CHN Lecture Part 2

Home/Clinical Setting to Levels of Clients

HOME SETTING AND CLINICAL SETTINGS

HEALTH SETTING IN COMMUNITY PRACTICE/PUBLIC HEALTH ACCORDING TO FREEMAN

Also called the Public Health Nursing

RA 7305

Magna Carta for Public Health Workers

Aims to give benefits to the Public Health workers in the Philippines

HEALTH SETTING IN COMMUNITY PRACTICE/PUBLIC HEALTH ACCORDING TO FREEMAN

Occupational Health Workers

• OHNAP (Occupational Health Nurses Association of the Philippines)

RA 11058

Occupational Safety and Health Standard Act of the Philippines

Goal: ensure safety of the workers

Precursor of this law: RA1054

1

Guidelines based on Occupational Safety and Health Standard Act of the Philippines

How many RNs in 100 or more workers

1 km away from healthcare facility

100 below workers

Guidelines based on Occupational Safety and Health Standard Act of the Philippines

Guidelines if there is NO RN

well

in CHN, we cater to sick or well populations?

hospital/clinical

sick populations should be in what setting

100 well workers

Guidelines based on Occupational Safety and Health Standard Act of the Philippines

1 bed is for _____

PD 442

Philippine Labor Code

1 FULL-TIME RN

According to PD 442 (Philippine Labor Code), 100 or more workers in a establishment should have

1 FULL-TIME RN, PART-TIME MD, PART-TIME DMD

According to PD 442 (Philippine Labor Code), 200 to 300 workers in a establishment should have

FULL TIME RN, MD, DMD

According to PD 442 (Philippine Labor Code), 300+ workers in a establishment should have

8 hrs

minimum number of hours considered full time

2 hrs

minimum number of hours considered full time

Night Shift Differential

will be given to those who are in night shifts

10 pm to 6 am

night shift duration

10%

night shift differential how many percent

RA 124

School setting of nursing (Freeman)

About the assessment of pupils from both public & private school

nutritional status, snellen chart (visual acuity), hearing screening, IPPA (physical assessment

areas to assess in pupils according to RA 124

height and weight by age

WHO standard: assess nutritional status

< 5 years old

BMI

WHO standard: assess nutritional status

< 5 years old

Weight in kg/ Height in m2

formula for BMI

feeding program

WHO standard: assess nutritional status

if result is NOT NORMAL, do what

breakfast

what meal for the day a nurse should conduct the feeding program

60-120 days (2-4 months)

how long should a feeding program last

deworming

pre-requisite of feeding program

done with consent

meds: -dazoles (albendazole, mebendazole)

red, <16

BMI categories

severe thinness (color and BMI)

orange, 16-17

BMI categories

moderate thinness (color and BMI)

yellow, 17-18.5

BMI categories

mild thinness (color and BMI)

18.5 - 25, blue

BMI categories

normal (color and BMI)

blue-green, 25-30

BMI categories

overweight (color and BMI)

yellow, 30-35

BMI categories

obese I (color and BMI)

orange, 35-40

BMI categories

obese II (color and BMI)

red, >40

BMI categories

obese III (color and BMI)

visual acuity

what do you assess using snellen chart

Ball pen Click test

test used in hearing screening

2-3 cm away from the ear, One ear occluded, then the other ear 2-3 clicks of ball pen and do it on the other side

Assess for volume

• Should note if both ears will hear the same volume of the clicks

arms - rashes (measles, german measles, chicken pox)

eyes - visual acuity

nose - hygiene

mouth - dental assessment

ears - infection, mastoiditis

neck and chest - rashes

hair - lice

lower extremities

IPPA/Physical Assessment

There areas are the ones that can be exposed and common site of problem for the children

individuals

families

aggregates

community

4 levels of clients

individual

entry point of levels of clients

atominist

approaches in treatment of individuals

treating clients by parts (usually used by MDs)

holistic

approaches in treatment of individuals

treating client as a whole 

community-based nursing

• level of clients: individual, families

• focuses on: sick

• secondary and tertiary level of care done in the community

• acute or chronic patient care

• TB DOTS

community health nursing

• levels of client: family and community

• well clients

• primary level of care

• promotion & prevention

• immunization

TB-DOTS (Directly Observed Treatment Short course)

• 6 months

• ”Tutok Gamutan”

• Worldwide

• Prescription antibacterials

• Goal: monitor compliance (always the problem) -> develop resistance -> avoid relapse

• Normally, patients should go to the hospital to get the medications -> RHU, Health Center setting

  • When patient did not go to health center = HOME VISIT

family

• levels of clients

• unit of service

• FOCUS of the nursing care

• Main caregiver in the primary level of care

• Groups of people that share blood relation, birth, legality and choice

socialization, healthcare, affection, reproductive, economic, status/social placement

functions of family (SHARES)

IMCI (Integrated Management of Childhood)

• Protocol-based program (can be done without MD) to reduce morbidity and mortality rates of pediatric patients

• Developed by WHO and UNICEF in 1995

• Adapted in the Philippines in 1996

1st: assess, 2nd: classify, 3rd: tx/mngmt

columns in IMCI

Pink

IMCI Classification of Diseases

Severe - has general danger signs; refer to the hospital

Can’t swallow/drink

Can’t sleep

Continuous vomiting

Convulsions

Consciousness - lethargic

general danger signs in IMCI

yellow

IMCI Classification of Diseases

Moderate - RHU management; for follow-up

green

IMCI Classification of Diseases

Mild - home care; for follow-up

nuclear

types of family

father, mother and children (natural born/adopted)

extended

types of family

common Filipino family

3 generations

dyad

types of family

no children at home 

empty nesters

have children but move or leave the house to create their own family

blended

types of family

children from previous marriages

genogram

presenting family using symbols (square - M; circle - F)

co-habiting

living in arrangement

Not yet married

common-law spouse

someone who lives with their partner in a marriage-like relationship without the legal formality of marriage

compound

types of family

man has one or more spouse/s

Not constitutionally accepted in PH

Allowed in Muslim as long as the husband can provide

PD 1083

Code of Muslim Personal Law

It establishes Sharia courts and outlines provisions for marriage, divorce, inheritance, and other family-related matters among Muslims in the Philippines

