE PHASE
1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies
5 components
Demographic, social and economic profile of the community
derived from secondary data
Health risk profile
Health/wellness outcome profile
Survey of current health promotion programs
Studies conducted in certain target groups
Steps in community analysis
Define the community - Determine the geographic boundaries of the
target community. This is usually done in consultation with representatives of
the various sectors.
Collect data As earlier mentioned, several types of data have to
be collected and analyzed.
Assess community capacity This entails and evaluation of the
driving forces which may facilitate or impede the advocated
change. Current programs have to be assessed including the
potential of the various types of leaders/influential, organization
and programs.
Assess community barriers Are there features of the new
program which run counter to existing customs and traditions? Is
the community resilient to change?
Assess readiness for change _ Data gathered will help in the
assessment of community interest, their perception on the
importance of the problem.
Synthesis of data and set priorities This will provide a
community profile of the needs and resources, and will become
the basis for designing prospective community interventions for
health promotion.
3. Implementation
Implementation put design phase into action. To do so, the following
must be done:
Generate broad citizen participation - There are several ways to
generate citizen participation. One of them is organizing task
force, who, with appropriate guidance can provide the necessary
support.
Develop a sequential work plan - Activities should be planned
sequentially. Oftentimes, plan has to be modified as events
unfold. Community members may have to constantly monitor
implementation steps.
Use comprehensive integrated strategies - . Generally the
program utilize more than one strategies that must complement
each other.
Integrate community values into the programs, materials and
messages. The community language, values and norms have to
be incorporated into the program.
4. Program maintenance consolidation
The program at this point has experienced some degree of success and
has weathered through implementation problems. The organization and
program is gaining acceptance in the community.
Integrate intervention activities into community networks - This
can be affected through implementation problems. The
organization and program is gaining acceptance in the
community.
Establish a positive organizational structure - A positive
environment is a critical element in maintaining cooperation and
preventing fast turnover of members. This is the result of good
group based on trust, respect, and openness.
Establish an ongoing recruitment plan- It should be expected that
volunteers may leave the organization. This requires a built in
mechanism for continuous recruitment and training of new
members.
Disseminate results - Continuous feedback to the community on
results of activities enhances visibility and acceptance of the
organization. Dissemination of information is vital to gain and
maintain community support.
5. Dissemination reassessment
Continuous assessment is part of the monitoring aspect in the
management of the program. Formative evaluation is done to provide
timely modification of strategies and activities. However, before any
programs reach its final step, evaluation is done for future direction.
Update the community analysis - Is there a change in leadership,
resources and participation? This may necessitate reorganization
and new collaboration with other organizations.
Assess effectiveness of interventions/programs - Quantitative
and qualitative methods of evaluation can be used to determine
participation, support and behavior change level of decision-
making and other factors deemed important to the program
Chart future directories and modifications - This may mean
revision of goals and objectives and development of new
strategies. Revitalization of collaboration and networking may be
vital in support of new ventures.
Summarize and disseminate results - . Some organizations die
because of the lack of visibility. Thus, a dissemination plan
maybe helpful in diffusion of information to further boost support
to the organizations endeavor.
Contents:
1. Introduction
1.1 Rationale accurate, valid, timely and relevant information on the
community profile and health problems are essential so that resources can be
maximized
1.2 Purpose to analyze the data in order to develop responsive
intervention strategies that address the root cause of the problem
1.3 Statement of Objective what are to be accomplished to attain the
study
1.4 Methodology and tool used a description of the adoption,
construction and administration of instruments
1.5 Limitation of the study state any limitations that exist in the
reference or given population or area of assignment
3. Analysis of Data
3.1 Identification of health problems
3.2 Prioritized problems identified
5. Conclusion
6. Recommendation
Community Diagnosis
1. Preparation of Community Diagnosis
a. Identify barangay to survey or required by the health center
b. Ocular survey
c. Community assembly
2. Conduct of survey proper using the format/survey form
a. Random sampling or saturation
b. Guidelines in filling survey form
c. Data collection techniques
3. Make graph or chart of each data gathered
4. Data analysis and interpretation
5. Preparation of action plan /project plan
HRDP CO-PAR
COMMUNITY ORGANIZING
A continuous process of awareness building, organizing and mobilizing
community members towards community development.
FAMILY HEALTH
Aims to:
1. Improve the survival, health and well-being of mothers and the unborn through a
package of services for the pre-pregnancy, prenatal, natal and postnatal
packages.
2. Reduce morbidity and mortality rates for children 0-9 years.
3. Reduce mortality from preventable causes among adolescents and young
people.
4. Reduce mortality and morbidity among Filipino adults and improve their quality
of life.
5. Reduce morbidity and mortality of older persons and improve their quality of life.
a. Antental Registration
Prenatal Visits Period of Pregnancy
1st visit As early as possible before 4 months or during the 1st
trimester.
2nd visit During the 2nd trimester.
3rd visit During the 3rd trimester.
Every 2 weeks After 8th month until delivery.
Important Concept!!!
COUPLE Decision maker
DOH Regulator
Community Health Nurse Facilitator
Important Concept!!!
High risk Pregnancies
-Too early
-Too late
-Too Frequent
-Too many
3. Condom
- 97% effective
- Mother is most responsible in inserting the condom.
2. Vasectomy
- 99% effective
- Vas deferens is cut
- Does not give immediate sterility
- There is a waiting time of six (6) months
- Sperm is still stored
- After six months, patient can engage in unprotected coitus.
- Not Popular among Filipinos
Nursing Alert!!!
Methods that are not part of Natural Family Planning: (not accepted by the
DOH)
- Withdrawal
- Calendar Method
To Mother:
Reduces womans risk of excessive blood loss after birth
Provides natural methods of delaying pregnancies
Reduces the risk of ovarian and breast cancers and osteoporosis
Newborn Screening??????
