CHN across the lifespan Flashcards
Who are the clients of a CHN?
individuals, families, and communities
What ensures retained excellent care throughout a changing healthcare delivery system?
continuity & collaborative care
community-based programs that aim to improve people’s well-being and self-actualization by helping them engage in actions that help them reach their full health potential
health promotion programs
most vulnerable members of the community
mothers and children
important markers of country’s present health status
health of mothers and children
According to 2003 FHSIS report, what are the leading causes of maternal and infant mortality?
> maternal mortality = difficulties connected to pregnancy
> infant mortality - other perinatal disorders & pneumonia
DOH program that aims to reduce perinatal, infant, and young child (0-4) morbidity and mortality by sustaining optimal maternal health and ensuring physical, emotional, and cognitive well-being of the child
Maternal and young Child Health (MCH program)
DOH program that aspires to create a vision of healthy, empowered Filipino moms who are capable of making their own decisions and contributing to our country’s socioeconomic progress by increasing mother’s well-being through a holistic strategy (preventive, promotive, curative, and rehabilitative care)
Safe Motherhood Initiative program
women capable of becoming mothers (fertile age)
15-49
essential healthcare services for mother & child
antenatal care & emergency obstetric care
normal prenatal check ups include
> an antenatal visit during 1st, 2nd, & 3rd trimester
> visit every 2 weeks after 8th month of pregnancy
care required for high-risk pregnancies and difficulties during delivery and postpartum
emergency obstetric care
instrument utilized to improve prenatal, natal, and postnatal care for women, as well as family planning; analyzes health of the at-risk woman
Home-Based Mother’s Record (HBMR)
most important physiologic changes during pregnancy with nutritional implications
- increased BMR
- tendency to retain water
- decreased gastric acidity and intestinal motility (early trimesters = digestion & absorption impairment; last trimester = constipation)
- production of simple glycosuria
- hormonal changes
- positive nitrogen balance
- increase in plasma volume & corr. decrease in hemoglobin concentration
pregnant mother’s food intake should account for
- increased BMR
- increasing fetus’ nutritional needs
- dev’t of reproductive tissues
- nutrition reserves to compensate for losses following delivery
normal weight gain during pregnancy & distribution of weight
normal weight gain = 20-25 lbs
> 7 - 7 1/2 lbs - infant at birth
> 3 - 3 1/2 lbs - uterus, placenta, and membrane
> 2 lb - amniotic fluids
> 1 - 1 1/2 lbs - mammary glands & tissues
> remaining lbs - increased blood vol & maternal fluids
to avoid constipation
increase fiber & water intake
closely managed during pregnancy to keep weight growth under control
caloric intake
supplementation for strict vegans or as prescribed
iron, zinc, folate, & b12
limited to 2 cups
regular coffee
can cause fetal alcohol syndrome and should be avoided
alcohol
dietary guidelines for women in first trimester experiencing nausea and vomiting
> dry crackers before rising > small frequent meals > liquids between meals > hard candies for relief > no oily or fried food
iron supplementation
> 1 tablet/day for at least 180 days (6 mos)
> 2 tablets/day if starting at 2nd-3rd trimester
folic acid supplementation
800 mg
vitamin a supplementation
> 1 tablet/capsule of 10000 IU twice a week from 4th month to birth
not for mothers taking prenatal vitamins w/ vitamin a or micronutrient tablets
iodine supplementation for mothers in goiter-prone locations
1 iodized oil capsul containing 206 mg iodine once a year
supplementation for mothers in malaria-prone areas
150 mg Choroquinone twice a week throughout the course of pregnancy
significant nutrient-related risk factors for pregnant teens
> low pregnancy weight gain
low or excessive pre-pregnancy weight for height
low gynecological age (age of conception - age of menarche)
unhealthy lifestyle
history of eating disorders
presence of anemia, toxemia, & other chronic diseases
caloric intake of pregnant teen
must account for anabolic demands of pregnancy & fetus and developmental demands as a growing teen; surpasses caloric needs of mature adult pregnancy
normal weight gain of pregnant teen
14-15 kg or 30 lbs at a pace of 500 g/week
How to prevent Tetanus neonatorum?
