Week 2: NCM 112 Ma’am Laput

Common Blood Disorders

HEMATOLOGIC BLOOD DISEASES

 RED BLOOD CELL (RBC) DISQRDERS
- Anemia
 PLATELET DEFICIENCY
-Thrombocytopenia/Thrombocytopathia
 WHITE BLOOD CELL (WBC) DISORDERS
-Leukopenia
-Leukemia
-Lymphoma
 BLEEDING DISORDERS
-Platelet Function
-Coagulation Factor
ELEMENTS ESSENTIAL FOR ERYTHROCYTES
-PROTEIN
-IRON
-FOLIC ACID
-VITAMIN C
-VITAMIN B12
ABSENCE OF THESE ELEMENTS WILL CAUSE ANEMIA
ANEMIA
 Reduction of normal value of erythrocytes, quality of Hgb, and the volume of erythrocytes.
 Causes:
- Decreased BC production
- Increased BC destruction
- Acute or chronic blood loss

Different types of ANEMIAS

 Iron deficiency Anemia
 Pernicious Anemia
 Folic Acid Deficiency Anemia
 G6PD Deficiency
 Sickle Cell disease
 Thalassemia
 Aplastic Anemia
DIAGNOSIS
 History Collection
 Physical
 examination
 Laboratory
 Investigations
 Bone marrow studies

3 Broad Etiologic Classification

1. Hypoproliferative Anemia- Resulting
from Defective RBC Production
 Iron deficiency
 Vit. B12 deficiency
 Folate deficiency
 Decreased erypoietin
production (eg. From renal
dysfunction)
2. Bleeding- Resulting from BC Loss
 Acute post-hemorrhagic anemia
 Chronic post-hemorrhagic anemia
3. Hemolytic - Resulting from BC destruction
 Altered erythropoiesis ( sickle cell, thalassemia)

Classification of Anemia According to Morphology

• Normocytic - occurs when the overall hemoglobin levels are decreased, but the red blood cell size (mean
corpuscular volume) remains normal. Causes include: Acute blood loss, Anemia of chronic disease
• Microcytic- result Of hemoglobin synthesis failure/insufficiency. Iron deficiency anemia, thalassemia.
• Macrocytic- Megaloblastic anemia, the most common cause of macrocytic anemia, is due to a deficiency of
either vitamin B12 folic acid, or both. Also seen in hypothyroidism, alcoholism.
• Hypochromic microcytic- iron deficiency anemia.

ANEMIA owing to blood loss- Iron deficiency

• Iron deficiency is defined as a reduction in total body iron
to an extent that iron stores are fully exhausted and some
degree of tissue iron deficiency is present.
• Females are mostly affected.

Etiology
 Chronic blood loss
 Inadequate dietary intake
 Faulty iron absorption
 Increased requirements for iron- infancy, childhood, pregnancy.
CAUSES
 Decreased iron stores
 Decreased intake
 Increase losses
 Increased Demands
CLINICAL MANIFESTATIONS
 Chronic fatigue
 Pallor of the conjunctiva, lips, and oral mucosa;
 Brittle nails with spooning, cracking,
 Splitting of nail beds, koilonychia
 Palmar creases
 Palpitations
 Shortness of breath, numbness
 Bone pain
ORAL MANIFESTATIONS
 Angular cheilitis,
 Glossitis with different degrees of atrophy of fungiform and filliform papillae
 Pale oral mucosa
 Oral candidiasis
 Recurrent aphthous stomatitis
 Erythematous mucositis
 Burning mouth
LABORATORY FINDINGS
• Microcytic hypochromic anemia due to inadequate supply of iron for normal hemoglobin synthesis.
• RBC-3.000.000-4.000.000/cubic mm
• Low hemoglobin
• Low serum iron and ferritin with an elevated total iron
binding capacity (TIBC)
MANAGEMENT
 ORAL IRON THERAPY
  PARENTERAL IRON THERAPY
 DIET THERAPY

Oral iron therapy

 Recommended Dosage
 Infant and children: 3 mg/kg/day
 20 mg elemental iron +100 mcg folic acid
 Adolescent : 100 mg elemental iron +500 ug of folic acid +25-50 mg vit.
Mild Anemia: Once Daily
Moderately And Severe Anemia: Twice
Daily
Result
 Peak increase of reticulocyte count in
DIET THERAPY
Good sources of iron:
• legumes, nuts, Green leafy veg. dates, yolk of egg, fish, meat, liver, ripe banana, mango Cooking in iron pots
Poor source of iron:
 Milk, Administer iron with fruit juices, iron with milk or antacids
Folic Acid Deficiency Anemia
 Associated with decreased dietary intake of folic acid
Causative Factors:
 Alcoholism
 Malabsorption
 Diet deficient in uncooked vegetables
 Use of oral contraceptives
Dx tests:
 CBC: decreased RBC, Hgb, hematocrit
 BC are large with fragile membranes that rupture easily
 Low Serum folate
PATHOPHYSIOLOGY OF FOLIC ACID DEFICIENCY
Decreased Folic Acid
I
Impaired DNA synthesis in the bone marrow
I
Impaired BC development; impaired nuclear maturation but cytoplasmic maturation continues
I
Large Size

