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lron supplementation is vital hecause of the blwd loss in <lelivcry. I! the woman ic; already anemic before delivery and in the postpartum period, itincrcas1. >s the p<Jssihility of needing blood lransfusion whic:h not only opens her to more risks but also very costly. Jn 2003, 77% of pregnant women receiv,ed iron supplementation. The National Nutrition Survey of 2or,3 reports 4~t9% of womf!n as having iron dcfic:icncy nnemia. 111ere were 43. 9% of pregnant and 42. 2% of lactating women who had iron <leliciency anemia. The goal of the g<Jvernme nt i!> a reduction tu 38% of the number of women with anemia.. Accord1n~ lo the WHO (2no7), a daily dose of 60 mg iron and 400 ug folic acid daily for 6 months is adequate to meet the physiologic needs of r,regnanc.-y. (13) The HBM R gives a standard prescription for Filipi no wr. >men to take iron/folate supplement s twice a day (60 mg/tahlc l) starting on the 511> month of pregnanc.-y up to 2 months pos\partw:n or for a periud of 210 d:. ys. If an,m:!a has a high prevalence of anemia, the supplementation of 100 mg iron and :350-500 ug folicacid is recommende d for more than 16 \veeks nnd suggestecl to continue for 3 months pm,1:partu m. Nurses must know how to use a multiple-s. ite assessment for anemia. Stoltzfus et a J (1999) identifies the inferior conjunctiva, palm and nail beds as some of the sites to assess aside from 11sing the results of laboratory examinatir,n. (17) r·alc conjunctiva was found to he higher among rural compared to urban dwellers (Velandria, et al, 1995) (18) It is also Lmportant to inquire about history of malaria or other parasitic diseases since they can also cause anemia. VITAMIN A SUPPLEMENTATION Vitamin A supplements have been recommended in pregnancy to improve outcomes that include maternal mortality and morbidity. Broek et al (1996) performed a review offive trials involving 23,426 women. One large population based trial in Nepal showed a pos. sible beneficial effect on maternal mo·rtality after 1. veekly vitamin A supplements. In this study,1 reduction was noted in all cause maternal mortality up t O 12 weeks postpartum ";th Vitamin f\ supplemen tation Night-blindness was assessed in a nested case-control stndy within this tri:11 and found to be reduced but not eliminated. Three trials examined the effect of vitamin A supplementa tion on haemoglobin levels. The lrinl from Indonesia showccl a beneficial effect in women who were anemic ([Hb] <11. 0 g/dl). After supplementation, the proportion of women who became non-anaemic wns ;35% in tl1c Vitamin A supplemented group. 68% in the iron-supplemented group, 97% in the group supplemented with both Vitamin A and iron ancl 16% in the placebo group. (19) In the Philippinl:!S,women receive 10,000 IU of Vitamin A during the t1 µ·renntal visit in the 1"' trimester and throughout the pregna-ncy. The women are given the supplements and their intake followed through during pregnancy. Only 77. percent of pregnant women receive<. ! i1·on supplcmcnt. 1tion during pregnancy while only 45 percent of postpa. rtum women received a dose of Vitamin A. In 2003, 17. 5% of pregnant women and 20. 1% of lactating women hnd Vitamin A deficiency. TREATMENT OF DISEASES AND OTHER CONDITIONS Iodine deficiency is one of the preventable cause of mental retardation and brain damap,e. It is also associated with cretinism, lower mean birth weight and increased infant mortality. locline cleficien-cy is conlrollecl through direct supplementation with oral or intramuscular iodized oil. addition of iodine to water, or most cnmmonly ir Ju izat ion of sa JL In the Philippines, about 36 out of every 100 children (35. 8%) have 295 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
. I 296 moderate to severe iodine deficiency disorders ODD). All 4 provinces of Northern Mindanao (Region 10) are high-risk IDD areas. About 6 to 7 out of every 10 children am moderate lo severe f DD cases. The government's presci:-iption is to administer one capsule of iodi7..ed oil is given to all pregnant women in areas where goiter is endemic. The nurs. :e cau assess the pregnant woman's thyroid gland by palp. ;ition. The importance of this examination is based on the report that 30% of pregnant women have goiter (Safe Motherhoo d Survey. 1993) (21) Malaria is t11e 911> lending cause of morbidity among women (DOH ten leading causes of Morbidit y by Sex, 2004) In areas where malaria is endemic the health care provider gives 2 tablets of chloroquine phospate (250 mg /tablet) every week for the duration of the pregnancy. ln endemic areas, pregnant women are also provided,"vith long lasting impregnated nets (LLINs) as a protection EARLY DETECTION AND MANAGEMENT OF COMPLICATIONS OF PREGNANCY The nurse needs lo l1ave the skill in detecting the danger signs of pregnancy. Patients manifesting these signs need to be referred to the nearest facility or physician. Interestingly. the results oft'he stu<ly by A. DB on41 out of 79 provinces in the Philippines show that only 56. 6% of women were advised to go to specific public facilities (35. 4 %) and private facility (14. 7"/4) in case of pregnancy complications( 21 ). _ The rest were not adequately informed where they can go if they encountered pregnanc y complications Prompt detection and management vvill help in decreasing the chances for maternal and fetal mortality and morbidity. Specifically, the nurse needs to report vaginal bleeding, edema oft11e face and hands. headache, dizziness, blurred vision, pallor. In the prenatal check up, tl1e health care provider also takes the woman's fu. ndic height, temperature, blood pressure, weight, signs of urinary infection (pain and frequency in urination) and signs of eclampsi a especially starting the 20" week. The results of urinalysis are also reported for proper management in case of infection '. The blood pressure is the most sensitive sc1·eening test for diagnosing hyperte m;ive dis. orders in pregnancy \. vith a 71% sensitivity, 95% specificity and 40% predictive value for pre-eclampsia in pregnancy, labor and puerperium (Hall 1992, p. 22) (22) It is measured in ll1e same arm (at the hea11: level) and position during each visit_ Below is the classification of blood pressure for adults aged 18 years or older: (23) Dependent eaema is common in normal pregnancy ·while generalized edema is seen in pre-eclamps ia. Edema is best assessed on the face, bands and sacrum and taken in conjunction with blood pressure readings. Abnormal-findings warrant referral to the physician. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
FAMILY PLANNING COUNSELING The Women 's Health Safe Motl1erhood Project 2 reports.. As tlie 2003 NDHS nwca/s, the acnml total fertility rate (TFR) of 3. 5 is lriylw,· thmi 1oanted. (ati/ity of 2. 5. a,1d unmet family pfa1111i11g 11ced exists Jo,· one 0111 of. fii. 'C' women (19. 8~t,}. The 200. ; Family Planning Suruey shows tlrnt this co11/'in11cs to be: rhe mse.,dth :Jo.,'J;; total unmet need, of which 10. 9% is for spacing bir-tlts um/ 9. 2\"\5Ji:i1· /imi11·11g /Jirt'l,s. naecl to make a decision on family planning is dnne cluring preg11n11cy. (2007. p. Ci) (21) Family plannin g aru. 1 fertility awareness are part of whal. is uisc:ussed in I he firs L prcn. it,11 visit and the subseque11t visits. After delivery, the benclits elf family pl:rnnin~. 1isks of a pregnancy too soon and most ;;uitahle family planning methods for a breastfeeding woman,Lre discussed. The choices offered nre IUD. condom. prvi;csleronc unly p UI. natural family plannin g, spermicides,111d pern1anent methods. (9) 1\s:sistuncc is i:;iven to tl1e couple to help them decide on a choice of n family plnnni11g mctbocl. STD/HIV/AIDS PREVENTION AND MANAGEMENT The WHO standard aims for nil women seen during prcg11. 1ncy. c:hilclbinh and the poshia. tal period lo be given appropr Late inform:1tinn on the pr C'vcntion ~111d recognition of sexually tr,rnsmillcd inl"ettion::; (STls) and rcprnd11clivc tmt·t infections (RTls). They should be :1ssessed for ST!s/R,Tls :,ml, when rcquin:d, pro\'idetl with prompt and effecth·e trcatmenl for themselves :incl. in the case nf STls. their partners. Effective managem ent of STls is key to their cnntrnl, :,,: it prc,·cnts the development of complication s and sequelae, reduces the s1iread of these dise:iscs in the community and offers a unique opp01i:uni ty for targeted ed11catinn on I I IV prcvt:ntion. The prevalence of STls is increasingly becnming a source of concern in the country. A May 2002 su. rvey nf the general populntion showeci n relatively hig,h prevalence of chlamydia1 infections (5. 75% for women, 4,4% for men. 7. 7'X, for female youth and 9% for male youth), rrichomonias is (3. 18% for women) and p,nnonhca (0. 75% for women, 4-4% for men. 0. 7% for female youth and 1. 7% for mnlc-youth). The !-lituaticm :1. mong h1gh-1;sk groups is more disttll'bi11 g. Peliollic sl Udics from L994·:!. 00:!. t'Ollducled in 18 sites sho..,,,· that amon~ high-risk females. hacteri. il rnp,ino,;is is t J1c mo:st predominant, reaching 70%, followed by chlamydinl infections fup to 36%), gonorrhca (up to 31%) and syphilis (up to 7%).. 1-\mong high-risk males, chlatnydia leas lhl:! highest pre,·ulcnce (up to 16%), then syphilis (up to 11%) o1nd gonorrhe(I (up to 3'X,). The problcm is cowpounued by the emergenc e of antibiotic resistant strains. Ncnrly all gonorrhea isolates were found resistant to penic. illin iu L997 while 63% wl!rt! found rl. 'sistant to quinolones in 1998. ) (21). The health services for STls include !>creening. hc:ilth edltcation and referrals for lhose who need management and treatment. STANDAROS IN HOME DELIVERY A plan for birth and ways of dealing with uncxpeded adverse events, :-uch as complications or emergencies, lhat may occur dming r1·cgnnncy. d1ildbirth or the immediate postn<1tal period should always l>e avail,1ble. This pbn is Hrn H. :thin~ that is done with tl1e bealth earc provider at each antenatal visit ancl nt least cine month prior to the expected date of birth. Historical e..,,;denceshows that nu counlry has managed to bring its maternal mortality ratio below l OC> per 100 ooo live birlhs "~lhout cnsu1;ng that all women are attended by an appropriately skilled health professional during labour, birth and the period immediate ly afterwards (24) In focus-group discussions, midwives and hilots consi<lcr ed the delay in rt!femd 297 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
298 treatments as one of the main reasons for maternal death. The service providers faced more difficulties convinci ng women from ethnic minority groups to seek treatmen L This hesitatio n stems from cultural barriers and language unfamiliarity (21) Births attended by health professionals iucceased from 56 percen l in t998 to 60 percent in 2003. The goal is to hnve So% of all births attended by skilled health attendants. Based on current data, 61% of births occurred in t Jie homes while 38% in health facilities. Hornedeliv eryisanotherimportant. nursing intervention. Republic Act No. 9173 states that nursing care of individual s, families and communiti _es in any health care setting and includes but not limited to nursing care during concept. ion, labor, ddivery. It also the duty of the nurse to perfom1 internal examination during labor in the absence of antenatal bleeding and delivery. Birth attendance by professiona l health ¼lorkers will be a significant step in having better risk assessment and referral. If the person handling the delivery is well trained, t]1ere is a greater chance of detecting pelvic inadequacy and fetal malposition. The client vrul benefit from a more skilled practitioner doing abdominal and internal examination. The DOH came out with a Protocol for Horne Deliveries tb. rough DOH Department Circular No. 187-As. (Compiled Policies 1994, p. 46) (4) This circular allows licensed nurse-midwives and nurses trained in delive. ry to conduct home deliveries. License d physician s, midwives and trained traclitional birth attendants or hilots (allowed only in areas where there are no licensed physicians, nurses, midwives or no available health professional at the time of delivery) are also listed as other legitimate birth attendants. For nurses adequately trained in labor and delivery, this is an important opportunity for nursing practice. Since most births in the rural areas happen in the homes, the Protocol for Home Deliveries v. ill help in ensuring safety of the woman and baby. The list below shows the DOH criteria on who are qualified to have home deliveries... Adctitiona J assessment pointers for the nurse are al. so included: Pointers Quallflcatfons For Home Delfverv Take a complete history and examlnadon on Full term (9 months) current pregnl!ncy. Compar:e the l!!Stfmated age of aestatron by the last menstrual by the last 2nd to 4th delivery menstrual period (LMP) and the measurement of the tundlc height. Complete lnformatfon on Gravrda, Parity and TPAL score.. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Pointers Make a p ysica examrnation olhgt &-Leopold's maneuver for the fetal position, Ile and presentation, lntema I i!Xamination to determlne pelvic adequacy, rupture of membranes, engagement and signs of Imminent delivery This presupposes that the nurse had previous trralning on Internal e>camination _ (IE), The nurse can also use maternal height as a possible predictor of cephalo-pelvlc disproportion. 1nspec:t abdomen for CS scarfs. comp ete ata on present eal condition an past obstetric history with emphasis on the following : Presence of a medical condition, hlstory,of difficult delivery, prolonge d labor, hemorrhage-o r previous caesarean section For rmme ate re erra, t e i Ft atten ant must accompany the patient together with a relative. Forother refi?rral s, the birth attendant may not accompany the patient but Instead make a referral slip which Include the following information, a5 suggested by the DOJ,l: name, complete address, age and reason for referral Qualifications For Home Dellve Cep allc presentatfon Pelvic: adequacy No premature rupture of membranes Imminent-delivery Di cu t and pro onged la-or (greater than 24 hours for prlmlgra111das and more than 12 hours for multigravidas) durfng previous deli Vfilries Hislory of hemorrt,age.. A previous caesarean section Imm ate re erra must e done to the nearest faclllty with cap. ibllity of handling the needed servlce/s in the following sfgns: DANGER : Vaginal bleeding. ·convulsion Blood pressure above 140/90 Severe abdominal pain Re~rral but not lmmedlarelyr O A pregnant woman who is not qualified for home delhtary A woman who develops abnormal signs and symptoms but NOT dang!!r signs during pregnancy and postpartum like ·edema and pallor 299 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
300 The nurse needs lo make preparations for a delivery. The DOH protocol (listed below) presents a list on what are needed for a delivery: A de U11ery left contalnlns the ft:lllowlng : IJ Pair of sterilized scissors of a new and cj~I) st9ril Jied razor blade (to be used for cutting the cord) 0 Sterile cord stf\np (for tylns tt,acordl 0 2 pairs of clamps (If ava Oa~ D Anttseptl!= (may UM 70" alaofiol) 0 Soap for washlns O ~ean towel or a c:ifin pi C Flashllght 0 Sp-hvs,n11manometer Stethoscope Plastic sheet (as delhlef V~rhtce) suctfon bulb (for su. ctloolns newl;,om $e«et1e,ns) Spring-type we,lghlng ~· 0phthaimle SOIUtlon Clean towels or pleces of cloth (for drying and Wtapp Jng newb9rn) N. all cutter {to cut-11nd cl Nn the nlllls oftha birth attendant) Sterile gtol,es It Is a very good l'!Urslns practice tt>11lwavs have a de Jlv,ery kit on hand. The following may be added: cor:d clamp (IMtead of cord str. J11g$}, at lea'$t 2 sets c:if 2"l<2' ga1. 1ze (to help wipe secretions on the baby's face and used for perinea! :support), povldon-e ioclir,e antiseptic (for eleanl"g the perinea! area before deltverv ar,d:clear,ln,t·the birth attendan t's hand-s). In the DOH Sentrong Sigla Supervis ory Package, special emphasis is given to the 3 Cs. 111ese are clean hands, clc11n delivery ~mrfacc, clean ct1tting nnd care of the cord (DOH,2003, p. 31). The nurse is also a!Jowecl to sul'ure superficial 1.-. cei·a Lions and administer necessary intrnmuscular,md intravenous medicatio n, pr-ouided, however that there is adequate trninjng for such procedures. Monitoring of the woman within the first 2 hours post delivery is also done. This is through the vital signs and noting for signs of bleeding. Breaslfeedin)!. is also initiated right,1fter delivery. The need to refer to the nearest health facility any complicated and difficult delivery is a]so mentioned. B-irth registration within 30 days after is also em. pb:isi7. e<l STANDARDS IN POSTPARTUM VISIT There is an increase in the percentnge of women with. at least one postnata l visit from 43 percen L in 1998 to 51 percen l in 2003. The goal of the goveran1en t is to have 80% of women benefit from postpartum l" visit within the 1 week of delivery. The DOH Sentroug Sigla Technica l assistance Packi1ge for Integrated,-vomen 's Health states t JJe government's goal of having 80% of women receive two (2) postpartu m visits done within two (2) dnys after delivery and a month after and licn·e received the | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
essential services namely: Physical and abdominal examina tion Vitamin A 2uo,uoo l U within 1 month after dclive1y lron supplementation (. 1t least 90 tabs) Cotu1scling on breastfeeding (BF), family planning (FP), personal hygiene, newborn care. STD/ HIV/ AIDS prevention To ens\lre that U1e goal is met, Lhc Scntrong Si~la Supervisory Package provides nformation on the important activities that the nurse and midwife need Lo do when ~rovicling care for a womm1 <luring the postpartum p~riod. Postpartum visit Provides management for postpartum problems (mastftis and breast abscess, sore or cracked nlppl~, engotgemenl & Insufficient milk, postpartum fever, depression, 1. 1rlnary problems, signs and symptoms of a fistula-poor control In urination and elimlnation); lf beyond capab,lit, refers to the doctor Glves mlcrqn1,1trienl supplementation (Vlta,min A 200. 000 1U Immediately after delivery or within. a month, 2 tabtets of lron/Folate (60 mg elemental Iron plus 0. 25 mg fohc acid dally for 2 months and longer if she has oallor) G[ves postpartum messages ([j(cluslve breastfeeding, famlly planning, hygiene, routine bab care care of the cord, Gives adv(ce when to see~ consultation or when lo ceme for follow-up visit (problems, artum visits. imrn11nii;<1ttons) One of the important concerns in postpartmn care involves breastfeeding. TI1e mirsc belps the woman 1·0 make a decision on breas H·ceding. The Philippines. being supportive of the 1981 lnternationa l Code of Marketing of Breastmilk Subs Li lute by the World Health Organization ('v VHO) is pursuing strong advocacy workin the promotion of breastfeeding. We recommend brcastmilk as the best form of infant fcccling for the first sh: months. The Nursing Outcome Classifico tiou (NOC. 2008) provides practical gujdauce on breastfeeding c:;tablishm1ml. (24) There h; a !isl of indicators Lliat Lhe nurse will look for in the mother that points to cst;1blishing proper breastfeeding. Some of them include the comfort position while nursing and use of the "C.. hold, recognitio n ofinfont swallowing nnd hreaking the suction when removing from the breast. The beauty of the NOC is the listing of infant indicators 11la1 determine tl1e success of breastfeeding. Some of t J1e t:ues Lhal nw·se,vill luok for :are: proper areolar grasp and compression, audible swallowing, coneet tongue placf!ment and nursing for a minimum of 5-10 minutes pc1· breast. · The Nursing Intervention Classification (2. 008) has a list of 40 activities that the nurse can do to prepare a new mother to·breastfeed her infant. (25) Some of the activities include a wide v..11·iety ofinstn1ctions on what the mother can do, need to watch out for, to avoid, and actions to better take ca1·e of the self and the infant. ln the p·ostparti. 1m visit, the nurse can assist the woman to maintain her physiologic stability and adaptation to her new role. She can be a resource person in helping the woman gain support in continuing breastfeeding and making decisions regarding fertility control. 301 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
302 THE NURSING PROCESS IN A NURSE-MANAGED CARE A nurse-managed pregnancy care is best described as the nurse ~taldng ownership" of the delivery of pregnancy sesv_iccs. Her roles include being a practitioner, health cduc,1tor. nnd coordinator. This means that the nurse has a level of expertise and decision rnakinp, capabrnty to work with the client and family in attaining the expected outcomes nfc:1re. \Nhether she works "'rith the clien. l tb1·ough a clinic 01· a hon1e visit, Lhe nrni11 responsihility of ensuring that the woman is a hie to undergo a l'isk assessment, receive visi H;pccilic screenings tesls, education, immuni zations ot· supplen1ents and interventions. The use of nurse-m::in::igc dl care is also part of unple1nenting current evidence that women benefit most when there is continuity of care. The nurse will also bridge the gap of making effective refena]s so that women know where to go and what to do in the focc of complications in pregnancy. NURSING ASSESSMENT AND DIAGNOSES Nursing assessment identify human responses to states of health and illness which become the focus of nursing interven tions. Gordon 's Functional Health Pattern is a typology that links assessment and human responses to actual or potential health problems. ·nie use of available standards of care \'I. ill be very helpful when making the assessment tools. The Board of Nursing, throngl1 Resolution 459 cecently approved the Standards of Mother and Child Nursing Practice for the Guidance/Observance of Nurses engaged in the practice of Mother and Child nursing as initiated by the Materna l Child Nursing Association of the Philippines (MCNAP). ln the DOH, all personnel use a standard form in assessment called HMBR, a tool to identify risk factors, danger signs and to help deliver appropriat e measures. lt is kept by tbe woman and is brought to the clinic every visit. Nursing has progressed in such a way that we have standardized language to communicate the results of assessment and clinical judgment (nursing diagnoses), nursing ou1co1m:s and nursing interventions. It makes it easy for nurses to talk about somethi rig when we use a standard language. It is also a great step that will help nurses charge for their services. Allen (2000, p. 26) presents a way of clustering data using the framework by Gordon to include subjective and objective cues. This method hastens the identification of nursing diagnoses. Students and nurses with beginning skills in maternal care find this way of clustering data vei:y useful and practical. A sample is presented on the next page: | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
-111utrtt Jon and Metabolic pattern -Elimination pattern 1, 1, " ,1 1, Actiyity Exerc:ise Pattern Subjective Cues {Susllt Ste d que5ttons) Op you know nutritional neea. s In pregnancy? Relationshlp between weight gain and fetal development? Food likes & dislikes? Restrictions cravings & feod taboos? ' Vitamin and mineral supplements? Experienc e In taking lrori tablets? What discomfo11ts related to eating & digestion do you experience? Manage_menti' Fluid fhtake? Fiber intake? What changes in ellmlnat1on (urinary and bowel) are you experiencing? Management? Use of. laxatives & stool softeners?. History of urinary tract infections? What do you usu!llly do doing the day? Do you ·have any change in your activity level since you got pregnant ? Are the're any changes in your 1,athing/hygienic pra ctlces? How do you feel about tl\is? How is your level of·energyi"Experlence of shortness of breath? Do you experience any back pains, varicosities and eramps; other body pains? ' What do you think about prenatal exercises? · Do you have any previou~ Injuries/ joint problems that are affecling your activity? Hrstory/cunrent cardiovascular/respiratory diseases? DETERMINING OUTCOMES OF CARE Objective Cues Weight (gain or loss) Height; Results of a 24 hour dietary recall or typical food Intake; Condition of the oral cavity Swallowing; Signs of anemia; Parasitism; Results of C8C(Hemoglobin, Hemato orlt); Thyrord gland enlargement Bowel sounc!s; Flatulence, Hemorrhoids; Bladder distention ; Results of urinalysis & fecalysis; frequency and pattern of urination and defecatio n Vital signs; Fetal heart·rate; Chest examination; Range of motion; Posture & musculo skeletal deformities/ problems; Varicosities; Areas of tenderness/ pain An outcome of care is the health state of a client resulting from health care. It can be used to assess quality of care. When the expected outcome is dear, it is easier to reflect the inputs of the team on the health of the client. The NOC (2008, p 462) lists 13 areas of knowledge on labor and delivery. When the nurse assesses knowledge on birthing options, effective strategies on promoting comfort on and the birth process using the criteria of 1 (no knowledge) to s (having substantial knowledge), it becomes easier to keep tra. ck of the gaps in knowledge that the health care provider need to fill up. 303 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3{)4 Thl'I'\' i» :iii,,, li'-1,,1 ;q p,..cclpnrt11111 11\!lh'rnnl hchnvit,r. ; {:1c H18, p. :,(>6-:,C>7) lhnl the 1n\1~c-,·. in httk fpr inn p,,~1n. 1t. 1l,;sit. The h<'li:wl,11-,. : i1wl1uk ndion.-. lnkcn hv the w, 111:111 i. 1 mnn,11. :c lwr,-1111,hl im1 a1ul lwr c11pah1 lil~ 111 mnn it11 I he pn·:-c nee of prol;l<ms ,11111 di,,·<>1n1nrt,-l'\1111111111 111 tlw p,·ri,~l hlll\~",n~ d\'11vt. 1)·. Tl1,· n·ilcria i111·l11dc a :,;calc fn "" 1 ( n,·, l'r d,n,pnst nil L-..-l tu ;, tnn,-,stt"ntly u,·1111111st n1\ l'd ). ,.,,r,·nmi,. 1,·. tlu: 111,r,-r dsit,-Con11.-lu. ::o. IJC"<II':< oh/. 1Plit1 i:,; 011 /re:,· tliinl post /'>V. <lpurru, 11. in11 ·11w n:1~-rrui 1ec1s,fuc ru pr<>b/n11s in,w(f care c,nc/ 11r1u/,on1 care. ll'it/1 u 11111·si11y dt,t!,}it>. ~1·$ c:f 1'. '11<tdl"d/l(' <ii:tic:it r. ·lottcl to sc{(<ln<i 11c1vhar11 c<11·('. tl,e ,:..tf)(. "f"-ft'"\I ciirril ~1rrt.,~,rrtt '~ err"(. · 0 ~ho,, ad,,1uat,· k1Hlwkdf. '-' c,f i 11crc:1si11g brc:i~t milk product ion D Shm, c..,rnxt, 11 fo 111 p,,..., t i,111 i ni, in hrc:t!:-1 focd i ng D Pl-.,-rilw tlw prop,r. ::hp:: in pcrin,al hygiene D D,·-.,·nhl· prorwr,,.,y~ 1,1,·an· for l be cpisiolo1ny D ldc11tit~ thl. ' <1~ns tll postp. irlun1 compliculions that need 11,cclical i 11 t <'l'\'l' 11 t ion 0 E11um~r:it<!,,·a~-s to mun~1p. c stress CHOOSING NURSING INTERVENTIONS >:ur-. inc: 1111erv,nlion:,. an. "h:11 "L' <lo as nun-c..'<. They :11-e the rcai-on for the a,nf~nu L nt.,f a li L,'ll'-'-' lo pcrf, or111,.,ur duti,. i-. They ca11 hr ind L'pe1 1dc11l and colbhnr:1t1,·,· 111. l,·p,·n.. knt 11th'l'll'lllit11,~ an i11ili:11c<l by th,· 1n11·-. e in nspn11s, to n nnt,in~,h,1~n,,,;.... C11ll:1t,nr:. i1h,·. 1cli11ns are tho~ tlint tlic lltll'!--L' p-crfon11:: in ..-nllal'<,i-"1111n,,i1h,,th,-r l:,·.,llli c. 1n· pr11k-<,irn1al:< 11n J that 11111:, r. _q11irt" a physician's ,1nkr. tnd 111:11 l'-: 111 n'!'pu1,,· t,> both 111,'<. lkal :1nd 11ursin~ di:1~11<Jsts. Cn. :. 1t efforts hm t> 1-.-. 11 don, 1,, lidp... 1Jnd,◄rdiz1: m1n-i11g i11lerve11tiu11,., Dul,'"t'h'C. h. <'I al (:ino8 pp H:. !l-8:. !:. !) ha<: c. :ncgorizcc J nursing i111cr·vt. 11ti<>ns for J\h~h\lfrn· ;-. :u~1ni:,ind :--:,1111. 11al Nur-. ing. Sumc i111cn·.,11tjon.., un<lcr 111ic. lwifcry n1,1r-<1nr. 111s tu. It!. 11!1111,.. 11111 con:. antic-ipntury J!Uidantt, :i1t:1(''1111cn1 pro1111,tion. 1,ir1h111~ lln,;.. 1,·'\. 11nma111111, ~hfhll,irt!i pnpar:iti1111, f:imilv planni11g, lrat·1:. 1i1>n nn<J health. md 1,irt111,·du...,11,m i:,,, 11,.,. 11,1tal 11ur,i11~.,,1111,· in1,n·,111io11, ar<· "" i',,llowb; bru.,-. 1tud111~,h,1,1. 111,·,·. l1'1llll· ft,-di11~. 1a·,,·tx,rn care. f:11nily involvcn1<. :nl pro111uliu11, ::!Np cnh. 1m·,11knl. knn~an10 t·ar,· ond n11trili D11 mn11:i'1,c·111cnt. HOME VISIT AS AN INTERVENTION Te> :IC<:'Ulll J)li<"h 1l1< 1,,·0-folrl rot, >f rite nur-. e r Jnd midwife In provide positive r,pc,;1-rn,. tn '"mu 11. 111d <1,,1;~,·r C":1rr· th,H i J-h;<1~,·d 011 st1111tlnrds i. e. t htrc :-1 1wcc J 10 ,·,1:,hl1,h,, tit, rap,111i, r.-l. 11inn'-h1p "'ilh th,· clt,Jtt.-n,is l'an be ucc. :omplislw<l in the C'r,111,,1 t1J lh,· cli1111· 111 th,· ltum,· '"'I \n~ d1,111 1h:,1 who 1111rn llti!--1·,·lation. ship has <'IJIH-~rn,-du1 ;11,,,...,.,,11... f\·1 lt J 1H1r-,i11g i11llr. ·,nl1ons. Tho, n11r-. l· l'<Hn<·.-. vvitl, a body .,f knuwlt·tl~·.,11. J-. ). ill.. li;a,,d 11n <'' 1d1·111,. ;,11,I '-la11tl11rd-. of c;,rt;, nd i. s 01w11 lo hcing tully pr,·.,, 111 111 th,·,"q><. ·1·w111·t· ol 11111r111-t111). ( \\1th tlw c. :licnt. Tiu: lllll'M' g,1es bl:yond ln◄Jl..i Ill!,11 1111 dwnl.,. Jt1,1 1111,: uf I h,· pn·gn,1111 '"'°' ·,1 nd-. 1. 11 t-. ltv I n·a Ii 11g c:it:h cl icnt with n·,p,..,·t Ila,· 11t11-..-d,, 111 1·0111,,. ·1 tlrnl I..irn d,·.,.-rilnng,. _ aki11 1<> tlw v.-ny.-. 01nc IT,,. i,11«11 11,",tl th,· m1,-,,.,·1u,n bt1,,·,... n ll h,·al,·r and II f}Hli,·111--h·ing a :-111·re~I work o nc. l I hu"' l n·ar.-d \,')th «11111lol-t r,·,p<·ct. All 1, nrnc·.., Hnd ot ~wr CCltl C.-1,'r T1S an u II owed lo ·th il". i' ?. 11d V\111110'-I (,1cu. _ 1,-. t'<>IIIPnu nn Lht-t:litnt. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