- tetanus toxoid vaccination
2. proper/good hygiene
TT1 dose timing & period of protection
as early as possible during 1st pregnancy
none
TT2 dose timing & period of protection
4 weeks after TT1 during the same pregnancy
3 years
TT3 dose timing & period of protection
6 months after TT2 or during subsequent pregnancy
5 years
TT4 dose timing & period of protection
1 year after TT3 or during subsequent pregnancy
10 years
TT5 dose timing & period of protection
1 year after TT4 or during subsequent pregnancy
All child-bearing years
Maximum TT doses during a lifetime
5 doses
months of immunity conveyed to newborn by immunized mother
5 months
dental care of pregnant woman
> regular brushing of teeth with fluoride toothpaste and dental flossing
dental visit for treatment at 2nd trimester
invasive procedures postponed until after baby is born
When is the puerperium stage, the most critical stage for the mother because of unstable vital signs?
1-2 hours after delivery
Puerperium nursing responsibilities
PFV BBN RIPP BFE
- Perineal care
- feel the Fundus
- Vital signs (BP, PR, RR)
- observe flow of Blood from vagina during uterine massage.
- keep Bladder empty.
- offer Nourishing liquids or foods as tolerated.
- encourage Rest and sleep.
- prevent Infection by hand washing technique
- encourage mother to practice Personal hygiene
- teach mother to wash Perineum with concoction of herbs (e.g. bayabas)
- discuss the importance of Breastfeeding, care of the newborn and immunization
- motivate to practice Family planning
- issue an ECCD card for the mother to fill-out
frequency of checking the fundus
every 15 minutes for 1 hour
then every 30 minutes for the next hours
for the first 12 hrs after birth the fundus should be
firm, at the midline, and above the umbilicus
NI if uterus is not contracted
massage to prevent bleeding
NI if bleeding is present
place mother in trendelenburg position
BP and PR may be slightly above normal due to labor, but will normalize in how many hours?
1 hour
the 30-50% increase in fetal cardiac volume during pregnancy will be reabsorbed in how long?
5 minutes after delivery
How much bleeding is normal postpartum?
moderate amount; pad completely saturated by 30 minutes
signs of full bladder postpartum
fundus at right mid-line, clots expressed, & dark-red bleeding
a record of important services that a child should get from birth to 6 years
early child care development (ECCD) card
originally yellow, now printed as white; a chart for monitoring appropriate weight for child as he/she ages
growth monitoring chart
BUBBLESHE stands for
> Breast > Uterus > Bowel > Bladder > Lochia > Episiotomy > Skin > Homan's sign > Emotional status
what is the homan’s sign
thrombophlebitis, edema, or tenderness of legs
progression of uterus down its original location
1 fingerbreadth below the umbilicus each day
How can the mother prioritize her health during postpartum?
eating well (for her own nutritional needs and for milk production) & returning to normal physical activities as soon as she is able
Immediate Newborn Care
SACS CCV KKI
- Suctioning to clear the airways.
- APGAR scoring 1 minute and 5 minutes after birth
- Crede’s prophylaxis or eye treatment
- Skin care
- Cord dressing
- Complete physical assessment
- Vital Signs
- Keep warm & dry
- vitamin K injection
- proper Identification
what is checked during 1 minute APGAR score
cardio-respiratory and nervous system functioning
what is checked during 5 minute APGAR score
newborn’s adjustment to new environment
RATIONALE for crede’s prophylaxis
to prevent opthalmia neonatorum or gonorrheal conjuctivitis
medicine used in crede’s prophylaxis
Terramycin opthalmic ointment placed 1 cm from innter to outer canthus of the NB’s eyes
RATIONALE for strict asepsis during cord dressing
avoid tetanus neonatorum
What are checked and monitored during cord dressing?
