CHAPTER 5 Flashcards
The Family Health Office is tasked to operationalize health programs geared
towards the health of the family.
Specifically, it aims to:
1. Improve the survival, health and well being of mothers and the unborn through a package of services for the pre-pregnancy , prenatal , natal and postnatal stages.
2. Reduce morbidity and mortality rates for children 0-9 years
3. Reduce mortality from preventable causes among adolescents and young
people
4. Reduce morbidity and mortality among Filipino adults and improve their quality
of life
5. Reduce morbidity and mortality of older persons and improve their quality of life
This strategy entails the establishment of facilities that provide emergency obstetric care for every 125,000. This strategy calls for families and communities
to plan for childbirth and the upgrading of technical capabilities of local health
providers.
BEMOC
The standard
prenatal visits that a woman has to receive during pregnancy are as follows:
1st Visit: As early in pregnancy as possible before 4 months or during 1st trimester.
2nd Visit: During the 2nd trimester
3rd Visit: During 3rd trimester
Every 2 weeks: after 8th month of pregnancy till delivery
Tetanus Toxoid Frequency?
-2 doses of Tetanus Toxoid vaccination must be received by a woman one month
before delivery to protect baby from neonatal tetanus.
- 3 booster dose
shots to complete the five doses following the recommended schedule provides
full protection for both mother and child.
-Then the mother is called as “Fully Immunized”
Micronutrient Supplementation
“Vitamin A”
Dose: 10,000 IU
Schedule of giving: twice a week starting on 4th month of pregnancy
Alert: Do not give Vitamin A supplementation before the 4th month of pregnancy. it might cause congenital problems in the baby.
Micronutrient Supplementation
“Iron”
Dose: 60mg/ 400 ug tablet
Frequency: Daily
Follow first aid treatment :
DOB/ OBSTRUCTION OF AIRWAY
-Clear airway
-Place in her best position
-refer woman to hospital with EmOC capabilities
Follow first aid treatment :
UNCONSCIOUS
*Keep on her back arms at the side
*Tilt head backward (unless trauma is suspended)
*lift chin to open airway
*Clear secretions from throat
* Give IVF to prevent or correct shock
Monitor blood . Pressure ‘ pulse and shortness of
breath every 15 minutes
Monitor fluid given. If difficulty of breathing and
puffiness develops , stop
infusion.
Monitor urine output
ALERT:
-Do not give oral rehydration solution to unconscious/ convulsion woman.
-Do not give IVF if you are not trained to do so.
Follow first aid treatment :
Post partum bleeding
- Massage uterus and expel clots
- If bleeding persists :
- place cupped palmed
on fundus and feel for state of
contraction - massage fundus in a
circular motion - Apply bimanual uterine compression if ergometrine treatment done and postpartum
bleeding still persists - give ergometrine 0.2
mg IM and another
dose after 15 minutes.
Alert: Do not give ergometrine if woman has eclampsia, Pre-eclampsia or hypertension.
Follow first aid treatment :
Intestinal parasite infection
-Give mebendazole: 500 mg single dose from 4-9 months of pregnancy if none was given in the past 6 months.
Alert: Do not give mebendazole in the first 1-3 months of pregnancy.
This might cause congenital problems in baby.
Follow first aid treatment :
Malaria
-Give sulfadoxin-pyrimethamine to women from malaria endemic area in 1st or 2nd pregnancy.
-500mg, 3 tabs at the beginning of 2nd to 3rd trimesters not less than one month interval.
The necessary steps to follow during labor, childbirth and immediate post partum
include the following:
- Do a Quick check upon admission for emergency signs:
* unconscious/convulsion
* vaginal bleeding
* severe abdominal pain
* looks very ill
* severe headache with visual disturbance
* severe breathing difficulty
* fever
* severe vomiting - Make the woman comfortable
-Establish rapport - Assess the woman in labor
This can be done by taking the history of the ff:
o Last menstrual period(LMP)
o Number of pregnancy
o Start of labor pains
o Age/height
o Danger signs of pregnancy
Taking the history through interview will help determine the client’s condition
during delivery of a baby. - Determine the stage of labor
- when woman’s response to contraction is observed
pushing down and vulva is bulging, with leaking amniotic fluid, and vaginal
bleeding. A vaginal examination can be performed to determine the degree of contraction - Decide if the woman can safely deliver
- Give supportive care throughout labor
o Encourage to take a bath at the onset of labor
o Encourage to drink but not to eat as this may interfer surgery in case needed
o Encourage to empty bladder and bowels to facilitate delivery of the baby.
o Remind to empty bladder every 2 hours.
o Encourage to do breathing technique to help energy in pushing baby out the
vagina. Panting can be done by breathing with open mouth with 2 short breaths
followed by long breath. This prevent pushing at the end of the first stage - Monitor and manage labor
8.Monitor closely within one hour after delivery and give supportive care.