A home visit is :,n inlcrvenlion by itself. It becomes an opportunity to help the client and the family Lo develop ;wc J implement a plan IQ promote positive birth expcricn1:1·~ and 01. 1tct1111c... :;. In the l'hilippi11 c scllinv_, dienl1, nccdin~ 11 home visit are typically listtd as priorities in the· 111:ilcrnal n. :)c\istr:. :i1ion orth1: henlth c:entersnr rural hcalth 11nils. The nurse and 1hc 111iclwife ddcrmirn:s who of the clicnls need to br visiten. With ;1 go;il of havini; Ao'¼, of prc~nnnl wnmt'n have at least 4 prcnat:-il visits. il sometimes h<'rnmcs essential lo come to the worn. 111·. s home tu llelp her make a commitment to having a good prt'gnancy out1:0111c. Similarly, if the gual is to have 80% of post parturn wumen 10 Jrnve the 1" visit within the J" week of delivery, the importance of the home visit is much more glaring. Various cul111rnl nnd ethnic practices in the postpartum period cal Js for having the woman and hl!r baby within the confines of the home at this period. 111erc are nlso cnllllnil nnd social 1,;xpcclations that need lo be given import;mce for the visit to be mutually s:1tisfy111g. Fnr cxnmple, t J1e 11ursc pays attention to the social custo,m; cxpcclecl in a hnme "i~it ranging from her conveyance of respect to the clien1 to her demeanor while doing the visit. Given these premises, it now becomes important l'o understand the preparation needed to accomplish t'I mutually satisfying home visit. The table on the next page shows n list of activities thnt will serve as a guide in doing home visits. 305 _j | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
i t g_ S°· &> ij, ~ " ~, (Ji 0 O'I I PRCPARATORYPHASE Rt Nlew record· faue~~rn H,i h\·otn~r mernbrr, of the ht·. i!:h I Nm, CSC, 1monl~lli.. ~putum mcro~cop,, l"llcl. :ir~1 ~rnl'ar>, clcl & rdtm. l d&~ Pn,pdre ~u1arnent,. 1up;iit~ ;;ml at:t;-ic--, ipet,iit forms t Her. 111. i. etc) No\1t,, cl1tflt/hrn"ly <,,I \lit, lit lnt1ocut1: ~ell ' c:~w~\ thr purpo,t of th E:,,i~,,. ' ilttiv,nc\ ' Set an appo,111rnent !d. :e ;111d t~tim Jl~d dura1ro11 of th P. v,~h) [n\Ure safot~ ll!Qui1t:m Lnt~ Lr~ adequate ACTUAL HOME VISIT I POS1'VISIT NURSING PROCESS Introduce stl! am; p. ;rp:>sf! of the v1s1t Complete recor<llng of data on the chart or agency-II th!: 1. 1 the HI cont. ict with the thent/famlly, state specific form~ As)essmen t data and nursing diagnosis mr pu:po~ec o! th: v~Jt and a,lo~, d,ent/iamily to. Ptan of care decide ii ·,011,an gc, c-n mth the v1~lt as planned or ~tt anc. lh H ctn>! for tr. e appo:ntirent. Interventions done Outl0il1es of visit: respo Mes, deciilons, U:e ag~. nw-j,pe. :lhc v,messrr<:ru tools and forms problems, concems ba~d 011 ~lc:. dard Other s,gnlhunt lnformal Jon for fottow-up; Oocur T. H,t ·101:: t' ni:al 111dgment !nursing r:i1:ieno~e. ;l schedule of next visit De1r:lop.-i r. ani11g c:;;rc plan w,1h client or farnllv a11d racllit. ites referrals (to other health professionals or to:ne up v,it'1 agreements on e,~cted outtome. s agencies) Sel~n arid c;,rry out int&rvention~/acffvilies, seek th~ por!lopanon of family ca1eg Ners, a5 needed lnlt1,11e and complete discharge from nursll)g care, as Pro~ldl! brochuru, health education mate1ials and dowmen; the outcome or resuhs of the health education appropriate; Prepare a iummary of care given Sumll'tame de. cis,ons made and family responses 10 care Complete pr ogress notes and now sheets Set the schedule of the next visit with the family; leave a note or reminder Inform the client/f amtly of referrals and need for irste,dlsciplinary servlces communlc;at!on system Ensure practice of safety precautions | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
REFERENCES 1-Philippin e Nursing Act of 1991 (R. A 7164) and Implementing Rules and Regulations (March 8, 1994). Series. No. I Professional Regulatio n Commission. Hoard of Nursing. 2. National Objectives of Health 200. 5-2010. (onlioe) August 23, 2008 http:// www2. d oh. gov. p h/noh2007/N oh Main. h tm 3. Nationa l Demographic Health Survey 2003 (online) August 23, 2008 http:// www. ce 11sus. guv. ph/da La/t1::ch aotes/notendhso3. btml#sa mple 4. Compiled Policies and Guidelin es for Comprehensive Maternal and Child I /ea Ith Programs (1996). Department of Health. 5. Hodnett ED. Continuity of caregiver s for care during pregnancy and childbirth. Cod1rane Database of Systematic Reviews 2000, Issue 1. Art. No. : CD000062. DOI: 10. 1002/14651858. CD000062. 6. Murray SS and Mc Kinney ES (2006). Foundations of Maternal and Newborn Nursing. Elsevier. Inc. 7. Lowderm ilk, DL and Perry S (2004) Maternity and Women's Care. Mosby, Inc 8. Villar,J, C,irroli G, Khan-Neelofur D, Piaggio G, Gillmezoglu M. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database of Systematic Ueuiews 2001, 1ssue 4. Art. No. : C0000934. DOI: 10. 1002/ 1465 L858. CD000934. 9. Senlrong Sigla Supervisory Package Program Flowcharts and Checklist (21)0:i), Department of Health, Philippines 10. Institute for Clinical Improvement Systems (l CSI). August 2007. Rou. tine prenatal care (11111 edition). From http://ww.. v. icsi. org/prenata J_care_4/ prcnntal_cnrc_routine_full_vers ion_2. html 11. l-10111e 13ase<l Maternal Record. Guidelines for Development, Adaptation and Evnl11ntion (1994) Noose. rial Publication World Health Organizatio n 12. Stanfield,Jl>, Gall D, Bracken. PM. Single-dose antenatal tetanus immunisation. Lancet, l973, 1:215-219 13. World Health Organization Standards of Maternal and Neonatal Care (2007). Department of Making Pregnancy Safer. (online)-August 23, 2008 btt-p:/ /whqlil>doc. who. int/hq/2007 /a9 t272. pdf 14. Core information for l'lie development of immunization policy. 2002 update. Geneva. World Heallh Organization, 2002 (document WHO/ V&B/02. 28), page 130 15.. Fishbach F and Dunning M. (2009) A Manual of Laboratory and Diagnostic Tests (8'" ed). Wolters Kluwer H. ealth/Lippincott Wi. LHam and Wu. kin 307 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
308 16. Pagnna K ;md Pagam1 T (2003). Mosby's Diagnostic and laboratory Reference (611' ed). St Louis: Mosby, Inc. 17. 8toltzf\1s. R. J el al. (L999) Clinical pallor is u~eful to detect severe ane1:nia where anemia is prevalent and severe.. Journal of Nutrition. 129: 1675-1681 18. Velanc. lria FV & olhers. (Augusl 1995). C!i J1i,. :al Nutrition 811rvey. ln Fou,. th Nc1tiom1 l Nutl'itiorw l Surucy Philippin es: Report No. :3, Food ancl Nutrition Research I nstitu Le. Bicutan, Tnguig: Department of Science and Technology. 19. Brock N. Kulier R. Giilmezog lu AJ\1, Villar,r. Vitnnl'in A supplementatio u during pregnancy. Cochnmc Dc1wbase of Systenmtic Reviews 2007, Issue 4. Arl. No. : CDQn 1996. DOT: 10. 1002/1465 1858. CD001996.. 20. Safe l\lolherhood Sun·ey, 1993 http://www. rueasu redhs. com/p ubs/pdf/ OD4/05 Chnptero5. pdf 21. 1'hilippi 11es: VV01rn:m's 1-!c:-illh,ind Safe Motherhood Project. Project l'erformancc Evnluntion Rcpo1·t. July 2007. Oper. :itions Evaluation Depurlmeal. Pru_iccl Numb L'r: PPE: PHJ 27oto Loan Number: 1331-PH I (~F) on line. Aug us I 23. 2no8. http://www. odh. org/Dt>cuments/ PPER. s/PHl /2701. 0/27010-l'Hl-PPER. pdf 22. Hall MH, Ching PK, Mac Gilliv ray 1. (J992). ls rou Linc anlen;,1t;1. l care worthwhi le? la Rooney, C. A11lenatal ca,·e and materna l health: /-low c;/)ective ts it? i\ review of cuidcnc:c. World Health Ori;nnization 23. The Sc,·enth Repn1·t of I he,Joint National Committee on Prevention. Detecth111. Gv,1lua1ion anti Treatment of High Hluotl Pressure. US Depnrt111 cnl of [·lenlth and 1111man Scn;ccs, Nntional J. nslitule of hcollh, National Heart. Lung,ond Blood Jnstitutc, National High Blood Pressure Education Prtoiz;r:un. NII-I Publica Lion No. 0:3-5233 December 2003 24. Moorehead S, Johnson M, Maas M, Swanson E. Nursing Outcomes Classific. 1Lion. (2008) Moshy, Tnr~ 25. Bulcdwck, GJ\11, I-Jowa1·d, U, Dochterman,,JM (2008) Nursing Interventions Classification. Moshy, Tnc 26. S/<111dardsfur· the Safe l'rnctice of J\llothe1· a11d Child Nw·sing in the; Philippines. (::ioo1 ). 1\lnt-ern. :11 and Child Nursing Associat ion of ll1e Philippine s (MCNAP). 27. Philippine H<. 'nlth Statistices (:;?004) Lai;t Updnte: February 11. 2008 DOH Ten Leading Causes of Morbidity by Se. x (2004) in http://www. do h. gov. ph/ kp/ stat isti C$/ morbid ity 28. http://v,,ww. w ho. int/nu lrition/challenges/en/i ndex. html 29. Black RE; Allen LH; Bhutta ZA: Caulfield LE: de Onis M; Ezzati M; Mathers C; Ri\'crn,1; Maternal and Child Undernutrition Study Group Ulncet, 2008 ,Ju. n 19-25; 371 (96()8): 243-60 (jonrnal article-re. s;c;1rch) CSSN: 0099-5355 PMID: 18207566 CINA. BLAN: 2009855303 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Philippine Nutrition F;:icls and f. igiures 200s. Food Nulri Lion Research Institute. Deparlment of Science and Technology. Bicutnn, Taguig City; Juy 2007 http;//ww,v. who. int/making_pr egnancy_safer/events/2008/mdgs/ 31. nutdtion. pdf 309 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
310 Chapter 12 DEMONSTRATING INDEPENDENT NURSING PRACTICE Ma. Brige N'e T. Lao-Nario Globo Jly. countries Llult arc in memhcri;hip with Lhe lntcrnnt ionnl Council of Nu,rses (JCN) are developing inn()vntive models: of c.,re that thrust nurses into new roles and responsibilities. 111ese new models create changes in the boundaries of nursing practice. Mm·h interest ha.-. been genernted in the development of advam;c nursing practice (A. NP) and nurse entrepreneurship which have different faces in v(lry:ing countries depending on the needs of the l>l!ople r CN has identified characteristics of ANT' by three (3) dimensions. namely: educational preparation. nature of pr. ictice and regulatory mechanism. ANPs have advanced level of an educational program and :'. I fom1al system of licensurc. registration and certification or credentialing (Schober and Affara 2006: 23). They :ilso demonstrate a high<'r npgree of :rntonomy and independen1 pr:ictice and ha,·e a<lvan<'cn ;is.-;cssment and decision-making skills,,;th recogni7. t!d adqmced dinic. 11 competencies. Aside from ca!<t! management. ther also have the ability to integrate research, education and clinkal mana~cment, perfonn case management, a J1d provide consultant services to other health professionals and are recogni7,ed as first point of entry for services. There are country-speci fic regulations that grant authorities for ANPs the right to prescribe medic..,tions and treatments and aut J1ority to refer to other professionals, admit lo hospitals and title protection. On the oilier hand., we bave the nurse entrepreneurs and intr:iprcneur who have Ll,e ability lo perform a wide range of acth-ilies and services wilh focus on healt J1 promotion, diseal-<' prevention. rehabilitation and management coni;:ultanc;ics. Based on the IC. "N definition. a nurse inlr::ipreneur is "a proprietor of a b11sin('. 'l S I hat offers nursing services of a direct care, educ. 1 Lfr,nal research, ;idm in isl r:J Hvr· or consu ltativc nature" (ICN 2004: 4). 111 this arr:ingemcn1. t J1c nur.-c is account1,1l,lc to the client to \,·horn the services arc offered. A nurse intraprencur as ICN <lcfines is ",J salaried nurse who develops, promote:. s and dcli\'Cr.. inncwativc health. 11ursing programm e or projects within a given health care setting" (JCN 2004:,i). In most countries. nurses are legally pcrmit1ed to offer nursing services tlrnt fa Jls ,,,,ithin the domain of the nursing pr3ct,ic-e-act. s or nttr. ;ing I. aw. They are at a liberty of offering i. ndependenl practfre tn areas of health promotion, disease prevention tmd rehabilitation. The,-ision of the go"emment as retleciod in the Medium Term Ocvcloprnent Plan of 2004-2n10 is to 11ttain.. He:ilth for All Filipino~-anti the mi-. sion i. <: to cn;;urc ncccssible and quality hca Jth care to improve the qualityoflife of all Filipinos espccial Jy the poor. (NOH 2005-2010 ; 35) This includes health sen·iccs that are responsive, accessible and affordable to the peopte. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
The Philippine Nursing Lnw, Republic Aet 9173, states that «;is independent nurs,~ prnctilioncrs, nun;cs arc primarily responsible for the promotion or health und prevention or illness». Also, 1hc Br)ard of Nursing was l-\iven the mantl..irc lo "supervise nnd regulate the practice of nursing". /\ recent clcvcl CJpmcnt i,; lhe availability of guidelines for Nuri;i11g Srccinlty certification brisecl on Lhe BON llesol111ion n<J. t4 s. 1999. This is in line with the aim or providinl-\ ;i n H!c. :lrnnism of ensuring that :, practitioner was able lo h11fill the requirem ents of practice. As part of lliis tm,k. Bon rel Resolution No. 459 was promulgnlcd with rule~ and regulations governing the practice of nursing for theobservauce and guid,rncc of prnctitiuncn, <Jf mother and child nursing. The document entitled "Standards for the Safe Pracliccof Mother Chi It. I Nursing in the Philippinc. s" inclu<lcd n section whkh makc:s the,\'lalem. il Chilr J Nursing Associat ion of Lhe Philippines (MCNAP J lht!,lccrediling organiz;ilir,n for mother chilr J nursing specialty at:crcdi t,1tio11. Tl1e levels of. specia li7. ation arc as fo LJows: Generalist (level I), Nurse Clinician I (I. eve) ll), Nurse Clinician 11 (Level 111) and Clinical Nurse Specialist (Level rv). The requirements for specialization combine education al preparation, work experience and passing the specialty qualifying examination (MCNAP 200L 45). However, being just recently promulgated last October 2001., the implementing guideline s arc in the process or being implemented. This development is a good step towards the establishment of credentialing for advance nursing practice. EXPERIENCES IN SETTING UP INDEPENDENT NURSING PRACTICE Nursing is commonly associated vnth practice in the hospital setting. The public health nurse usually comes to mind when we think of the role of the nurse in the community setting. With the thmst of the government to deliver essential services to the Filipino throu)!;hout the different phases in the life cycle, the time is rife with opportunities to be part of the providers of basic and essential health services in all localities. This chapter describes experiences in dohlg independent nursing practice among preschoolers in an urban poor community, provision of consulting services to an educatio nal institution and operating a health promotion nursing c Unic in a university. One of t J1e key elements in establishing a practice is to determine the roles, services and tlie work settings. The ICN guidelines point to the importance of the assessment of the client/population's health needs and creation of a plan that will ensure that the project or program will be viable METRO MANILA DEVELOPMENTAL SCREENING FOR PRESCHOOLERS l worked v. rith a non-profit organiwtion (NGO) based in 11. fanila. This organization provides social services among selected families living in Smokey Mountai n and its nearby communities with the core va]ues of self-reliance, self-sufficiency, peacefulness, justice and healthy environment. The NGO has a day care center that also offers preschool educ. it ion at minimal costs to U1e family. The center provides a learning environment that responds to the emotiona l, social, physical, intellectual and spiritua1 needs of children and to provide opportunities for parents to have a meaningfu] participation. Smokey Mountain now called Paradise Heights, is a densely populated community of 311 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
.-. l,-t U1. 1. uoo low-income familie« houo;c-d in 28 five storc.,y-bu ild in A c:il led Prirn1a n1·nt 11.. u.,. mg. 11,r 11vf'n1Jtc fom1ly ~i T..<' of (, hn,; hou.. ~:h<>ld fiends working 11<; :w;iv,·riw:n,, ('11lf1l< \'C<. "" tn nr:1rln· l-,uc:tne<. "<-"-like lhc.,lnus::htcrhou:-~· and :-ihnul a third n,., l111vin,i :,n, <Hllrt'(',,f i. nc-ome. On~inally n dur11po;ite to. ipprnxisn:ttl'ly r,n,~ third t1f M!trr, :-1aml:i w. t<:t~. lhe community i,; beset "·ith ;i l01 of,;oc,al problem s. Childrt!n Art C'"q)'1. ;;d 10 the <. 'ffccts of eon~c,;tcd livin~,poverty and lack of npproprh Jlf. :. o. ;1im111~1tion to fo<;l!.. r s::rowth and d. c--elopmcn L r-:ur-ing entrep N?neu~ hip io,·ohes selling of services anc. J healtl1 care pr0t. lu1,;L<; nnd utill:r. ini <tand. ard1' of care.. ·n,e nurse entrepreneur can assume the rol<· of :i clinician, aa Mil!f. ind con. sukant. The work settin:g can be flexible as it c. :in be in the office or th1! '-'--'llin~ m CJ!. t comfortable ~,;th the clicntile. I nfft<rc<l to perform developm ental screening for the preschoolers who nrr-~fling 1n be enrolled in the :-. :Gos prog:rnm. Since J am able to utili7,e the Metro M,,ni1;1 r>,-..,-tnpmtnta l Screening T~<t (~1!-t DSll with a hig. h level of proficiency a~ tr:iinccl hy Lh L'f' Crlll"Ji!~ nf :,. ;,ir;in)!. this hcc. amc the basis for establishing ;i cnntrn c--1 r,f. ;,. rviccs ,,ith iii,-r,:;. ni7. at1<1n. ~!:,· ~r-'ices were di S(;uf. se<l with the fio:Hd of Oircctor!' and the t,·rm, nf :izr,_.,m!!nl,~·er10 laid forth. The JC]\: guidelines cite the nec-d for r·nntr:ir:ls or dlt I'\. '-lnnt<. mf Jrder tu protect the nurse and the clien L \Vhat we want.-. cl l(J attain was -~l pn--. c_h11o lt:!r.-,H. lmit,~ \c> the school will be sc:recne<l for de-..·clorm11mtal t. lclay and :ippmpria tc act1on. "',-,-i. JJ be done to help them. · The follov. ing summariz es the r~ull~ of I. he :i~emf. m L using tbe standards of ca. re as a frame,,rork: 3. 12 JJr;.,eda siatement to all teachers. ~ eff Pf'escho O IPr.. wrll be rooms for prfvacy and ns. !. Ch~dule of each chlld given ao t:estlnc to help~ 11Jt111i. 011111latal lanauqe. .,P<ollqe of . to promote | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
In the proccs:~,,r ru Hillfng 1hr: 11:rm·; 1,f :ip,r,!1:rnenl, m,Jm than fsfly (. 50/ c..l1i J,Jrrm wr;:r-e rested wi1 h I h,: ;,1 M f. JST. It wa,; mrr,t ;,,pprr,pri;,t<: tr J J>(:rform I hr:,<7t-1nin~1 in the community b~~:JLJh': tlii,. will,~n1,ure th:,1 th: ·,i·rvir:1 W'J', vi:ry :iu:1:~;ihl:. C. 'l1ildn:.-n wen: accr,mp;rni <. :-tl their parent. <, with m;,j,,nty er,min~ with rh<·ir mr1th1:r.. In c;;1~ when the p:,rcnt o,me v:ith more th:m r,n1: child, ;,rran~m;nl<; w:rt: mad: tr, make sure that only th<: tesll;r, child and parent ;:in,: in th: r<1<,m. Th;,t arrang <:rn E:11t w;i~ the respom,ibility of the NGO. To make sure that t J,c standard <Jftesting wa P. followed, th(:,,,..,ters utilii..cd the ki L,; and forms nf MMDS-r. The st. andard,i c,f rcrfnnmanc,. ; v,ai;;Jls J fr,Jlr Jwed as stipulated in the manual. Only the testing materia Js in th<: kit wr;re u,,;cd. Schober and /\farra (2006: 70) cite the importan c:t of interfacing with the organi7. a tion as an important stratc,zy in mle and practice developm<:nt. In this project, th!! interface came in thtc! form of meeting with key officials in the r,r;!pni7. ?li on and tc;ich-. :rs. The staff of the NGO took the rc:. sponsibility of er. plaining th<: activities tr J the fam iii es within tbe cat,chment area as part of building acceptance and making <;urc that the screening ,,.,;11 be successful. After the screening was done, there was a training-work'ihop ;;ith lhe teachers to give them a feedback on how the children performed <1od how to hr. :lp children with development al delay. Since the communit y is densely populated the children's concept on certain words and objects is based on lheir experience. For cx. imple, when asked about "'·hat a ·roof' is, most children responded by saying "rnay gulong ang bu bong" (A roof has automob ile tires). This stemme d from their visual expcricnc:t ~ that roofs in the community have auto tires as lnads to prevent them from bci. ng carried away by the strong \,ind. Their concept of a 'rive,~ is "puno ng tae at basura" ( a river is ;i dumping site garbage and human feces). This is due to their experience of seeing the nearby body of water full of garbage and human excreta, Their concept of a 'e11rtain" i-. ; 'pinw ng hahay-(A curtain is used a door of the house). This concept emanates from the experience of having the curtain as a 'divider' in lhe house which they usually share with ull1er famil. il:!S. This session with the teachers helped in creating learning experienc es that foster growth and development. Eventually, selected staff from the orgnni7..ation,,;ere trained by t J1c UP College of Nursing to perform the developmental screening to boost the NGOs se J f-refomcc. PROVIDING CONSUL TING SERVICES One of the avenues for nursing practice is· to provide consulting services. The ICN guidelines identify some personal qualities of a nurse entrepreneur as follows: independent, risk-taker, visionary, good org:mize r, planner and proactive. This must also be coupled with adequate professional experience, competence and knowledge. (ICN 2004: 24). Wit J1 a compreh ensive e..xperieo ce and backgrou nd in developing. implementing and evaluating curriculum using a competency-based framework. a proposa l was submitted too technicol hetilth school to strengthen the existing program and improve structures in the company for cost effectiveness and efficiency. Part of the program is doing a pe1·forrmmce audit lo ·find areas of strength and weaknesses. TI1is was done in partnership with ::t nurse who had extensive experience in nursing administration. Before any of the activities started, the tenns of agreement were laid down together with the cost, du. ration, expectations of the service. Meetings were held to finalize the 313 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
(manaaement and service delivery) ney of Its operations. Of-,q\lllltyendlh~ Orpnlration B's tore values. l'i'IINltors af oraanlatlon 8 lnll'l'"il'll'S with k1'Y I '1'1~11\llll'l am\ lllp onidnh: Wl'l't d!>llt' with l h,· l'I Ill,·iew 11r k11owi 11~ ll(m' th,' C\l');:minllio11,11wrn1t·:: in tlw <litii. ·nnl hrnnl'hv,: :1ml williin lh,· 1,r~;111izalio11 :111d 1111its (,. i:. al':11l,·mi,·,:,,,·11,111. m\111i11i,:trntiw. 111nrkl'li11g) 1111. I h:n·inh :1 glimp,:( n( llw o~m1i'tnti111111l n1lt111,· nnd km!t-r::h ip ~h-ki<. ~tml,nt s,,·,re :ilst> i111<'1Tit\\'t'd on wlrnt th,·y lik,11 1111,;I and l,·a~t 11ith tlw tri::111i1. 111io11 and their h,·,\ nf,:ati,:f:H'tion with th, l't\')!111111. \\', :1l;;11 n·Yi1wtd d<'1·11111t111::, rt't'onl,:;,md rt·p,,rt,:-pnilik nf the f:wnhy,,·111,,lh1\\11t :md )\n11l11:lli1ll\ l\)\tm,:,,·orri1'11l11111/11111d11k-::. fi111111dal,;lat,111,nt:: 11ml m,'111nn1ml :1. l1:1dlitit',: w,r. dn J,k,d 1111d nbl'ern(l.,\divitie:: of the,mployccs \\"\'t\' nls,i nh.,,'l'\'l'cl in rdt1ti Clt\ to lht' 1't11'1' \':lh1t'!: ot' llw orp. :rnizalion :mt! th, pt'o~rn111 of m:th)11. Tlurill!! th, intpk11w11tu tio11 )'\'(ll'<'$!', tl\i'1·..-Wt'rt mcl'lin~s with lhli lwml 1it· lho c>t~nnin1ti,,n In rnlidnt, i111111'(::si1>11$ nml :ah11n.,·ritknl obscr\'nlinns lhnt ll!'l'dl'd In 1,., !\iwn 111111Hio11. :\t th, t'ml,1f th,' 1111di1, llu' pktm·c cmcrgcd n11d 1wrfor111a11 cc imlil'nl Ms,,,..,.,. i,_k11tili,,,I l O!\<'thtr with key q11nlily mcmmrcs. :\ wrillt. :11 report wn~ i:. inn tn)tcthcr,dth a nll'din~ with thl;) h,ml of the orp. nniznl ion. Afkr the n. ':mlls w,r,,-ubmill,'tl. one of thl! nrc1t!' thnt nccdcll strenp. Lhcninp. were c11rric11lill' in ur1t111'\'. A 1~om1l<!t<'ncy-hn:-,d henlth care wc,rkcr pre>grnm nnd 111tm1111l ",,~ d.-,.... lnp,"<1 wi1h n t'flrrespondinlt tr:iininp. prop. mm for lhc faculty. Tl11 11111111ml "~=-,11,·i:<ione<I :1~ lwin R the wmp1111y blncprint thnl enshrines the core vnh1,:< nml :it 1h, ~anw tinw ful!illing th,~ l'<'<Jlliremenls of the p. ovcrnmc nt. It was C't>mpr..lu. nsil·,· :111,l,·n111i1ilwd 1111 lht,·nmpl'l L'lll°il's. content. and 1h0 c1·al11al'ion tools. The 1m11m:1! b ~1,111,lhi11)\ "t:()1\$1:tul°' ti~ ll'adll'r!< n11. 11c and go within the orgnnizntion. It,,ill b, tlw n~1mn-,· of th<' 111::mization to be sure th:11 the com J>ctcncies in the difforini: S<'l. 'ti,,11~ nnd t,,,,,,[,-,1re com:i;:tcnt. 314 After tlw con~tructi,,n llf the mnnnal. training of lcachc1-s wns done with lite use of the 11mm111l. 011 the ne .._l pa. ge is n pnrtion oft he prog TUm for the training: | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
TEACHER TRAINING COURSE course Description: This Is a twelve-hour course for teachers of a techntcal school to nhance teaching competencies. It wlll Intl Lide theoretlcal Inputs on the competencv :ased framework and teachlng-learnlng exercises. ..-ed competencies: f,c,,---Glvefl questions: 1 explains the features of a competency based curriculu m 2: Discusses the compariy 's phtlosophy and framework for health care Given hvpod,eti cal sjtuation/si, 1. tdentifies the appropriate teaching-learning activities 2. oemonstrates the proper use of teaching met:hodotoates 3, constructs test Items 4. Formulates a performa nce evaluation toot program: Time Topic------------------------------. 7:30 am Registration/Opening ceremony 8;00-8:30 Company's philosophy and framework for health care 8:30-9:00 Competency based framework for health core: utfllzlngthe manual 9:00-10 Designing & Implementing the Instructiona l Plan 10100-10:30 Break 10:30-11:30 Workshop : Designing and Implementing the lnstruotlo«111l.,. _n 11!30-12 Presentation 1. 2-1 Lunch Break 1-2 Teaching Methodolostes 2:00-3:00 Practice session on tea Ghlng methodologies 3-4 Evaluation of Student leamlns 4-5 Practta!' s_esslo Tl on Construction of Test Items S-5;10 Presentation 5:ICJ..6 Performance Ev1lu1tton &-? P. racttt:e 5esslbn: developlna ~f Ofman CII evaluatton tools 315 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
316 The shared experience of pro1-iding consulting services dcmonstratec] the Poss ii ·u. that are open lo a nurse who has the preparal'ion, t:xperience and tl1e attitude to Ji hes du... explor a 111erent avenue on independent nursmg practice. · e THE HEALTH PROMOTION NURSING CLINIC The Department of Health has recently launched lbeir program on the Prom. of Healthy Lifestyle. This includes risk as~essmcnt on hypertension, alcohol afhon physica I inactivity, smoking and family history of <l i seas es (for a sa m pie tool, sec Ch Jtise, ~ Table 2. 1 on Assessment Database for Family ~~irsing Practice). _ The intcrven~fote~ mclude the promotion and reinforcement of pos1t!ve ~ealt~ _practices. Counseli ~s also provided for clients al-risk of the obesity, physical mac Liv1ly, smoking and.,1 "1 s abuse. 111ese clients a re also referred to the pl1ysician, as needed. ' co 101 Jn,January 2000, U1e Health Promotion Nursing Clinic based in the Univers· the Phi Jippine s Manila College of Nursing formally accepted clients with con~ty of such as nutrition, health maintenance, mobility and sleep patterns. There,~rns !WO p,~actitioners, a_faculty member a~d-:-in apprentice 7ra~ua~e studenr doing~;~ intensive field experience. !twas an exc111ng prosped because Lh1s was an opportu. to demonstrat e imlepem. lenl 11ursi J1g practice. On lhe basis of pre-formulated prc1c~!ty guidelines, general estimates on consultation fees and confidence on its success t~e clinic formally opened to the public. It would later offer regular service to clie t Je seeking assistance i11 making lifestyle changes n s There are many ways of maki?g sure ~hat nur~in~ care is delivcr~d with high level of competence. The firnt requirement 1s establishmg the legal basis for the practice This makes $Urc that the nurses who deliver the care have advanced cornpelencie~ and capability for decision-making. Recent development in the Philippines is U1e move towards credentialing. The Maternal Child Nursing Association of the Philippines (MCNAP) will serve. as the accrediting orgaufaation for mother child nursing practitioners. The levels of specialization,tre as follows: Generalis t (level l) Nurse Clinician I (Level TT), Nurse Clinician JI (Level HI) and Clinica J Nurse Specialist. (Level TV). The requirements for specialization combine educational preparation work experience am. I µ. issing the specialty qualifying examination (MCNAP zoot; 45). Promulgated Inst October 20. 01, this development is a good s Lep towards the establishment of credentialing for advance nursing practice. Credentialing is always linked to a country's resources and regulatory practices. rt can be done by licensure, certi. fication, registration, and recognition (Schober and Affara 2006: 89). Another way of ensuring quality care is the development or utilization of standards of care. Johns (2004: 228) defines a standard of care as a local practice situation that is professiona lly agreed and both desirable and achievable. For the nursing clink, it was done in the form of the following concerns: Defining the type of nursing services to be provided Listing the criteria for admission, enrollment, discharge from tl1e program or services Delineati. ng the ai:eas of responsibilities; functions of the health team members Establishing a system of documentation Setting up a system of reimbursement, payment Mrs Feda Llon·to lsaloc was a former faculty men,l,,,r of the. Notre Dome U11iuersity, College of Nursing and a graduate srvdcnr of clw M. A. Nursing of UPCN. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