Single parent

types of family

d/t death, separation, pregnancy outside wedlock 

gay and lesbian family

types of family

two same sex living together

EO 209

Family Code of the Philippines

Marriage as permanent union between a man and a women

Same-sex marriage is not allowed

Evelyn Duvall

Who developed the stages of family life cycle

Rule: Basis is a always the eldest child

• ex. 12 y/o, 6 y/o and newborn

  Family with school age

Beginning of family

Duvall’s Family Life Stages - newly married

Childbearing family

Duvall’s Family Life Stages - birth to 3 months old

Family of preschooler

Duvall’s Family Life Stages - 3 months to 3 years old

Family with school age

Duvall’s Family Life Stages - 6 years old to 13 years old

Family of teenagers

Duvall’s Family Life Stages - 13 years old to 20 years old

Family launching young adult

Duvall’s Family Life Stages - 1st child to last child leaves the house

• not chronological

• based on who leaves the house first

Middle-aged parent

Duvall’s Family Life Stages - from empty nesters to retirement

Aging family

Duvall’s Family Life Stages - retirement up to death of parents

AGGREGATE

4 levels of clients

• Population groups

• Sub-population of brgy

• Includes vulnerable groups: infant/children, pregnant, adolescents, elderly

bacterial sepsis

Old leading cause of mortality in infant/children worldwide

Sudden infant Death Syndrome (SIDS

leading cause of mortality in infant/children worldwide now

pneumonia

leading cause of mortality in infant/children in the Philippines

Malnutrition

• A condition that occurs when the body does not get enough nutrients to maintain healthy tissues and organ function.

• Can result from both undernutrition (deficiency of nutrients) and overnutrition (excess of nutrients).

• Leads to various deficiency-related diseases including anemia, goiter, and visual impairment.

• Common in infants/children

Vitamin A Deficiency – Xerophthalmia

• Under malnutrition

• progressive eye disease caused by Vitamin A deficiency, starting with dryness of the conjunctiva and cornea (xerosis).

• Can lead to excessive dryness and wrinkling of the cornea, which may progress to corneal ulcers.

• Severe cases cause scarring of the cornea, ultimately resulting in blindness.

Bitot's Spots

• Whitish-grayish, triangular, foamy spots that appear on the conjunctiva.

• A cardinal sign of Vitamin A deficiency (Xerophthalmia)

Nyctalopia (night blindness)

• An early symptom of Vitamin A deficiency.

• Inability to see well in low light or darkness.

• Caused by impaired function of retinal photoreceptors due to lack of Vitamin A.

Iron Deficiency Anemia

• Under malnutrition in children or infant

• A condition caused by insufficient iron in the body, leading to reduced hemoglobin production.

• Symptoms include fatigue, pallor, shortness of breath, and weakness.

• Commonly caused by poor dietary intake, blood loss, or malabsorption.

Goiter

• An abnormal enlargement of the thyroid gland due to insufficient iodine intake.

• Appears as a swelling in the neck.

• Can be prevented with adequate iodine in the diet (e.g., iodized salt).

Mental Retardation

• Severe iodine deficiency during pregnancy and early childhood can impair brain development.

• May result in cretinism, characterized by stunted growth and intellectual disability.

• Iodine is crucial for normal cognitive and neurological development in children.

Food Fortification Program

• Addition of essential micronutrients to commonly consumed foods

• Aims to prevent micronutrient deficiencies at the population level

• Includes fortified rice, flour, and condiments

Kalusugan at Nutrisyon ng Mag-Nanay Act

• Focuses on the health and nutrition of mothers and children

• Addresses maternal and child undernutrition

• Emphasizes proper nutrition before, during, and after pregnancy

Garantisadong Pambata (GP)

• Biannual child health campaign

• Includes immunizations, deworming, and Vitamin A supplementation

  • Vitamin A helps prevent xerophthalmia and other related disorders

• Part of the Micronutrient Supplementation Program

  • Government initiative to address deficiencies in vitamins and minerals

  • Includes distribution of supplements like Vitamin A, iron, and iodine

April; October

Garantisadong pambata schedule

G1: ____; G2: _____

6 months

Interval of giving vitamin A for children LESS THAN 5 y/o

RA 8976

• Food Fortification Law

• Mandates fortification of processed foods with essential nutrients

• Foods attractive to children (e.g., junk foods) are included

Sangkap Pinoy Seal

• Part of Food Fortification Law

• Can be seen on the product packaging if compliant to the law

RA 11148

• First 1000 Days Law

• Covers nutrition and health from pregnancy to age two

• Focuses on critical window for child growth and brain development

• Promotes exclusive breastfeeding, complementary feeding, and maternal care

RA 11223

UNIVERSAL HEALTHCARE LAW

RA 11463

MALASAKIT HEALTH CARE LAW

RA 11332

MANDATORY REPORTING OF NOTIFIABLE DISEASES

PD 491

NUTRITIONAL ACT OF THE PHILIPPINES

Hypertension related to pregnancy

PH: leading cause of mortality in pregnant women

Ex: Preeclampsia, eclampsia, pregnancy-induced HTN

Postpartum hemorrhage

Worldwide: leading cause of mortality in pregnant women