DPT:
HepB 5 ml IM destroyed by freezing
TT
d. Glandular enlargement- abscess (2-3 weeks abscess will leave scar 12 weeks
after)
SIDE-EFFECTS OF DPT:
SIDE-EFFECT OF MEASLES:
* Even if the interval exceeded that of the expected interval, continue to give the
doses of the vaccine.
* Immunization can still be given until the child reaches 6 y/o
* If there has been a reported epidemic of measles, measles vaccine can be given
as early as six months
* BCG booster dose must be given to school entrants regardless of presence of
BCG scar.
* There is no contraindication to immunization, EXCEPT when the child had
convulsions upon giving the 1st dose of DPT.
* MALNUTRITION is not a contraindication, but RATHER AN INDICATION for
immunization since common childhood disease are often severe to malnourished
children.
*COLD CHAIN
Principles:
The vaccine stored the LONGEST & THOSE THAT WILL EXPIRE
FIRST should be distributed or used 1st.
II. Transport
III. Handling
Goal: By 2010, to reduce the infant and under five mortality rate at least one third,
in pursuit of the goal of reducing it by two thirds by 2015.
AIM: To reduce death, illness and disability, and to promote improved growth and
development among children under 5 years of age.
IMCI includes both prventive and curative elements that are implemented by
families and communities as well as by health facilities.
Objective: Aims to reduce death, illness and disability, and to promote improved
growth and development among children under five years old.
*To reduce SSIGNIFICANTLY global mortality and morbidity
associated with the major causes of disease in children.
*To contribute to healthy gorth and development of children.
***For many sick children a single diagnosis may not be apparent or appropriate.
Presenting Complaint:
*Cough and / or fast breathing
*Lethargy / Unconsciousness
*Measles rash
*Very sick young infant
Steps in IMCI Process
-
-
-
-
-
-
Micronutrient Supplementation
Dental health Early Child Development
Child Health Injuries
Its main goal is to reduce morbidity and mortality rates for children 0-9
years with the strategies necessary for program implementation.
Essential Packages of Health Services for Newborn, Infant and Child
Causes of INFECTION
Some bacteria develop resistance to antibiotics
Some microbes have so many strains that a single vaccine cant protect
against all of them ex. Influenza
Most viruses resist antiviral drugs
Opportunistic organisms can cause infection in immunocompromised
patients
Most people have not received vaccinations
Increased air travel can cause the spread of virulent microorganism to
heavily populated area in hours
Use of immunosupressive drugs and invasive procedures increase the risk
of infection
Problems with the bodys lines of defense
RISK FACTORS
Age, sex, and genes
Nutritional status, fitness, environmental factors
General condition, emotional and mental state
Immune system
Underlying disease ( diabetes mellitus, leukemia, transplant)
Treatment with certain antimicrobials (prone to fungal infection), steroids,
immunosuppresive drugs etc.
Mode of Transmission
Contact transmission
Direct contact - person to person
Indirect - thru contaminated object
o Droplet spread - contact with respiratory secretions thru cough,
sneezing, talking. Microbes can travel up to 3 feet.
Airborne Transmission
Vector Borne Transmission
Vehicle Borne Transmission
Control Measures
Masking Wear mask if needed. Patient with infectious respiratory
diseases should wear mask.
Handwashing Practice it with soap and water.
Gloving Wear gloves for all direct contact with patients. Change gloves
and wash hands every after each patient.
Gowning - Wear gown during procedures which are likely to generate
splashes of blood or sprays of blood and body fluids, secretions or excretions.
Eye protection (goggles) wear it to prevent splashes.
Environmental disinfection Clean surfaces with disnfectant 70%
alcohol,diluted bleach)
Ex. Normal clean clean the room post discharge, final clean- MRSA and
infectious pts.
ISOLATION PRECAUTIONS
Separation of patients with communicable diseases from others so as to
reduce or prevent transmission of infectious agents.
7 Categories Recommended in isolation
Strict isolation prevent spread of infection from patient to patient/staff.-
handwashing, infectous materials must be discarded, use of single room,
use of mask, gloves and gowns and (-) pressure if possible
Contact isolation prevent spread by close or direct contact
Respiratory isolation prevent transmission thru air.
TB isolation for (+) TB or CXR suggesting active PTB.
Enteric Isolation direct contact with feces
Drainage/secretion precaution- prevents infection thru contact with
materials or drainage from infected person.
Universal Precaution for handling blood and body fluids. (Bloods, pleural
fluid, peritoneal fluid etc.)
PREVENTION
Health Education educate the family about
Immunization
MOT
Environmental sanitation breeding places of mosquito, disposal of feces
Importance of seeking medical advice for any health problem
Preventing contamination of food and water.
Environmental Sanitation
o Water Supply Sanitation Program DOH thru EHS (Environmental Health
Services)
o Policies on Food Sanitation Program
o Policies on Hospital Waste Management
The Community Health Nurse is in the best position to do health education
such as
o > development of materials for environmental sanitation
o > providing group counselling, holding community assemblies and
conferences.
o > create programs for sanitation
o > be a role model
Immunization introduction of specific antibody to produce immunity to certain
disease.
o Natural passive (from placenta), active (thru immunization & recovery
from diseases)
o Artificial passive (antitoxins), active (vaccine, toxoid)
Maintain vaccine potency by preventing:
o Heat and sunlight
o Freezing
Antiseptic/ disinfectants/ detergents lessen the potency of vaccine. Use
water only when cleaning fridge/ref.
COLD CHAIN SYSTEM maintenance of correct temperature of vaccines,
starting from the manufacturer, to regional store, to district hospital, to the health
center to the immunizing staff and to the client.
Classification
1. Inactive asymptomatic, sputum is (-), no cavity on chest X ray
2. Active (+) CXR, S/S are present, sputum (+) smear
Classification 0-5
A. Minimal slight lesion confined to small part of the lung
B. Moderately advanced one or both lungs are involved, volume affected
should not extend to one lobe, cavity not more than 4 cm.