An co. ncrete example of standards uf cart! is the American Nurses Association (ANA) Standards of Clinical Nursing Practice (2004) which lists fifteen (15) standards of professional performance \vi-th appropriate measurement criteria. The use guidelin es is also beneficia J. For example, the. Philippin e Guidelines for Periodic E. xamination (2004) provide for effcclive screenin g for diseases among apparently healthy Filipinos. Guidelines provide flexible rc:commendations that can be adapted to sped fie needs. Tbis reference is a useful tool for nurses in making decisions as to what tests clients need lo have. Another vital need in indepenc. lenl practice is the u~e of accurate and concise document ation. lf sometl1ing was not documented, from a legal perspective, no nursing care was done. To cite, a young pregnant wo1m111 was discussing with the nurse her concern for her hack stool. 'f11e nurse replied" Did you remember our discussion about the effects of iron supplementation~ The client could not remember it, lnlerestingly, there was no documentation of 1hat encounter. II Is imp<>rtanl to have entries like "client verbalized understanding on the effocts of iron supplcmenlalion on the color of stools". In the principle of documentation, it is alwa~·s good practice to document as much as possible nnd reflect important clinical information. In countries where health services payment is done tl1rough insurance reimbursements, a comprehensive system of documenta tion is part of regulatory requirem ents. In the nursing clinic of UPCN, clients coming in with nutritional concerns,vill: Be assessed using the appropria te anthropometric measmements like triceps skinfold thickness, weight and height, body mass index (DMD, waist circumference (WC), hip circumference (HC); 2-4 hour dietary recall for at least one regular day and one weekend Have a dietaiy and body composition analysis Participat e in meal planning to ensure that it-is patterned to personal needs and based on the Filipino Pyramid food Guide and Recommended Energy and Nutritional Intake (REN!) Be given pointers on therapeutic diets with emphasis on what can be eaten and what needs to be avoided D Upon detection of risk conditions and medical problems, will be referred to the doctor Be n;ionitorcd on their p'rogress This nursing guideline helped in ensuring adequate care was provided for clients with problems of Allered Nutrition. Experience showed that the developm ent of guideline s for pmetice is an ongoing process. A quali1. )' circle among UP College of Nursing faculty was held to discuss the case of nvo clients,~ith Alte,-ed Nutritior L· mo,·e than body re. quiremcmts who sought c-t1re in the nursing clinic. This became an opportunity for colleagues to look into how the nursing assessment and care was delivered by the clinic practitioners. It became a chance to d. iscuss the use of waist to hips ratio (WC/HC in cm) as a national standard to determine android or central obesity (2:, 1. 0 for males a. nd ~ 0. 85 for females), proper w:iy to take waist circumference (WC) and 317 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
318 the value of using the BMJ in nutritional assessment. It was also a chance to review· the Nutritional Guidelines for Filipinos 2000 and the Filipino Pyramid Food Guide for Today"s Lifestyle. In this case, it was clear that the guidelines provided a mechanism for ensuring th;it the nurse deliver will deliver care that is evidence-based. In general, the nursing practice guidelines included basic compon ents like: a What data is essential to assess the client's condition? How should the assessment be done o What are the intervention options: independent, dependent and collaborative interventi ons? a What are the signs and i"ndicators that the client needs refcrrnl to a doctor/ other health profcssiona Js? a What are the signs lliat the client is/not making a progress? There was a need to determine the nature of assessment data in the consultation. It was a question of doing a comprehensive physical assessment and rmrsing history or making a focused assessment. TI1e two approaches have their own merits.. This was a dilemma that we opted to solve on fill experientia l basis. Taking a comprehensive assessment has ils merits. However, it lengthened the consultation time considerably. Some clients, too, did not want to discuss matters that are perceived as unrelated to the cause for visit. lil the end, the amount of data in assessment was based on the client's condition and the judgment of the nurse handling the consultat ion. The key was to be balanced in assessme nt, being focused on the client's concern and at the same time looking at the holistic aspect of health. COMMONLY USED NURSING DIAGNOSES In the course of practice, certain nursing diagnoses emerged as the more frequently encountered ones in the clinic: NU ~COMMON LY U9ED IN ~Ol'ION NURSING CLINIC Impaired health maintenance F. a. ch client is unique and all encounters provide exciting challenges for the nurse in determining assessment parameters and what to do in the domain of independent nursing practire. There were challenging situations like the one narrated below: The clients were three middle-aged women whose cause for consultation was the feeling of imbalance. " They shared the following information: - | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
''l"lala akong lakas. Para nkon. g nmmpos" (I lnck energy) ~Parang Ttindi ako makapag-isip. Laying nawaumla sa sarili" (l cannot think clearly. I feel that J am nol myself) ··par-ang may liangin sa aki11g katawan" UMC1i11il ang pakiramd am ko pero wa/a akong lagnat" (I feel lhat there is 'air· inside my body. I feel warm but I am not sick) Physical assessment revealed no medical problems. No one manifested any palhophysiologic conditiuns, trcalmcnl related problem~ (ex. immobility, pcrioperntivc c. xpericnce, labor and delivery) and maturutiona l factors. They Wt:!n: all working and c:apahlc of doing their regular activities and 1rc::portcd no strain in Lbcir fomily and personnl relationships. All of them have a low level of work-related stress. Eventually, the diagnosis of Eruirgy Fidel Disturbance was used. Carpenito (2002: 348) calls it ll state of disruption of the flow or energy su1Tounding a person's being thnl results in a disharmony of the body, mind and spirit. $ini;e the practitiom:rs were also trained in Reiki (a type of loucl1 Lherapy lhal uses sc:nnning of the energy fieltl~). Lhe perceive<l ch,mg\1S in energy flow (sensed as hot, culd) pruvidccl add it ion. 11 dati1 for the assessment. This is a particular situation where there was a need to expa11d ;1wareness on the differing viewpoints on he human hody. Cnnvcnlional p;1radigrns would refer to the physica J body as the basis for assessmcnl. In other traditions of healing, the body is composed of the physical and the non-physical layers (also c;JIJed the ;mric fields). The distortions in the non-physical J. wer can be dctcc. :ted by an experienced practitioner as areas of "hot, cold, tingling". Carpenito (2002: 349) describes the management of clients with this type of disturbance by using therapeutic touch. The nursing-clinic based practice also provided e~-periences oo the use of wellness diagnoses. A wellness diagnosis is very useful for healthy clients who require teachin. g for health promotion and disease preveotion and personal growth (1. Vilkinson, 2007: 232). lt is commonly stated as "Readine:;s for Enhanced, Potential for Enhanced, or Potential for Growth or Effective ft Some wellness diagnosis used in the clinic were: Potential for Enhanced Pareoting Effective Breastfeedi ng Effective Health Management/ Health. Maintenance Pattern a Health-Seeking ·Behavior Consider the case below as an example of a client w:itb a wellness diagnosis: Client A, 35 years old visits the clinic. Assessment reveals no problems. She verbalizes the desire to have an exercise regimen ao<l a health. ier diet. She said, "gusto ko na manatiling malusog at malakas (I want to be healthy and strong)" Nutritional assessment reveals normal findings. There were no signs and symptoms of problems nor risk factors to her health. Sioce she needed help in establishing an exercise routine, she was assessed on readiness for physical fitness activity using the Physical Activity Readiness 319--- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
320 Q11t. '!<ti1mnt1i N'. PAR Q. ·n1is wr1s d. :,·cfopcd by British Columbia Ministry of H..-alth tll lklt>m1in<' a l"'Crson's n. ndincss for participntion in a progrmn for ~,,,rcb<'. (Cnrbin '..!l H>O: 46) The nsc of vnrious physic. 11 fitness tests and sllmts: r. 1rcii1,,·nsrnh1r fitn.-s.-.. fle.,ibility, muscular endurance, strength, n. 5ility. b:ilan<·c co<1n Hn:ition. po"·er. reaction time and speed also helped in appn1i,-ing Raqn<'rs st-. 11m:. The w~llness di:l!:nosis that was Ul't. >d for Rnquel was E_{fectiue Health . \!ai J11r1m111 't' a Jl(f ;\fu11ag.-111ent. ESTABLISHING THE OUTCOMES OF CARE 'Kllo"-ing the ex JX.--cted outcomes of care is critical in independent nursing practice. This 1,i U make the al:tlinmcnt of goals clear and precise. 'Wben botb the nurse and client are aware of what needs 10 change. the expectations become c. lear. The inputs from other health profesfilonals can be identified. Consider this client: Client Bis a 16-year-oldadolescent \\ith obesity and hyperglycemia. She is using insulin and oral hypoglycemics nod verbalizes great difficulty in maintaining the dfobetic diet and exercise. The mother e.,-pressed her great concern for tbe daughter's oon-compliance. Aft. er the assessment, the nurse and the client agreed on these e.,-pected outcomes of Deza: o lose 1 kg of body weight for the first week o maintain CBG within the normal range The:e outcomes im·oked acfo,ities that both nurse and the client listed. Monitori ng of dafly blood gluco..~ level9,,,;n be done and communicated to the nurse by phone ca Jls. Weighing \1il] be done at the end of the week. There was a need to work closely with her physician to adjust the insulin dose, as needed: 't\1hen the outcomes are dear, the nurse will have an estimate of the number of visits required and the type of monitoring that is needed. Having clear outcome s of care also makes reimbursement and pa}ment for services easier. THE NURSING CONSULTATION AND ITS COMPONENTS The challeoge of independent practice is learning the boundaries of nursing practice. 1bis is based on the legal expectati,J n among nurses to develop a plan of care to anain expected outcome$. Titese expectations are enshrined in the professio nal standards of care. Independent practice enhances awareness of interventions that are independent. ·. rnese. :. re actions smd acthitie. s thnt a nvrsc L. ; licensed l'o prescribe, perform and de J1:g;ile ba:. w 1111 knowl:::dgu and :-..kilb. Dependen t interventions are those prescribed hy !he phrsic-ian and carried out by the nurse. Cofiaborative interventions, also called intl!rdependcmt, arc carri"d oui "itl1 other members of the health team. Iney may include cormlirwtiun of health ca re: scndccs. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Jn II clinic-bosed prnctice, the client seeks the services of the nurse for various reasons. This is a list of the clients' most common causes for consultation: a problems on comfort: ''mnsakit ang aking likod, balikat, kamay, buong katmvan. paa. talompak011 {body aches and pains). " [n a Touch Therapy Clinic held at the UP College of Nursing in. October 2001 1 there were ninety one (91) clients who came for consultation. Fifty percent reported body pain (shoulder, upper and lower back). a problems on body composition: "gustong lumiit ang tiya11r, dmataba ako~. "gusto kong pumayat", "gusto knng twnaba" Perceived high levels of stress: "p1Jno ako ng l'ensiyon", 'hindi na ako nakakapag-isip ng k/ar·o·, Jbabagsak ako sa aking kurso", "magulo ang a king isipr. unawawala aka SQ sarili'' a Menstrual concerns; "hiridi ako nir-cregla r, "'masakit kapag may reg/a aka~ High blood pressure. About 30% of dients who came for the Touch Therapy Clinic were diagnosed as having elevated blood pressure readings or reported being dia,gnosed hy a doctor as having hypertension. Initially, there was a hypothetical estimate on the duration of a nursing consultation. A practical measure was to record the duration of consultations. It became evident that the time ranged from thirty (30) minu'tes to one (1) hour. This estimate ensured that the consultation is a focused interaction. Nursing deals with human responses and there is a need to spend enough time \dth a client while being aware of time constraint. Also, as a clinic practitioner, becoming aware o[ the time factor is a practical concern since th-ere are also other clients waiting for their turn. Establishment of rapport was a very essential step. It was done by greeting the client with a smile. introducing the practitioner 's name and asking the client what name and form of address they preferred to be cal Jed. The preferred name was included in the client record to remind the nurse in futllre transactions. Tbev were also asked to fill out the forms with basic identifying information., Another important component of a nursing consultation was the Mcreation of a liealing space. " TI1is is a practice from the teachings of a spiril-ual leader and shamanic healer, Gurudevi Ahalya Running Deer Mahakali ~ who made sure that clients undergoing ex"t. raction healing were in a healing space. lo the nursing c Unic, this was done in various ways. Clients are asked to sit comfortably. remove shoes and wear comfortab le slippers to help release tension. Bags, books, cellular phones, pagers and other belongings are set aside temporarily. Relaxing essential oils Like chamomi le and lavender we. re also used in burners to help create a healing atmosphere. The c:lients' remarks that the consultation caused them to rest, relaxed and be focused on their goal for the,isit validated the value of~creating a healing space. n When the client is comfortable, it was easier to talk about the cause for the visit nnd do the interventions. ] Gurudevi Ahnlyn Running Deer Mahakali is a spiritual teacher and shamanic healer of the 1-lari Om Tat Sat Henn it. age (visit www. h Qtshrcmilag c. arg) 321 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
322. Marn, a 42 year old, single client consulted clue to 11 '1>ai1!ft1l se11satio 11 011 the rigllt breast wrd because three relatives haue already,lied of cancer. " The !>Elin was dull, on and off and with an intensity of 2 to . 3 out of 10 on a pain scale. Since Mnnt w:1s vc1y comfortable while discussing her conccr·n, it was also easy to explain the apprnpriatc period in doing breusl e. xnmination. She was properly draped and positioned on the examining table. Palpation was done and no masses wece noted. She was also taught to do palpation and h Qw to ensure that the appropriate areas were covered. The nursing consultation also made us. reali7£ that clients nre used to having "something to bring" after a consultation. This, we l1ypothesized, was a product of a long history of consultin g with the doctor where one brings home a medicine prescription written on a piece of paper. To address this concern, nursing prescriptions were written. This includes reminders, pointers for care and instructions that they need to can-y out as part of the interventions. The schedule of the ne::-. 1: visit was also written down. As appropriate, client!; were made to experience interventions on a sensory level th. rough verbal instructions, aromatherapy, massage, and Reik. i. This worked well for clients e. '\-periencing various types of problems. Counseling and sound healing through the use of audio tape recordin gs were most useful for those having difficulty in making decisions. These interventions helped create a state of relaxation which tl1e clients thoroughl y enjoyed. The experience of relaxation was what they eventually decided to 're-create' on their O\'l'Tl. These sessions also helped them ach. ieve a state of mind that is devoid of too many tho1)ghts. rt gave them clarity on decisions that they needed to make. Students would often flock to the clinic for so,und healing sessions before taking their examinations. At the end of the consultation, the practitione r needs to have a review of the plan of action and agreements on management. This gives the client a nm through on what transpired and prepares for the closure of the visit. A subsequent visit is also planned and its purpose identified. rt is also very important to record the care given. The client's feedback on the treatment and care is documen ted. Proper documentation makes the nurse aware on the progress of the client and serves as a reference for a next visit. CHARGING CLIENTS A NURSING PROFESSIONAL FEE Since nursing pi:actice in the countcy is in settings where the nurse works in an institution for a salary, there was an initial apprehension on how to deal,vi. th clients who will self-pay for nursing services A review of literature was done to look into the costs of nursing services in independent pra. ctice. There was not much information to serve as basis for local costing. Most countries ha\fog independen t nurse pra<. 1. itioners charge the cost of se1vices through the national health insurance. This is based on their inclusion as legitimate providers of care in the health system and the e. icistence of prnvisions in the insurance system that covers their services as part of health care. This was not the case in our cow1try. The experience of holding a nursing consultatio n for a fee was something new. Some viewpoints on this are: people cannot afford to pay services because of the severe economic situation; nursing must be done as a service to humanity and must be given | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
freely nnd without n cost; nurse practitioner's lnck of readiness to charge a foe; setting a sliding scale of fees to accommodate the client's capacity to p Ay; setting a standal'd fee for some treatmen ts. The ICN guidelines for nt Lrse entreprene urs encourages actjve participation in the developme11t of equitable fees for service. The suggested criteria for calculating fees include: {ICN: 20) complexity of the task tbe professional responsibility implied levelof expc1tise required time involved equipment needed Since the clinic operation was done to demonstrate independ ent practice, the following principles served as basis for professiona l fees: a There v,,;11 be a standard fee for treatment and follow up consultation (c Hent will be charged less if the visit was for monitoring or progress check) a l11e cost of the fee will be openly discussed with the client to give t]1em the opporlunil-y to make a decision. a No client will be deprived of nursing service because of lack of monetary capability The experience of e Kplaini. ng the professional fees was very enlightening. Clients showed willingness to pay the nursing professional fees. Many would explain that paying a standard fee for the nursing consultation and treatment makes a good closure for the transactio n and helps prepare for their next visit The professional fee was commonly paid after the consultation. MARKETING THE SERVICES OF THE NURSING CLINIC Marketing of the services is needed for the viability of the venture. It was done to make sure that a segment of the population knows about the services. The flyers contained the nature of lhe services offered, schedule, location of the c;;linic, practi~ioner!;i ~nd the contact number. They proved to be very helpful. Clients would usually come bringing the said information material. Allother method that was used was holwng short talks in the various offices of the 1miversity about the nursing clinic. The talks commonly 1asted for fifteen minutes and consisted of the giving out of flyers, explanation of services and an open forum. Common questions include: O Wbat are the services? a What is the du. ration of a consultation? a Wbat are tl1en credentials of the practitioner? a What are the problems that they can c,onsult with the nurse? a How much does a consultation or treatment cost? One of the best ways in attracting clients were referrals from satisfied friends or relatives. For the Westhaven Nursing Clinic in the USA, the strategies included door to-door flyers that listed the clinics services, open houses, mass screenings and home visits done by students (Heh,;e 1998, p. 387) ESTABLISHING LINKAGES AND A REFERRAL SYSTEM The cycle of care will not be complete without the setting up of appropriate linkages. ·323 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I l ' l l I l 324 In managing the client's condition, they would often request for information on the medical practition ers whom they need to visit. Conversely, when forma J linkage is establishe d, referrals from med. ical practitioners will also come in. Helvie (1998: 397) re. port that they collaborated with other agencies and health providers. The agencies and providers were those being u~ed by the clients. The nursing clinic, with the clients' consent contacted these pro,;ders with an offer to work together in serving the patient. In the end this resulted in referrals from such providers and increased credibility \\ith the clients In the Philippines, establishing linkages include makin_g a presentation of the services being offeredaud a discussion oftl1e fees for nursing services. Since·the clients shoulder much of health care, doctors olso find it important to have an idea on the type and cost of nursing senices. This also :helps them explain to their what the nurse has to offer. It was a good practice to leave broclmres of the nursing services to the health provider with whom linkages are established. The brochure include the type of service offered, schedule, location of the clinic and in most cases, the name of the person to be contacted. In mak;ng referrals, it is very jmportant to have a refen-al form tl1at has data useftil for the nurse and the referring health care provider. This works in bolh ways. The nurse knows what sen1ice she will provide and the doctor will have informatio n on wby the nurse made the referral. · REFERENCES L Carpenito LJ. (2002) Nursing Diagnosis. Application to Clinical Practice (9tl1 edition). Philadelph ia: Lippincott. 2. Guidelines on the Nurse Entre/Intrapreneur Providing Nursing Services. (2004) International Council of Nurses. Geneva, SY..itzerlau d, pp 1-35. 3. Heh~e, C. (1998). Advanced Practice of Nursing in the Communit!J. Thousand Oaks, California: Sage Publication. 4. Johns, C. (2004). Becoming a Reflective Practitioner. l31ackwe 11 Publishing Ltd. 5. National Objectives for Health Philipplnes 2005-2010. Department of Health. Republic of the Philippines. 6. Philippine Guidelines on Periodic Health Examination (PHEX) Effective Screening for Diseases among Apparently Healthy Filipinos. (2004). The Publications Program. IPPAO. University of the Phmppine s Manila. 7. Philippine N'ursing Act of 1991 (R. A. 7164) and Implementing Rules and Regulations. (March 8, 1994). Series No. 1. Professional Regulation Commiss ion. Board of Nursing. 8. Standards far the Safe Practice of Mother and Child Nursing in the Philippines. (October 2001) Maternal and Child Nursing Association of the Philippines (MCNAP). 9, American Nurses Association. (2004). Nursing: Scope and Standards of Practice, 3"' ed. 2004. American Nurses Publishing. American Nurses Association, 600 Maryland Ave. SW, Suite 100W, Washington, DC. C | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
scbober, M and Affara, F. _ (2006). Advanc,ed Nursing Practice. Blacl-.-well 10 publishing, Ltd. International Council of Nurses. Wilkinson J. (2007). Nur~ing P~·ocess and Critical Thinking (4th edition). Upper 11-ddle River, New Jersey: Prentice Hall, lnc. Sa INTERNET SOURCE http:/ /srdkoninp l1i L blogspot.,z. 325 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
324 In managing the client's condition, they would often request for information 011 lhe medical practitioners whom they need to visit. Conversely, when formal linkage is establisbed, referrals from medical practitioners will also come in. Helvie (1998: 397) report that they collaboraled 1v:ith other agencies and health providers. The agencies and providers were those being used hy the clients. The nursing clinic, with the clients' consent contacted these providers with an offer to work together in serving the patient. In the end this resulted in referrals from such providers and increased credibili ty with the clients In the Philippines, establishing linkages include making a presentation of the services being offered and a discussion of the fees for nursing services. Since the clients shoulder mucb of health care, doctors also find it important to have an idea on the type and cost of nursing services. Tbis also helps them explain to their what the nurse has to offer. It was a good pract. ice to leave brochures of the nursing services to the health provider with whom linkages are established. The brochure include the type of service offered, schedule, location of tbe clinic and in most cases, the name of the person to be contacted. In making referrals, it is very important to have a referral form that has data useful for the nurse and the referring healtb care provider. This works in both ways. The nurse knows what sen-ice she wi D provide and t11e doctor \1.-ill have information on why the nurse made the referral. · REFERENCES 1. Carpenito LJ. (2002)Nursing Diagnosis. Application to Clinical Practice (9th edition). Philadelp hia: Lippincott. 2. Guidelines on the Nurse Entre/lntrapreneur Providing Nursing Services. (2004) International Council of Nurses. Geneva, Switzerland, pp 1-35. 3. Helvie, C. (1998). Advanced Practice of Nursing in the Community. Thousand Oaks, California: Sage Publication. 4. Johns, C. (2004). Becoming a Reflective Practitioner. Bl ackwell Publishing Ltd. 5. National Objectives for Healtb Philippi. oes 2005-2010. Department of Health. Republic of the Pbilippines. 6. Philippine Guidelines on Periodic Health Examination (PHEX) Effective Screening for Diseases among Apparently Healthy Filipinos. (2004). The Publications Program. f PPAO. University of the Philippines Manila. 7. Philippine Nursing Act of 1991 (RA. 7164) and {mplementing Rul~ ?nd Regulations. (March 8, 1994). Series No. 1. Professional Regulation Comnussion. Board of Nursing. 8. Standards for the Safe Practice of Mother and Child Nursing in the Philippi~es. (October 2001) Maternal and Child Nursing Association of the Philipprnes (MCNAP). 9. American Nurses Association. (2004). Nrrrsing: Scope and Standards of Practice, 3ni ed. 2004. American Nurses Publishing. American Nurses Association, 600 Maryland Ave. SW, Suite 100W, Washington, DC. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Schober, M and Affara, F. _ (2006). A~vanced Nursing Practice. Blackwell t O· publishing, Ltd. International Council ofi Nurses. w·i Jcinson J. (2007). Nursing Process and Critical Thinking (4th edition). Upper 11. 1ddle River, New Jersey: Prentice Hall, Inc. Sa J2· u,rr ERNE T SOURCE http://srdkoninphil. blogspot. 325 I,-d | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