9.Continue care after one hour postpartum . Keep watch closely for at least 2
hours. - Educate and counsel on FP and provide FP method if available and decision
was made by a woman. - Inform, teach and counsel the woman on important MCH messages:
* birth registration
* Importance of BF
* Newborn Screening for babies delivered in RHU or at home within 48 hours
up to 2 weeks after birth
* Schedule when to return for consultation for post partum visits
1st Visit post partum case visit:
1st week post partum preferably 3-5 days
2nd Visit post partum case visit:
6 weeks or 1&1/2 month post partum
proper spacing of birth?
Birth spacing of three to five years interval.
-will help completely
recover the health of a mother from previous pregnancy and childbirth. The risks
of complications increases after the second birth.
First stage of labor
-Not yet in activate labor
-cervix dilated 0-3 cm
-contractions are weak <2-10 minutes.
WHAT TO DO?
-check q hour emergency sign
-frequency & duration of contractions, FHR, etc.
-Checy q 4 hours Fever, pulse, BP, cervical dilatation.
-record time of rupture of membranes & color of amniotic fluid
ASSESS THE PROGRESS OF LABOR:
-if after 8 hours contractions are stronger and more frequent and no progress refer to hospital facility w/ comprehensive emergency OB care.
-FALSE LABOR: after 8 hours, there is no increase in contractions, membranes are not ruptured, and there is no progress in cervical dilatation.
WHAT NOT TO DO?
-Do not do vaginal examination more than frequently than 4 hours
First stage: in active labor,
-Cervix is dilated 4cm or more
WHAT TO DO?
-check q 30 mins for emergency signs
-check q 4 hours for fever, pulse, BP, and cervical dilatation
-Record time of ROM and color of amniotic fluid in Partograph/ patient record
WHAT NOT TO DO?
-do to allow push unless delivery is imminent. ↑ exhaustion
-do not give meds to speed up labor. can cause trauma to baby.
Second stage of labor
Cervix dilated 10cm or bulging thin perineum and head visible.
WHAT TO DO?
-check q 5 minutes for perineum thinning and bulging. descend of head during contractions.
-Emergency signs, FHR, mood & behaviour
-record to partograph/ pt record
WHAT NOT TO DO?
-No fundal pressure to deliver baby
Third stage of labor
-Between birth of baby and delivery of placenta
WHAT TO DO?
-deliver placenta
-check completeness of placenta & membranes
WHAT NOT TO DO?
-do not squeeze or massage abdomen to deliver placent
The overall goal of Family Planning
“to provide universal access to family planning information and services wherever and whenever these are needed.”
Family Planning aims to contribute to:
* reduce infant deaths
* neonatal deaths
* under-five deaths
* maternal deaths
Objectives of Family Planning:
- addresses the need to help couples and individuals achieve their desired family
size within the context of responsible parenthood and improve their reproductive
health to attain sustainable development - ensure that quality FP services are available in DOH retained hospitals, LGU
managed health facilities, NGOs, and private sector
Strategies of Family Planning
-focus service to urban & rural poor
-Reestablish FP outreach program
-Strengthen FP provision in regions with high unmet needs
-Promote frontline participation of hospitals
-Mainstream modern natural family planning
-Promote and implement CSR strategy
The Family Planning Methods:
- permanent contraception for
women who do not want more children.
-AKA bilateral tubal ligation that involves cutting or blocking 2 fallopian tubes
Female Sterilization
Effectiveness:
99.5%
Advantages:
-Permanent
-no repeated clinic visits
-does not interfere with sex
-increased sexual enjoyment -no need to worry about pregnancy
- brestfeeding-quantity and quality of milk not affected
-No health risk
-Minilaparatomy can be performed after giving birth
Disadvantages:
- Uncommon complications of surgery: Infection & Bleeding.