C. Far advance more extensive than B
MANIFESTATIONS
Primary Complex: TB in children: non contagious, children swallow phlegm,
fever, cough, anorexia, weight loss, easy fatigability
Adult TB
o afternoon rise in temperature
o night sweats
o weight loss
o cough dry to productive
o Hemoptysis
o sputum AFB (+)
Milliary TB - very ill, with exogenous TB like Potts disease
Primary Infection
o Asymptomatic
o No manifestations even at CXR, Sputum AFB
Primary Complex
o Minimal manifestations
o Lymphadenopathy
DX
Tuberculin testing
CXR
Sputum AFB
Prevention
BCG
Avoid overcrowding
Improve nutritional status
TX
DOTS
6 months of RIPE
Respiratory isolation,
Take medicines religiously prevent resistance
Stop smoking
Plenty of rest
Nutritious and balance meals, increase CHON, Vit. A, C
MENINGITIS
Inflammation of the meninges usually some combination of headache,
fever, stiff neck, and delirium
Meningococcemia: cerebrospinal fever
o Etiologic agent: Neisseria meningitidis
o Incubation: 2-10 days
o MOT: droplet
Acute meningococcemia - with or without meningitis
o Waterhouse Friederichsen Syndrome
Diagnostic exams:
o Lumbar tap, CSF - high WBC and CHON, low glucose
Manifestations:
o Sudden onset of fever x 24h
o Petechiae, Purpuric rashes
o Meningeal irritation
Stiff neck
Opisthotonus
Kernigs sign
Brudzinski sign
o ALOC (Altered level of consciousness)
o S/S of Increase ICP
Nursing Mgt:
Administer prophylactic antibiotics: Rifampicin - drug of choice
Aquaeous Pen
Mannitol
Dexamethasone
Priority: AIRWAY, SAFETY
Maintain seizure precaution
Respiratory precaution
Handwashing
Suction secretions
DIPTHERIA
Acute contagious disease characterized by generalized toxemia coming from
localized inflammatory process
Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus)
Incubation period: 2-5 days
Period of communicability: variable, ave:2-4 weeks
MOT Droplet, direct or intimate contact, fomites, discharge from nose, skin,
eyes
Manifestation
PSEUDOMEMBRANE - grayish white, smooth, leathery and spider web
like structure that bleeds when detached
Types of Respiratory Diptheria
NASAL
o serous to serosanginous purulent discharge
o Pseudomebrane on septum
o Dryness/ excoriation on the upper lip and nares
PHARYNGEAL
o pharyngeal pseudomembrane
o bull neck ( cervical adenitis)
o Difficulty swallowing
LARYNGEAL
o Sorethroat, pseudomembrane
o Barking, dry metallic cough
Complications
o Due to TOXEMIA
Toxic endocarditis
Neuritis
Toxic nephritis
o Due to Intercurrent Infection
Bronchopneumonia
Respiratory failure
DX
Nose and throat swabs - culture of specimen form beneath membrane
Virulence test
SHICKs TEST: test for susceptibility to diptheria
MOLONEYs TEST: test for hypersensitivity to diphtheria
MANAGEMENT
1. Penicillin, Erythromycin
2. Diptheria Antitoxin after skin test if (+), fractional dose
3. Supportive
O2, if laryngeal obstruction tracheostomy
CBR for 2 weeks
Increase fluids, adequate nutrition- soft food, rich in Vit C
Ice collar
4. Isolation till 3 NEGATIVE cultures
Prevention
DPT
Manifestation
o rapid cough 5-10x in one inspiration ending a high pitched
whoop.
Catarrhal slight fever in PM, colds, watery nasal discharge, teary
eyes, nocturnal coughing, 1-2 weeks
Paroxysmal Spasmodic stage; 5-10 successive forceful coughing
ending with inspiratory whoop, involuntary micturition and defecation,
choking spells, cyanosis
Convalescent 4th- 6th week; diminish in severity, frequency
Complications:
Otitis media
Acute bronchopneumonia
Atelectasis or emphysema
Rectal prolapse, umbilical hernia
Convulsions (brain damage - asphyxia, hemorrhage)
Dx:
Elevated WBC
Nasopharyngeal swab
Nursing Management
Prevention:
o DPT
Parenteral fluids
Erythromycin - drug of choice
Prone position during attack
Abdominal binder
Adequate ventilation, avoid dust, smoke
Isolation
Gentle aspiration of secretions
MEASLES
Acute viral disease with prodromal fever, conjunctivitis, coryza, cough
and Kopliks spots
AKA: Rubeola, 7-day measles
Etiologic agent: Morbilli Paramyxoviridae virus
Incubation period: 10-12 days
Period of communicability: 3 days before and 5 days after the
appearance of rashes. Most communicable during the height of rash.
MOT: Airborne
Sources of infection secretions from eyes, nose and throat
Diagnostics
Nose and throat swab
Treatment
1. Antiviral drugs- Isoprenosine
2. Antibiotics if with complications
3. Supportive O2, IVF
Complications bronchopneumonia, otitis media, encephalitis
Nursing Management
Preventive measles vaccine at 9 months, MMR 15 months and
then 11-12; defer if with fever, illness
Isolation - contact/respiratory
TSB , Skin care daily cleansing wash
Oral and nasal care
Plenty of fluids
Avoid direct glare of the sun- due to photophobia
GERMAN MEASLES
Mild viral illness caused by rubella virus.
AKA: Rubella; 3-Day Measles
Incubation period from exposure to rash 14 -21d
Period of communicability one week before and and 4 days after onset
of rashes. Worst when rash is at its peak.