326 Chapter 13 ENHANCING COMPETENCIES ON NUTRITION FOR WELLNESS Lucila B. Rabuco INTRODUCTION Over the years, there have been significant changes in dietary patterns of individuals i;rnd pop\tlations. These ch Mges are brought about by advances in food technologies, including improvements in prescrvntion, storage, transport and distribution. Changes in social values, attitudes and lifestyles have also influenced patronage of convenience foods as evidenced by the ever increasing fast food industry. Dietruy changes have nutritiomil implications which impact on the overall health and well-being. Because of this, there is a growing concern and interest to achieve good nutrition and wellness among the public. This chapter deals with the basic principles of nutrition that will provide tools to achieve wellness Uuough good nulrilion. As integral part of health care, adequate nutritional status should be achieved ·with the help of the health care team,vhich includes the doctor, nurse, dietitian, social worker, occupational, physical and speech therapists, and pharmacis t. NUTRITION Nutrition is the science which deals with food and how the body uses it. Man needs food to live, to grow, to keep healthy and well, and to get energy for work and play. Several factors affect food consumption and utilization of an individual. These include the emiroumen l (natural or man-made), psychosocial, cultural, social and even philosophical. The choice of diet influences long term health within the range set by genetics hence some diseases may or may not be influenced by nutrition. The lnteragency Committee on Nursing Education (ICNE, 1964) enumerated the following basic concepts of nutrition: 1. Nutrition is the Food you eat and how the body uses it. We eat to live, to grow, to ke'ep healthy, and to get energy for work and play. 2. Food is made up of different-nutrients needed for growth and health. a. All nutrients needed by the body are available through food. b. Many kinds and combination of foods can lead to a well-balanced diet. c. No food by itself, has all the nutrients needed for full growth and health. d. Each nutrient has a specific role in the body. e. Most nutrients do tlieir best work in the body when teamed with oilier nutrients. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. All persons throughout life, have need for the same nutrients, but in varying amounts. 4. The way food is handled influences tlte amount of nutrients in food, its safety, appearance, and taste. FOOD Food is any substance, organic or inorganic,,,..hicb when ingested or eaten, is used to provide energy, build and repair tissues and regulate body processes. Food consists of chemical s which are nutrients and non-nutrients in nnture. Based on the major nutrient content, foods have been grouped into three namely: (11) Energy-giving foods, (b) body-building foods and, (c) body-regulating foods. (a) Energy-giving foods The energy-giving foods consist of foods rich in carhohydrn tes and fats and oil. loods rich in carbohydrates include cereals (rice, wheat, corn or maize). starchy roots and tubers (sweet potatoes, yams, taro, potatoes cassava and others). Fats and oils include butter, cooking oil, coconut milk and margarine, and animal fat. (b) Body-building foods The body-building foods are sources of protein and include: animal foods like meat, fish, poultry and milk and vegetable sources like legumes, pulses (soybeans, mungbea ns, red and white kidney beans and other dried beans) and nuts. (c) Body-regulating and protective foods Body-regu lating foods are sources of vitamins and minerals. These include fruits and vegetables. They are further grouped into either Vitamin C-rich fruits and vegetables and other fruits and vegetables. NUTRIENTS A nutrient is a chemical substance present in food and is needed by the body for proper functioning. The nutrients are classified into macronutrients and micronutrients. The macronutrients include carbohydrates, fats and proteins which contribute to the total energy requirement of the body. l'he micronutrients include the vitamins (fat-soluble and water-soluble) and minerals (macro-minerals and trace minerals). Macronutrients Carbohydrat es Carbohydrates are the cheap and chief sources of energy in the body. It has been recommended that carbohydrates provide 55-70% of the total energy requirement (TER) of an individual (RF..NI, 2002). Carbobydrates spare protein from being used as energy source. In the form of glucose, it is the sole source of energy for the brain and nervous tissues. It is stored as glycogen in liver and muscles. Complex carbohydrate like dietary fiber pro\lides bulk that promotes normal functioning of the intestines and helps prevent many chronic illnesses. As the chief source of energy in the body, one gram of carbohydrate is easily converted to 4 kcal of energy. The types of carbohydrates include monosacc harides or simple sugars (glucose, fructose and galactose); dissacharides or double sugars (sucrose, lactose and maltose) 327 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I !. l 328 :md the polysaccharides or starch, comple. x c~rbohydrates. Glucose is found in fruits, certain roots. honey and corn while fructose is found in fruits, honey and vegetables. Ga. lactose in nature is fou. nd olll~ in mammalian milk. Sucrose or table sugar is fow1d in sugar cane, 111oln~scs, sug. nr beets. natl syrups. Lnctose i. c: found in milk nnd milk products while maltose is fvu11u in 111<1lt. md malt products. Starch or complex carbohydrntes are found iu grains and g Tain products, seeds roots, tuben;, potatoes nnd other rootcrops. Diet. 1ry fihcs (indige:;tihle) is found in skins and seeds of fruits, vegetables and grains. Larie. 1moun1s of soluble filler are found in legumes, greens, citn. 1s fruits, oat meal :ind barley. Excessive intake of carbohydr:1te may contribute to oven. veight and ohesity }ls well as incrcascd risk of chronic illncs~es like di:ibctes,md heart disease. Also, high intake of sugars like sucrose bas l,eeo associated with dental caries. Proteins Proteins are esst:ntiul to all life. I I consists of clrni11s of 20 amino acids helcl together by pcptidc bonds. These ami110 acids arc classified into essential (cannot be synthcs i;1,cd bylhc body nnd should be supplied in lhc diet) und non-essential amino acic. l!l which can be synthcsi. zcd by the body. Protein~ have several r11111. :1 ions: fur building 11 nd repairing oftissu Ci!'i; to n1. 1i11tain important c:ompountl s suc:h as c11;1,ymcs. honno11es, :111tibodics, other 5(;. >t:n:tion:-;): maintain vascular osmotic prc,;:m~. It al:;o prnvidcs 10-15% of the c11crp,y rt~1u ircrnc-nl :Ind supplies 4 Ja::11 per gram. The protein requirements nn greater during periods of growth as in infoncy, enrly childhood, udolcscence nnd prcgnuncy and hii. :tatio11. Depending 011 whi. :ther a U the essential amino ucids nre present in the right amounts, 1>rott>ins art cl. L~sifit"d into complete protein 01· im:omplete protein. Complete pro Leins contain all the essential amino ndds in the right amounts while incomplete proteins nmy Le lucking i11 one or more ess<:ntial atilino acids. Animal sources like meat fish, poultr:v. milk,rntl milk products are sources of complele proteins. Incomplete proteins arc from n:gc. tablc ~ourccs like legumes, dried beans as well,1s whole grains and seeds. J-lowc Yer, a combination of incomplcle protei. n foods that would complement what is lucking in one or the oilier can increase the biologic value of lhe protein in the diet. Prolonged lack of dictnry protein can le. ad to undernutrition or protein-energy malnutrition (PEM). '!'be severe forms of PEM nre marasmus and kwaslliorkor. On the other hand, mccessive intake of protein will be stored as fat in the body. Fats Fals are found in many foods and provide concentrated source of energy. P::its also supply the essential fatty acids whid1 have specific functions in the body. In ridditjon to its role in providing essential fairy acids. fat has other fuucliuns. Fat is stored mainly in the adipose tissul' and Ullls maintains body temperatu re. JI also serves as protective pad nnd support to various organs. Pat increasc. s tlie satiety value of foods and add flavor and palat. 1bility to food. fl promote s absorption of fat-solub le vitamins. Fat also provides structuml component of cell membrnn cs, honnones and other secretions. As source of energy, fat should contribute 30-35% of the TER of an individual. Dietary fat c,111 be ohlained from animal sources like meat, milk, butter and are mainly saturated fat. s. Unsaturated fots on the other hm1d can be obtained from vcgetnble and seeds such as com, safflower, cottonseed, sesame and so}bean oils. Polyunsaturated fats stay in liquid form while saturated fats are solid in cold temperature. Fish from cold regions are high in polyunsaturated fatty acids called omega-3 fatty acids. ~--------------------.-:rt | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
E,xcessive intake of fat can lead to overweight and obesity MJCRONUTRIENTS VITAMINS Vitamins are organic compounds which are found in small amounts in food. TI1ey cannot be synthesized (except vitamin D) in the body and have specific and vital functions in cells irnc J tissues. Vitamins function in regulating the synthesis of many body tissues, participate in cellular metabolism as coenzymes and cofactors, involved synthesis of gene-cnntaining 1m1terials a. nd may function its antioxic Jan1s. Vitamins are classified into lwo groups according to their solubility in c. ither organic solvents (fat soluble) or water (waler-soluble). Fat soluble vitamins are stored i11 lhe body whil. e water solul Jle vitamins are generally not stored in significant amounts and are readily e,xcreled. Fat-soluble Vitamins Vitamin A 111ere arc two main forms or vitamin A. iu food: the prefonne<l vitamin A (retinol) or the vitamin itself :ind the precursor 01· pro-viti1min A (carotenes and simila. r substances). The nrnin function of vitamin A is i Ls role in vision since it is an essential component of rhodopsi. n (visual purple). It is also needed to maintain the integrity of epithelial tissues. Vitamin A is also needed for hone growth, immune system and reproduct ion. Prcformecl vitamin A is found in animal soun:es such as liver, milk, and eggs. Precursors (carotenes) nre found in dark green leafy vegetables and deep orange fruits and vegetables. Vitamin A deficiency is the main causeofprevenlablenutritioual blindnessamongyoung children. Clinical signs associated with the deficiency range from nightblinclness to keratomalacia (severe lesion}. Vitamin A deficiency is also associated with keratinfaation of the epitl1elial cells, depressed immune response, poor dental health and growth. On tl1e other hand, because it can be stored iu the body chronic excessive intakes can cause hypervitaminosis A or toxicity. Vitamin D The two most important forms of vitamin D in man are: vitamin D~!2 (ergocalciferol) found i. n plants and vitamin D-3(cholecal ciferol) found in animal tissues. Both vitamins are formed by ultraviolet irradiation. Cholecalciferol is found in eggs, butter, liver and cheese. A cholesterol-related vitamin D found in the sldn is converted to the active form of Lhe vitamin when exposed to sm:ilight. Vitamin Dis needed int. he absorption of calcium and phosphorus, it is needed in l>one formation, cellufar differentiation and modulates immune function. Deficiency of vitamin D can lead t bone,deformities called rickets, malabsorption syndrome, diseases of the liver and l..~dney. These can be prevented by exposure to sunlight, consumption of fortified foods and fish including its liver. Vitamin E Vitamin E exists in at least eight tocopherol and tocotrienol forms of which d-alpha tocopherol is the most widely distributed and has the highest biological activity. The richest dietary sources of vitamin E are the polyunsaturated vegetable oils and nuts. Vitamin E functions in the body as tissue antioxidant protecting liquid membrane of cells from oxidant damage. In food, it acts as an antioxidant by preventing the oxidation and breakdown of polyunsaturated fats. 329--- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
330 \"1trtmin E dc6dency I:; 11:-sociah:<I tu po:-sihlo hcmolytk uncmin in lvw hirthwci1d1t infant-s ond in m:. ilabsorp tion!>tote. <-. E. xce..ssiw intnkcs of viu1min E mny luwc i111plic111 ions in pnlicnts tnkii,g nntico~u lant mcclic. otions :ii> it inhihils vitnmin K 11ction in clotting. Vitm11i11 A: Then nn:-two nnh1rnlly =11rnng fonn~ of,·itamin K: yiltm1in K-1 (phylloq11inonc) formed from pl:mts and vitmnin K-~ ~ynthtsized hr intc..,tinnl bncterin and found also io small nmoun1~ of nnimnl tissue. Diclory wurre..'l of vitamin K arc dark ~rccn leafy wgctablc-;,. The ma111 function 0£\'itomin K is for blood clotting unc J <lcficicncy of the ,;1nmin hntl~ to hcmorrh~c. Water Soluble Vitamins 'f11inmi11 (Yi1umi11 81) Thiamin is a ('()fnrtor thul piny~ n n. ~lc in r:,rhoh~·drnte metabolism. II also helps in Lhc pmpcr funrtioui 11g of lhf. ',wn't)u,: s~-stcm, henrl muscles and digcsliv~· t r:u. :t. Food source. ~ IIH'htd, lt·an m.... 11. li,·<·r 1(11umes nnd l'Crcnls. Ddicicncy of thiamin includes htri·btri. "--~" of appetitt'. Mt:::tric tlistrc.-. s. fatigue, ht:nrt failun·. c<lcmn of the legs mid mentnl pruhlcms Requ Jr,mh?nt for intake is relnted lo C':t. loric requirements. Ri/)(:,jhwiri (l itnmin 8:J} Kil>ttlm,n i$.,lso important in many em~1ne rc:. 1ctions. It is ncccs.-. c,ry lo mnintain h,. :tltliv. skin. lir und ton):lu:'. Food sources uf thc vi Lamin,ire milk. m,'nt, poultry. fuch. ~n>,n. lf. 'ill Y \'\. 'Jw1atih.... Ot>ficienc;y s1·nh: i< chnrncteriied by wound aggrnvn tion, stornntit1~. swoll,m n!<i ton~ue. cyl' irritations, i-kin cnt~ltioni: nnd dcr11111tili:,,. Rt'Q11in·mt>nl fur in1akt' dc~m. ls on energy n. 'quiremln Ls. physical activity. 111l!labolic rate, _r.-;mw1h r. lll' :rn<l h<. >c. ly si7c. Niacin (Viramin B3) Nincin. also lmm,n as nicotrnic acid is also found in menl, l~umcs nncl cnriclwd cereal wnin-< ll. l. t' thinmin nnd ribofln,. in. nlndn is r1l~o liwoh·1:cl in en CT)t)' mf'tnhnlii. 111. 1'11n ofnin<"rn i, cltri\nl from tryptnphan. :rn amino add, nbtained from pm1,lt1 containinl( foodc.-,c:,·p1 t·on1. ·n1e cla<. ~ical dcfiri,nt-:,· ~11dr11111c :l:. !«>cintc<l with nin. :111 dcli<:1cn<. ;· i-. 1wllai. r. i rh:1rn.-tt>ri1C"f l hy diarrhr11. dnrnrn iii~ (('a,.,;11',, n1·ckl;1rl') wltl'. 11 t''<p<N:u 10 sunliih1. d,m,,ntrn Cronfu,1011, lo!-'\ (>f m<'m<JI)'), :rnd drolh. Rc. '<1u1rc-r11<111 for 111nc1n i~ C'tf)n-<-«l in ni;idn equh-;ilen~,inc-c it is derived from prcforrn,"(I nincin 1111d tryptopl11111 Py rid, u-i11t> \llumin IV. includt' pyridmc1ne (1lrrin~d fmm :mimol MJt1rce_q), pyndox:il :rnd pyridoum111c (fmm pl. lnt /itlu~) piny impon:m t roles in hcmoi;lobin,'iy11lh sli, :ind in thr t'Om t'l'tnr1,,r I 1:1111,phrin t n nia<"in. Ocficirm·y of nincin b, mnnlfcstcd by J:Cncml ymp1om,,,1, h ""lei,~"' ~tnmina, 1m1nhilit y, conv1. 1l,lonq and 1111tt11i:t. l'rutdn-rich foods surh a~ nwat. fi. '1. h and poultry. as.,-ell 11~ r. n. :cn h·nfy Vl'jtclu!Jlt·. s, 1:cnal itmins, nnd SC>lll' fruit<; are good c:. o111·c<''" rolatr 11,is,,1,,min i,; alsio rd MTrd l·o a., foli C' 11rid, fol;icin or plt'l'll YIAlutnmk ncid. "l11c main function 1s a, ran o( 3 COo'n,:,-me ne NW in n,w r. t'II "}'nthrsi~. A-: the nnmc ,m,,li,~, thi' m:lm '-'\111\"{'C of folntl' ~n' <l11rk 11. r Nn l<-ofr Vl'Jtl'tnhl<q, hut it ii; nl:iu fmrnd m In, 1. 1,,. n,m,·, imd wl"d. Fol ate dl'hnenq c':lluq,~ nne type rif 11111 ri1 ion al 1111t;m. in. m,~olohlo,t1<' i1n,m111 l1t11'l(I' 1mm11turt C\'ll~I but It ha11 n(,"' ~11 t!-tnhlishl'd thnt fol tile prf"·~nl:, neun. l htl X' ddect (NTD). | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
cn/m/0111ir1 (Vi1r1111i11 IJ12) Cohnl:1111in is also par1 or cn<Jn,:yme syst«:m m,cd in cell synthesis and helps to maintain nerve cell)-;. The snurnis of cobalnmin iire animal products (meat. fish. poultry, milk und cgw,). Stric:I vcgt:tari;111s arc likely tt J develop deficiem. ')' symptoms if there are 110 01hcr :;otircc of the vitamin is 1ak P. n. Vitamin defici1mcy is also characterized by 111cgnlohlastic ;,ncmia. l'aticnts who had partfol or totnl gastrec:tomy arc at risk of the dcf-idcncy becm1sc of loss of the inlrinsic factor needed in the metabolism of the vitamin. Pa11tnthenic l\cic/ panl Ot heuic acicl is part of a coen1. ym e system used in energy metabolism. lt occurs ahundnnlly i11 animal foods, whole grain cereals and legumes. Deficiency syndromes ;,re unlikely. Jiiorin Biotin is a s11lf11r-cont:1ining vitamin and is essential in coenzyme used in energy metnlmlism. fat. Hrnino acid and glycogen synthesis. It is widely found in foods. Dd1cioi1cy symptoms include loss c,f appetite, nausea, depression, weakness, fatigue, hair loss and dci-nrnl itis. Asw,·l,ic Acid (Vilomi11 C) Vitamin C is. :-. sscntia I in a wide range offuncti ons. Vitamin C is needed in the formation c>f cnlln)!. cn. th<. : base for 1111 con ncctivc tissues in the body such as bones, teeth, skin llnd wndnn. 4 11 i11c-rc;is1. s resistance t O infection, enh:rnces the absorption of iron. and functions :is m1 :rntinxidnnl. Vitamin C is found in citrns fruits, dark green vegetables, strnwlwrril!s, p,·rrwro;. potatoes. p:1payas. Deficiency nf inlakc may evcntu,11ly leatl lo scurvy-swollen. hlccdini:; )!,t1ms, nncl loose teeth. Other symptoms are rough skin, poor w()und hc;tlini. ;. bruise easily. increased risk to infection und anemia. Megacl. oses of vit. umin C. supplements can result in rebound scurvy. MINERA LS M incral. s ha"c,·arious functions: ( 1) asstn1ctured components of bones; (2) ns central atoms in t11')')!,i'nc11rrying proteins: (3) :u; consti I11en1s of numerous en-zymes: and (4) as dectrnlyte rt'. sponsihle for the movement of wnter through tissues. Requirements ,·nl)' frwn r,w micrni:rams (trace minerals) lo hundreds or mi. lugrams (major minerals) n d11y. Minerals nrc widely but unevenly distributed in nature. Major Minerals C<1/d111t1 C11lci111n is thl! most 11hunda111 mineral in the body with 99% found in bones and teeth nncl ahout 1Y<, in body fluids. Cnlcium is needed to keep strong bones nnd teeth. Other mujc11· roll':-: or 1. :aldum arc rc1sulntion of transport of ion anoss membran es particularly nervt' tr:111):n1issinn. It is e SSl'ntial in muscle contrnction :md bloocl clotting, helps mai11111i11 bkl$1d pres. sure. and (11111. :tioning nf :some cn7. ymcs. Fuod sourcc::s include milk, clri,d small lish with ho1ws e:11,n. some green vegc::tablcs. tofu, canned fish. and fortifod 1m,d111·t:<. Dl'fici L·ncy lead to po L1r hone growth and tooth devel<>pmcnt, poor bl CJod cl11tti111,t. i111·rrn:-1·d risk ofn. stenmalacia and ostt. 'Oporosis in adul1i;. Toxicity may lead tu tctany or formal inn of rt!11al stones. l'lws{'htw11 s M. tjorlty of 1hc phosphoru · in the body is combined with calcium in the bones and tf'cth. Ph1)>-f)honis helps rnninroin acid-bas·e bolnnce and energy metabolism. Primary fond su11n·cs nrc foods rich in proteins such as meat fish an. d poultry. Deficiency from pho:-phoni. s i:-prnctica Uy unknown. 331 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Ma51n(!!;i11m /,fagne. ~ium i~ invoh·ed in numcrou. s cm;ymc. systems and energy rnct1,lx,l h1rn prordn ~-ynthe. L, and fot m<!Wbo Hsm. fl also help build s1 rnng bone. ~ ;, nr J 1cc1 h :,11,j regul;i11: h:anl>ea L Magne<;ium source..-. ; ar<. : S<. :ufoods, wbolr, ~rain. ~, le:gu rm:!. :. nd n111. Dt'fici~ncr 'iti,t~ have rccr::ntly been associated Ylith hypencnsir,n. i.,d1tmic lv:;,n disea. "'-', arrhythmia, precelamps-i,'. 11 and :i_<;thma. To;,cicity m,1y h E: as. '>oci;,1,~d wirh intah, af magm!Sium-cont. aini ng ant. acids, laxatives and other mtdic:sti on. ~. Sodwm Sodium is the main catir)n in the extracellular fluid compartment or the bo<ly. Sc,diurn b!!lp, main Lain th,;2cicl-ba. 'i#: balanc:e Mthe br. Jdy anti is important in mu. '>Clc cintrac1 i,,n :me r..!,r. ·,; transrn. 1. !i'ii'ln, The major diet. an· source of sodium is u. ble ~alt anrl prr J<.-..=<. v . ;:f for..<l5. ~,t:ral fr:...-,d~ including ~-c~et,,bl<.-s. mra L mill and milk pmduc:ts cont a in Y,m.-: . :mr;unt., of s,;,. lium. C,,:1dim<:nt:S lilt!: fish and sr JY sauces, monosodium g. lu1;,mat!! OY... ln1n:t: tn s;;it intake am,,ng man:, Asian coootries. Too much int. ikc ()( s,. x:fiurn !Il2} cau:;. e h:--penerui. on v:hich c::an It-ad tr) cardi O'-'ascular and kidnt. "Y d Lc;ea.,;es_ Pm~<:fum Po:zs~-n is the m::jo-r ~tir,n in the intra~Uular oompartment and als,, ph,ys a maj,,r rc!E ir: i::v . i:nair:mz fluid a,~d ~1=:...,.,J,"te balance and cell integrity. Best wu rces cl P'l"~~-T. !>P: :. 7:'. !:-. :r.,-~ lih-m!dnns. · ban. an. a. milk. baked potatoes and fish, l. n-;s (Jf ;x:'~~:r. ir: ca:;s·-uab. = can be fal21 because it. affects rate of heart. beat. Pali. ems on -=· L '· i-'"" ri:. 7"ki ~= intake of po-..zss:ium from foods. Excess potassium intake ~.. ;;5"'. J ~ d2-gert)C£ U> h:~lth-0-Jr;-,:,:::q mci Si!1fu:, c.-. ;,:r::~ ts t:e ::=. ;n ~ of th'!: e. _=cellula. component in the body. It is found ~ ~.,.-r. =... at:...-,:: ·,. j:;:i ~ tnsi..1<> ~ cell it is in association ·with potassium.. it is f. ::::_;,,:-:. <. :::-e. '....:. r J :n ;:,.-h:1aiaing 2:cid--base.-nd e!ectrol)1. e balance and is part of the :::,--i. _...-..,-J-j;zi,::,_,. :.,; b Ge $mn2d1.. lts. source is mainly from table salt and natm:ally CY----~ i:: :ood::_ 5::i:-. :-:. s b!p:):um: b h. dp'. ng protein strands assume a particular shape. It is also fu=. d b :f. :ir, &Ir znd :l. 2fu. Trace Minerals Trori [nm :s ci Tl es--a:,ti;;I ~':Dt needed in the synthesis of hemoglobin. The primary foor-rico m L"mog!ob:n is to c:2:ny o>:;,gen to the tissues and carbon dioxide from the celli. iro::i oo. :n'::5 in l:',,o forms: heme iron which is found in red meat, and organ m. ":Z..; l1r;er. ~!sen. ki<l. ne,. · heart) and is \:ell absorbed in the body. Non-heme irou, 0:1 th<: other ~nd, o:,mt:S from plant sources such as legumes, cereals, dark green leafy ,·ege:12b:e::s and grains an. dis poorty absorbed by the body. To improve absorption of =-heme iroo, ·,it:amin C-rich foods and meat should be eat. en together ·with i L Iron dclicienc.-y anemia is the most,,idespread micronutrient deficiency globally and affects a JJ peop1e but the most vulnerable groups are infants, preschool children, adolescent girls, pregnant and lactating women and elderly. It is characte. riz. ed by small. pa Je red blood c. e. l. ls. lron i. s !>tared in the liver and excess intakes can lead to iron O\"erload.. For e. umple, some. African tnl>es.,..'ho use i. ron cooking pots suffer from hemosiderosis due to hi~ intake of iron from these pots. 332 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
t Jadin~ Iodine i_.., an t",.,·ntial rnmpon Pnl,,( th,, ll1;-;-,,it1 br,rm,,n,,. th:,Tn-un II L found 111 ,;e;1foo<b '>urh :i<. fi-,h :rnd ~. :;,v.,·rih.,n,j,,,di,,,..J ~It. J..fi..-j,,n,:y.,, i,din,. re,,I in a Rpt't"lnim uf <'t Jntliuon~ ~ud, ;1, p,r,ilf r (rh:--r11ld,·nlar;trmrnl /. yo"'1h w Yr<iatlrm. cretini~m. m,nt:ll n:t. 1rdation, and hyp,,1hyr<1id L~m. Fluorine F111nrin1: j-. an cs,(.-nual rnini·ral,d1ich hl"lp, in Lh P fonnatirm o(btm.-anrl t,,rtl, It is. ncc~"ar:,· t,, pre·. ·P. nt <lenta. l.-an~. 11tf' mr)",t ~·.,mm<1n v,un. ·t· 11f flw,nd, · ilnnl<inr,i ..-atcr hu1 in plac(::'I "· here th! IP. n!l t!t Irr.... 011Jn1fat1on 1, n:cnmmr nr J,.,J. Otlwr «,11n.,~ are fish and tea. \\11P. n Cl')n,;umr J m la111,P am"unu.. llunnd, r-. in ti, 111"11" Ctl11tir,,.-l-1. ). Dental fiour-o'ii. s is manife:-ted,,. ;lb mr:Jttloo ern:unel of 1hc trrth.. Zinc Zinc i. c; an ~vntial rdemf'nr in pm1PIM n11d 1n1ymr'I. Fc. ><xl,oun:1....., q( 7-im· ltrl' animal proteins particularl;,· oy er: and crnhrni:-nl, ~<. 'rm or ~min<. nut,. rnill.. :ind eggs. Zinc:: d. 1:diciency h,J. _~,,ciate J '-Ith J)')Of imrmm11~ ·,ind '"1und lwalin~.,:;m.,,,. 1h retardatio n, hypogonadism and poor ta'-1..-acun-y Th Q'. C wit J1 rhrnmc di:irrlw:1 and chronic pancreatiti. s and others ";th mal. ab--,1r-ption ":71dmm~ are :it lugh n-. k of Tine deficiency. Selenium ln recent ~·ears, increasing interest in selenium i. !. brou~ht :ihout by II$ :intioxl<lan t propertie s. Selenium is found,,,. ;dely in foods lil<c meal nnd :;hcllfi,. h anti in VL~t,;t.,blcs and grains grown in selenium-rich soil. Selenium d<dk1en L·y l1:1, 1>,.,,..n :i~"'1cfa1t'ti ";t. t. 1 card. iomyopathy, a certain heart disca..o;c. This wa.,; first dc,,crihed in China nmon~ people U,ing in a rea. s where the wil is defir:ic. ni of sclenium.. E.-,;cc:..,ivc sclcuium intake due to intake of supplements may cause hair loss. di:irrhea and dcfocts on fmiernoils and toenails. Chromium Chromium is also involved iu enzyme systems and is required in c. 1rbohydr. ite a11d lipid metaboli sm. It has two forms: Chromium 3-'-(non-to:-cic) and Chromium (>+ (toxic). Good food sou. tees of chromium liver. whole grains. meat, cheese t1nd nuts. Chromium works \,itb insulin receptors io tbe control of blood glucose. Lack of chromium may result in diabetes-like high blood glucose (Allderson et al, 1991). Copper Copper is a Jso and essential part of many enzyme system and is involved in the absorption of iron. It is also needed in the maintenance of the l. trcliova. scular ~\-stem. Copper deficiency is associated with prot!!in and iron deficiencies. Primary food s~urces are organ meats like liver, seafoods, nuts and seeds. It is unlikely to get toxicity from foods but it is possible th. rough use of S\lpplements. ASSESSM. ENT OF NUTRITIONAL STATUS Nutrition is influenced by many factors and therefore different methods may be applied in order to assess the overall nutritional status of an individual. group Or population. There are direct methods which provide direct infom1ation on the actual nutritiona l status. These include aulhropomclric m. :asurcmcnts, biochemical :md biophysical examinations and clinical assessments. lndin.-ct methods pr O\ide information on factors that can affect the nutritional o::on J. ition of a population being Studied. These methods include the dietary assessment and ecological sunrey. \"/hile these methods do not directly assess nutritional status they provide information on the 333 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
334 risk u( r1 1111tritimrnl clcfic. :lcncy and therefore arc also important 1:1<. ljunctx to the more t Jirccl 111clhod H. Indirect methods Ecologlcal Informr1ti on regarding existing health statistics in the communi ty, socio-economic foclors, rmd cultural factors and environmental conditio ns give information which can help in the. assessment of Lhe nutritional status as these woul<l dfrcclly or indirectly influence an individual' s health and nutrition. The prevailing con<litions in the enviro11mc11t aid in assessing the risks that the population are exposed to and which can contribu te to the health and nutritional status. Dietary Methods Food consumption surveys examine dietary intake of individual s, a group or. 11 population. Data obtained from surveys can be used to provide bases for measures aimed at improving the dietary practices which can then help in the improvement of the nutritiona. l status of affected people. The basic tools used in dietary assessmenl include: the dietary method, the food composition tab1eand the recommended nutrient intakes. There a. re three revels where dietary evaluation can be done: at the population level, household level and individual method. A. Population leuel-the most commonly used method at the population is level is the Food Balance Sheet which provides information on the amount of food available for consumption oftbe whole country. rt does not give information about djfferences in food consumption patterns between groups in the population. B. Household l<!Vel-tbrough a food inventory or food list, foods consume d by the family is obtained but does not take into account food bought and eaten outside the home. C. Indiuidual level-information on individual intake is obtained either quantitative ly by reca U or record using actual weight measurement of foods, estimates in household measures o-r qualitatively by dietary history and food frequency questionnaire (Gibson 1990). 1. Twenty-four hour n:call method In this method, tlie respondent is asked by a nutritionist to recall all foods and drink consumed during the past twenty-four hour. Details of food and beverages including coolcing methods, brands (for processed foods) and estimate s ofamounts in household measure s are recorded.. Intake of vi tam in or mineral supplements should also be noted. To help respondents in estimating amounts or portion sizes, the interviewer may use memory aids like cups, spoons, ruler or food models if available. All information should be recorded in a form. The data is then processed by convertin g the household measures to weights and then analyzed for nutrient content using the software oftbe Food Composition Table for use in the Philippine s (FNRI 1997). Pe1·cent nutrient adequacy is calculated by comparing nutrient intake with the recommended intake for the particular nutrient (RENI 2002). To estimate the average food intake repeated twenty-four hour recalls can be done. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
..... Example of a 24-hour Food Recall r-iame : Juan dcla Cr~z, Jr. Age S. O ~ears old Sex : Male Date : April 1, 2009 Address : 1234 Mahirap St., Lupang T1gang, Manila 15 this a typical diet? Yes_ No_ (If no, Interviewer should go back another day) Twent Yfour hour food recall. rime Description of food and Amount in For Lab Use Only drink household Food Code Amount For processed food, give measures and (grams) brand name if possible portion sizes AM 7:00 Pan de sal 2 pc (5 x 5 cm) A042 Hot dog, fried 1 pc (10 x 4 cm) F252 Milk, powdered, filled 2 tsp powder J019 10:00 Biscuit, Marie 1 pack, 4pcs A092 12:00 Rice, well milled, boiled 1 cup, packed A020 Chicken Tinola with green papaya and sill leaves I Chicken leg 1 small leg, (13 F108 broth 1/2x3cm Banana, lacatan 1 pc (9 x3 cm) EOll PM 3:30 Pan de limon 1 pc (6 x S x4 A040. cm). 7:30 Rice, well-milled boiled l cup, packed A020 Bangus, fried 1 slice (middle) G076 7x3x2 cm Vitllmin/mlnera l supple· ment-brand and dose \. _.. J 335 Sc. :,.., ~ wilh Cam Scan:11:r | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