> completeness of vessels (1 vein, 2 arteries)
presence of omphalocele or umbilical hernia
presence of omphalangia (for 24 hrs)
what is omphalocele
congenital protrusion of abdominal viscera into weakened portion of the navel
what is omphalangia
bleeding of cord
normal weight at birth
3-3.4 kg
weight doubles at ____ and triples at ____
6 months; 1 year
average height at birth
50 cm
normal head circumference at birth
23-35 cm
normal abdomen and chest circumference at birth
31-33 cm
best route for checking newborn’s temp
axilla
risks of checking anal temp
> mucosal perforation & peritonitis
tissue injury
inaccurate results
What is vitamin K for?
promote blood clotting
best IM site for vitamin K injection
vastus lateralis or mid-antero-lateral aspect of thigh
best identification for NB
footprints
identification band should contain
mother’s name, date & time of birth, sex
simple procedure to check for congenital metabolic disorders that can cause mental retardation or death if untreated
Newborn Screening (NBS)
method used in NBS
heel-prick method
When is NBS done?
at least 24 hrs after birth until 72 hours (1-3 days); repeated again after 2 weeks
what should be avoided while expressing breastmilk?
pinching (instead press towards chest wall)
washing containers for breastmilk should be done with ____ and rinsing should be done with ____
hot soapy water; hot clear water
how to warm stored breastmilk?
place in bowl with hot water
what to do when fat globules separate from milk
shake to recombine fat with the rest of the liquid
breastfeeding positions
> cradle hold
side-lying position
football hold
how should a mother’s hand be positioned when holding her breast?
C-hold/C-position
how often should a nursing newborn be burped?
after each breast and at the end of each feeding
are both breasts used during feedings? how?
yes. first breast for 10 minutes, then transfer to the other breast for 6 minutes. at the next feeding, start with the breast you ended the last feeding with.
how often should a newborn be nursed?
shortly after birth, every 2-3 hrs
what do sore nipples and prolonged feedings indicate?
baby not latching on breast properly
which is normal during first week of breastfeeding, soreness or tenderness?
tenderness
until when should an infant be breastfed?
2 years old
how much milk does a nursing woman produce each day on average?
750-1000 mL
nutritional requirements for lactation
> 300-400 additional kcal per day
1 glass of liquids at each infant meal time
750-1000 mL additional fluid intake each day
additional protein, vitamins, and minerals (esp calcium)
avoid coffee & alcohol
medications may imply that breastfeeding is contraindicated or newborn will have to be monitored for adverse effects
age marked by fastest rate of growth and dev’t; triple weight; increased height by 50%
first year of life
caloric requirements
> 0-6 mos = 108 kcal/kg/day
> 6-12 mos = 98 kcal/kg/day
milk should provide how much of the infant’s caloric reqs? and what would provide the remaining calories?
2/3; additional carbs & later supplementary meals
protein reqs
> 0-6 mos = 2.2 g/kg/day
> 6-12 mos = 1.6 g/kg/day
Fat provides necessary fatty acids and accounts for at least 1-2% of total caloric demands. Where are they sourced from?
human or whole cow’s milk
most variable nutrition need due to changes in infant’s activities and ambient temp.
fluids
where is niacin and choline generated from?
tryptophan and methionine, respectively
how much fluids needed
4.5-5 oz/kg/day
which vitamin needs to be supplemented, while the rest is adequately sourced from milk?
vitamin a
which mineral store is depleted after 3 months and needs to be supplemented?
iron
What indicates a sufficient nutrition supply?
appropriate weight and height gain > 5-8 oz weight gain per week -slows to-> 4 oz/week > doubled weight @ end of 5 months > tripled weight @ end of 12 months > +10 inches or 50% of height @ end of 12 months > firm, well-formed muscles > moderate subQ fat > happy disposition > normal dental and motor dev't
until when should NBs be exclusively breastfed?
4-6 months
when can NBs be introduced supplemental feedings?