MOT: Droplet, nasal ceretions, transplacental in congenital
Manifestations
1. Prodromal low grade fever, headache , malaise, colds, lymph node
involvement on 3rd to 5th day
2. Eruptive FORSCHEIMERS SPOTS: pinkish rash on soft palate, rash
on face, spreading to the neck, arms and trunk
o lasts1-5 days with no pigmentation or desquamation
o muscle pain
Treatment
o symptomatic treatment
Complications
1. Encephalitis, neuritis
2. Rubella syndrome microcephaly, mental retardation, deaf mutism,
congenital heart disease
Nursing Management
1. Isolation. Bed rest
2. Room darkened photophobia
3. Encourage fluid
4. Like measles tx
PREVENTION;
MMR, Pregnant women should avoid exposure to rubella patients
Administration of Immune serum globulin one week after exposure to rubella.
CHICKEN POX
Acute and highly contagious viral disease characterized by vesicular eruptions
on the skin
Infectious agent Herpes zoster virus or Varicella zoster
Incubation period 10 -21 days
Period of communicability: 1 day before eruption up to 5 days after the
appearance of the last crop
MOT: airborne, direct, indirect
o Direct contact thru shedding vesicles,
o Indirect thru linens or fomites
Manifestations
Pre eruptive: Mild fever and malaise
Eruptive: rash starts from trunk
Lesions - red papules then becomes milky and pus like within 4 days,
Pruritis
NURSING MANAGEMENT
Strict isolation until all vesicles scabs disappear
Hygiene of patient
Cut finger nails short
Baking soda - pruritus
PREVENTION: Live attenuated varicella vaccine
VZIG - effective if given 96h post exposure
Herpes Zoster
Acute inflammatory disease known to be caused by herpes virus varicellae or
VZ virus
Infection of the sensory nerve charac by extremely painful infection along the
sensory nerve pathway
Occurs as reinfection of VZ virus
MOT
o Direct
o Indirect airborne
Incubation: 1-2 weeks
Diagnostic procedure
o Hx of chickenpox
o Pain and burning sensation over lesions of vesicles along nerve
pathway
o Smear of vesicle fluid- giant cells
o Viral cultures of vesicle fluid
o Electron microscopy
o Giemsa-stained scraping multinucleate giant epithelial cells
S/S
o Burning, itching, pain then erythematous patches followed by crops
of vesicles
o Eruptions are unilateral
o Lesions may last 1-2 weeks
o Fever, regional lymphadenopathy
o Paralysis of cranial nerve, vesicles at external auditory canal
o Paralytic ileus, bladder paralysis, encephalitis
Complications
o Opthalmia herpes blindness because of damage of gasserian
ganglion
o Geniculate herpes deafness because of infection of 7th CN (AKA:
Ramsay Hunt Syndrome)
Nursing Intervention
o Compress of NSS or alluminum acetate over lesions
o Analgesics, sedatives weeks to mos
o Steroids
o Keep blister covered with sterile powder esp after break
o Prevent bacterial invasion
o Encourage proper disposal of secretions and usage of gown and
mask
Tuberculosis*
Leprosy
Schistosomiasis
Filariasis
Malaria
Dengue Hemorrhagic Fever (H-Fever)
Measles
Chicken Pox (Varicella)
Mumps (Epidemic Parotitis)
Diptheria
Whooping Cough (Pertussis)
Tetanus Neonatorum and Tetanus among older age groups
Influenza
Pneumonias
Cholera (El Tor)
Typhoid Fever
Bacillary Dysentery (Shigellosis)
Soil Transmitted Helminthiases
Paragonimiasis
Hepatitis A
Paralytic Shellfish Poisoning (PSP I RED TIDE POISONING)
Leptospirosis
Rabies
Scabies
Anthrax
Sexually Transmitted Infections
i. Gonorrhea
ii. Syphilis
iii. Chlamydia
iv. Gardianella Vaginitis
v. Trichomoniasis
vi. Hepatitis B
HIV/AIDS
Meningococcemia
Bird Flu or Avian influenza
SARS Severe Acute Respiratory Syndrome
Policies of EPI:
I. Coverage--------------------------------------
A. Target Setting
B. FIC ( Full Immunized Child )
C. Wastage Allowance
OBJECTIVES OF EPI: To reduce morbidity and mortality rates among infants and
children from 6 or 7 immunizable disease
II. Cold Chain
III. Immunization Technical Responsibilities of PHN
IV. Surveillance--------------------------------
Planning, Supervision, and Training---
Mobilization, Monitoring and Health Education Administrative and
Supportive Role of PHN
Referral, Research and Evaluation ---
I. Coverage
A. Target Setting:
1. Target Population is the population group meant to be benefited by the EPI
Programs where DOH is responsible.
a. Infants ( 0 12 ) get the 3% of population
b. School Entrants get the 3% of population ( dictum of DOH ) = 6 years
c. Pregnant Women get the 3.5 % of population ( MWKA ) = 15 49 years
2. Eligible Population ( EP ) rae those qualified to receive specific immunizations
where PHW is responsible PHN, RHM, MO
*3 Population Groups to benefit
a. Infants (I) BCG, DPT, OPV, HBV, MV
b. School Entrants (S.E) Booster of BCG
c. Pregnant Women (PW) Tetanus Toxoid
*To determine Eligible Population:
EP = Population of the Community x 0.03 (Infants and School Entrants) or
X 0.035 (Pregnant Women)
*Example: Lanting Community with a population of 7000
a.) DPT = for infants
EP = 7000 X 0.03 = 210 to receive DPT
b.) Tetanus Toxiod = for pregnant women
EP = 7000 X .035 = 245 to receive TT
c.) Booster BCG = for school entrants
EP = 7000 X 0.03 = 210 to receive booster BCG
c. Wastage Allowance
- DOH doesnt ptoduce vaccines biologically and therefore dependent on suppliers
abroad: Germany and Switzerland to economize:
1. Be aware of the availability of vaccines:
Example: BCG
CHN: vial Private Practice: ampule
Frozen powder with a diluent
( 1 ml per content )
Examples:
1. Mrs Dela Cruz received the 1st booster dose (TT3) on November 20, 2004.
When is the 2nd booster? November 20, 2005
2. As a child, you have 3 doses of DPT. Now you become pregnant. What you
need to receive are the 3 booster doses only-TT3, TT4 & TT5 respectively.