336 Steps: 1. Col'ect d. ata a:id rerord rn dleia,y evaluation form as shown in rabte above. 2 !'l'eparatton of c!. a~ fa: ar. a-Jysi. s. : A. Com~:. househ,old m:astires into grams using the Table of Weight and ~eas,..-es (FNi,I 19771 c: ;'-2 c::,oo &change List, (FNRI, l':?9~) S. li~~t cs gr,cen "' 'A!, P,..--chaseo· (AP)-,.,eight, change to weight ~Edble 0o-. 'ori· (E"l b,, rrul::c. ";ing \\/Ith~ EP for th'! p. ;rtt CIJlar iood from the Fooj Ca~ ~n To'J:e (FCT). Exatr. :!e: Ii c-r. e ;-<ea?· oi oa~..a=, lac:a:an has an AD" eig_ht of EO g and its% i:? f:-:;-m :t<i= KT is fil';,,. then E?-,., ba. :,an1! = 60 x 0. 69 = a 1 g ~~ :! ~ !:iar. :s-..rs.. fried !7x3x2 er. t)-E? COO""--°"ti 1Vei1;ht :: 356 Cc-::1ad 't-ir~:tl X Cln""R5. o:'l fa,rto( = EP rc,, \atai;. ~t 3. 5. x ! ~ = ~g ~=- :;..; ~ :;o. :;4.-. sc ~ rs ~. a-.-..a. b'..e in the 'FCT.. th~re is no ne-ed to c. c,ven to ra--~~ live. :::c-c-c red:?E is. ix:: ~-72""'-at!e. ti U-1.-e FCT~ cato-.,l#tion has to b~ cion-Et r..s7~ =--~,:z« v,~~~-~ d-..:S ~ cr. e ca. c=. a. fl:w one-:ea:s-oo~;i of oil for fried u~ ~-~ =-;;i:;S ;;-,::: se..-.-:-. ;.. o... O:h+--e-1.-":?'i~ (O:!:::c;~ ::Y ~ fa-r~ item ar. C major fooc it£m in m=' ::o:-i5, t;;S;",g me Kr e:. :. ~ rn2nis!!y er using the FCT $-0:V,Vcre (FNRJ. 2m2j . :-. ~ ~: i' vd, a;-= cf 1 S-:-re ni':':! bangus (from CJ Foe,;; Ccc E cf~. ;-"is-n:....:. s: G076 from KT Pre.-_g_-. :. g EP/l JJJJ. n:. ttnfu-"!t. ro:i~ fro-::, FCf = 35/3. 00 r: 23. 5 " 8. 3 i; dnw~of~ (6¢ g} is usd FCT Code is G074 P!G¢ei(J,,. g a> n,,w/J. 00 'Jf. nutrient CZ>l'J'tefft from f CT =-64/JJJO i,;19. 8 = l2. 7 E. C-a!a"3!P Ole total amour¢ of each nl. ltfient from all foods consumed and ,,ita,,. iu /ffl1M. f21 tal:en. f. To~ adequ;;,cy of l'lll'ttlem lnll!ke, compare the actua I intake with the. ,ew,,woa acfed intalr. e {REHIJ for each m. rment fer particular age and sex. "lfww:nt A6eqnar:y"' amc,um of nutrient consumed ~nutrient intake -- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2. Estimatedfood record ln this method. the re... pondent is asked 10 record nil fond and drink am«umed over a period of tim~. The recordin,; i!' dnnt' at th~ lime nf con"'-!mption. The amount con;,-umt.-<l is recorded in hm:1-. :h,ild m<'. a. 4un:--, and dct. '3ile J description,, oi prep2rauon and coolani; are not~!. Thi< metliod require<: lhat I. he ~-ponden1 is li1er:11e and f"e Gutre. !' more c,x,pc. rat1nn. D:ila an:ilyri. "' i« similar lo thi'lt of th.,. twenty-four houir n. 'call method. 3. 11·eighcdfood rec-ord Thi!' is the mo... "'1: preci. '-e method and re:cp,:,nden~ arc a. kod to wei!1,h 1111 food and tiri·nk as it happens durin~ a,;-p,ecifie-d p('nod nf ttm<:. Detail-. of fnod preparati on. cooking methods. brand name,;; arc alw ra--. mkd. In thi~ method. the actual wei~l. 5 of food,ccorded are u,~ m the an..11:,---i!-. 4. Dietary hi. ctory This method attempts to estimate the usua J m1,1kc of an mdi,,dunl o.-c-r lnn); periods of time (Burke. 1947). This consic::c_<; oi :i r.,cn~-f,,ur hour food n. 'C:111. followed by a frequency o[ mt. Ike of ccrtem fnod item., ;i< c~<hed: and a three-<lay food record (this is ao ion~cr u..-. uall~· clone). The rn..-thod i. <,-er)· tedious and requires a trained aulritioni. sl w orrr i1 out. 5. Food frequency quesrionnai-rc (FFQJ The FFQ consists of a list of ioo<l!, and a :;et of Fn-qu..-n~ of U. "<: ~ose categories. Depending oo I. he objecti,-e,. of the srudy. the list of foods may be short or very long. The FFQ m2:,-b-z admin Lru?red fac:e 10 face or it can be a self-administered questionnaire_ Thi5 i., now,cz:. · commonly used in investigations of diet-di_c:ease relationships. .->. s stated earlier, the dietary method i5 an indin.-ct method of assessing nutritional status since it does no~ define the nutrition. ii deficiency but only the risk of deficiency or e:,ccess. Also. one mu.,;i ~Li7..e that there are limitations in the different methods used. For ec1t2mpl. :, m--:thod:-using re1:all rely on me:mory and errors may arise ·.-. ·hen icx:xi. 5 are omittt:d or estimates of amounts are inaccurate. On the other hand. the food record met. hods h:!,-. : the advantage of not rci)ing on menlory since food intake i:; recordt.-d as it happens. However. this requires a lot of moc:h-ation and cooperation from the respondents. Direct methods Anthropometric method Nutritional anthropometry has been defined as-measurements of the v:manons of the physical dimensions and the gross composition of the human bod,.. at different age level and degrees of nutrition-(Jelliffe. 1966). Toere are h,-o ty~ of anthropometric measurements : growth and body compositi on measurements. Body composition measurements mclude two types: body fat and fat-free mass. This has se,..eral advantages in that the procedures are simple. non-invasive_ and ioe.-..pensive. Pro\. ;ded standardized techniques are used and properly trained personne J do the measurements, the method is precise and accurate. Ho,,·ever. there are limitations of the anthropometric method which should be recognized (Gibson. 1990). 337 ::J | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
1. Weight Wejght is measured using a beam balance that has been calibrated by a standard weig_ht and following standard procedures (,Jelliffe, 1966). l11c subject should preferahly he naked or if not, should wear minimum clothing, barefooted and asked to stand at the center of the platform. head straight. relaxed and still. Weight should be recorded up to the tenth of a kilogr11m. For infants and children less than two years of age, the infant (pediatric) weigbing scale with a p,in or a suspended scale and weighing bowl or sling (e. g. Salter scale) may be used. 2. Length/lleigh t Length or height measures skele Lnl growth particularly of U1e skull, spine and the legs. Recumbent length is measure in infants and children less tlian two years of age using a wooden length board or illfanwme ter. The subject is placed on the wooden hoard, face up with Lhe head agninst the fixed hoard. Two persons arc needed to take the length. one Lo hold the head ~Lr;lighl ;ind the other to do tl1e measuremcnr. ·n1c measurement is done with the subject's feet, without shoes or socks, is held by the examiner, who makes sure that the knees arc str;,ight and the toe. s pointing stmi&)it upw;rrd. The movahle foot piece is brought firmly ngainst the heels and the reading taken to the nearest millimeter. For children two ye. ars and above and adults, height is mcnsurcd using a 1m1c Jiometcr. If this is not uvai !able, a measuring rod or non-stretch tapemcasure or /i'lecl tape and ;J wcxxlr::n right-angle lwadpiecc can be used p:ir1 ieularly in the field. ·nw mc11suring lope is :itt;ichcd to a st rnight vcrtic. al wull, and the floor ~hould h,1\'C' rm 1:vi:n surface. ·n1c :rnbjecl is lwrcfool and asked to stand str. 1ight, fel!I tc J~·liler. hern. 1 pu~iliomid s1n1igh1 in the Fr;,nkfort Hori;,. onlnl Plane, and the l1N·l~. huttr,ck. ~ ;ind !. hnuldcr blade. <; touching the: wall whe:rc the tape is fixed. 111c 11rm. ~ ;,r1 lmn~ir1g l H,~c rm the sit!,: :md 1111! s11hjcc1 is asked t·o rake a der-p breatl1 11ncl m11inlarn ;:, fully urect r10sili1,n. ·n1c headpiece is lowered until it t<>11chc11 tl1r: mo,, 1mp1rlt>r p<iint of the head and the measurement is recorded is recorded to thr. : n<!;,rc,a 0. 1 cm. ,"J, Midupp Pr arm cfrr. 11mferrm. ce 'f11,. mldupp<:r :-. rm circumforr:n<'..e reflcc:t,i muscle rmd :1dipo~e 1i1rnue rc,;crvc. TI1c mid JM1i111 I. wt,v,-rn I hr; tir, ar. rnmion and till; ti Jl nr I lu: oltcroncrn pro1... 1. :ss hy askirri; thri r,11h;··t to flr:x 1h1: ;,rm (usuallytlw left hand unl(ss imbjcct is lcl'th:rndcd) and :, mark i,, nwd,· ril 1}11; mldpoinl. With :orm lurn King l"widy on thr; side:, 11 non otrf'ld11111w rn<as,urf' i. 11 pl:1od. iround the ann where lhc, midpoint is ll'>f. !Hted :ind fitr. ii,11111)1. ly. ·nw drcumfon;nc:a i11 rcc,:irded t" I he nearest 0. 1 cm. 1, Tnr:rrt1 Sklr,jf!ld 71,ickne. <1. ~ '11i-· llkinfold tllicl. m:<11 pr,,vi!"-: a nlrnplc i,nd nr,n-inv:mivc e.,;tirn:itc of body fat. Ma... uri·nwnl nf,ldnfr,l<l thir-km"lq in fivi; Nit,~q, triccr,R. l1it:cfk'l,,mbi;capular, i. uprailia,· 1,nc J,ni,11,xillary c;;in provi,I; ;, g,n1:rol ($timntc of total l!ody fat. lluvwwr, ii i. t, 11111 ;1lw;1y,1 f·a,ilil· in th,; field I"< t,1k1; all thr:. '\C rnem;urcmen ts, h"n<'· tl1· trlccpn ukinfold thlckne«r:. i11 th,: mf Jqt common ly me;isurcd site. M~ai. 1m·nw111 nf,ik Jnfol1I thlckncs'l n'(1uin:11 a 11kinfold c;;1fiper. Triccp H Rkfofold 1hkk11,.,. ~ i1t mea-'lurtd ;,t tl1r midpoint of th· Jp(t 11rm rn:1rkcd :,s i11 the mid-uppe r nrm nwa rirr-rnrnl. Ahout I cm fm,n I lw run rk, u pinch i1, rnmlc· ln elevate the r1khif,,l,J :,ml, withoul r,l:. 11ir111, llw pi1Jd1, 1 lw j:-iwi 1Jf tile c111ipt T i. ~ ~ppli,:<l :ind 1h·11 th· prc'.-. urr [,. r,·Ji. :11,,·d. ·r,,,. n·11di11g i1 11111d1: f Jh1:r 1,b,,111 four i,ccrnds of 1hr n·Lcll"'"' llflh1· 1:alif)'·r prt,Mun: ;111d th: thkkm!li>1 is rccorcled lo 1he n,;ircst 0. 1 mm. J | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
iodices of Nutritional Status 1. Weight for Age (WFA) Weight for age is an indicatorof presentacuteundernutrition. Weightmeasureme nts for children 0-83 months are comparecl with International Reference Standards (IRS) adopted for Filipinos (Mendoza, TS, Ocampo, ML and Barba, vc, 2003) specific for age ancl sex. Children are then classified using the following cut-off levels. The exact age in months must be known. Norma 1 : with. in :t: 2SD of median IRS Underweight (Below Normal):<-2SD of median IRS Overweight (Above Normal) : > + 2SD of median IRS For children 9 years-19 years of age a. nd adults the Body Mass Index is calculated using by dividing the weight in kilograms by the square of the the height in meters [JJMI = Weight (kg)/ Height (m)~J Ch1ssmcatio n of nutritional status for 9-19 years Normal : P15-P85 Mild underweigh t: P3-< P85 Underweight:< P3 Overweight : > P85 BMI Classification for Adults (WHO, 2000) Underweight Normal Overweigh t Obese : < 18. 5 : J8. 5-24. 9 : 25. 0-29. 9 : 2: 30 a. Hciyhl for /1. ge (!-!FA) Height for age indicates past, chronic undernutrition and a good index of stuntini:;. The height measurement is also compared with the IRS. For ch ildrcn 0-83 mon U1s the exad age is should also be calculated. The cut-off levels for classification are the same as that of the weight for age. Nonna! : :!: 2SD of median IRS Short for age : < 2SD of median IRS Tall for age : > 2SD of median TRS I,. Weigh/'for l-lci9ht (WFH) Weight for height is a sensitive indicator of current nutritional status. It distinguishes stunting (weight is height but height is below normal) and wasti11g (weight is low but height is normal). A child whose weight and height are both below normal is considered both wasted and stunted. Normal : ± 2SD of median IRS for WFH Wasted : < 2SD of median IRS for WFH Overweight: > 2S0 of median IRS for WFH 2. Diochemical Method Uiochcmical method of nutritional asse. 55ment is an obje<. i. ive method of nutritional assessmen t however, it is expensive and not all laboratories may :33. 9 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
3. CO be l':lp::ihll' of c-11r~·ing out U1c specific. · test. Moreover, it could be invmdve und t fwrt'fon. ' 111. iy not be ;,ok to dkit c-ooper11tion of subject~. The mo~t common biod1cmic;il tcs L~ employed in nutritionnl assessment include the following: Deficiency J. Protein deficiency 2. Vitamin A 3. Iron 4. Folic Acid/ 812 5. Iodine 6. Vitamin C 7. Thi:imin, Riboftwin, Niacin 8. vit:imin B6 :2. Biophysicul Tc..~ts 8iochcmic,1I te-~t Serum albumin Urinary urca:crcatininc ratio Serum vitnmin A Hcmo~lobin. Hematocrit Serum lron Serum and RBC Folate Serum and RBC vitnmin 81. 2 Urinary iodine excretion (Ul E) TSH, T3, T4 Senim Vitamin C Urln:iry Excretion Tr:vptophan load test Biophysical usscssment includes tests of functional ability such as nightblindness, and enl:!rgy expenditure. delayed hypersensitivity. It also includes examination of clinic. ally ac=sible tissues such as hardness of nails, tensile strength of hair. ind radiographic e. ~arninations. Dc,iations from the normal functions may be associated "~th nutritional deficiency. 3. Cli11ical Examination Clinic. 'tl examination is relative. ly simple, inexpensive, and non-invasive. It is practicnl ;rnd useful when the deficiency is endemic. It assesses changes in the skin, h:iir, mouth. and thyroid. TI1e c JJnica. l signs are suggestive of nutritional deflclcncy include the following: Deficiency Anemia Vitamin A R. il>oflavin Niacin Vil Jlmin C Iodine l'roteiu Vitamin D Suggestive signs Pale conjunctiva, inner Ups and Palm of hands Bi tot's Spol Stornatitis Casal's necklace Bleeding gums 1l1yroid enlargement Edema/moon focc Epiphyseal enlargement COMMON NUTRm ONAL PROBLEMS OF PUBLIC HEALTH IMPORTANCE 1. PROTEIN-ENERGY MALNUTRITION (PEM) Protein-energy malnutrition remains to be a public health problem in many developin~ countries includin11 the Philippines. ft is usw1lly manifcs1cd as growth failure. PEM r~ults mainly from lock offood and frequent infcctirm. G thot c:wse lnck of appetite while: incna:,ini; tht: body's llt. 'l.--ds for nutrients. lnodt.-quate intake is hroughl about by the interplay of scvernl factors inc. luding political, i;oc-ial, cultural, economic | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
. L and environmental factors. Pnorfeccling practiccssuch as not exclusive ly breastfeeding for six moths, r<11,r reeding 1>rnctices (giving foods too early or 100 lalc) and giving foods whjch lack in <:ncrgy, protein and other essential nutrients from varied foocls are cnuscs of un<lcrnutrili <Jn. This is aggravated by frr. quenl infections because or poor cnvironnumt, inadcqu:1te access to health services, poor maternal and child care practices. The severe forms of malnutrilion are marasmus and kwashiorkor., Marasmus Marasmus results from prolonged starvation and is associated with severe wasting with classical signs of "old man's facie" because ofloss of fats in the cheeks. A child vii th marasrnus appears apathetic, with ilhfo, sparse and easily plucked hair. The child usually has good appetite. Kwashirokor The main sign of 1.-washiorkor is the presence of pitting edema in the legs and feet and can also affect the hands and face. The face is characterized as~rnoon face" likely rlne to edema, hair is described as flag-sign, because ·of alternating dcpcgmentation, the skin lesion called M{laky paint dermatosis". Children with kwashiorkor are also apathetkand irritable. Marasmic-Kwashiokor This is a. mixed form of PEM and manifests with edema bnt do not have the 0th. er signs of kvvasbiorkor. Management of PEM Children with severe PEM are at risk of hypoglycemia, hypothermia, dehydration, electrolyte in1balance, micronutrient deficiencies and infection. Thus, manageme nt of cases requires first, an initial stabilization for acute and medical conditions followed by a rehabilitation phase (WHO, 2000). 1. Treatment of dehydration, hypoglycemia, hypothermia and electrolyte imbalance 2. Treatment of infection 3. Vitnm. i n and mineral supplements to treat micronutrient deficiencies 4. Treat mcnt of other conditions 5. Initial feeding 6. Assessment of recovery To prevent and control malnutrition, ilie following are recommende d: ensure tl1at food that is adequate in quantity and quality, control infection through public health measures and proper nutrition education of mothers and caregivers (encourage breastfeeding, knowledge on appropriate foods for the young). 2. IRON DEFICIENCY ANEMIA Anemia is defined as low hemoglobin level. Nutritional anemia results when there is an inadequate store of a specific nutrient needed for hemoglobin synthesis. The most common causes of nutrition al anemia are: iron deficiency, folate deficiency and vitamin B12 deficiency. Iron deficiency is the most prevalenl micronub:ie nt deficiency worldwide and the most common cause ofnutrit:iona J anemia. Iron deficiency anemia is of major concern because it can affect various stages of life and have serious effects. Iron defkiency anemia results in decreased work performance since low hemoglobin level means low supply of oxygen needed by tissues to perform 341 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
342 work. Anemia 11nd iron deficiency also increases complications dllring pregnancy including premature delivery and low birtlnveight-babies. Jt has been suggested that iron deficiency increases susceptibility to infections. Among children, iron deficiency subnormal cognitive performance. Causes of iron deficiency 1. Decreased absorption of iron whicl1 may be due to decreased intake or poor bioavailability oriron depending on whether source in the diet is heme or non heme iron. Absorption of iron from heme sources is higher than fron non heme fron. In addition, µresence of inhibitors such as oxalates (from leafy vegetabes) and phytates (from cereals) and tannin (from tea) form insoluble complex with iron and thu,c; it is not available for absorption. On the other hand, vitamin C and meat, fish, poultry can enhance absorptio n of iron. 2. Increased blood loss due to hookworm and malaria and to a limited extent tricburis; excessil,-e menstrual flow and bleeding from the gastrointeslinal tract due to ulcers. 3. lncreased requirements irn infancy, pregnancy adolescence. Clinical features of iron deficiency anemia are non-specific. Pallor should be examined at three :;ites: conjuncq\ ·a, the inner lips and nail beds and palm of hands. Other clinical features are respiratory distress, sleeplessness and easy fatigabi Hty, reduced power of concentration. · Diagnosis Diagnosis of anemia is based on determination of hemoglobin and then specific-tests may be requested (refer to the bioc]1emical method section) Treatment For immediate alleviation of anemia, iron. supplementa tion is necessary. The dosage will depend the age and physiological status of the patient. Prevention and Control Approaches to the prevention and control of anemia include the following: 1. Iron supplementation 2. Control of infections 3. Forti. fication offood 4. Nutrition education 5. Public health measures 6. Combination of approaches 3. Vitamin A Deficiency Disorders Vitamin a deficiency is defined as the condition that results when the level of total body stores of re. tinol nod of the active metabolites is depleted such that normal physiologic function is impaired. Vitamin A deficiency disorders (VADD) describes the spectrum of conditions associated with Vitamin A deficiency from chronie d. ietary deficit, tissue depiction, systemic effects, xerophthalmi~ and finally corneal blindness. Vitamin A deficiency is primarily due to Jack of intake of the good sources: namely: animal sources, liver, eggs, meat, milk and dairy products. Dietary lack of fat, protein | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
and vitamin E which are needed in the metabolism of vitamin A can also lead to the deficiency. Frequent infoction increases the requirement for the nutrients including vitamin A hence increases risk of deficiency. clinical features The clinical signs associated with Vitamin A deficiency depends on the stage or severity of the deficiency. t. Nightblindness, a functiona l sign character ized by difficulty in seeing in dim light 2. Conjunctiva! xerosis or drying of the conjunctiva 3. Bitot's spot-a cheesy, foamy whitish deposit usually in the temporal quadran t of the eye 4. Corneal xerosis (corneal crying) 5. Corneal ulceration 6. Keratomalacia-the most sever lesion characterized by the softening of the cornea Biochem ical Feat L1re 1. Serum retinal determination by high pressure liquid chromatography : Normal Low Deficient Treatment 2:20 µg/d L or 2: 0. 70 µmol/L 10-< 20 µg/d L or 0. 35-<0. 70 µmol/L <10 µg/d L or< 0. 35 µmol/L Treatment Schedule (WHO 1988): Inf-ants and ch1ldren-<8. 0 kg. Presd:loolers Immediately on diagnosis 100,000IU 200. 000IU Followlng day 100,000IU 4 weeks. tater 100,0001U 200;0001U Prevention and control There are several approaches to prevent and control vitamin A deficiency. 1. Prophylactic doses given every slx months Infants 6 months to <l year of age-100,000 IU 1-5 years-200,000 Il J Mother upon delivery-200,ooo IU 2. Give fortified foods 3. Health educati. on and horticulture 4. Nutrition educ;ition 5. Public health mea::.-ures to prevent infections 6. Combination of interventions 4. Iodine Deficiency Disorders Iodine deficiency dfaorders (IDD) refer to a spectrum of conditions associated with lack of iodine. These include goiter, ment,. land growth retardation, cretinism, abortion, stillbirth s, thyroid enlargement and slow decision m~ng in adults. 343 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
causes of IDD IDD is due to inndcquot e intake of iodine-rich foods such as seafoods, seaweeds and jocfu,ed ~alt. incre:isccl l'l'(Jllirement-s during periods of rapid growth (adolescence, pregmmcy :md lactation). nnd consumption of J)laots grown in iodine depleted soil and waler. Consump tion of foods containi11g goilrogens like cassava. cabbage and lima be:ins mny interfere,dth the metabolism of iodine by the body. Const-quen ce. ~ ofl DD lodinc defiriency l111i; serious consequences. The most commonly recogni1,ed con~uence is goiter or enlargement of the thy Toicl gland. This can affect man al n U s1age;; of life. Crt'tini$m results when there is iodine deficiency during fetal life: ncurologic-;il crl'tinism (dc-fidl'cnl'y in early prci:n11ncy) nnd h~1,ot. hyroid cretinism (drfirienry in lnlt'r pn·gn. i111. :~·). Mnnifl·:-tation:-of endemic crct ini~m a re cle;1f-rnutism, squint. ntt'ntal ret:ird~tion.,;rowth rvtnrdatic,n. Children i;ufforing from I DD ha\·e poor school p('rforn1ru1<. 'c dm· to low [Qin childr<'n antl oflen drop out or sehool while adults would not able to perfnm1 we_ll :11~0 at \\'Ork,md other tasks. Among pri:-gnant women with l DD, the conseque11ces include nbortions, still births, and miscarriages. Diagnosis of IDD Iodine deficiency di~orders can be diagnosed through clinical mctliods by e:mmining the thtmid gland and identifying cretins in the eornmuni ty. 13iochemjcal methods include dt>termin:i tion of urin:1~· iodfoc excretion nmong school age children, serum len:li-of 111~-roid hormones. T3 and T4 nod thyroid stimulating hormone (TSH). Iodiu P len?I of drinking may also be detcm1inecl. Prevention and Control The implementation nf the Salt lodizntion L. 1w in the Phi Hppines cnn be regarded as imtnunental to the-dmmatic effect sct:n in reducing the proportion of schoolchildren \\ith deficient ll',·el;; of 11rinn1:· iodine e.-:cretion. Also consumption of iodine-rich foodsl'bould be contirn11>11:<l_1·c11eourni;ed nnd in nreas where IDD is endemic, ghingof iodized oil should continue as pnrt of the nutrition progr:1m. 5. Overweight and obesity It hmi no"· been recognized that oven,·eight and obesity are emerging problems that need to be addressed. lt has been observed that over the years, the prevalence of o,·erwright i~ constantly incxcnsing (FNRJ, 2007) :md is seen in all ages, thus efforts to prevent further increases are in order. 0\'1!1wdght nnd <1be. sity result from nn imbala11c e in energy intake·and energy output (Seidell :ind Vi~scher. :. ioo4). Tl\is is due to chronic excess energy intake and reduced physical arti,;t) (decreni-ed ener~· expenditure). Obesity is now well-recognized to be a risk factor of rar<litl\'ascul:1r disenses, hrpertension, type 2 di11betes mellitus. It has also bi!i!n assoc-i. ated "ith cert·ain types of cancer, nnd conditions like osteoarthrit is, and respiratory disorders. Pn·vention nncl control of overweight aud obesity, should include modificntion of lifestyle habits, promotion of healthy eating lmbits and regular physical activity. SUMMARY Nutrition pla}'S nn important role in nchle Ying overall health of an individual. A person cannot achieve healt J1 and well-being at the highest level unless U1at person is or good nutritiona l status. Therefore, henllh workers, whetl1er in the community 344 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
or the clinical setting should ha Ye a b.-isic undemanding of how to achil. ?\-c optimum nutrition. th. : factor. ; d1a1 can affect it. and the solutions whicl1 cnuld be the basis for appropria te ad,;ce. REFERENCES AND READINGS 1. Food and Kut Tition Rese;ircl, lnstill1tc. Food Excha11oe l,i!lt:5 For M1c'Ol Pla1111ing. R-Rl P\1bl. No. 57-ND 8(3) 1994. FNRt. DOST. 2. Food and Nutrition Research Ln~itute, Tnbl. : of Weights 1111d Mcam11"1:$. and Table uf Conversion Fl1ctnrs. 19,. FNRI-DOSr. 3. Food and Nutrition Research lnstih:ile. Re·rorw11t"tl(led F. r1crpy and N11trit·nl Intakes. Pltilippin~, 200:. 1 Edition. FNRl-11OST. 4. Gibson, R. S. 1990. Pr-inc:iplc s q[N1r. cririorml Assrssmt"n t. O. "rfonl Unhcrsily Press, New York. 5. lnterngem:y Committee on Nutritio11 Educution (l CNE). llgn'cult um/ Research Service. USDA. Nutrition Proi::mm News. Scpt. :mbcr-Octoocr 1964. 6.,felliffe, D. B. 1966. Assessment of N11triticmnl Status of tlw Community. 'Nl'f O Monogr. Series No. 53, Gtnc.,,-:1. 7, Mendoza. T. S., Ocampo. M>L>. ond Onrhn. C. V. C.. 2003. U:::r T·s Manual 011 the l11ter11ational Reference Standard (]RS) (;rp1NII Ta/Jlci: and Cltarrs Adoptedfor Field Use in the Philippir 1c$. FNRl, 0057' 8. Peckenpaugh, N>J>, 2007. Nl1tritiorr lisscnrials a11d Diet 111crc1py,1oth Ed. Saunde. rs, Elsc\"ier, St. Louis. Missou. ri. 9. Seidell, J. C. and Visschcl',T. LS. 2004. Public 1-fralrli.-\!'peers n/ Overnutririon in: Public Health Nu. tririan, eds.. Gibney, ~LI.. Mnii;ctts. B. M. Kearney, J. M., and Arnb, L nlnckwc Jl, Scicnc:. t, UK. 10. World Health Organization, 1988. Vitamin II Supp/cnrnntntion:. A guide to their-use in the treatment and pnwention of vitamin A defi-c:ioni:t J a_nd . '\'. erophthalrnia. \-VHO/UNl CEF /IVACG Task For C\!. Geneva 11. World Health Organiw. tion. 2000. Mcmagcmcrit of the cltild with a serious infection or severe ma. lnutrition Guidelines/or-care an: tl11:Jirst n:ferrol level in developing co1mtries. WHO/FCH/CAH/oo. 1 12. World Henltl1 Org:mization. ::?Ooo. Obesity: prt'irt'nting and managing the glol>al epidemic:. A report of IVHO Cons11/tation. Te<. Rep. Seri~s No. 894, Geneva 34S | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Chapter 14 APPROPRIATE TECHNOLOGY FOR THE PREVENTION AND CONTROL OF MALNUTRITION IN EARLY CHILDHOOD A1'aceli S. Maglaya NUTRITIONAL STATUS OF FILIPINO CHILDREN : CONSEQUENCES AND IMPLICATIONS In Ilic 11pan of fifteen ycors from 1989-90 to :,mos, there Jion been a rc<. luction in 111c prrvttlencw r,( 11nrlcrwci;;ht (from :~,1-5 pcrc<:111,,, 24. 6 peret:nl) 1111d under height (fr,,m '. l'J. <J pr·n··nt,., :. 1r1. :i rwrcr:n1) among J/ilirin,, c:hil<lrcn agr;s :1. cr0 '" five years (FNHl-l><JST, :.,11117, p. 14J. 11,,w,v1r. acr·1,rdi11Y, 1,, the l'hilir>r>in~ Nutritiun l(uport of lhc fl<1<1rl ;ind N11tri1i,,11 Jnr,1i1111:. /)1:1mrtm1:nl,,r Scit:m. ::,md T:d111ol J~Y, 1hr;,,vcn,11 lr·nd>< i11r J.,. :,1r· 1/i;,1 ru:oln111r,1i,,11 r1..:11i:,irn, Ir, lw 1111;,,v,;rridin). \ prr,bl1:n1 H111r1r11~ the vry y,;1111,1, ;imf ·,11II 111:·d. <i 1,, t,,, tl11 prit. 1rily,.,,,,,. (:n1 (J'NIU-f)OST, :;,,r1<17, p. 15). To rlund::. 1,-. liir,d11mir~;J ;u,..,-,,.,n,,nr d,,111: iri 'l-<ir,:s n:w:nlcd 11,:,t lr,w hrr JJ<J)<,lohin l1:vcl11 (ln<llr:11i11Vi 1r,,n dl"firi·nr ·y iln<!mi;, 1r ID. I\) ;unrmg i11f,. nt:<1, '7·! 1,n,,nth!< (()(,. ::. ! '1/2,) nnd onr y,·aro,lrl c l11lrlrr·n lr,:f¼> w·re,,( liiv,h rrw1~,11ilud1:, with,,vcr-all r11·cval1:n,:r; of r1111·n1ia :1111,n~ 6 rrirmlh11 tr, !'i y,,;,r,,,,Id h1:i11K ::2.,f1/2.. 'll H! prr:v:ilcnc,, of vitru11in A ,1,-fwl,·rwy (VAl)J :,rri,,ris~ i11fan1'1 h M, h·r11 in1r,:rnl11~ frorn '. {7,:,% in 199'. $ tr, '17'X, in ~ri,,:1, w,111,,w·r-:ill r,r,-v1tl1n<:·,,( 40. 1% am,,nv. c:hildr<: n five y,;am <1( us;1: und nclr,w, irwr,·:11,in1~,J.,. ir ri<ik 1,,,,,.,,,, rr·<,i;. ;t;,111·1: 1,, di~,<::rn,:, r,11ir J~rr,wth, i11al1ility 1,,,,;r in dim Jli:,ltt,,,,.,,.,,,,v,1y,,( tlw r-y·'> tr, hri?,hl llithl, dry111:w,,,( th: 1:y1!, and l,linc. l11rm11 i11 ncvcn: 1:J1>1', ( VI~ Hf f >( J~T..,,, 111(,, p. 7.-;J. ·11,,, prv;t1,,n1·,! (If zinc dtrfid,:111:y H m,,n J~ i, 1(:i111H w1-111 9 1% with 1h1 f1,11r y1:,r-t1ltl, t1ilrlr1n ti:,vlu;~ th,, hi;~l11:. 111 pn:v:1l1:n<:~ of ;d11(: di:fi<. :i~ncy al 1:~:7'x.. ·11,,,,,vrr-all p,,,v:,1,·rw· r,{ 1. iur rlr·fidcn:y :1111m1g i11fa111J., a11d cl1ildn:11 up lo f1v1, y1,11r11,,f ns:. · vmt,,,r,,,irl·r·l 111r,l1,:,1,, at 'J. H'. I(. in :. i1J<>:1. Zi11t: (l,,fii;ir:11~:y r:n1t ril>ut<. :t J to lm-rr,,·d rain, rr( inf,.,.,,,mr. li,I,,. di:1rrl1,,;, ;11ul pnc11rnr,ni;,, :,. Inc· h<:ins, :,n i1npor1. ant fr H'l<,r in 1,,,.,1 iinm11rw rlf·m. ·., /I l<1ft:, ;. r1t·J l~r,,vrn, 21,04). <;Jl11I a!II prr Jd11c:li1m nnd 11,;,11·,rml n111(r:,1l,,rr.,.,,,,nt<l 111vrolv·d in rapid aynapli· cr,n,w<:tir,n;, ;incl wirins~ in br:1in d-v·l,p111 111 il11r111;~ f,t:rl 1,/r Jill r-:;rly r-1,ilrllir,r,d, arr· ;,ff1t Jr·d l,y 111:tl1111iri1ion. Iron c J,·f1,trrn-; 11r1·1rti;i,:;11J'l1" in,pnl,.-. d l1r;u11 Jv··l,,pn,,:rit dur· t,, d,-cr1·r1}!J dr,11:nrnine while. fr,I,,,ti 111 rld1r "''"'>',·;11,,,,. _ IJl'1tr. 1I '"'"' r1,-r,-,·1 frt Jn d·fl<'i<JH')' in Hlrlf Jrt;t, tltc nr·onale R i" r·h,1,,,1 Ir, anti;,,.,,,,.,..q,1·ttr··,,I pr,-v:1l·nr·1,,fr11wr11la :1111r,n1~ rh,·ir prr·g11;,11t rnolh(;n; (-1;V/K) it11d IJ><1. a1 tr1K nrnl hn>1 (-1 :. i. :/K,). llli,, m pirirally,w ppr,r1 ·d by I I Ir: :. ioo:3 Pl Ii Ii ppi rl C N11tritl11n Rrpmi ur llw l:-..'HJ, 1>0/i T (:. t C>tl6, p. 71). 3116 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Protein-caloric malnutril itm ranked numhcr JO ;1s cause of child mort:11ity among J'lilipino children one lo four years of a~c: (Nati,mal Epidemiology Center, 11epartme nt of J·Jcalt h, :. ioo2). I II the snmc year, Lhc tnr tl,rec causes or murtnlity in early chilc. lbnod \'/Crc p11c11nio11ia, diilrrlu;:, ;,nd m,,,,slc:,;, ;111d,,ftc11 a ('r,mhim,t ion of thcqc factnrs with unc. lcrlyin~ mal1111t. ritinn. Thns<, who ~,,rvivc death will carry the residual effect.,; of cliildhnocl 1111dcr nutrition, as le. 'l'i fit :,dulls with low productivity potential. According t<J the f-'N l{f 200s Phil i pr,inc Nutriti11n l«:port, the tripling uf the prevalence of c,vcr·wcight ehildrcn frorn 1998 111 11005 (from o. o'¼i t. <i 2. 0%) sh!Juld not he taken for grnntcd, pur1ic11larly hcca11sc of the r. :mer-i-:ing lifostylr!-rclalc<l nrmcommu nicahle diseases und risk fo,:1r1n: :;uch m, diuhct1:s rncllitus, r. :m Ji,,vascuh,r rfo,e. ise and hypertension in 1. itcr life am. I even am<in)c\ childn:n in s<irnc cases (j!f J07, p. :30). community health m1r Hcs play :i c:n,t:i;,I mle in the prev<:ntic,n 1Jnd control of mnlnutriti<m i111:,1rly d1iklh111,<l, IIy fr1cusing (m the rcas<m!. why m;ilnutrition per~;sts nnd w1,rsc11H in tl,i,; :i;;c: ;;mup, they 0111 ma;,cinii~. e 1lw full p,,rticipation of familic.-i and c. :11n:-;;ivcrs 11n tl,c Ullt: of nppmpriatt: tcchn,,l,~gy t,J cnh:inc. :c family cnmp<:tcnc,ies ,m food Hclec:tirrn, prcp,,rntion ancl feeding using 11,c;,lly,,w1ilahlc ancl afforclubl. c food sources ;ind,,pt if Jn~. CAUSES OF MALNUTRITION RELATED TO FEEDING PRACTICES Studies and experience show that the cause. ~ of mi,lnutrition, particularly 11nc Jc;rnutrilion, in c;,rly <:hil<lll'1od rc:latml tn fccclin~ prnc:ticcs include: (a) non hrc;,st fc:titling or !:srly wc:rning; Ch) absence IJr tir inad11q1i:. 1t,~ r.-omplemcntary feeding during cxtcntl1:tl p<~riods,,f hre:istfectling or dcpcncl<'ntt 11n :,r1ificial feeding; and, (c) J;1ck of rir i11:1clc1p,at1: 9kill in n11rnu1~in~ diarrhr:u :it hornc. diarrh<,a being the second :imnn~ the l!. !tidini. : c,1uf. Cs r,f child m,,r1ulity and,1m,;ng 1h1; Hlf> 3 most commc,n causes of infnnl clc:uths (Nution;. d l~pidcmiolo~y <. :enter, Department of l lcalth, :wo2). NON-BREAST-FEEDING OR EARLY WEANING In a study on conlcmpornry pattcrn11 ofhrem;t-fccding involving countries like India, Chile. Ethiopi;1, Nh;cria, G11ntcmal:1, llun~ary, Sweden, Philippines :ind 'l... ain:, it was 1llinw11 that the l'hilippiru:s ha. ~ the lr Jwcst p1:rr. :1:ntag1; of molht:rs hmasl-fceding their ch ild1 ·11 at birl h :,crn,s so<:i,,-c:cnnomir: lcv<:ls ( W 110 19fl1, p,:M)-1\1:ycmd 1hree months of c:hild's ll J!,'', th· l'hi I ippirn. :s r:rnkr:t. l lhi rd lri l:hflc and Gu:,t,am:ila :inwn~ the countries with th; low"-ll 1ti:r1,r,11ta)(<' of urban poor um1l11. :rs br,:ai;t-fl:ccli11g. II rank,:cl v;cnnd to Chlh; um,111i. ; 1l11; c<>ttr1triw; with the l<iwest perccntogc ofnirul rnrithf:rn hrcnst-fc:cding. 