-Ectopic pregnancy
- Permanent- reversal surgery is difficult,
-not protected against STDs
-limitations in physical activities: heavy work & lifting heavy objects.
The Family Planning Methods:
-Permanent method wherein the vas deferens (passage of sperm) is tied and cut or blocked through a small opening on the scrotal skin.
Male sterilization AKA vasectomy
Effectiveness:
Perfect use: 99.9%
Typical use: 99.8%
Advantages:
-Very effective 3 months after the procedure
-can be performed in clinic, office, or primary care center
-Permanent & simple
- No resupplies or repeated clinic visits
-no health risk
-female partner could not undergo permanent contraception
-will not lose sexual ability or ejaculation or hormonal function.
-increases couple’s sexul drive
-Partner will not get pregnant
Disadvantage:
-uncomfortable, due to slight pain and swelling 2-3 days after the procedure
-Reversibility is difficult
-Bleeding: hematoma in scrotum
The Family Planning Methods:
Contains hormones -estrogen and progesterone taken daily to prevent contraceptions
Pill
-Taken Per Orem
Effectiveness:
Perfect use: 99.7%
typical use: 92.0 %
Advantages:
-safe & convenient to use
-make menstrual cycle occur regularly
-↓ gynecologic symptoms: painful menses & endometriosis
- ↓ risk for ovarian & endometrial Cancer
-reversible
-does not interfere w/ sex
Disadvantages:
-not correctly used, ↓ its effect
-SE: nausea, dizziness, breast tenderness
-health risk for small number of women
-no protection against STD’s
-can suppress lactation
-Requires regular resupply
The Family Planning Methods:
Thin sheath of latex rubber made to fit on a man’s erect penis
-prevent sperm and STD’s into vagina.
Male Condom
Effectiveness:
Perfect use: 98%
Typical use: 85%
ADVANTAGES:
-safe & has no hormonal effect
-protect against STD’s
-Accessible
-used in managing premature ejaculation
DISADVANTAGES:
-Allergic to latex or lubricant
-↓ sensation ↓ enjoyable in sex
-interrupts sexual act
-requires man’s cooperation for its use
The Family Planning Methods:
-Contain synthetic hormone progestin
-suppresses ovulation, thickens
cervical mucus, making it difficult for sperm to pass through and changes uterine lining
Injectables
Effectiveness:
Perfect use: 99.7%
Typical use: 97.0%
ADVANTAGES:
-reversible
-no need to take daily
-doesnt interfere w/ sexual intercourse
-culturally acceptable
-private since it is not coitally dependent
-No estrogen side effect
-no breastfeeding quality & quantity of milk affected
-beneficial noncontrceptive effects
DISADVANTAGES:
-progestin suppress ovulation making sperm difficult to pass through uterine lining.
The Family Planning Methods:
-Temporary introductory postpartum method of postponing pregnancy based on
physiological infertility experienced by breastfeeding women.
Lactating Amenorhea Method or LAM
Effectiveness:
Perfect use: 99.5%
Typical use: 98%
HOW IT IS USED:
-Amenorrhea
-Fully or nearly full breastfeeding her infant
-Infant is less than 6 months
ADVANTAGES:
-universally acceptable to all postpartum BF women
-protection from unplanned pregnancy begins immediately postpartum
-no other FP commodities required
-↑ Maternal & child health & nutrition
DISADVANTAGES:
-short term FP, effective only for maximum 6 months postpartum
-↓ effectiveness if mother & child are separated for extended periods of time (working mother)
-↓ to women who do not pass any 3 criteria to practice LAM
The Family Planning Methods:
-Abstaining from sex during fertile (wet) days prevents pregnancy.
Mucus/ Billings/ Ovulation Method
Effectiveness:
Perfect use: 97%
Typical use: 80%
How it is used;
* Recording of menstruation and dry days
* Inspecting underwear regularly for presence of mucus
* Recording the most fertile observation/characteristics at the end of the day
ADVANTAGES:
-can be used by any woman of reproductive age, not suffering from disease with discharge that make observation difficult.
DISADVANTAGES:
-not be used by woman that would make pregnancy especially dangerous.
The Family Planning Methods:
- identifying the fertile and infertile period of a woman’s cycle
-daily taking and recording of the rise in body temperature during and after ovulation.