3. If as a child, only 1 dose of DPT was given, is there a definite immunity?
Theres no definite # of years of immunity. If until 3 years she failed to receive
vaccine, she got to start with the 1st dose.
RHCDS
2. Proper Transport
- Vaccines are to be transported from the health center to the area of
immunization (community: focused, based & oriented)
- Tools provided by DOH: Vaccine Carrier which maybe
a. Black: use by staff of HC during epidemic & needs 5 cold dogs
b. White: use by student affiliates & needs 4 cold dogs
- Cold Dogs: 4 plastic containers filled with water which is placed in the
freezer a day before immunization which is used as freezant to keep
vaccine potent
I. Immunization
Guiding Principles for HW in Administering Vaccines & Screening of Children
for Immunizations:
1. No BCG for a child born clinically positive to AIDS because they have a
damage immune system & introducing bacteria will further aggravate their
condition
2. There are no contraindications such as slight fever, LBM, cough & colds
and malnutrition, in giving the immunization unless upon assessment of the
practitioner that the child has serious medical problems that warrants
hospitalization
3. In giving immunization with multiple doses such as DPT, OPV & HBV,
continue counting in giving the doses. Never count back even though the
interval exceeds weeks, months or years. As long as the child is on the
eligible age
Example: DPT, OPV & HBV
1st dose: At 6 weeks (1 months), the child was given vaccination
2nd dose: The mother brought back the child when he was 8 months old
instead at 10 weeks (2 months). PHN should still give the 2nd dose
3rd dose: The mother brought back the child at 2 years old. PHN should still
give the vaccine because child is still at the eligible age (0-59 months or 4
years & 11 months or 5 years old) to receive vaccine
4. DPT: it is a normal reaction for a child to develop high grade fever because
of the pertussis component (killed bacteria)
SOP Management:
Paracetamol q 4 hours RTC for the 1st 2 days (or 3, 4 days if still febrile)
If after 1st dose of DPT, the child develops high grade fever with convulsion,
DPT 2 & 3 are not given anymore because convulsion affects the brain cells
resulting to brain damage
DPT vaccine is only for prophylactic/ preventive use
IMMUNITY
Natural Artificial
Provided by nature Accepts vaccine
No vaccine was given
Duration is longer/even for a lifetime Duration is shorter period
Example:
BCG-vaccine for protection from TB
gives 7-10 years immunity so booster
is needed
HBV-after 3 doses booster is needed
after 1 year
Active=person himself is involved in Active=person himself has no
the production of antibodies participation and done by another
1. Carrier (person harbors the disease person
but asymptomatic) of the disease Upon receiving vaccine (antigen) for
2. Constant exposure to disease immunizable diseases such as BCG,
3. Acquired or experienced the disease DPT, OPV, MV and HBV
Passive Passive
1. Breastfeeding IgA (present in 1. Serum (Blood):
colostrums) HBV
2. Perinatal immunity is acquired ATS (Anti-Tetanus Serum)
during the term of pregnancy ADS (Anti-Diptheria Serum)
2. Antitoxin: poison or causes infection
TAT (Tetanus Antitoxin)
DAT (Diptheria Antitoxin)
3. Immunoglobulins: IgA, IgD, IgE, IgG
& IgM where IgG is most predominant
3 Categories of Dehydration:
a. No dehydration-uses oresol
b. Some dehydration-uses oresol
c. Severe dehydration-uses IVF
Objectives/Plan/Policies of the Use of the following Program:
a. Plan A: for prevention of dehydration
b. Plan B: for treatment of dehydration-mild & moderate
c. Plan C: for treatment of dehydration-severe
Oresol is given/LBM or
every time stool is
passed out:
< 2 years old: 50-100ml.
always give the
maximum amount
2-10 years old: 100-200
ml.
10 years old & above: as
much as tolerated &
desired
2. Increase feeding:
3. Fast referral
1. Condition Some dehydration Plan B-Treatment of mild
a. Restless & Moderate DHN using
b. Irritable oresol
2. Sunken fontanel
3. Sunken eyeballs & If less than 2 years old:
absent tears use age in months
4. Dry mouth, tongue & If < 4 months: 200-400
lips ml.
Eagerness to drink 5-11 months: 400-600 ml.
5. Skin returns back 12-23 months: 600-800
slowly ml.
2-4 y/o: 800-1200 ml.
5-14 y/o: 1200-2200 ml.
15 & above: 2200-4000
ml.
TYPES OF DIARRHEA
o ACUTE : < 14DAYS
o PERSISTENT: 14 DAYS or more
o DYSENTERY: Blood in the stool; with or without mucus
CLASSIFY DEHYDRATION
SOME DEHYDRATION
Two of the following:
Restless, irritable
Sunken eyes
THIRSTY: drinks eagerly
Skin pinch goes back
Treat PLAN B
O.R.S: first 4hours after assessment
200-400ml 0-4mos
400-700ml 4-12mos
700-900ml 1-2 yrs
900ml-1L 2-5yrs
NO DEHYDRATION
Not enough signs to classify some or severe
Treat PLAN A
Give extra fluids
50-100ml after each watery stool (0-2y/o)
100-200ml (2 y/o & above)
as tolerated (10y/o & above)
Continue feeding
Return if with danger sign/s.