'l11c sa111c Ht111ly sh,,wcd t. h:,t ;,111n11g ti,<: urh;,n pc,or, the nccr,nd i;h,,rtcsl tlurnlion of l,.-c,L1o11-fct:d i11~ is in I he l'hi Hppin ei; wh C!r C 2/~1 of all infont J; h:11] been wc:mcd hy the age of Rix mont lis (p. :1:J). Eitpcricm. :c flh1Jws that urhrin poor mothers,ire lcsi, likely tti hri::;1stfced their habics at r1 long1:r period (if th,!y arc :1bk tu brc:. ast. focd at :ill) because they join the l:1hor force to aui-rncnl the rnrnily im;om~. In s11mc arc:rn amr,n~ the urhan slums, these mothers are thl! Hole hm:id,...,. i11ncrs, wilh hush;1nds hecorning lcsii able tc> c,,rn for t J,e:ir familic.,;. Among poor families, hahtcs who urc not brc:;1s1-fed fire likely to suffer from mulnutrition c:onr;ic. lcring the unavailability of low cost, highly nutritiou s aml easily dlgcstihlc rcpl. iccmcnt for breast milk. 347 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ABSENCE OF OR INADEQUATE COMPLEMENTARY FEEDING DURING EXTENDED PERIODS OF BREASTFEEDING OR DEPENDENCE ON ARTIFICIAL FEEDING M:rny infan L-. and toddlers suffer from malnutri Lion becaw,e inudcquat e milk int:-ih. : i, 1101 auzmenled by other foo<. I sources to meet the body's rcqui rcmen L.., f,,r calc,nr,,, prr,ti,,in, iron, otlcium,,;inc, vitamin,\ and other nut ricnt.,;. They;, n. : 11,,1 J!,ivr=n c0>mplemcnt;;il")' f,,,x J in th!: amount anc J kind needed for v,rowth and dr:vc:1,,p rru:nt. . :",lorr1,vcr, non hreastfeedin~ or early weaning encourages derendenc:c on :,M ifi<;i;,J r,r h<1ttl~ fr,ding. \\'ith the increasing cost of comrnercia J milk formula, p,,,,r fomili,. :s re,,rt Ir> )!. 1·. ·ing hi~hl), diluted mil. k formula lo their babies. Amr Jng ud;a n pr,r,r f;, mi li C!. 'i .,,1,,, n·ly 1,n h<,ttlt-fc:.-rc<ling, condensed milk is widely ust,d bec:,usr: ii is c:h<::,rer and last'< 1<,ng<-r h;lhout refrigeration compared to other types of milk in liquid form. Con. "id!!ring that condensed milk contains more sugar than prot·cin, babic,s r C!cx:ivl: inadequate nutrien t'>...._;th the absence of or inadequate cornplement,11]1 feeding. LACK OF OR INADEQUATE SKILL IN MANAGING DIARRHEA AT HOME :. fill, and c,her cnmple:m. entary fec<ling are often discontinued when babies and trxlcl!:'r-; ha·-~ diarrhea. ~lathers and other care takers are afrajd to give milk,md i. olids .,, 1. h~1r id· chll-1. :.,n ~use the !aner pass more stools..,,;th fo<xl int:Jke. ·1111. : lo,-., rif fluid-:md au,r. ~m... du~ tr. > diarrhea i!; aggravated by the v,·i thd r. awal of milk and food. Th1;~ rbar Tn~ n'!!p<; t<, c;,o...--e ma Jmu. ntion,,,,,hich, in turn. leads to a m;il:,h<;orption r,~r,t;..... ~a· =···=:s di.-. :Thea,,·o~S'!-Studies have sha.....-n that maln<,urished children M··'" d~a:. n,::,: m";n,,,ft. en t:. hat ·.-. ·ell-noiuished ones (Cutting and Savagc 1981, pp. 13-1,1J. y,. ;,. L"-uvi ·.-ierr~"-C-/d!, uf malnutrition and diarrhea. They each make the other .......,..,J~.. INTERVENTIO ·NS USING APPROPRIATE TECHNOLOGY rr-f!r. ~. i,::. rtt> ~e-;1:nt on::ontrol malnutrition in earlychfldhoo<l using appropriat. e eri-. r;r;m-. i:1d::,:,e: <a1 Increase f. a:mit;· comv. aencies on how· w mr,nitr Jr nulriti,:mal .. :.,. ·1 ~:-~-. :::,,. u;::. u. ru·e 1~ or<lel-w ace dress nutrient inadequacies thru prop(!, fr>Od -e...-,.,..... _~ ;......,-,..r::,·..,-,-:. ba. ~ r:n..,pecific nutrient function s and food <;r JLJrcr~: (b J re;;a:,;,,: v,. :.-:-.. :c-.,,;t:. u:-· ~~mi t Jf t,:. tj}:,· ciigest:ible, locally availab le prr,tein s,,ure<;S; «:. 1,.-~~...-~-,,~~!: ~"-; th1: :=mmend!!d energy and nutrient intake(R. E~I) fur r. r. ··r· an-:::-~-pe:-&:.-: a;;tl. <c> appropriate home management for diarrhea. FAMILY COMPETENCY-BUILDING ON NUTRITIONAL STATUS OF CHILDREN AND OPTIONS TO ENHANCE PROPER NUTRITION :: hel-. :::1: fami~ uac~ d the irec:lities of undernutrition among the young. 2·-r I a~ ·-,;;-,;e::-... b!e r:;~mber<,. the CH}. : c;m us,, experiential learning approaches w ~. h,!' ~ ·J,.. f. a::nil. '!' ;,:Ow!:} t<. 1 kn~. rt their lived experiences on food selection. p;-~:-2-.._1, n ttr-d ~·~. :~ p~;;,i:-ic-.,.... u~ing their ~~ nutritir,n;d a~~es. smcnt d,ata on ...-~. : !-i,-zm,:>1 <121ly f,,.-~ 1:1wt:. Thr'7UJµl pra('tl CP--;,on<: on taking v. ·eigh L J-.,-~h c-. c-:.-~. n~ ;:;d c=roir:2 dieta..";, in. take usin~ lhc daily food r Pcord ( Sec chaptc. r 13 r..c:),... :,,.,. :-.. : <f1>:r fa::iil:, c--c. r. :-t2ke!r'S can appreciate earl~-and regular monitoring of n. i::. u~ ~:t.,n..~ r.,f,h. '?ireuldn: n. The au. rse-catal ) st panner can use these data as WI. L"-tr. Tt. ion, 1. n ba: :::. rapn p:. e chan or pictograph to help families visualize I. he nature a:-.-! e:w:1e. ;:;: o~ rr;2!r;. ;rr TTtit1a in oroer to address its specific causes. For ex. ample, based 34B | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
011 the dietary intake C0llut1:,J from U11. : di,ily food n:C(,ro, the families 1;,1n,111;,fy,. r; specific nutric. :nl c. lcficir Jncic!'I f mm the n11n-,;'r, explicit ilf 11sw,tions, pict 11n:. ~ :,nrl '>imp!: explanations mi nutritional a~sl,s,,;me:n1 d:,tu, their imr,lir:atious u11d crin,;,:,Ju<:nc,,,-c,r proloni4!. !<l nut ricnt <lcficif;!ncics. Using the "fnr1k-think-a1;'1,;1clr: rif 1111: p:1r1i,:ip:J1r1ry approach, the fo111ilics arc mr,tiv:itcc. l to ;;dc. lrc. % the ide11tifi1:d prril,l,:111. Sp<:1·ilif·-. t:r,s 1,i (:[lrry nut ti 11. : r,plior1:, <:Hn he:,Jc. n<: thmugh i,d,;q UJJI<; prac;I i<:t: M:s~ir,m, ;n fo,,d !. <:l:ct irm, preparatirm and fcc:dini l<:chnique s. The cr. imp,,t,mcir:. <, Ir, c;,r,y 0111 1 hr inlr:rw:ntion options can l,c su~lai 111. :d through enhancing t JH, w1Jrkability CJf nut riti(,n optir,m; (Sc:c chapter 13) :rnd affirmati on of fomilic:. r;' sense CJf cffi C<J<='J in handlini; lmpli:mcrllalic,n problems and lapses. REGULAR COMPLEMENTARY FEEDING USING PROTEIN POWDER S Low cosl, easily digestihlc and highly nutritious food sources nf prr,tein (:.,n be a tided to the diet or i nfonls,rnd trx:ldlcrs who are usually ~iven,,nly pl,11 n ric,;,,,th1:r cerr.,.,J:,; nr root cmp, for (;(,1-nplc:nicnlary feeding. Hom!:rna<le prot,. :in p<,wdr:rs c:in b· prt:parc:d using lor:;tlly,ivailahlc: for,d sw:h :as smi. 111 shrimps (1:. g. "1,l;,man. ( :md ·u. guntr,n"}, small fish (r:. g. "dilis'·, "hiy:,-, ·ayungin") and dried h<,ans (c. f!,. m1m!!,Wl,,,:hile, black and red hc:sns J. Prntcin analyi,is r,f specific type. s <if )()<:ally i,vailablc fr,Qd wa;; d<Jnl! by the Philippin e: Institute of Pure and Applied Chemistry. Table 14. 1 shows t J-11: pro LC::in content of lhc:se lir,rni:maclc protein p0wdcr. s.. Protein powders,:an be woked for at least 5 minute!; with boih:d rice ond sanll'-e<l c,r stewed vegctabl<:.. c;. Sugar a. nd t Jil t:an be added in the mizturc. PO\,:derr:d hcans e;.,11 l:x: given to infants a~ early a<; three or four months in case. '> when they are n<Jl br1. :astfc:d or are suffering from malnutrition. Powdered shrirnpr. and fish can ~,,, giv,:n at age six mrmths and older. 'Jbe amount to b<: givc:n dfapends upon the. protein crml{:nl of the locally a\'ailable food and the recommended nutrient intake (Rl\'IJ for infon L,; 11nd toe. Idlers per day (see Tables l4. 1 and 14. 2). TABLE 14. 1 ANAI. VSIS Of ~flll Oi id N CONll!Nr GI s,,a;a. r,,'ifs OF LOCAU. V IN/IAAIN EJOOD SOURCES Smail Shrimp Small fbh ("'dffls"} Monao White Beans Blacklleilll S Red Beans 349 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Toddlers . :1.-3 years 2'l/3cups (cooked) 1. small piece 5 level tsp. 6Tbsp, 4Tbsp, 81/2Tbsp. 101/2 Tbsp. 10Tbs. j::,. 11 Tbsp. :lkup, cooked '4 Tbsp. sp. P The following section of this chapter describes the procedure. in the preparation of specific types of protein powders. Powdered Small Shrimps 350 1. Clean the shrimps. Remove tl1e dirt and let water pour down the shrimps in a strainer. Be sure to remove the antennae of the ''tagunton" (shrimps bigger than the "alamang"). | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
2. 3. 4. 5. Steam the shrimps. Sun dry in an aluminum ware or flat basket ("bilao") placed under intense sunlight. Cover tl1e container \\ith clean cloth to keep away mes or dust. If the sunlight is not enough to dry the shrimps thorough ly, toast them in low fire while stirring constantly. Grind oi: pulverize t J1e dried shrimps. Store in a clean, dry, ai1·tight bottle. powdered Small Fish 1. Clean the fish. Remove t J1e seawc1.-ds or other dirt and let Wtltcr pour down the fish in a strainer. · 2 sun dry or toast until thoroughly dried. Follow the prowdure (above) on how to sun dry or toast the stu-imps 3. Grind or pulverize the dried fish. 4. Store in a clenn, dry and airtii;lit container. Fish and shrimp powders must be prepared using fresh ingredients. Otherwise, dried fish and shrimps available ill the market may contain allergens., or may have been frozen too long before drying. 1bese can cause problems to the infants and toddlers. The advuntage of sun drying can be maximized by preparing the protein powders in the summer months or during. sunny days. Powdered Dried Beans 1. Soak the beans for two hours. 2. Boil the beans in the water used for soaking. Make sure tllat the amount of water is just enough to m. ike the beans soft. · 3. Mash the c. ooked beans. · 4. Sun dry or toast until thoroughly dried. Follow the above procedure on how to sun dry o. r toast shrimps. 5. Grind or pound into a fine flour. 6. Store in a clean, dry and airtighr container. INCREASE KNOWLEDGE ON THE DAILY RECOMMENDED ENERGY AND NUTRIENT INTAKES (RENI) FOR INFANTS AND TODDLERS. Bodybuilding food sources are critical for growth and development during late infancy and early childhood especially after the weaning period. Infants (6 mont. hs to less than 1 year old) need 14 grams of protein and 720 K calories per day while toddlers need 28 grams of protein and 1070 K calories per day (FNRI, 2002). Table 3S1 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
8 shows the daily RDA based on the RENI for babies and toddlers. Note that proteia powders are recommended in place of whole milk, meat and poultry as bodybuilding foods. Meat and poultry are \Jsually more costly and not as easily chewed as protein powders by infants and toddlers. Considering the price of commerc ia1faed whole milk, protein powders made from less expensive, locally available food sources of protein are considered as appropriate technology option. The daily RENl from protein powders and other foods can be divided into several feedings. Infants ant. I toddlers may need to be fed more frequently than older children and adults consider ing the capacity of their stomach. Certain behavioral characteristics such as short attention span and preoccupation with new found freedom due to increasing locomotor development among older infants and toddlers may decrease their interest lo finish a serving full of foocl in one meal time. APPROPRIATE HOME MANAGEMENT OF DIARRHEA Many families believe that it is wrong to feed their children suffering from diarrhea. They have noticed that the diarrhea seems to stop sooner if their children are not given food. As ex-plained earlier, starving a child with diarrhea makes his nutritional state worse and he will have more attacks of diarrhea later. Families need to know that the two-part oral therapy of fluids and food can prevent many hospital adnuss ions and many deaths from b_oth dehydration and mulnutrition. Adequate fluids must be given as soon as the child first begins to pass diarrhea stools. At this time, extra fluids such as water, fruit juices, soups, milk or whatever the child drinks can replace the ones lost due Lo diarrhea. When rehydration is not started before the child begins lo show visible signs of dehydratio n, the amount of oral rehydration solution (ORS) containing sugar and salts that must be given is determined by the degree of dehydration and the weight of the child. The guideline s are described below (Cutting and Savage 1981, pp. 4-16): Mild dehydration (5%)-characterized by thirst, dry mouth, less urine, weight loss: Give 50 m J. ORS/kg. body weight in 4-6 hour~. · Moderate dehydration (5-9%)-characterized by sunken fontanelle (for babies less than 1 year old), sunken eyes, rapid deep breathing, Joss of skin elasticity: Give 75 ml. ORS/kg. in 4-6 hours. Severe dehydration (10% or more) characterized by weak pulse, cya. ilosis, cold limbs and/or coma: Give 100 ml. ORS/leg. in 4-6 hours. May need rv fluids and hospita1i7. atio n. If a child needs to go to the hospital give him oral fluids on the way if he is conscious. With ORS be will not be so seriously ill when he gets to the hospital. · While diarrhea continues ORS must be given in the same volume as the fluid lost in the stools. If the eyelids become puffy, stop giving the ORS and continue giving other fluids. Start ORS again when puffiness is gone and if diarrhea continues. If rehydrati on is slowed up by some vomiting, additional replacement fluid must be given. Diarrhea due to infection is the body's reaction to get rid of the toxins produced by microorganis ms. With diarrhea the toxins are washed away from the body. Drugs that aim to stop diarrhea are not encouraged because these result in the absorption of the toxins. ORS does not stop the diarrhea, which may continue for some days. However, ORS reduces the danger of diarrhea (dehydration) because it replaces the essential 352 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
water and salts lost \\ilh each diarrhea episode. some henlth centers in the,;llagcs or "barangays· supply patients "ith prepacked oral rehydration sa Jts. Each pac:kel is dissolved in one liler of the cleanest drinking "·ater available,,~ith iustructions to disc:ird the solution if not taken within 24 hours after mi:-. ing. If the oral rehydration packets are not available. home-made ORS can be prepared. lfased on the Reduced Osmol. iritv Formula (WHO/UNICEF, 2004) of 13. 5 Gm/L Glucose and 75 m Eq/L Sodium, home-made ORS c:m he rnixe<I using 3 level huusehold teaspoons (15 grams) of sugar and i/3 level lea!-poon of in<li1. ed salt dissolve<l in 1 liter of the clea11es1 drinking water nvailablc (prefcrnhly cooled boiled ,-,ater). 1f rock salt is used. 1/., level of hous<Chold tca$poon will give approximately the same amount of sodium. The reduced·osmolanty OR. S addressed the concern for occasional hypematremia from the standard ORS formula. Howf. 'Vcr, the new ORS showed increased risk of hyponatremi;i (odds ratio 2. 1) (AJam & ot J1cr. :. 1999). Sbou Jd there be early clinical indicabon of hyponatremia, such as lethargy or wcakne.,;s, the child must be brou):\ht immediately to tbc nearest health facility. ln the interim. the child should be given foo<l sources of sodium. Juice from citms fmits such as orange and ca\aman si can be added to each cup or serving of ORS to improve its taste. These fniits arc rich sources of potassium, an important sa Jt needed by t11c body. Another liquid source of_potassium is coconut· warer. Wboever mixes and gives the ORS must ta... <:te it before making the sick child drink it. It must not taste more salty Lhan tears. Too much sall cnn result in hypematraemia (high ]eve] of sodium in the blood) which can cause fits and brain damage. W11en the solution js very sweet the diarrhea may continue longer and the child may lose more wate. r. The ORS must not be contaminated "ith dirty hands, teaspoons, cup and storage vessel. Once mixed the ORS must not be used after 24 hours. The ORS must be given frequently and in smnll drinks. Following the guidelines on the amount to be given, the fluids must not be given more tha. n 1 teaspoonful (s ml. ) every minute. If ORS is given too fast. the child mnyvomitor refuse to take ony more. If vomiting occurs, give drinks of about 5-10 ml. (1-2 teaspoonfuls ) every 5-10 minutes. Tlris allows more time for the fluid i. n the stomach to pas. s into the intestines to be absorbed before the next drink is given. Milk and so Hds comprise the second part of the oral therapy for diarrhea. Mothers need not stop breast-feedi ng their children suffering from diarrhea. Infants and toddlers taking solids can go back to norma J diet after 4 or 6 hours of oral rehydration. Mothers or other care takers can give easily digestible food such as soft-cooked rice with protein powders and stewed, mashed vegetables. Ripe bananas ("latundan") can provide additional potassium. Fats or oil can be added to the diet only when the child has recovered from diarrhea. Solids can make the child pass larger stools but that does not matter. Uthe child vomits food, give ORS for a few more hours and tty to give food again later. [fa baby vomits breast milk, let the mother express her milk for one or two feedings. Start food again as soon as possible. Food is a very important par1 of oral treabnent. After the diarrhea bas stopped, the child can be given one extra meal each day for one week. This will help him make up what has been Jost. Diarrhea due to infection can be prevented by making sure that the food and water taken by-the. child are clean. The things used for eating and drinking mu!it, lik C\\ise, be clean. Hygiene and sanitation are important aspects to be emphasized to prevent diarrhea and parasitism, two diseases highly :related with malnutrition. 353 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
SUMMARY This chapter presented Philippine nutrition data related with the nature, extent, consequences and implications of ma Jnutrition in early childhooc L Causes of malnutrition among infants and toddlers related to feeding practices and fami Jy-b ased intexvention options are described. Emphasis is gi. ven on appropriate technol ogy to ensure adequate complementary feeding a. od accurate home management of diarrhea. 354 REFERENCES 1. Alam, NH, Majumder RN, and Fuchs, GJ. (1999). CHOICE Study Group: Efficacy and safety of oral rehydration ontl solution with reduced osmolarity in adults with cholera: a randomize d double-blind clinical trial. Lancet, 354, 296-299. 2. Cerdena, CM and otbers. (2002). 2001,Updating of Nutrition. al Status of Filipino Children at the Regional Level. Bicutan: Food and. Nutrition Research Institute, Department of Science and Technology. 3. Clauclio, VS. and Dirige, OV. (2002). Basic Nutrition for Filipinos (5lh Ed. ). Manila: Merriam &Webster Bookstore, Inc. 4. Corra, MN and others. (1985). Malnutrition in the Philippines: A Task Force Report. In Iglesias GU and others (Eds. ) Severe Malnutrition of Filipino Pre school Children : A Policy Review_ UP College of Public Adroioistration and UNICEF. 5. Cutting, W. and Savage, F. (1981). Diarrhea Management. London: Institute of Child Health/Foundation for Teaching Aids at Low Cost (TALC). 6. Department of Health. (1999). National Objectives for Health. Philippines i999-2004. HSRA Monograph Series No. 1 7. Department of Health. (2005). National Objectives for Health 2005-2010. PMlippines: DOH. 8. Dian7..on, BD. and Vi Uamejor, MF. (1985). Philippine Malnutrition Update: Focus on Pre-schoolers. In Iglesias GU and others (Eds. ) Severe Malnutrition of Filipino Pre-school Children: A Policy Review. UP C<;Jllege of Public Administration and UNICEF. · 9. Food and Nutrition Rese;i. rch Institute (FNRl), Department of Science and Technology (DOST). (2007). Philippine nutrition facts & figures 2005. Tnguig City: FNRJ-DOST. 10. Food and Nutrition Research Institute (FNRI), Department of Science and Technology (DOST). (2006). Philippine nutritio n facts & figures 2003. Taguig City: FNRI-DOST. 11. Food and Nutrition Research Institute-Department of Science and Technology. (2002). Recommended Energy and Nutrient Intakes Philippines, 2002 Edition. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
12. Holz, C. and Brnwn, KH. Intemationa J Zinc Nutrition Consultative Group (IZi NCG) Technical Document #1. Assessment of the risk of zinc deficiency in population and options for its control. Food and Nutrition Bulletin: 25:i (Supplement 2) S94-S200. 13. Kel Jy, DG and Nadeau, J. (2004) Oral Rehydration Solution: A a Low Tech" Oft Neglected Therapy. Prat. tical Gastroentorology. pp 51-63. 14. Maglaya, AS. (1989). Factors Affecting Weight Change among Children Below Six Years Old enrolled at the Nutrition Program of a Selected Social Action Center in Metro Manila, The Anphi Papers, 24 (land 2), pp.. 5-4. 1. 5. National Epidemiology Center-Department of Health. 2002 Philippine Health Statistics. 16. Singer, HW. (1985). Priority Problems Pertaining lo Infant Mortality, Malnutrition and Pre-school Child Development. In Iglesias-GU and others (Eds) Seuere Malnutrition of Filipino Pre-school Children: A Policy Reuiew. UP College of Public Administration and UNICEF. 17. WHO. (198. 1). Contemp orary Patterns of Breast-feeding: Report on the WHO Collaborative Study on Breast-feeding. Geneva: World Health Organization. 18. World Health Organization Report: Reduced osmolarity oral rehydration salts (ORS) formulatio n. Available at http://www. wh o. int/child-adolescent health/New _Publications/NEWS/Statemen t. htm Accessed 8/30/2004. 355 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
356 Chapter 15 PARASITOLOGY IN NURSING PRACTICE Winifreda 0. Ubas-de Leon INTRODUCTION Nurses perform important roles in the delivery of basic health services, both in the rural and urban settings. They conduct health promotion, health maintenanc e and disease prevention activities as health team members with U1cse designated bealth education functions. They are challenged to help improve healtb and living conditions through family and comm. unity empowerment. Recent studies have documented the importance of political advocacy and client empowerment to prevent and control communicable diseases in the community (Maglaya 1999; de las Llagas 1-999). Apart from the nurses· major role on health promotion and maintenance, anotl1er critica J area of concern is related with managing health 1,Jroblems/diseases in many parts of the Philippines, especia JJy in doctor-less rural villages where communicable diseases are prevalent. Competencies on accurate diagnosis for prompt and appropriate treatment are necessary for client care. lbischapterwilldealbasica Jl ywithparasitesasca usativeagentsofselectedcom~uunicable diseases encountered in community nursing practice. Some of the diseases, like malaria, filariasis and scbistosomiasis. are endemic in specific communities because of the presence of vectors or intermediate hosts in the locality. Others are prevalent among population groups and marginalized cultural/ethnic communities where unsafe drinking water supply, unsanitary waste disposal and unhygieni c practices are still lhe prevailing conditions. Sections of this chapter \,ill discuss the life cycle of each parasite to illustrate lhe foci of prevention and control measures. Appropriate I aboratory tests for diagnosis and management options for the communicable diseases are also specified. Discussion on the laboratory procedures can be utilized either as requ L,;ite competency for appropriate referral lo laboratory facilities or as additional diagnostic skill that L11e oun-e practitioner can learn for prompt and appropriate treatment. This competency is especially useful in areas where laboratory technicians are not accessible and drug resistance is becoming a big problem as a consequence of use of radical treatment without laboratory confinnati on of presenting signs and ~-ymptoms. THE PARASITES Parasites are organisms that live in or on the body of another organism for survival The primary needs of the parasite such as food and shelter are provided by that otller org;misrn technically know11 as the host. This relationship can be best exemplified by man as the host and hook-worm as the parasite. Parasitic organisms are found practicall y everywhere: air, food, water, soil, inanimate objects like linen and clothing. Some are carried by insects like bugs, flies and mosquitoes, while some sunrive in some animals like swine, cow and cattle. While majorit:y of the parasites are found within or inside the body of a host, there are those that are found outside tl1e body of the host like skin miles and head Hee. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
fhey are able to invade the host using different portals of entry, but the most common is still through the mouth. A few are able to actively penetrate the skin or are passively introduced into the host by some insects. lnfected individual s may or may not show signs and symptoms of infection. Those who do not show the signs and symptoms may however serve as carriers and extra source of infection. Most parasites live in humal) and animal intestines, and are usually passed out with the feces. Howeve r, parasites ha. ve also been recovered from other organs like the liver, lungs, brain, meninges, lymph nodes, lymph vessels, subcutaneous tissues, muscles, reproductive organs, blood vessels, blood cells and even the eyes. Parasites may be single celled culled tbe protozoa or may be multicellular call "worms~ or "helminthes. " The collective term applied to wonns found in the human intestines is hintestinal heliminths " and infection is "intestinal helminthiases" which is one of the top causes of morbidity worldwide. The most vulnerable sector of the population. are the children. There are few parasitic infections which can cause death like malaria and capillariasis. A few may cause permanent disability like elephantiasis due to filariasis. There are increasing evidences today that associate parasitic infections with malnutrition, poor . learning ability and growth retardation. Infected individuals oftenmanifost abdominal discomfort, lack of appetite, hunger pangs and loss of weight. As a whole, parasitic infections can affect the economic productivity and quality of life of an infected individual in particular. If the parasitic infection is present among a big segment of the population, then the effect of this parasitic infection is magnified. The following sections will discuss the parasites according to the different modes of transmissio n. The life cycle of each parasite show the points where spread of infection can be prevented or controlled. Illustrations of the life cycles were adapted from l1andouts given to students of the course on parasitology at the Uniformed Services University of Health Sciences in Maryland, USA. DIRECTLY-TR ANSMITTED PARAS'ITE Enterobius (Oxyuris) vermicularis This parasite is also known as the human pinworm or seatwonn.. It causes an intestinal infection with worldwid edisl-ributi on. Jnfected individuals usuallysufferfrom intense perianal itching whlch maybe complicated w1th secondary bacterial infection. Because of itching, most patients have disturbed sleep resulting to nervousness and irritability. Enterobiasis or o:-. ')'U. riasis is observed in places where there is overcrowding and water supply is inadequate for personal hygiene. Eggs of the parasite have been found in fingernail clippings, door knobs, faucet tops. and even from the keys of the piano and keys of typewrite rs. Eggs are deposited in the perianal region causing contamination of underwear and bed linens. Outside the host, eggs become infective in four to sh: hours. Transmission takes place either through ingestion or inhalation of the eggs (See Illus. 15. 1). Infection is easily transmitted to the othe. r members of a family or a group. Adult worms may be found crawling out of the anus but the choice of diagnosis is recovery of eggs using the Scotch tape method in S\Vabbing the perianal region (See 11lus. 15. 2). Specimen 357 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
358 collection is best done in the morning prior to a bath and/ or washing the periana J region like in defecation. Specific drugs must be administered. Personal hygiene like proper hand washing and keeping finger nails short must be advocated. Contaminated linens and clothing of the patient must be properly sterilized t J,rough boiling. SOIL-TRANSMITTED PARASITES Some para. sites. ire p11ssed out into tl1e soil, where they undergo further development until they become inf~tive. These parasites remain as major public health problem not only in the Philippines but in many tropical and subtropical countries as well. Children who live in areas where there is unsanitary human fecal disposal are often infected by soil-transmitted parasites. Ascaris lumbricoides This is also known as the giant intestinal roundworm. Adult roundworms live in the small intestines. Fertilized and unfertilized eggs are passed out by tbe female ascaris. ln about two weeks, fertilized eggs develop in the soil into embryonated stage which is the infective stage. Soil is commonly contaminated in areas where there ax-e no sanitary toilet facilites or where human fe:ces is used as fertilizer in vegetable gardens. Man acquires infection when these infectiveeg. gsare swallowed mainly via contaminated food. Upon ingestion, the larva is released from the eggs and then undergoes lung migration. During this larval migration, the patient will usually manifest pulmonary symptoms like chest pain, cough and fever. Toe parasite will then settle in the small intestines to develop into the adult stage (See Illus. 15. 3). With the presence of adult' ascaris, the most common SYffiptom is vague abdominal pain. At times patients may harbor a high number ofwormsresulting to intestinal obstruction. Some vomit out these :1dult wom1s as well. There are reported cases when adult worms undergo em:itic migration to other organs like the liver and even the common bile duct. Ascariasis is established ·when adult wonns are expelled by the patient. However, expulsion of the adults does not happen all the time, so in the laboratory, stool e.-:amination is done to determine the presence of fertilized or unfertilized eggs. Techniqu es recommended include the d. irect fee. al smear and the Kato thick smear preparation. To determine the intensity of infection, tbe Kato-Katz (which is n quantitative metl1od) is recommended. Tho patient must be properly treated periodically with broad spectrum anthelmintic, because rapid re-infection bas been reported. Stools should be properly disposed and sbou Id not be used !IS fertilizer. Proper hand washing must also beencou raged. Vegetables that are usually eaten raw must be thoroughly washed before consumption. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Ponovato and do-nlop In mu. co,a / ,rvae lla!Ch...-J :-:;nl Htine ~-~I ___ llfil,...,... ~... w (lnf<!Cllve Sbg,>) M A N Adu~ In lumtn of cecum Egg on Perlanal rclds (dlagno1Uc it. age) EXTERNAL ENVIRONMENT lllust,ration 15. 1 Life Cycle of Enterobius vermlcuiarls 359 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