Basal Body Temperature (BBT)
Effectiveness:
Perfect use: 90%
Typical use: 80%
HOW TO USE:
-Thermometer is placed in axilla or under the tongue at least 3 hours of undisturbed rest throughout menstruation cycle. (upon waking up & before any activity)
-Cover line is determined to identify highest temp from day 6-10 to identify thermal shift
-3 consecutive temp above the cover line is labeled as day 1,2,3
-intercourse is allowed only from 4th day of thermal shift until end of cycle
-these are known as absolute infertile phase day.
ADVANTAGE:
-Very Effective
DISADVANTAGE:
-Requires to take BBT everyday and time to record temperature.
-Couples may practice abstinence during fertile periods
The Family Planning Methods:
-Combintion of observing cervical mucus and basal body temperature recoridng.
Sympto-Thermal Method
Effectiveness:
Perfect Use: Sympto-Thermal: 9%
Typical Use: 80%
The Family Planning Methods:
Is a simple fertility awareness based method involves:
* cervical secretions as an indicator of fertility
* women checking the presence of secretions everyday
Two day Method
Effectiveness:
Two Days Method: 96.5%
Typical Use: 86%
ADVANTAGES:
Advantages:
* Can be used by women with any cycle length
* No health side effects
* Incurs very little or no cost
* reversible
* Promoted male partner involvement in FP
* Enhances self-discipline mutual respect cooperation communication, and
shared responsibility of the couple for the FP
* enhancing the couples’ sexual life
* Can be integrated in health and FP services
* Acceptable to couples regardless of culture, religion, socioeconomic status, and Education.
*Not dependent on medically qualified personnel;
*once learned, may require no further help from health care providers.
DISADVANTAGES:
- Needs the cooperation of the husband
- Can become unreliable for women who have conditions that cause abnormal
cervical secretions
-Does not protect the client from HIV/AIDS
The Family Planning Methods:
-A new method of natural family planning, all users with menstrual cycles between 26 and 32 days are counseled to abstain from sexual intercourse on
days 8-19 to avoid pregnancy.
-The couples use color-coded cycle beads to mark the fertile and infertile days
of the menstrual cycle
Standard Days Method
Effectiveness:
Perfect Use: Standard Days: 95%
Typical Use: 88%
How it is used:
Abstain from sexual intercourse during fertile period
Use color coded beads to mark the fertile and infertile periods
Advantages:
* No side effects
* Increases self awareness and knowledge of human reproduction and can lead
to a diagnosis of some gynecologic problems
* No need for counting or charting since the standard days method makes use of
beads for tracking the cycle days
* Can be used either to avoid or achieve pregnancy
* Very little cost and promotes male partner involvement in family planning
* Enhances self discipline, mutual respect
* enhancing the couples sexual life
* Can be integrated in health and family planning services
* Acceptable to couples regardless of several factors.
* Not dependent on medically qualified personnel
* Once learned, may require no further help from health care providers
Disadvantages:
-Cannot be used by women who usually have menstrual cycle between 26 and
32 days long
The Roles of Public Health Nurse on Family Planning Program
-Provide counseling among the clients will help increase FP acceptors and avoid defaulters
*to inform & educate the use, importance, benefits/advantages, disadvantages, side effects, complications, and effectiveness.
-Provide packages of health services among reproductive age group in all health
facilities
*Family planning
*MCHN
*Management of
reproductive tract
STIs/HIV/AIDS
*Violence against women
*Availability of FP Supplies
& logistic for client
Child Health Programs
- Infant and Young Child Feeding
- Newborn screening
- Expanded Program on Immunization
- Management of Childhood Illnesses
- Micronutrient Supplementation
- Dental Health
- Early Child Development
- Child Health Injuries
WHAT IS THE GOAL OF THE CHILD HEALTH PROGRAMS
to reduce morbidity and mortality rates for children 0-9 years with
the strategies necessary for program implementation
The strategic thrusts for 2005-2010
-Develop local capacity to deliver the whole range of essential health packages
for children. Pursue the Sentrong Sigla initiative.
- Implement programs and projects that favor disadvantaged populations.
- Apply the Reaching Every Barangay (REB) strategy for immunization to reach
every child.
- Intensify health education and information campaigns at the ground level to
increase the proportion of mothers practicing behaviors that
promote children’s health
-Enhance medical, nursing and midwifery education
- Pursue the implementation of laws and policies for the protection of newborns,
infants and children
IYCF
Infant and Young Child Feeding