Program:
1. Assessment:
History: Subjective
Age
Cough and Duration
Able to Drink or stop feeding
Fever ---- duration
Convulsion
Treatment:
1. Refer urgently to hospital
2. 1st dose of antibiotics
3. Treatment of Fever ( TSB ) * Wheeze (NEBULIZE)
4. Antimalarial
2. PNEUMONIA:
Signs and Symptoms:
a. Chest in drawing
b. Nasal flaring
c. Grunting
d. Cyanosis
2 Types:
a. Severe Pneumonia
Symptoms: Chest indrawing, cyanosis, nasal flaring, grunting.
Treatment: Same with very severe but anti malarial is not given.
3. NO PNEUMONIA
Assess for other problems and provide home care.
No Chest indrawing, No fever
If with sore throat in children: Mild, warm tea with syrup.
If chronic, refer.
2. PNEUMONIA
Symptoms: Severe Chest indrawing and Fast Breathing
Treatment: Same as severe.
BABY:
*Provide Antibodies.
*Contains Lactoferin ( Binds with Iron )
*Leukocytes
*Contains Bifidus factor
Promotes growth of the Lactobacillus inhibits the growth of
pathogenic bacilli.
Garantisadong Pambata ( GP )
-Garantisadong Pambata is a biannual week long delivery of a package of
health services to children between the ages of 0 59 months old with the
purpose of reducing morbidity and mortality among under fives through the
promotion of positive Filipino values for proper children growth and development.
1. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE
TARGETS?
GP offers the following:
1.1 Routine Health Services:
-*The child should not have received megadose of Vitamin A above the
recommended dosage within the past 4 weeks except if the child has measles or
signs and symptoms of Vitamin A deficiency.
-**For any between 12 23 months, who missed any of his routine immunization,
the health worker should give the child the necessary antigen to complete FIC and
shall be recorded as such.
Garantisadong Pambata ( GP )
Sangkap Pinoy
-Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables, fruits, liver, seafoods, iodized, salt,
pan de bida and other fortified foods.
These micronutrients are not produced by the body, and must be taken in the
food we eat; essential in the normal process of growth and development:
a.) Helps the body to regulate itself
b.) Necesary in energy metabolism
c.) Vital in brain cell formation and mental developmet
d.) Necessary in the body immune system to protect the body from severe
infection.
e.) Eating Sangkap Pinoy rich foods can prevent and control:
1. Protein Energy Malnutrition
2. Vital A deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder
Breastfeeding
-Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is
recommended for the first six minths of life. At about six months, give carefully
selected nutritious foods as supplements.
-Breastfeeding provides physical and psychological benefits for children and
mothers as well as economic benefits for families and societies.
BENEFITS:
For INFANTS
a. Provides a nutritional complete food for the young infant.
b. Strengthens the infants immune system, preventing many infections.
c. Safely rehydrates and provides essential nutrients to a sick child, especially to
those suffering from diarrheal diseases.
d. Reduces the infants exposure to infection.
Mission:
*To provide the means and opportunities by which married couples of reproductive
age desirous of spacing and limiting their pregnancies can realize their
reproductive goals.
TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1. Ovulation suppressant such as PILLS
2. Depo Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap / Diaphragm
III. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation
Research in community health serves a number of purposes, among which are: (1)
improve our understanding of clients and their specific contexts;
(2) provide data needed for program and policy development and evaluation;
(3) improve the delivery of health services and implementation of existing programs;
(4) improve cost-effectiveness of programs; and (5) project a good image of nurses.
The PHN can initiate small researches on the major concerns in health service
delivery and in the management of the health facility. Research topics that could be
studied by the PHN by himself/herself include, among others, socio-demographic
profile of those who utilize health services, client waiting time, referral from and to the
health center, perception of clients on the delivery of health services, response of
clients to different health or nursing interventions, supply management and effects of
specific health education activities.
-HEALTH INDICES
I. Basic Health Indicators
2 Indicators to assess a national health situation
A. Nutrition
B. Disease Patterns
Context of CHN: Health Situation
**Leading Causes of Morbidity**
10 Leading Causes of Morbidity
1. Pneumonia -- Bacterial
2. Diarrhea
3. Bronchitis
4. Influenza -- Respiratory
5. Hypertension
6. TB Respiratory
7. Diseases of the Heart
8. Malaria
9. Chickenpox
10. Measles
-Health Care Delivery System the totality of all policies, equipment, products,
human resources and services whichaddress the health needs, problems and
concerns of the people. It is large, complex, multi level and multi disciplinary.
Categories:
According to Increasing According to the Type of Service
Complexity of the Services - The
Provided Healt
Type Service Type Service h
Primary Health Promotion, Health Information Sect
Preventive Care, Promotion Dissemination or
Continuing Care for and illness
common health prevention GOV
problems, attention ERN
to psychological and
MEN
social care, referrals
T
Secondary Surgery, Medical Diagnosis Screening
SEC
services by and
specialists Treatment TOR
Tertiary Advanced, Rehabilitation PT/OT S
specialized, DEP
diagnostic, ART
therapeutic and MEN
rehabilitative care T OF
HEA
LTH (DOH)
VISION:
-Health for all by year 2000 and Health in the Hands of the People by 2020(OLD).
-A global leader for attaining better health outcomes, competitive and responsive
health care system, and equitable health financing(NEW VISION by 2030).
MISSION:
-In partnership with the people, provide equity, quality and access to health care
especially the marginalized.(OLD)
-To guarantee equitable, sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.(NEW)
5 Major Functions:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as
public health goods
4. Plan and establish arrangements for the public health systems to achieve
economies of scale Phil Health.
5. Maintain a medium of regulations and standards to protect consumers and
guide providers Sentrong Sigla = Training and infrastructure
-Private Sector
-Composed of both commercial and business organization, non
business organizations
Commercial/Business Non-commercial
Profit-oriented Orientation to social development, relief
and rehabilitation, community
organizing
Manufacturing Socio-civic groups
companies Religious organizations/foundations
Advertising agencies
Private practitioners
Private institutions
GOAL:
*To improve health indicators through access.