9-1-~po.,_,..,d of dop,.._. t. o -.......-... 11.... · Jtepl&. e,re ta P4 cm. ud. a. nd amoolb 1, o Ut with th tl:nunb. Illustration 15. 2 How To Use the Scotch-tape Swab (Modified from Brooke, Donaldson and Mltchelle, 1949) | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
M A N Eggs In f«a -f111'§~~~;------___; )tll. _~ Emb,yonatfd Eoo with 2nd s~g l. 1rv;l (lnfe<:tlvc stag) (d L>gno,rc 1>9) Advane<>d c;lea11agc EXTERNAL ENVIRONMENT Illustration 15. 3 The Life Cycle of,o. scarls lumbrlcoides 361 r | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Trichuris trichiura Tliis worm is also knowu as the whipworm because the anterior end is highly atlenuatl'<l and the posterior end i. s thicker and more fleshy. 1t is another common intestinal worm nnd is usua Uy found together "ith Asca. ris. Trichuris eg_i:s that are passed Ollt by the female wonn embryonate in the soil in two to three we.-ks. "·hen these infecti\'e eggs are ingested, larvae are released. They then migrate to the large intestine$ particularly the caecum. where they de,·elop i1lto the adult worm:; (See l Uus. 15. 4). The attenuated anterior end penetrates the intestina l mucosa. In light infection, the patient i~ usually asymptomatic. lo cases ofhea\'y worn, burden, the patkul may suffer from abdominal discomfort and blood-streaked diarrheal :;tools. Bleeding sites h:n·e been observed at tl1e site of attachment. There are available e,idences in the cases ofhea\'y worm infection, anemia may develop. Heavy infection may, likewise, re,,-ult to rectal prolapse. The direct fecal smear, Kato thick and Kato-Katz techniques are very useful in the reco,-ery of Trichuris eggs during stool examination in the laboratory. Like J\scaris, Trichuriasi scan be controlled and prevented through periodic treatment, use of sanitary toilet facilities and proper hygienic practices. Hookworms These are blood sucking roundworms, because they can get attached into the intestinal mucosa of the small intestines through their b11ccal capsule. This buccal capsule ii; provided 1dth a definite dental pattern, which can he Jp is species identification. The two common species of hookworm are Necator ame. rica. n us and Ancylostoma duo<lenale. lo the Philippines, Necator americanus has a wider distribution compared to Ancylostoma duodenale. Animal hook,vonns are also existent namely: Ancylostoma brazilie11se of cats and A11cylostom a ca11inum of dogs. The eggs of these two parasites are very difficult to diffcreatint e. When these eggs reach the soil through indiscrimina te defecation, they rapidly embryonate and after 24-48 hours, the rhabditifrom larva is released. In about 7-10 days, the rhabditiform larva develops into the infective filariform larva. Human infection occurs when the filariform larvae penetrate the sk-in. After skin penetration, the patient develops some form of dermatitis commonly called ground or dew itch. The larvae then migrate to the lungs and the patient manifests pulmonary symptoms like coughing and v. ihee7. lllg. Then the parasites proceed to the small intestines where tl1ey develop into the adult worms (See Illus. 15. 5). The presence of adult worms in the intestines may result to abdomina l pain. Because of the buccal capsule, the parasite is able to bite into the intestinal mucosa and while biting is able to suck out blood from the hos L For as long as the worm is attached, the patient suffei-s from a conslilnt blood loss which may resolt to microcytic bypochromic anemia. Development of anemia, however, is determined by the·worm burden and the iron status of the patient. 362 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I lngcs WI Ll NOC h. !t<h In lnt~tint ---~ Embryonated Egg w (lnfe<UVO 13ge) ~In~'"" develop In muco. M A N Egg lnloce> (dlagno;stlo sb9) EXTERNAL ENVIRONMENT / Advanced cleav~o Illustration 15,4 Life Cycl. e of Trichurls trichiura 1-cell 363 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I I \\1\,\ ' I \ \ \ \I. \ \ \ I 1~ I I \ \ \ \ I \ \ \. \ \ ' \ \ ·.,_,,,-5willowed...._ Pt,arynl Atuitbtd to / 1m. tlllnletl lne' 1m:Ml I Lunas I Circulation I hr1elnln o\ln f 364 M A N (dlagnosllo >lgi EXTERNAL ENVIRONMENT I / Rh>bdltttonn la111a hateltos----:/ IOcculonllly In old ftcu) 11\u,stra\to~ 15. S life Cycle of Hookworm | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
.,,,,,---t\,fl ff Adult In s111al Intestine...,,,,,,.,. _., . / Scolex ettachos to lnloslino Ingested M AN -~ Cystio?'"us In muscle ~ (Infective sta,go) ® ~~·~ge;~~~ln. oyo, connective !Issue t Clrc Uladon ♦ G Oncosphero hotches ponetratos tntel'tinal wan Embfyonated eggs g or progloctids . occasslonally · ingested in feces \ tdiagnostio stages) Circulation s WINE \ © Oncosphere hatches penetrates intestinal wall Embryvnated eggs or proglottlds ingect6d Illustration 15. 6 life Cycle of Taenla sollum 365 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
' \ \ l -' 1 I I \ Adult In small Intestine M A N Gravid proglottfd 1nges11!d _ ffir\ cystie-. .. eus-1nmus·e1e------(-dl. ag·no-,tk-s~cs-) ~ (Infective >lage) 366 \ Clrcu~tlon CATTLE \ ~ Onco>i>'b~e hatches \J. ~IJa Jeslntns Un. !IWall In feces or ciwlronment Embryonated egg, or proglottids Ingested Illustration 1s:1 life Cvtle cf Taenla saginala Egg · In feces | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Ingested Abdoml11al.,;;;-ty ~ Pnlr>lu dlo J)hrogm / Pe7e'5 lnttstin.,I wall Excysb In SIOm. ith Metacerc. 111 In crustact. an (lnfec Uve stage) Cercan A In crustacean M A N " Pll'\11'21 c.,vlty "' Adulllncystlc I cavi!its In luno (and 01hor sllc,s). · \ Unembry<>nlcd egg In sputllm (dlagno,Hc st>ge) fece~ 11,w1oawed SNAILS CRUSTACEA I tissue E9~ embryooa le:s~ lnwa~r.. Rec!la In snail liuu Sporocysl In >na U e-· / "'-i. / Mlracldlum halches ~ penelnles snall Illustration 15. 8 Life Cycle of Parogonimus westermani 367 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Autolnf C>(;tlon Illustration 15. 9 Proposed life Cycle of Capl Uarla phlllppfnensls 368 rr1 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
L Hookworm infection (nccatoriasis or ancyclosomiasis) is often found in areas where people nre not protected from skin contachvi th the infected soil like in most agricultural areas. Jt might be good to add that for Ancylostoma duodenale, ingestion of filariform lnrva from contaminated food mainly vegetaiblcs has been found to cause infection ain some countries like Papua New Guinea and Africa. Fina I diagnosis of hookworm infection is dependent on the recover, of book·worm ova from the stool. Species identification howeve·r, cannot be establisl1ed through the eggs. Studies show that a clirect fecal smear and/or the Kato thick smear is not very efficient compared to the formalin ether concentration (FECT) procedure. Use ofbroad spectrum anthelmintics have been effective in the treatment of infected individuals. Iron supplementation and proper diet are useful in patients with anemia. On the other hand, if man is exposed to the nlaforrn larvi'te of the animal hook-worms, the skin lesions arc more serious, because the flariform larvae remain on the skin resulting in what is known as creeping eruption or cutacnous larva migrans. They do not reach the circulation and therefore do not develop into the adult hook,vorms in man. Health education must be strong]y advocate d in relation lo use of sanitary toilet facilities and wearing of appropriate footwear like slippers, shoes and/ or boots. FOOD TRANSMITTED PARASITES Man mey acquire parasitic infectionsthrougb the consumption of improperly cooked or raw food like meat, crustaceans like crabs and crayfish, fish, snail and vegetables. These infections are generally related to the eating habits of the population and to a lesser extent to the beliefs that eating raw food is actually a healthy practice. In some areas, however, lack of fuel for cooking purposes or lack of food in general contribute to the occurrence of food-transmitted parasi loses. Taenia solium and Taenia saginata The ndult stages of both parasites are found in the intestines of man and l11eir eggs are indistinguishable. The eggs of Taenia solium may be ingested by the pigs while the e. ggs of Taenia saginata may be ingested either by the cow or the cattle. The eggs, when ingesteu. will develop into encysted larvae called cysticerci: Cysticercm; cellulosae in pigs and Cysticercus hovis in cows/(;}1tlle. Man acqllires the adult infection when pork and/ or beef are ingested raw or improperly cooked (See lllus. 15. 6 and lllw;. 15. 7). Gravid segments can be properly speciatcd by counting the number of lateral branches arising from tl1e main uterus stretched at the center of the segment. Taenia solium branches number 8-12 while Taenia saginata has m0t·e than 13. Eggs can be recovered from the stool or the perinnal swab. Manifestations of the adult infection range from nervousness, insomnia, poor appetite, to ahdominal pains with digestive disorders. Many cases are, however, as Yl T. !ptomatic. But the majority of patients complain of annoyance due to the emergenc e of tapeworm segments per anus. Prope. r treatment of Taeniasis must be given to the patient. Recovery of the scolex from the patient after fuerapy is the gauge of successful l Teatment. Health education must emphasize thorough cooking of meat. Freezing of meat at l_ess than s 0c can kill 369 _[ | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
the ('_v~tirerc-i n, wpll. l'rupcr di:-posol of h11m;u1 feel!. " will prcvc11t :1cccss (If a11 i n,uls t CJ !111111:111 free_. ;. ror Adlll'd infor111111io11. thcr, i-s n larrnl inf,-ction uf 1111111 1. h1c lo 1111· an:i. lr. :111,;I in"1'~""" 11f Tt1t. >11ia. !-t>liu111 <'~!,.. Like in pip,. ra1. :11i11 ~oli11111 q~;; will 111,o dcvdup intn 1h,·,1-:lir,n;I,,H"'""t'<l in lh· diffrn11t li!>,;m,: 11f rn:111, ·t11l' 1·y:-. 1in·11·i h:t VI' hccn ll. 'J""r1t. Jl_1 f111md in th,. sull<. 'u Utr R>(. )Ui, tissues,,--irintnl 11111:-. t:hs, c. :ye,:, ltc. ;11 I and,,vc11 1hr r1111rnl n<"n\111s 1'')"'l<:m of man. I 11,·vlvl'nll'11t oft he: central nervous :;ystcm is ea llcd ni:11rv\:,tkf'~i. ;. Mnn)' ca:. es,,f :,,dn1rcs of unknown origin hnvc been associa lctl with tlus rondil ion. Furth L'rmnrt!. llwn ;1nz-:t11dies to show th:ll in Asia, :mother species of T:. icnin c:illcd Tr1rri10 1L<mti1u i, i11 e,i,ttnc1:. Lt. presence in the Philippin es ha:; hccn c. ·stahlishc:d when,-. :y. nw11ts fmm pulicnt,-al lhc Dcpnr1mcnt of l'arnsitology. Collc14e c,f Public lkaitl1 Cnl\en. 1ly vf tlw l'hilippinc. s ~l;mila were brought to,Japan and were esumincd for the 111Rl\,\ ~1xdfic for T,1euia n::intic:i. Parogonimus westermoni Thi, trematode. known,,.,. _ Llw Orient. ti lung fluke. is usually found in pair,. insirlc C~'-l" 10 lht lun1,t parcnchr 1na orthe final hosl. ""hiclt co11lcl be man or animal r.. ~<:crvoir ho>'l hk P c. at,; nm. I dr,p. ~ of lhc p:imsite that 4-!-~capc from these cysts an· either e<mi. ht~ nut "ith thi?sputum or~wullowed bnck, :ind then pas. <:i;:u 0111 witlt the:;tools. Th~ !'",/,It-~ nre im111:11un: ;-ind 1?mhrvonalc 10 develop the mimcidium in wntc:r. ·111c miracidin "Ill<. \. rcl1·-™. 'tl. enter t J1c ;nail intermediate hosl whcn. ' dcvclopnwn t into spor°'"-..,t~. rnli,h!,wd ccn:ariac rx.-cu J~. "n1c rercari:ie go out of the sn:ail tn pcnctr:ilc til P "t'<'<,n J 1ntcnn... '<lullc tmst which is a fre~h 1,·:iter mount;iin n:-ah. ·nw r,·n·. 1riac develrip inru t Ja,,, nf,L"t Jve metacen. ::i riue in I he fiills. IH':in, lr)!. S ii ml 11111:,de:s uf t ltc cr,1b. Man,·. m. Lll!. 'rcf,m!. :1('QUirc UH. ! infection 1hrnup,h tlw ingc. ~tion vf rnw vr improperly n Y. J~1.-<l nah" r. ',,, lllu~ 15. R).. '\duh "~1rn1:, titc11 :. ettl<-in the lun1c: purcnd1ym;a, There are c. 1"<--. "lwn tht adult wum1., h,wc hccn rmrnd in cxtro-intcstin:il site. ", like the :1bcl<lmcn. the diaphra J. !Jll and r:1rcly even in the brnin. Durins. the early :;ta11,r of the infe<. 1fon, the patielll mny be ai-ymptomtttic hul later on, tllt' p,11ient will ~uffor from dry tough producing hlood-tingrid p11ntle11l sputum. There 1'. :!Jnld iil<:r> rn! few:r. cht:cat pain. dy,;pnea, c. 1,y (;ui,:uabilily and gc11('r:tli1. cd myulgi11. lk'f'. au-.., uf thew ~i~H ;rnd,ymptmn~. the condition can be misdii JJc;IIOSCd 1111d wron11ly tn·at N. l :i, pulmona n· tubrrrulo'>i". In some instance. <;, p11rngonimi:a si,; rn,1y co-exist \,11J1 tul. wrculo"i'-. · Definitive dia,µiosi~ i,; cstablii-hed through 1. hc recovery of Par. 1go11 imus eggs either from th(' sputum c,r the stool<,. Serologlc tests arc useful i( the worrn1, arc locali. 1. ed in the t'. \'. t ra-i at e«ti nn I nrg;m. c;. l';irngonimia~i, il' primarily found in the Par East,vhich include.-. lhc l'hilippincs. In tlw Philipptn!'<;, llw par. isit~ has been identified in lhc following provinces: Mindoro, Sor!. <1,g1,n, C. imannc,. S..mar. 1..c~e. Da.,.-no, Aft'UMn, Cotohnto and 1/..nmbonngn. Rais, ca L, and Jog.,--en 1 a< rc. ~l"\·oir f Jfiofoctioo in th~ endemic foci. In,In pan, wild boar:; can M'r. ca:, parutcnic ho~tf',. Pn,ziquntcl ts nvailable for the 1reatmcnt of Par:i,grmim iasis. Recently. :1 research group imm t J1e College of Public lie:il1J1 did a drug trial for parogonimiosis using T'riclat,end. a7,0Je. 111e l!fficac:y wa found to be about 1hr snml! as Prm:iqunntc l. Tbcre 370 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
11111st be a stroni; ;idvncm..-y on thornugh c:ooking of crabs ~nd safe food preparation. \'\'hilc 11:-;c nf sanitmy toilets can cr. rntributc in r,revcnting eggs from reaching the interrncdic1tc srmil ho:-;t. there ;,re othc T aniimal reservoir hrists that can continue this chain of trnr1. smission. Capillaria philippinensis 111is is an<>lhcr inlc:,linal roundworm that was first described among humans in the Philippines way back in 19<>~3-Egg,, of the parasite that apparcntlycmbryonate in water a. re ingested by fresh or hrackish water fish, where they develop into infective larvae. Man acquires the infection upon ingestion of raw or improperly cooked fish (See Illus. 15. 9). Capillaria infection or capillariasis causes abdominal pain, gurgling of I. be stomach called borbvrygmi. in<l chronic diarrhea. The intractable diarrhea causes remarkable Joss or weight, loss of appetite, body malaise, then edema. I nfoclion is cslahl ishcd t Juough the recovery of eggs, larvae and adult5 from the stools. Ln areas where epidemic outbreaks have occurrerl, one of the main _problems identified was the inability of lhc loboratory microsc. opist to differentiate Capi Tiaria eggs from Trichuris eggs. Early diagnosis is essential for early treatmenl. If the problem is not immediately diagnosed, the patient usually dies due to loss of protein, low electrolyte level and mafabsorption of fats a. nd sugars. The infect ion was pri rna rily thought to be present only in the Northern Luzon pro-..inces of llocos Sur, Ilocos Norte. La Union, Cagayan, lsabela, Pangasinan and Zambales. Later on. it was found also in the Visayan province of Southern Leyte and in Mindanao (mainly in the provinces of Davao, Basilan, Agusan, Zamboanga del Sur, Zomboanga dcl Norte, :ind Compostela \'alley). All infected indh;duals must be properly treated. Health education must be focused on th(' risk nf eating rnw or improperly cooked fish. Use of sanitary toilet facilities must, likewise, he cmphasi1. ed. 1. aborntory workers must be properly trained on the idc. ntilication or the parasite as well. It was found that laboratory cliagnosticians may rnist;ik. ; eruw of Capillaria for the eggs of Trkhuris. Heterophyid Flukes This is a group l)f flukes that live in the small intestines of man and other fish eating irnimals like rats, cats and rlogs. They are composed of several species. The ones commonly idc. ntified from man are: Heterophyes hctcrophyes, Hapfo,·chi s taichui and Metago11imus yokogawai. · They are considered the smallest among the trematodes because they measure only 2 mm. or less in length. The eggs produced a:re also very small but they are already with mir;iciuia when Ll1cy arc passed Lhmugh t E1e feces. The miracidia hatch out onee the eggs arc in J!,ested by the appropriate snail in1em1ediate hnst. The cercariae released frnm Lhc snail will then cnerst as metacercariae in tish which is the second i. ntermediate hosl. Man ;ic;quircs the infection upon ingestion of raw or improperl y cooked fish caught from fresh wntcr, brackish water (rivers or lakes) or even salt water (oceans). IL wn. ~ a common observation that patients with heterophyidias is are concom. itantly infected with capillariasis, since the same species offish were were found to harbor the 371 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
l I l infectiw stage of hoth par11si1es. I.,, iormnllr suffer from epigastric pain and arc clini"'· 11. mfoctcc palll'. '. ll. S 1 · 1 1 k,. a Y d11. 1 1 llanun-ition nt the site may resu l lo t:o 1c ·v pnins ·ind, gnoscct ""PIie u cers. n .. 'b'I" r 1-· ' mucus.,. · us,,_.. t'ons. ahow 1b11l lho. :rc 1s a puss, 1 11,, u 1eteropln-icl, u1arrh Enrlyl _m,·~th~llgl ii \1,;; the dr. :ulation which may eventually result ·,0 ncggd. " 1111d udu~ats. reac 1111& e 1cll -..Ir Iac fail I Ute. .. f hctcroplwdiasis is done tltrough stool cxaminatio11 ·'. ind. Omgnos1s o ' . ' 1 ecnvcry characteristic eggs oftbe para SJtc. or the A previous natiom,idc survey in 1967 ~evealed a _1% pre,alence for hctcroph,.. but o rccentlycom:luded survey (::woo) LO C?mpostc lu \/alley, a province in Mi. n~d1~s1s btained a prrvalencc of more than 30% m the general population. Occ anao, ~eteroplwd iasis is related to the eating habits and the level of enviro1uneniatrre. nce _ of . san11rttto facilities in the community. 11 Drugs effective against tl1e other trematodes are also effe~tive agninst the hcteroph 'd There must be a strong advoca~' ll1rough health education 011 eating only th )1 s. cooked fish. Pro,ision of sanitary toilets will definitely be useful bul it shou J;~~~h~ forgotten that there are reservoir animals th;it can continuous ly seed the environment "'ilh heterophyid eggs. WATER-BORNE PROTOZ. OA Water is a very essential compoun d for th~ snnival of. living things. It is also relalcd to proper sanitation be it for personal hygiene or en V1ronmeotal sanitation. Wntcr however, when unsafe and inadequate, may be associated with nn cnomwus number of dise.,se agents. Parasites related to unsafe water are mostly protozoan. For the parasitic infections induclcd here, clrinking water serves as a passive vehicle for transmission. Entomoeba histolytica TI1is is the only pathogenic species of amoeba that can produce lytic substances that allows the parnsite to invade tissues. The infective stage of this parasite is call eel C}'St, which can ht> ingested from con ta min3ted water nod to some c,. 1cnt from contaminated food. Upon ingestion, tl1l! cysts go down into the digestive tract and in the lower part oftl1c small intestines where the p H is slightly alkaline. Four new parusitcs called the metacysts,viii emerge. These metacysts will the move to the colon where they "ill develop into the trophozoi tc stag-e (See Illus. 1s. 10). The tropboznites may develop back into the cystic stage when U1ere is proper reabsorption al lhc descending colon or may remain astrophozo itcs if there is no proper water rcabsorption. As tmphozoite. ~. they become capable of intestinal coloni?. ation resulting eitl1cr in mucoid. al stool, with or \'lithout bloocl strc;1ks. Sometimes, tissue i Jwasion may be e:...-tcnded to the deeper layers of the inlcstincs ghing rise to u. tceration of 1he mucosu, submucosu, muscle layer. ind even the scrosa. The trophor. oites are able to rea0 extra-in_testinal organs like the liver, lungs and brain, where the parasites can ~tabhsb amoeb,_c abscess for~1ation. As a maltcr of fact, trophowiles have been fouod mother organs hkesplcen, skin, :peri-cardium 11nd even the genitals. Infected individuals harboring c:yi. 1s are asymptomatic. However, they. ire cyst passers and can, themfore, be the e Atra source of infoction In the com mu nily. This is wl1ere the problems 011 food-handlers come in. 372 Sc. :,.., ~ wilh Cam Scan:11:r | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Diagnosis is confirmed through the recovery of cysts from Cormedstoolsand trophozoites from diarrbeic or watery stools. The consistency of stools dictates how soon the stools are to be examined in the laboratory. If-what we expect to. recover from the stools are t. rophozoil es, the stools must be examined immediately because trnphozoi tes are fragile and they die within 30 to 60 minutes outside the host. Cysts and tropho:w ites can be detected th rougb the direct fecalsmea. r preparation. Nuclei of the cysts are best stained with iodine solution while nuclei of the lropbozo ites with metl1ylene blue solution. Coucent. ratioo techniques like formalin el. }1er concentration (FECT), merthiolate iodine formaldehyde concentration (MIFC) and Zn S04 are very useful in the recovery of the cysts. Skill in the identification of pathogenic amebae from non pathogenic ones can be acquired through proper training. Jt";n he worth while to realiietliatusing microscopic examination the cysts of Entameba histolytica have morphological chnracter istics very similar to tvvo other amebae namely: Entam,eba dispar and 611tameba hartmanni, the latter however happened to be a lot smaller than E. histolytica and E. dispar. Transmission of amoebiasis is related to contaminated water supply, use of night soil as fertilizer and infected food handlers. Moreover, si:uclies have shown that flies and cockroaches carry amoebic cysts as well. Boili~g of drinking water from questiona ble source is a very good practice to avoid infection. Specific drugs must be given to the patients. Health education emphasiz ing environmenta l sanitation must be done. Drinking water and food must be safe for human consumption. There must be regular examination of food handlers, which is now mandated by the provisions in the new Code of Sanitation approved by the Departmen t of Health. Idenlification of cyst passers ~\;II reduce tr:ansmission. In a recent study among food handlers in school canteens in the City of Manila, a high percentage was found to be positive to non-pathogenic amobae by stool examination. Even if the identified cysts were non-pathog enic, their presence indicates a possible danger of transmissio n to the food consumers once personal hygiene is not strictly praclic. ed. Another indication is that, ch;nking water has been contaminated with humnn excreta. Giardia lamblia This is a flagellated protozoan which lives in the duodenum, jejunum and upper ileum of humans. It is also known as Giardia duodenalis, G. duoduenalis, Lamblia <luodenalis or L intestinalis. The clisease caused by this protozoan is called giardiasis or 1ambliasis which has an incubation period of one to fourwecks, averaging nine days. While it is asyrnptomnlic in approxima tely 50% of infected individuals, itis manifested in mild cases as moderate and protracted diarrihen followed by spontaneous recovery in six weeks. In acute cases symptoms usually. include cramping, abdominal bloating, nausea, anorexia, diarrheal stools, often with excessiv. e flatus with an odor similar to that of rotten eggs. Chronic infection is characterized by passage of greasy, frothy stools. Transmiss ion of the. Giardia liamblia parasite results from ingestion of mature cysts (infective stage) from feces oi humans or animals (e. g. dogs, rats, horses) via contami nated b:u1<ls, food or water. Ingested cysts pas.,; through the stomach and excyst in the duodenum in about thirty minutes. developing into trophozoites which rapidly multiply and attach to the intestinal villi (Illustration 15. u). They cause pathological 373 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
changes like flattened vi. Di tips,sha Uowc,ypts, in Oammation of mucosa and hyperplacia oflymphoid follicles. The trophozoit,es may then be found in the jejunum. As the feces enters the colon and dehydrates, the parasite then encysts. Newly formed cysts have two nuclei while mature ones have four. After encystation, mature cysts are passed out in the feces ancl are ll1cn infective (Beli. ?. ario and Solon 1998, pp. 38-4J). Lllboratory diagnosis is made by demon~tration of tropbowitcs and/or cysts in stool specimen or duodenal aspiration or biopsy. Doud en al aspirates can be collec1cd Uwough the so-called Entero-tcst or tl1c String Test method. Prompt intervention reduces cyst pass;1ge und possible transmission particularly when food handlers, children in day care centers, institulionalized patients and hom!Jsexuals are involved. The prevalence of giardiasis is associated with poor environmental sanitation. Poor hygiene, overcrowding, immunodeficiency, bacterial and fungal overgrowth in the small intestines are impc)rtant risk factors. Sanitary disposal of human excreta, proper management of reservoir :mimals, regular cxamina 1ioa of food handlers and i;anitary practices on food prepanllion and stor. ige ;ire cnici. il in the prevention and control of disease transmission. lloiling of drinking water may be required when potability is questionable. 374 Cryptosporidium hominis '11iis is an intestinal protozoan falling under Class Coccidia. There arc about eight recognized species, of which only C. hominis is the only one knovm to cause infection in humans. A wide range of an. imals ]rnve been found to harbor the parasite as well. II has been commonly isob1tecl from both tbe small and 1. irge intestines. Howeve1·, it has also hccn identified from other organs like the esophagus, stomach and appendix. Among the immuno-compromiscd 11. nd immuno-deficient patients, like AIDS victims, infection of the bile duct, gallbladdet ·, liver, pancrens, and lungs have been reported. This was initially thought to be an opportunistic parasite among AIDS patients but eventually it was found even among immuno-competcnt individuals. Among the immuno-compctcnt individuals, diarrheal episodes are sci( limiting but among the immuno-eompromi scd and immuno-suppressed. individ1111. ls, diarrhea crui be prolongcd and m::iy therefore rcsuhs in more serious conditions_ Like any of the toccidian, the parasite undergoes the process of schi:zogony that results in 1110 production of merozoites and sporogony whielt in turn develops oocysts. Both processes of multiplication occur in the extra-cytopla sm of the intestinal cells. When oocysts arc passed out with the feces, they arc already sporulated and are therefore readily infective. Data show that ingestion of even a few ooeysts can already estal>lish infection in man_ Patients with crytosporidiosis often develop acute gastroenteritis possibly due to the ability of the orgnni!;1n as an enterotoxin. With prolonged symptoms, patients mny eventually suffer from malabsorpti,on resulting from villous atro J>hy and cellular infiltration of the lamina propria. From the inteslines, the infection may go up to the bile duct and the pancreatic duct, which would lead to cholangitis and panereatitis. In some occasions, lung infections may be involved, causi. ng the patients to suffer from respiratory symptoms like cough and shortness ofbrcatl1. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
MAN Trophozoite-... t,.,u. In lumen of,:;olon EXTERNAL ENVIRONMENT Illustration 15. 10 Life Cycle of Entamoeba hlstolytica Trophowlte I Oisiltegratos 375 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
376 Mul1pl!fs by lcngltu<IIMI l:lna,y nu1on Elcysls In duodenum h M A N EXTERNAL ENVIRONMENT Illustration 15. 11 Life Cycle of Glardla lamblia rrcpho1olte I Dlslntegral6 :1 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