6 months
guidelines for supplemental feedings
> introduce one kind of food at a time
always start with small amounts, in a more dilute form and with smooth texture; gradually, texture will be coarser
when baby’s teeth erupts, finely chopped fruits, veggies, meat, toast, and teething crackers are suitable
whole eggs delayed until 10-11 mos
short-term measure of DOH to improve children’s nutritional status
micronutrient supplementation
long-term measure of DOH to improve children’s nutritional status
> Araw ng Sangkap Pinoy Food Fortification
Sangkap Pinoy Seal Program
Garantisadong Pambata program
set of tools for promoting and maintaining excellent health and growth in children under the age of five
Growth Monitoring and Promotion
begins in the mother’s womb and continues throughout life; achievement & maintenance of excellent health status
Growth Promotion
nutritional check-up done on a regular basis
Growth Monitoring
weighing children under 12 months should be done how frequently?
once a month
weighing children from 1-5 years old should be done how frequently?
every three months
where will the growth measurements be recorded?
growth monitoring chart of ECCD
the process of identifying clinical characteristics linked to malnutrition in order to identify people who are at risk and arrange suitable nutrition therapy
nutritional screening
nutritional anthropometric measurement indicators
- weight for age
- Waterlow classification of malnutrition (height for age & weight for height)
- Mid-upper arm circumference (MUA)
A child’s actual weight is compared with an ideal weight for his age.
weight for age
76-90% below ideal weight for age
1st degree or mildly underweight
61-75% below ideal weight for age
2nd degree or moderately underweight
below 60%
3rd degree or severely underweight
child’s weight falls below ideal for age
underweight
What measurements fall under Waterlow classification of malnutrition?
> height for age
> weight for height
A child’s actual height is compared with an ideal height for his age
height for age
child’s height falls below ideal for age
stunted
what does a stunted child indicate
chronic malnutrition or malnutrition that has not been corrected and has been occurring for a long time
A child’s weight is compared with an ideal weight for his height
weight for height
child’s weight falls below ideal for height
wasted
what does a wasted child indicate
current or recent malnutrition
if child’s MUA falls below ideal
undernourished
pediatric immunizable diseases
> hepatitis B > pertussis / whooping cough > tetanus > diphtheria > measles PH TMD
before his/her first birthday, a completely immunized infant has had…
> 1 dose of BCG (for TB)
> 3 doses of Hep B
> DPT (Diphtheria, Pertussis, Tetanus)
> OPV (Oral Polio Vaccine)
> 1 dose AMV (Anti-Measles Vaccine
(ABB DO)
3vaccines included in expanded program in immunization (EPI)
> BCG birth dose > Hepatitis B birth dose > Oral Poliovirus Vaccine > Pentavalent Vaccine > Measles Containing Vaccines (Antimeasles Vaccine, Measles, Mumps, Rubella) > Tetanus Toxoid > Pneumococcal Conjugate Vaccine 13
it is safe and immunologically effective to administer all EPI vaccines ________
on the same day at different sites
When is the measles vaccine administered? Should it be postponed if another vaccine is scheduled at the same date?
as soon as the child is 9 months old; no
Should the vaccine schedule be restarted if the interval between doses exceeded the recommended interval by months or years?
no
If the child is sick, can they still be vaccinated?
Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea, and vomiting are not contraindications to vaccination.
Generally, one should be immunized unless the child is so sick that he needs to be hospitalized. Then the hospital needs to decide on when to immunize the child.
contraindications to immunizations
> BCG vaccine on child with AIDS
> DPT2 or DPT3 on child who had convulsions or shock within 3 days of previous dose
When do you need to repeat a BCG vaccination?
no scar formed after 1st injection
monitor the developmental tasks of newborns, children, and adolescents through screening instruments, a comprehensive history, physical evaluation, and/or directed observation
developmental screening
tool used to assess the overall developmental status of children aged birth to six years; formerly known as the Denver Developmental Screening Tool
DENVER II
What are included in DENVER II?
Personal-social, fine, motor-adaptive activities; language; and gross motor abilities
primary cause of mortality in children over the age of 1
accidental injuries
protecting children includes
> promoting health
providing safe surroundings
providing medical care access
protecting from child abuse and violence
nutritional assessment tool used in the case management of sick children who come to the health center for help.
Integrated Management of Childhood Illnesses (IMCI) chart
six childhood ailments created in the IMCI
> malnutrition > malaria > measles > pneumonia > diarrhea > dengue hemorrhagic fever 3MP2D
antiseptic dye used to treat infections on infant
gentian violet
fast breathing in infant less than 2 mos
60 brpm or
fast breathing in 2- 12 mos
50 brpm or
fast breathing in 12 mos-5 yrs
40 brpm or