*To enable the Filipino population to achieve a level of health which will allow
Filipino to lead socially and economically productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability through
measures that will guarantee access of everyone to essential health care.
BROAD OBJECTIVES:
*promote equity in health status among all segments of society
*address specific health problems of the population
*upgrade the status and transform the HCDS into a responsive, dynamic and
highly efficient, and effective one in the provision of solutions to changing the
health needs of the population
*promote active and sustained peoples participation in health care
23 IN 1993
Refers to the 23 programs, projects, activities of the
DOH for the year 1993, which marks the beginning
of its journey towards DOG vision.
C. Vital Statistics
VITAL STATISTICS
Statistics refers to a systematic approach of obtaining, organizing and analyzing
numerical facts so that conclusion may be drawn from them.
Vital Statistics refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
Statistics of disease (morbidity) and death (mortality) indicate the state of
health of a community and the success or failure of health work.
Sources of Data:
*Population census
*Registration of Vital Data
*Health Survey
*Studies and researches
Ratio is used to describe the relationship between two (2) numerical quanitities
or measures of events without taking particular considerations to the time or place.
These quantities need not necessarily represent the same entities; although the
unit of measure must be the same for both numerator and denominator of the
ratio.
Crude Death Rate a measure of one mortality from all causes which may result
in a decrease of population.
Infant Mortality Rate measure the risk of dying during 1st year of like. It is a
good index of the general health condition of a community since it reflects the
changes in environment and medical condition of a community.
Maternal Mortality Rate measures the risk of dying from causes related to
pregnancy, childbirth, and puerperium. It is an index of the obstetrical care needed
and received by women in a community.
Neonatal Death Rate measures the risk of dying the 1st month of life. It serves
as an index of the effects of prenatal care and obstetrical management of the
newborn.
Specific Death Rate describes more accurately the risk of exposure of certain
classes of groups to particular diseases. To understand the forces of mortality, the
rates should be made specific provided the data are available for both the
population and the event in their specifications. Specific rates render more
comparable and thus reveal the problem of public health.
Methods:
*By applying observed specific rates to some standard population.
*By applying specific rates of standard population to corresponding classes or
groups of the local population.
Presentation of Data
The following are most commonly used graphs in presenting data:
Line or Curved graphs shows peaks, valleys and seasonal trends. Also
used to show the trends of birth and death rates over a period of time.
Bar graphs each bar represents or expresses a quantity in terms of rates or
percentages of a particular observation like causes of illness and deaths.
Area diagram (Pie Charts) shows the relative importance of parts of the
whole.
D. Epidemiology
E. Demography
Objectives:
- To provide summary of data on health services delivery and selected program
accomplished indicators at the barangay municipality / city, district, provincial,
regional and national events.
-To provide data which when combined with data from other sources, ca be used
for program monitoring and evaluation purposes.
-To provide a standardized, facility level data base which can be assessed for a
more in depth study /studies.
-To ensure that the data reported to the FHSIS are useful and accurate and are
disseminated in a timely and easy to use fashion.
-To minimize the recording and reporting burden at the service delivery level in
order to allow more time for patient care and promotive activities.
Importance of FHSIS
- Helps local government determine public health priorities.
- Basis for monitoring and evaluatinghealth program implementation.
- Basis for planning, budgeting, logistics and decision making at all levels.
- Source of data to detect unusual occurrence of a disease.
- Needed to monitor health status of the community.
- Helps midwives in following up clients.
- Documentation of RHM / PHN day to day activities.
Components:
*FAMILY TREATMENT RECORD (Cuevas, 2007) /
INDIVIDUAL RECORD (Famorca, 2013) / *INDIVIDUAL TREATMENT RECORD
*TARGET CLIENT LIST
*REPORTING FORMS / SUMMARY TABLE
*OUTPUT REPORTS /MONTHLY CONSOLIDATION TABLE (MCT)
Concept:
*TREATMENT RECORD Fundamental building block or foundation of FHSIS.
This is the document, form or pieces of paper upon which the presenting
symptoms or complaints of the patient on consultation and the diagnosis,
treatment and date of treatment if recorded.
*CLIENT LIST Second building block of the FHSIS and are intended to serve
several purposes.
First is to plan and carry out patient care and service delivery. Such lists
will be of considerable value to midwives / nurses in monitoring service delivery to
clients in general and in particular to groups of patients identified as targets or
eligibles for one or another program of the Department.
The second purpose of Target Client Lists is to facilitate the monitoring
and supervision of service delivery activities.
The Third purpose is to report services delivered.
The fourt purpose of the Target Client Lists is to provided a clinic level
data base which can be accessed for further studies.
3. SUMMARY TABLE
- Accomplished by Midwife
- 12 column table = 12 months of calendar year
- monthly summary of morbidity / monthly trends of disease
- serves as a source for the 10 leading causes of morbidity.
FLOW OF REPORT
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF
TOOLS SUBMISSION
BHS Midwife -ITR Monthly Monthly Every 2nd week
-TCL Form (M1 of the
-ST AND M2 ) succeeding
month
A-BHS Annually
Form Every 2nd week
of january
RHU PHN -ST Quarterly Quarterly Every 3rd week
-MCT Form (Q1 of the 1st month
AND Q2) of succeeding
quarter
Annual Every 3rd week
Forms of January
-A1
-A2
-A3
B. Target-setting
C. Environmental Sanitation
VII. Safe and Quality Care, Health Education, and Communication, Collaboration
and Teamwork
A. Principles and Theories of Growth and Development (Pediatric Nursing)
PRINCIPLES OF GROWTH AND DEVELOPMENT
PRINCIPLES EXAMPLES
Growth and development are Although there are highs and lows in
continuous processes from conception terms of the rate at which growth and
until death development proceed, a child grows
new cells and learns new skills at all
times. An example of how the rate of
growth changes is a comparison
between that of the first year and later in
life. An infants triples birthweights and
increases height by 50% during the first
year of life. If this tremendous growth
rate were to continue, the 5 ye-old
child, when ready to begin school,
would weigh 1,600 Ib. And be 12 ft. 6 in.
