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Public Health Services Family Health Service focuses on maternal, child, oral health. Goal is to ensure every expectant and nursing mother maintains good health. Vitamin a, iron and folic acid supplements are recommended for pregnant women.
Public Health Services Family Health Service focuses on maternal, child, oral health. Goal is to ensure every expectant and nursing mother maintains good health. Vitamin a, iron and folic acid supplements are recommended for pregnant women.
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Public Health Services Family Health Service focuses on maternal, child, oral health. Goal is to ensure every expectant and nursing mother maintains good health. Vitamin a, iron and folic acid supplements are recommended for pregnant women.
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Attribution Non-Commercial (BY-NC)
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Скачайте в формате DOC, PDF, TXT или читайте онлайн в Scribd
Family Health Service • Breast 1.Maternal • Abdominal exam: fundic height; leopold’s 2.Child health maneuver, FHT 3.Family planning • Exam of face, hands and lower extremities for 4.Oral health edema 5.Essential health packages for adolescent, adult, • Tetanus toxoid immunization- 0.05cc, IM, deltoid, 5 men and women and older persons doses Maternal: Stat 2000 Micronutrient supplementation: Vitamin A Maternal Mortality VAC SCHEDULE 25%- hypertension 10,000 IU capsule 1 capsule 2x a week from 20.3%- postpartum hemorrhage 4th month of pregnancy 9%- abortive outcomes 200,000 IU capsule 1 capsule within 4 weeks after delivery Underlying issues: • Delay in taking actions NB: • Delay in seeking care • Vitamin A capsule (VAC) 200,000 IU is • Delay in making referral contraindicated in pregnancy • Delay in appropriate medical management • Upon diagnosis, VAC 10,000 is given OD for 4 weeks for pregnant women with night blindness Goal: • Ensure that every expectant and nursing mother Micronutrient Supplementation: 60mg elemental maintains good health, learns the act of child care, iron (EI) with 400ug folic acid and has a normal delivery and healthy children. • That every child, whenever possible lives and During pregnancy: grows up in a family unit with love and security, in • 1 tablet OD x 6 months or 180 days during healthy surroundings, receives adequate pregnancy nourishment, health supervision and efficient medical attention, and is taught the elements of • 2 tablets OD if parenteral consultations start in the healthy living. 2nd and 3rd trimester of pregnancy For lactating women: Aspects: • 1 tablet OD x 3 months or 90 days • prenatal care, care during labor, postpartum care Micronutrient Supplementation: Potassium Iodide 200 mg capsule once a year for pregnant women Prenatal Period of Pregnancy Prevention and Treatment of diseases and other Visits: conditions associated with pregnancy 1st ASAP • Assessment of high risk factors 2nd 2nd trimester 3rd 3rd trimester Care during Labor Every 2 weeks After 8 months of 1.Delivery by trained health personnel (DOS)- pregnancy domicillary obstetrical service 2.Hospital delivery (periculture center, lying-in Assessment: clinics, hospitals) 1.history taking: family, menstrual, OB (LMP, AOG, 3.Rooming in/ breast feeding EDC) 2.weight and height Domicillary Obstetrical Services Qualifications 3.vital signs, with special attention given to BP 1.Full term 4.physical exam 2.Not a primigravida- greater than 5 pregnancies 5.laboratory examinations 3.Without coexisting disease 4.No history of complications/abnormalities in Identify high risk pregnancy: present and previous pregnancies and delivery 1. Age- less 15years; 35years above 5.Imminent delivery 2. Parity- higher than 5 pregnancies Post Partum Care 3. Weight- less than 95 pounds 1.Inform, teach, counsel (MCH concerns) 4. Height- less than 4”10 a. Birth registration 5. Hgb- less than 8.5 grams b. Breastfeeding 6. Signs of hypertensive (HPN) disorder c. Newborn screening for babies 7. Poor OB history d. Delivered in RHU 8.Associate medical condition 2.Family Planning counseling 9.Vaginal bleeding; premature rupture of bag of 3.Nutrition education/ supplementation action water 4.Post partum care everyday till cord sloughs off a. 1st visit- 1st week b. 2nd visit- 6 weeks 3rd year (24-35months) – every 3 months 4th year (36-41 months) – every 6 months 5th year (48-59 months) - once a week
Breastfeeding- 1st step to raise a bright child
Philippine Nutrition Program
1. Nutrition surveillance Laws and Presidential Decree affecting MCH 2. Nutrition education 3. Food assistance/feeding program • PD 996- compulsory immunization of infants and 4. Food production/livelihood children below 8 years old 5. Treatment of conditions associated with • PD 965- a decree requiring applicants for marriage malnutrition license to receive instruction on family planning and responsible parenthood Legislations: • PD 603- the child and growth welfare code 1. RA 8172- ASIN • PP No. 6- implementation of universal code 2. RA 8976- food fortification act 2000 immunization a. Rice with iron • RA 7600- rooming-in and breastfeeding act of b. Wheat flour with vitamin a and iron 1992 c. Refined sugar with vitamin a d. Cooking oil with vitamin a • RA #51- milk code 3. EO 382- nov.7- national food fortification day • RA 7846- compulsory hep.B immunization for infants and children below 8years old Conditions associated with malnutrition • PP #46- re-affirming universal child and mother Infections: diarrhea, vomiting, fever, intestinal immunization. Polio Eradication Project of the parasitism Philippines • RA 8172- ASIN law (iodization of salt) • Ascaris (giant roundworm)- nutritional • PP #1064- acute flaccid paralysis (AFP) competitor surveillance by all sectors • Hookworm- blood sucker, heavy infestation in • PD 79- revised pop. Act empowers rn’s and rm’s to seen as severe anemia; enters body through skin provide, dispense and administer acceptable • Enterobius/oxycuris (pinworm)- rectum, major methods of contraceptions sign is pruritis ani, highly contagious • RA 9288- newborn screening act • Taenia saginata/solium (tapeworm)- longest • RA 8976- food fortification act. (fortification of (15-25 meters) cooking oil with vitamin A, wheat flour with vitamin A and iron refined sugar with vitamin A and rice Nutrition Assessment with iron) 1. Anthropometry- major tool index of protein- • PD 651- birth registration energy malnutrition 2. Biochemical exam- more expensive; Hgb Child Care detection, serum CHON, BUN, creatinine A. Care of below 5 years old 3. Clinical- diagnosis of micronutrient • Immediate care of newborn deficiencies • Detection/referral/management of high risk 4. Dietary history newborn 5. Health history- to determine secondary a. LBW (lower than 2274 grams- not higher factors with malnutrition such as diarrhea than 2500 grams) b. Born with high risk mothers Anthropometry: c. Problems during neonatal period 1. Weight for age d. Born to families with psycho-social a.Lower than 5, operation timbang problems b.Not used when patient has edema e. Chronic or recurrent illness c. Used in diagnosis of: • Breastfeeding - Chronic low nutrition = stunting • Nutrition promotion/growth surveillance - Acute (current) malnutrition • EPI - Overweight- obesity • IMCI - Underweight- wasting
G- growth monitoring (ECCDC) Gomez classification of nutritional statistics
O- oresol Formula for computation of % of LBW: B- breastfeeding Actual body weight ÷ expected body weight x 100 I- immunization greater than 110% - overweight Schedule of Consultation: 91 – 100%- normal 1st year (0-11months) – every month 76 – 90% - 1° undernutrition (mild) 2nd year (12-23months) - every 2 months 61-75% - 2° undernutrition (moderate) less than or equal to 30-60% - 3° undernutrition dermatosis (severe) Management of PEM (protein energy 2. Weight for age malnutrition) a.Lower than 5, diagnosis chronic undernutriton- • 1st and 2nd degree malnutrition; home stunting management; nutrition education b. Heredity • 3rd degree- referral to hospital; nutrition education 3. Mid upper arm circumference (1-4years old)- rapid screening for malnutrition Micronutrient- substance in very small amounts of Procedures: body (less than 0.005% of body weight) • Determine midpoint between acromion and olecranon Vitamin A deficiency (VAD) • Measure circumference at midpoint Iron deficiency anemia (IDA) Interpret: Iodine deficiency disorders (IDD) Greater than or equal to 13cm- normal nutrition status VAD (xerophthalmia) Less than 13cm- acute undernutrition (wasting) Susceptible population: 1-4years old, occurs with PEM 4. Weight for height Foods rich in Vitamin A • Adults • Richest: liver, egg yolk and milk, retinol • Diagnosis for acute malnutrition • dark green leafy vegetables, yellow fruits and • Body mass index vegetables, contain carotene. Formula: weight in kilogram ÷ height in m2 Body mass index of 20-25 is desirable Signs: 5. Skinfold thickness 1. Night blindness- lack of rhodopsin (visual • Subcutaneous tissue purple) in rods. • Triceps 2. Photophobia • Femoral 3. Conjunctiva xerosis- dryness of conjunctiva for • Abdominal 2 hours to inadequate tears Adults to diagnosis acute malnutrition 4. Bitot’s spot- foamy, silvery spot on saliva Harpenden caliber 5. Corneal opacity 6. Keratomalacia- softening cornea- corneal Pt. of Kwashiorkor Marasmus rupture- eye evisceration- irreversible difference blindness Etymology After sickness of “wasting” older child when IDA next baby is Susceptible population: pregnant women and born infants Deficiency Sever protein Severe energy Foods rich in Iron deficiency deficiency • Liver and other internal organs, egg yolk, dark = qualitative = quantitative green leafy vegetables def.conditon def. condition Major sign of IDA, palmar pallor Age group Weaning age: Various age affected toddler groups IDD Health history Improper Starvation Susceptible population: woman weaning Most serious effect mental retardation (cretinism) in diarrhea baby: if mother does not have enough supply of iodine Wasting Present, not Present, obvious during pregnancy. obvious Major feature Edema; ascites, Wasting- skin Other signs: pedal and bones • Growth stunting appearance • Pasty skin Weight May be normal Abnormal = 2nd • Protruding abdomen or 3rd degree • Deaf mutism malnutrition Facial Moon faces Old man faces Foods rich in Iodine: seafoods appearance Goitrogens- interfere with Iodine use; found in Appetite for Poor Very Good cabbage, turnips, mustard, red skin of peanuts, food cauliflower, broccoli, cassava ________ Irritable Apathetic outlook Prevention and Management: Hair changes Sparse, Absent 1. Supplementation- administration of depigmentation concentrated source of nutrient “flag sign” Skin changes Flaky paint Absent VAD prevention: • Preschoolers (12-83 months)- 200,000 IU every 6months • Postpartum 200,000 IU within 1 mon. after delivery of every child