sources of the oocysts of C. hominis are variable, although the most common source is believed to be fecally contamina ted drinking water. It is noteworthy lo remember that 00cysts in ice remain viable once it thaws. Accidental ingestion of pool or lake water contaminated with oocysts can also lead to infection. High-risk exposure has also been associated to direct contact with feces positive for cryptosporidium hominis while caring for infected patients. This includes bathing, changing of diapers, changing of soiled bed linens or simple emptying of bedpans in caregiving institutions. Infected food handlers with poor personal hygiene can accidentally transfer the oocysts to food and beverages. Raw fruits and vegetables may, likewise., be contaminated. Contact with infected calves in veterinary hospitals, in dairy farms or zoos have also been implicated as sources of human infection. Diagnosis is established witlt the recovery of the oocysts from the stools. Oocysts are acid-fast and are identified best from stained stool samples with the modified acid-fast stain known as the Kinyoun's techii. ique. Before staining, stools may be concentrated using Formalin Ether Concentration Technique (FECT) or with Sheather's flotation. Since no chemotherapeutic agent bas been found to be safe and high1y effective for this pa.-asite, the objective of treatment is to reduce the frequency of diarrhea. Rehydration is highly recommend ed. To control and prevent infection, people mustbe strongly advised on personal hygiene and environmental sanitatio n. Sources of drinking water must be properly protected. Contact with infected individuals and animals must be avoided. Fruits and vegetables that are eaten raw must be properly and thoroughly washed. Cyclospora cayatensis This is another coccidian that has been isolated from patients with chronic and intermittent watery diarrhea. The diarrhea together with lack of appetite, loss of weight and bloating may last for weeks. However, the disease is generally self-limiting among patients who are immuno-competent. Like in cryptosporidiosis, prolonged diarrhea has been observed if the patients are· immuno-compromised like the very young and the very old. Infection bas been associated with consumption of contaminated food and water. Like the Cryptosporidium, Cyclospora oocysts are also acid fast in nature and therefore can be stained with Kinyoun's technique. When viewed under an UV microscope, the oocysts emit a bluish fluorescence. Blastocysts hominis This is another protozoan parasite whose taxonomic classification is uncertain. It is usual]y mistaken for an amoeba and was formerly classified with the fungi. Association of this parasite with gastrointestinal pathology is still controversial, however, if this parasite is present in large numbers, a variety of intestinal disorders was observed, especially among children and the immu. no-cornpromised. These include abdominal cramps, mild. to moderate diarrhea, flatulen. ce, nausea, and vomitting. The life cycle and the modes of transmission are still unknown, although it is believed that transmission occurs through the fe. cal-oral route. Occurrence of blastocystosis · 3n | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
\ \ \ I wai; associntcd \\itl1 history of drinking untreated,vate. r and exposure to crowded, unsanitary conditions. Diagnosis is based 011 lhc dctcclion ofthe organism from the stools. It has been observed from dirccl fr:cal smear but sensitivity of llic lahoratory prnceclurc is improved through U1e Formalin Ether Conrcntrntion Tcd1nique (FECT). The blastocysts v;i ry in si:r. c with a dlametrr rang. ing from about 6 to 40 pm. '111cy arn generally spherical provided with a centrol hody tlrnl occllpics about 90% of the cell. Because of U1e large centra J body, nuclei of the parasite are almost always pushed to Ille periphery cell. I:rom a i;tudy of foodl1and lers in a tertiary hospital located in Met To Manila and canleens operating in the University belt of the City of Manila, 40% and 24% of the students examined were found positive for Blastocystis cysts respective ly. VECTOR-BORNE PARASITES There are certain groups of living things that carry and transntit infective agents to man. Some mechanically transmit the pat J10gens like the mes and cockroaches, while in some vectors, like mosquitoes, these infective agents undergo development anc. J mtlltiplication. To. is St. >ction covers parasites that are transmitted l J1rough these vectors. Plasmodia There are four species of Pl. asmodia causing malaria in man, namely: Plasmodium falcipnn1m, Plasmodium vivax, Plasmodium malariae and Plasmodfom ovale. All of these $pecies are transmitted through the bite of the infected female mosquitoes belonging lo the Genus Anopheles. lo the Philippines, the major mosquito vector is the female Anopheles minimusjlavirostris. TI1e most common cat Lc;e of malaria in the Phi Jjppines is Plasmodium falciparum. About 70% of all malaria cases are due to P. falciparum, 30% are due to P. vivax and less than 1% is due to P. malariae. P/asmodium ouale,however, is believed to be absent in the Philippin~. On the other hand, a monkey malarial parasite aillad Pla1;modium k'llowlo>si was identified from indigenous people in Mindanao by the Research Institute for Tropic Medicine. Among Lhe Plasmodia species, P. falciparum is considered to be the most dangerous because it causes severe complications such as cerebral involve. meat. Among children in endemic areas, chronic infection with malaria can lead to childhood anemia. Pregnant women whe. n infected wilh malaria may suffer from stillbirths and abortion. Plasmodia undergo an ase>mal method of multiplication in man called sd1izogony and g,ametogony. This makes mao as the intennedial e hos1. The ase,mal multiplication is periodic am! lhe lens:th of schi2. ogony differs from one species to another 111e sexual method of multiplication called sporogony occurs in the mosquito, the definitive host. ln man tbe malarial parasites undergo sdli:1. ogony in the red blood cells and for this reason, these parasitesmey be1Tansmitted throu&hjndiscretc hlood transfusion. Stages that di-vdop during i;chi~ony are trophozoi K-s which "il J then become schizonts, inside (lf which are merowiles. Schi1. ogony was shorte..:;t in P. falcjparum but lon&est \ \ in P. malariac. 111e highest number of mer01. oitcs :ire produced by P. fa lciparnm. while the fowe;. 1 are producl'd by P. malariae_ When the sd,izonts arc mature, t J1c host red \ \ \ ~~■----378ce-llsru-ptur-ea. J-1dth-eme'rowites' ar-ereleased-intothccir-ciilntjon_. ltis-al thispoinl■w■·■h■c■n-ia!· ~- | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
rnan usually suffers from the ma fa rial paroxysm accompan ied by chills, fever, profuse 51,\leating heodoche 11nd prostration. l11e mero'I. Oite s will enter new red blood cells to repeat the schizogonic cycle. Some merozoites will, however, develop into ga. metocytes that are taken up by the female Anopheles during feeding time. ln the mosquito gut, the gametocytes become sexually mature gametes. The male gamete fertilizes the female gamete to procluce a fertilized cell called a zygote. The zygote develops into an ookinette then into an oocyst. Inside the oocysts are sporozoites which are released into lhc salivary glands of the mosquito and are eventua1ly introduced to a new host when Lhe mos4uito vector tak. es another blood meal (See Illus. 15. 12). Sporo7. ites introduced by the mosquito bite undergo exo-erythrocytic schizogony in the liver cells. The mero7,oites released from the liver cells will eventually invade the red blood cells. The interval betv,1een malarial attacks is determined by the length of asexual phase: 36-40 hours for Plasmodium falciparum, 48 hours for Plasmodium vivax and Plasmodium ovale, 72 hours for Plasmodium malariae. Thick and thin blood films a-re prepared from a finger prick on the patient. The blood films are stained with Giemsa and are read under the oil immersion lens. The thick blood smear is useful for rapid diagnosis while the thin blood film is used for species identification. ln Plasmodium falciparum infection, what can be seen from the blood films are mainly rings and gametocytes because the late tropho1. oites and schizonts are sequestered in the deep vasculature of some internal organs. While for the other three species, all ase,--.,:ml stages can be recovered from the peripheral blood. If the blood films are negative, serologica l tes. ts like IFA(lndirect fluorescent anb"body) and ELISA (Enzyme linked immuno sorbent assay) are available to detect anb°bodies. Recent advances in the diagnosis of malaria include antigen detection from the blood using monoclonal antibodies against enzymes produced by the parasites like histidine rich protein [HRP) and lactic dcbydrogenase (LDH). Treatment is available for both uncomplicated and complicated forms of malaria. Chernopro phylaxis is also sugg~ted to protect man from malaria infection. For the control of the mosquito vectors, ex-perts recommend the integrated vector control strategies,vhich include stream modification and/or other environmenta l manipuh1tion, biologica l control, and chemical control. To prevent man-vector contact, use of chemically treated bednets and proper screening of houses are advocated. Long lasting insecticide treatment nets (LLl TN) are nowavanable. Families are advised to use adequate protective clothing during outdoor activities at night when the biting period of the mosquito vector is expected. until early morning (de las Llagas, 1999: 23) Commun ity-based family empowerment interventions for malaria prevenb°on and control have been documented in 1999 by Maglaya, de las l..\gas, Ancheta and Belizario (See Chapter 18). Babesia spp TI1is parasite belongs to a group ofproto:i;oans called piroplasms. Human infection with Babesia mic.-oti has been identified main Jy in the United States and to a lesser extent in Europe. In the United States problem on Babesia is compound by the fact that the spirochaete called Borrelia burgdvrferi causing Lyme diseases is transmitted by the same tick Jxodes spp which transmits Babes. ia. Just like the Plasmodia spp, this parasite is intra-erthrocytic in habitat. [tis, therefore, transmjssible through blood 379 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
transfusion. fn babesiosis, howev-er. the invasion of the red blood cells will eventually lead to hemolytic anemin. Babesia microti is biologically transmitted through the bite of hard-bodied ticks call. ed lxodcsscapularis, which usually feeclon white-tailed deer. The tick also feet. ls on smaller mammals like lhe white-footed mouse which is the major reservoi.-host of Babesia spp. Incident·ally the tick is also the v(.-ctor of Lyme disease cause<l by a spirochaete named Borrelia burgdorfer i. In endemic places, ii is common t Jmt an individual is simultaneously infected with both Lyme disease and babesiosis. Diagnosi s of babesiosis is established when Giemsa-stained blood films reveal the presence of the parasites. The ring forms of Babesiaspp are very difficult to differentiate from the ring fonns of Plasmodium falciparurn. The tetrads called the Maltese cross are however diagnostic, while Polymerase Chain Reaction (PCR) is very useful in low parasitemia. Detection of antibodies by serology is a Jso useful. Clindamycin is an effective antibiotic against babesiosis. Use of protective clothing like the wearing of long pants and sleeves arc also recommend ed. Clothing can even be impregnated with insecticide. Wucherer/a boncroft; and Brugia malayi These parasites cause lymphatic filariasis and are transmitted by female mosquitoes. Wuchere ria bancroft is transmitted by mosquitoes falling under genera Aedes, Anopheles and Calex. ln the Philippines, however, the parasite is transmitted by Aedes poeci Jus whkb breeds pretty well in the axils of the abaca and bana. na plants. In some areas, Anopheles mjnimus is the mosquito vector identified in the Mountain province. Culex mosquitoes have been incriminated but they are more important vectors in other countries. On the other band, Mansonia mosquitoes are responsible for the transmission of Brugia malayi. Adults of Lhe above parasites habitate the lymph vessels and/ or lymph nodes. The progeny called mkrofilariaeare found in the peripheral circulation. The presence of the microfilnriae in the circulation exhibits a rhythmica l pattern called periodicity. Wbeo the mosquitoes lake a blood meal and they pick up the microfilariae, the microfilariae will develop into first (LI), second (L2) and third (L3) stage larvae in the muscles of the mosquitoes. When the mosquitoes bite a susceptib le bosl, the 3rd stage larvae are deposited oo the skin and the larvae actively enter the skin through the site of the bite. They will eventually reach the lymphati c system and the worms 1/2ill develop into the adu Jt filarial worms (See mus. 15. 13 and lllus. 15. 14). In the early stage of trmphatic fi Jariasis, the infected individua J suffers from fever with inflammati on of the lymph gland. 'I. There is recurren t retrograde lymphangiti s with localiu.-d swelling and redness of tbe arms and legs. This is believed to coincide with the release of microfilariae by the female worms. When the adult worms die, there will be an immunological reaction resulting in lymphatic obstn1ctioo which in tum can lead to elephantiasis or hydrocoele. Jt is worth mentioning that there are microfilariae positive individuals who are asymptomatic. A few. however, manifests the characteristic tropical pulmonary eosinophilia where patients do not manifest microfilaremia because the microfilariae are in the tissues. They have hypereosinophilia and usually suffer from pulmonary symptoms like paroxysmal coughing. 380 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Fig 15. 1. Malarla ll causing d·um viva. of Plasmo ' 2 Life Cycle 'L' l";,m1Sca11mff St. ~nr~<l w, II.., | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
382 " Mlcrofllarlae \ Cl. rcula Uon Ent. n skin llm,ugh mo,qut\11 bl1a woul!d 3rd St Jilt larva Qnle<:llvt slage J M A N \ Mlcrolllarla In blood (dlagnostk stage) :';!:'. !:. ":" MOSQUITOES 7~ \,.,,...... ,...-!'1113-:::""-....-;-···· -: ~le muscl H ·,.._,. __ / Illustration 15. 13 life cvcte of Wuchererla ban croft I | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Lymphatic$ I Ent<>rc skin rhrouoh moqulto blle wound \ Ml11~tes lo head ar>:lpro,cls 3rd stage larva "' Mlcrofllrt \ Clrcul1Uoo M A N \ Mlcrofflam In blood (dlagno11tc sta11l MOSQUITOES ... __,,........, S~s sha. ath; penelfa!M slomach wan / Tltor..,lc m~cl~ ~ stslagelarn~ Illustration 15. 14 life Cycle of Brugla malavl . 383 f | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Diagnosis of {i]ariasis is established "itl1 the recovery of microfilariae from staioed thick blood films. Wucbereria bancrofti microfilariae exhibit nocturnal periodicit y while Bnigia mala~i microfilariae exhibit aocturna J but subperiodic periodici ty. Because of these char. 1Ctl'ristic periodicity, blood samples must be collected from 8:oo pm to 4:00 am. To increase the chance of finding rnicroftlariae, concentra tion techniques called Knotts's technique and nucleopore filtration are recomme nded. Filarial antigens can also be detected from the blood using a monoclonal based card test, called the ICT card test. fu the Philippines, \. Vuchereria bancrofti bas a wider geographic distribution compared 10 Brugia mala)1. Bancroftian filariasis bas been reported in Camarines None, Ca. marines Sur. Albay, Sor:sogon, Mindoro, Marinduqne, Masbate, l'alawan, Sarnar, Leyte, Bohol, Mountain Province, all of Mindanao especially Sulu, Tm~; tfmi, Basilan and Zamboanga. On the other hand, Malayan filariasis is present in Palawan, Eastern Samar, Agusan and Su Ju. Effective dn1gs arc available for the treatmen t of filariasis. A combination of d. ieiliyl carbamazine and albendazole is being utilized for the so called mnss dnig administration (!\IDA) toeliminte lymphatic filariasis. Healili education should focus on the prevention of man-mosqu ito contact l Lke the use of bed nets, repellants and chemical spraying. The use of Bacillus thuringien.,is as biological controll1as also been tried. Schistosoma japonicum This is a Ouke. Among tbe Oukes, this is the only species provided with separate sexes. Adult worms live in the portal and mesenteric veins of man and a wide range of reservoir animals like rats, monke)'S, pigs, dogs, carabaos and cows. Schistosoma eggs are deposited in the mucosa) capillaries where they undergo maturatiou and are eventually able to enter the intestinal lumen via ulcerations. Upon reaching a body of water. the embryo called miracidium is released. The miracidium then enters the snail intermed iate host which is scientifically called 0ncomelania hupensis quadrasi. Within the snail host, tl1e miracidium develops into t\vo generations of spor~ysts tl1ep into cercariae. Tiie cercaria is the Wective st. ige and it can actively penetrate Lbe bumao skin. After skin penetration, the cercaria develops into juvenile adult called schistsomula. Jt will enter the circulation, undergo tissue migration until it reaches the portal veins where it wil J develop into adult schistosome (Sec Illus. 15. 15). Entry of the cercariae into the skin may or may not result in dermatitis. At the time of egg deposition in the intestines, patient starts to manifest diarrhea with blood. The deposition of eggs in the tissues, mainly the liver, results in granuloma formation. This usually leads to portal hypertension with hepato-splenomegaly, ascites and emaciation. Many reported cases of death due to schistosomiasis were caused by rupture of esophageal varices. 384 Diagnosis of schistosom iasis is confirmed with the recovery of the eggs from the stool through Acid-Ether Concentration (AECT) or Kato-Katz technique. Eggs embedded in tissues can be seen from rectal biopsy material A serological test to detect antibodies called Circumoval Precipitin Test (COPT) is usually requested together with stool examination. · Schistosomiasis is found in the Luzon provinces of Mindoro Oriental, Sorsogon, Visayas provinces of Samar, Leyte, Bohol and in all provinces of Mindanao, except Misamis | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Oriental. New foci of infection have been formd in Goni. aga, C. 'lgay:m Valley in Luzon and Calalrava. Negros Occidental in the Vlsay:is. Drog for treatment is a,·ailablc. Ad,·ocacy for the proper disposal of human feces. control of reservoir animals nnd snail control help in the control and prevention of the infection. CONCLUSION }Cnowledge of U1e life cycle of each par. i:-itc helps dct. em,inc nppropri:itc nursing intervention s to prevent or control iti; tmnsmission. i\lost of the parasite. ~ d C$crll X!d in this chapter are excreta-relat('d and arc m::ii11l1· ahlc to leave the ho. ~1 \;:l the fccc. ~. Therefore. unsanita ry waste disposal is a \'Cry,·mpon:111 1 factor llmt n,ntributcs to the continuous transmis sion of thes pnrnsih~$. Snmc h:t\'P animal rc. ~cn·oir hosts or intcnnedi ate hosts which complic,tle prevention an J control strategics. Uns. 'lnitary garbage/refuse and waste disposal can also cncourngc mechanical transmission of these pathogens through arthropods like flies ;ind cockroaches. community health nurses are challenged to be creative and innovative in dcsii;nin~ and implementing prevention and control intcn·cntions which require pannership and empowe rment processes (Nlaglaya 1999). Example s of these strategi~ to pre,..e. nt or control parasitic infections include: 1. Client-centered nursing interventions to fucilitnte development of healthy lifestyle, motivatin g clients nnd supporting their learning throui;h each stage of the behavioral change process (Refer 10 Appendix E): Emptu1sis rm personal hygiene, sanit:. 1ry food preparation, safe eating anc J drinking habits/pmctice$. use of sanitary toilet facility and lisc of self-protection measures such as wearing of appropriate footwear or sleeping under insecticide treated bed nets especially in endemic areas. 2. Advocac y, partnership and collaboration with the community, the loca J governme nt unit and the partner agencies to ensure the provision of safe water supply (specially from public sources) and npp Topriate facilities for garbage/refu se and waste disposal. Refer to Chnpters 5. 6 and 9 for l;trnt@gil:'. 5 and interventions. 3. Community-ba. sed and family-cen tered empowerment strategies (see Chapter 18) to eliminate breeding and resting sites of mosqni. toes (de las Llagas, 1999). snails, other vectors, intermed iate hosts and mechanica l carriers (e. g., flies, cockroaches, rats) of parasites. 385 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
M A N "'"'"' -SNAILS Illustratio n 15. 15 life Cycle of Schistosomes \ ',· i 386 ~--------------..... | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
REFERE NCES Belizario Jr. V. Y., aud de Leon, \V. U. (Eds. ). (2004). Philippine Texibook of 1· J'1edical Parasitology. Manila: Information, Publication and Public Affairs Office _ IJni\·ersity of the Philippines Manila. de las l Jagas. L. A. (1999). l. \laloria Vectors and Vector Control. In M. D. G. 2· Bustos and others. State-of-the-Art: Malaria Resea,-ch in the Philippin es (pp. 2132). Philippine s: Pltilippine Council for Health Research and Development-Departme. nt of Science and Technology. 3_ Henry J. B. (1998). Clinical diagnosis and ma11ageme11t 1.,y laborntory methods. (19th ed. ) Philippin es: W. B. Saunders Co. 4. 11. faglaya, A. S., de las Uagas, L. A.. Ancheta., C. A., and Beli1. ado, V. Y. (1999). A/amity health empowerment intervention model towards prevention and control of malaria in the Philippines: The local government 1mit/n1ral health unit perspective. Manila: Department of Health-Essential National Health Research. 5. Marquar dt, W. C.. and Demarce, R. S. (1985). Parasitology. New York: Mncmillian Publishing Co. 6. Stricklan d, G. T. (2000). Tropical Afedicine and Emerging Infectious Diseases. Phlladelphia: W. B. Saunders. 7. University of the Philippines Manila, College of Public Health, Departmen t of Parasitology. (1997). A Study Guide in Medical Parasitology. Manila: College of Public Health-University of. the Philippines Manil;i. 387 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
Chapter 16 LOGIC TREES FOR COMMON ADULT HEALTH PROBLEMS 1. Vfa. Corazon S. Maglaya and Araceli S. Maglaya INTRODUCTION For more than a decade. there has been a rapid increase in tl1e prevalence of non-communi cable diseases. particularly lifestyle-related health problems. W11elhcr in doctor-lesi-commun ities or in areas where prompt and effective entry inl~> lhc health care dclinry i-ystero is a prirua. r_v objec-th·e. lbe nurse has every av,iilable opportunity to ensure I. hat adull clients "ilh lifestyle-related hc;:ilth needs. concerns or problems can be prompt ly guided to sources of information. advice and managemen t appropriate to their particular complaints or situations. Sta. otlnrds of hea Jth and/or nursing care specillcd in assessment and management protocol,-c.. 111 enhance the nurse·s competence and confide. nee for independent practice and case m;;i na~eme. nt. These are effective. efficient and creative opt ions for improving access to quality c:1re "ith the increasing mmiber of patients in various pracl ice settings in the Philippines and the western world l. ike the U. S. A. and Europe. THE LOGIC TREES The use of the. Logic Trees \\-:1S introduced in Chapter 10. Varied sets of assessment nod management protocols have bee. n developed by the authors based on a long experience in J!<meral medical and e11isod. ic nursing prnctice in the community. Each protocol foc U. "-CS on a specific medical complaint or a set of signs and symptoms. A set of l. ogic Tn. cs for common signs and S)nlptorns or complaints,ire included in this chapter ai< examples for ours<: practitioner. s handling adult c. lient. 5 with lifestyle-related health need!-. et,nccni.-. or problem,;_ 388 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
ASSESSMENT PROTOCOL FOR PROBLEM ON COUGH, COLDS OR DIFFICULTY OF BREATHING NOT ASSOCIATED WITH FEVER: ADULT PATIENT (Logic Tree No. 7) o IRECTION: Determine/identify which of the following symptoms/signs (S/S) or history dat:1 (lh:D) are present and follow the flowchart for the appropriate plan of management. RED YELLOW GREEN S/S or Hx O 5/S or Hx D S/S or Hx D Difficulty of breathing Patient is 65 years old Patient has been when tying down for or older exposed to chemical several minutes but Respiratory Rate is at dusts like silicon or relieved when he is least 30/min asbestos for several propped up Symptom s have been years (like the patient Patient has coughed present for more u_sed to be or is out large amount of than 3 weeks currently working as a blood (at least two Cough productive of miner) teaspoons) yellowish phlegm Change in the quality of Systolic blood (the whole day) the patient's voice pressure of 160 mm Presence of blood in Mild or tolerable pain mercury or above the sputum (even if at the epigastric area and/or diastolic blood-streaked only) described as burning blood pressure of Difficulty of breathing or gnawing pain 100 mm mercury or when doing his usual History of intake of above physical activities medicine for ulcer Altered consciousness like sweepirig the like those containing (very sleepy or floor or taking a omepraz?ie, disoriented) bath laz_oprazole, Labored fast breathing Sharp chest pain esomeprazole, or Nostrils spreading out whenever he coughs those containing with e Gch breathe or breathes de. eply aluminum/ Swelling of the face Difficulty of swallowing magnesium hydroxide and/or both lower Marked weight toss Recent history of extremities P. rolonged period of intake of medicines Bluish tips and nail beds lmmobllity like causing gastric Prominent veins over patient stayed in irritation, such as the upper chest bed for several Aspirin, anti-arthritic Skin behind the days with almost no medicines (ibuprofen, collarbones and movement due to diclofenac. between the ribs illness meloxicam, sucked In when History of Tuberculosis piroxicam, celecoxib, Inhaling or intake of anti-etc. ) or antibiotics Neck veins that TB medicines like belong Ing to the pulsate well above those containing Macrolide group the coli::irbone with INH, rifampicln, (erythromycin or the patient In a ethambutol, azythromyclnl. reclining position pyrazinamlde and/ or streptomycin Injection. 389 | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
I I tilt i j I, . ! :... J . :. ~.. ") ··-REO S/S or Hx0 390 YELLOW 5/S or Hx D Patient is hypertensive or Is taking anti hypertensive medicine belongin g to the ACE Inhibitor or ARB group (e. g. captopril, enalapril, perindopril, losartan, ibesartan, Telmis-artan) Patient Is a smoker (especially if he/she is a heavy smoker, i. e. smokes at least one pack per day) or has just stopped smokin_g Systolic blood pressure of 140 to 1S9 and/ or diastolic blood pressure of 90 to 99 Enlarged cervical or a><illary lymph no. des GREEN--S/S or Hl<O--Previous history of ~ Asthma or u~e or antiasthrna medicines like salbutamol, terbutaline, etc. Chest is big "like a barrel" Wheezing sound especially when patient breathes out .. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
t cough, colds, difficulty of breathin g; adult patient With fever No at least one RED s/s or Hx D '--l-No at least one YELLOW s/s or Hx O No at least one GREEN s/s or Hx D LOGIC TREE FLOW CHART NO. 7 Yes Yes Proceed with Plan A Proceed with Plan 8 Rel C?r to logic Tre C? No. l Proceed with Plan C Yes No at least one RED s/s or -'IIJI, Hx D developed since last visit 391 ,-:: ' | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |
392 MANAGEMENT PROTOCOL FOR PROBLEM ON COUGH, COLDS OR DIFFICULTY OF BREATHING NOT ASSOCIATED WITH FEVER: ADULT PATIENT (Flow Chart No. 7) PLANA: 1. 0 2. 0 3. 0 5. 0 6. o Determin e patient's knowledge on the management of the problems presented Based on 1. 0, give/prescribe over-the-counter medicine or herbal medicine for cough and colds, specif)ing accurately the method of preparation (specifically for herbal medicine), the dose and frequency of intake. 2. J If mucus is thick and seems trapped in the chest, give/presc ribe a mucoly"tic preparation like those containing glyceryl guiacolate, carbocystei. n or ambroxol. A decoction ofsampaloc leaves or oregano leaves can also be given. 2. 2 If cough is dry or occurs very often, give/prescribe an antitussive preparati on like those containing dextromethorphan or butamirate citrate. A decoctioo of lagundi leaves cim also be given. 2. 3 If cough is associated \\ith a wheezing sound, give/prescribe a prepar. 1tior1 for asthma like those containing salbutamol, terbutaline ' formoterol, etc. 2. 4 If there is runny nose or nasal decongestion, give/prescribe decongestant. Advice the patient to: 3. 1 stop smoking or avoid exposure to smoke; 3. 2 avoid crowded places; _ 3. 3 drink plenty of water and juice but not caffeine or cola-containing drinks 3. 4 have steam inhalation for 10-. 15 minutes as often as the patient likes; there is no need to add anything to the water. drain mucus from the lungs by postural drainage when needed and this is done as follows: 3,5. 1 Jet the patie. at lie face down partly on the bed with his head and chest hanging over the edge and ms elbows on the floor; pound him/her ligbt Jy on the back; 3. 5. 2 3. 5. 3 ask the patient to take a deep breath and then cough as ha. rd as he/she could; If there is epigastric pain or history of intake of medicine for ulcer or recent history of intake of medicines causing gastric irritation, do the following: 4. 1 Give/prescribe medicine for ulcer. 4. 2 Advice the patient to avoid spicy food, sour food, and caffeine-containing drinks. · 4. 3 Advice the patient lo avoid lying down immedia tely after a meal 4-4 Advice patient to take small frequent meals. Advice the patient to observe the effe<-1 of the above intervention and to have a follow-up after two or three days or earlier if any. RED symptom develops. Do home visit if patient fails to return for follow-up after three days. Do the following during follow-up: 7. 1 Ask the patient if there was improvement in his condition. after the management or interventions were started. | Nursing Practice in the Community 5th Edition Aracelis. Maglaya Rosalinda G. Cruz-Earnshaw etc. Z-Library.pdf |