Tall.
Growth and development proceed in an Growth in height occurs in only one
orderly sequence. sequence from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they
creep, creep before they stand, stand
before they walk, and walk before they
run. Some children may skip a stage (
or pass through it so quickly that the
parents do not observe the stage) or
progress in a different order, but most
children follow a predictable sequence
of growth and development.
Different children pass through the All stages of development have a range
predictable stages at different rates. of time rather than a certain point at
which they are usually accomplished.
Two children may pass through the
motor sequence at different rates. For
example, one child begins walking at 9
months while another at 14 months.
Both are developing normally. They are
both following the predictable sequence;
they are merely developing at different
rates.
All body systems do not develop at the Certain body tissues mature more
same rate. rapidly than others. For example,
neurologic tissue experiences its peak
growth during the first year of life,
whereas genital tissues grows little until
puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning
head; Caudal means tail.
Development proceeds from head to
tail. A newborn can lift only his or her
head off the bed when he or she lies in
a prone position. By age 2 months., the
infant can lift his or her head and chest
off the bed; by 4 months., he or she can
lift his or her head, chest, and part of
the abdomen; by 5 months., the infant
has enough control to turn over ; by 9
months., he or she can control the legs
enough to crawl; and by 1 year., the
child can stand upright and perhaps
walk. Motor development has
proceeded in a cephalocaudal order
from the head to the lower extremities.
Development proceeds from proximal to This principle is closely related to
distal body part. cephalocaudal development. It can be
illustrated by tracing the progress of
upper extremity development. A
newborn makes ;ittle use of the arms or
hands. Any movement, except to put a
thumb in the mouth, is a flailing motin.
By age 3 or 4 months., the infant has
enough arm control to support the upper
body weight on the forearms, and the
infant can coordinate the hand to sccop
up objects. By 10 months., the infant
can coordinate the arm, thumb, and
index fingers, sufficiently well to use a
pincer-like grasp or be able to pick up
an object as fine as a piece of breakfast
cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding
refined skills. one. Because the child is able to control
distal body parts such as fingers, he or
she is able to perform fine motor skills (
a 3-year- old colors best with a large
crayon; a 12 yr-old can write with a fine
pen).
There is an optimum time for initiation of A child cannot learn a task until his or
experiences or learning. her nervous system is mature enogh to
allow that particular learning. A child
cannot learn to sit, for example, no
matter how much thechilds
parentshave him or her practice, until
the nervous system has matured
enough to allow back control. A child
who is not given the opportunity to learn
developmental tasks at the appropriate
or targert times for such tasks may
have ,ore difficulty than the usual child
learning the tasks later on. A child who
is confined to a body cast at 12
months., which is the time he or she
would normally learn to walk, may take
a long time to learn this skill once free of
the cast at, say, age 2 years old. The
child has passed the time of optimal
learning fo that particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until the
development can proceed. grasp reflex has faded nor stand
steadily until the walking reflex has
faded. Neonatal reflexes are replaced
by purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step
learned by practice. over and over before he or she
accomplishes this securely. If a child
falls behind the normal growth and
development rate because of illness, he
or she is capable of catch-up growth to
bring him or her on equal footing again
with his or her age group.
THEORIES OF DEVELOPMENT
1. Definition of Theories
Theory a systematic statement of principles that provides a framework for
explaining some phenomenon. Developmental theories provide road maps for
explaining human development.
Developmental Task a skill or a growth responsibility arising at a particular time
in an individuals life, the achievement of which will provide a foundation for the
accomplishment of future tasks. It is not so much chronological as the completion
of developmental tasks that defines whether a child has passed from one
developmental stage of childhood to another. For example, a child is not a toddler
just because he or she is 1 year plus 1 day old; he or she becomes a toddler when
he or she has passed through the development stage of infancy.
A. TEST III
1. Client in Pain
CLIENT IN PAIN
Pain- the fifth vital sign American Pain Society 2003.
-Identifying pain as the fifth vital sign suggests that the assessment of pain should
be as automatic as taking a clients BP abd Pulse.
-Whatever the person says it is, existing whenever the experiencing person says
it does McCaffery and Pasero, 1999
-Emphasizes the highly subjective nature of pain.
-Pain is the most common reason client seek medical advice.
-Pain is protective mechanism or a warning to prevent further injury.
- an unpleasant sensory and emotional experience associated with actual or
potential
Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the
skin that respond to intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System
2. Peri-operative Care
3. Alterations in Human Functioning
a Disturbance in Oxygenation
b Disturbance in Metabolic and Endocrine Functioning
c Disturbance in Elimination
B. TEST IV
1. Alterations in Human Functioning
a. Disturbances in Fluids and Electrolytes
b. Inflammatory and Infectious Disturbances
c. Disturbances in Immunologic functioning
d. Disturbances in Cellular functioning
2. Client Biologic Crisis
3. Emergency and Disaster Nursing
C. TEST V
1. Disturbances in Perception and Coordination
a. Neurologic Disorders
b. Sensory Disorders
c. Musculo-skeletal Disorders
d. Degenerative Disorders
2. Maladaptive Patterns of Behavior
a. Anxiety Response and Anxiety Related Disorders
b. Psycho-physiologic Responses, Somatoform, and Sleep Disorders
c. Abuse and Violence
d. Emotional Responses and Mood Disorders
e. Schizophrenia and Other Psychotic and Mood Disorders
f. Social Responses and Personality Disorders
g. Substance related Disorders
h. Eating Disorders
i. Sexual Disorders
j. Emotional Disorders of Infants, Children and Adolescents.