Folic Acid Deficiency Anemia

• Nursing Interventions:
-Replacement: 1-5 mg oral folate/day
-Prenatal vitamin
-Diet: leafy greens, liver, citrus fruit, nuts, grains
-Assess client's tolerance to activity
-Provide adequate rest

Pernicious Anemia or Vit. B12 Deficiency

 Inability to absorb Vit B12.
Lack of Intrinsic factor (needed for the absorption of Vit.
B12)
Causative Factors:
-Strict Vegetarian
-Gl Malabsorption
-Gastritis
-Gastrectomy
Assessment:
 weakness, pallor, fatigue
 Sore mouth, smooth beefy red tongue, constipation or diarrhea
 Loss of sense of balance, paresthesia, tingling, paralysis, mental confusion
Pernicious Anemia
Diagnostic tests:
- CBC: macrocytic RBC's and, abnormally shaped
•Decreased erythrocyte
-BM: increased megaloblasts
- Bilirubin: elevated
- Schilling test:

Aplastic Anemia
 This rare, lite-threatening anemia occurs
when your body doesn’t produce enough
red blood cells.
 Marrow failure may be initial presenting
reature.
 Causes of aplastic anemia include:
-Infections,
-Bleeding
-Certain medicines,
-Autoimmune diseases
-and exposure to toxic chemicals.

Aplastic Anemia Signs and Symptoms:

 Anemia (low Hb, Hct)
- fatigue, lassitude, dyspnea
 Thrombocytopenia (low platelets)
- bruises, petechiae
- serious bleeding
 Neutropenia (low neutrophils, a type white cell)
- infections
Aplastic Anemia Causative Factors:
1. Environmental Toxins- pesticides, benzene
2. Certain Drugs
-Chemotherapeutic agents
-Chlorampenicol
-Phenothiazines
-Sulfonamides
3. Radiation
4. Chemica;
5. Viral, Infection, bacterial. Idiopathic
Pathophysiology:
Toxins cause a direct bone
marrow depression
I
acellular bone marrow
I
Decreased production of
blood elements
Laboratory Findings:
1. CBC
• Decreased blood cell numbers
2. Bone marrow aspiration confirms the anemia-hypoplastic or acellular
marrow replaced by fats
Nursing Management:
1. Assess for signs of bleeding and infection
2. Pancytopenia plan of care to prevent complications
like infection and bleeding
-Private Room
-Strict hand Washing
-Minimizing invasive procedure
3. Provide client and family with support for lengthy hospitalization and treatment
WEEK 2: NCM 112- Ma’am Dulin

Pharynx
 PARYNGEAL TONSILS. Situated superior-posteriorly to the tors tubaris (elevation around the
pharyngeal opening of the Eustachian tube). In the roof of the NASOPHARYNX, the pharyngeal tonsil
is primarily responsible for"screening the air that enters through the nostrils.
 The PALATINE TONSILS are the ones that are located near the opening of the oral cavity into the
pharynx.
 LINGUAL TONSILS pre located Do the posterior surface of the tongue, which also places them near
the opening of the oral cavity into the pharynx.
The function of the palatine tonsils is thought to be associated with preventing infection in the respiratory and
digestive tracts by producing antibodies that help kill infective agents.

COMMON DISORDER OF PHARYNX

 Cancer: Types of throat cancer include nasopharyngeal cancer and hypo pharyngeal cancer.
 Dysphagia: is trouble swallowing because of muscle weakness, nerve damage or disease.
 Infections: Bacterial and viral infections can cause pain and inflammation in the throat (for example,
common cold, flu, strep throat)
 Inflammation in the auditory tubes: This can cause earaches and trouble hearing.
 Pharyngitis: Otherwise known as sore throat, pharyngitis is inflammation of the pharynx.
 Sleep apnea: is a sleeping disorder that may be caused by abnormalities in the pharynx.
 Tonsillitis: is an infection in the tonsils.

LARYNX
Your larynx is a hollow tube that connects your throat (pharynx) to the rest of your
respiratory system. It helps you swallow safely and contains the vocal cords, so it's often called the voice box,
What does the larynx do?
Your larynx has three main functions in your body:
-Breathing,
-Creating vocal sounds.
-Preventing food and other particles from getting into your trachea, lungs and the rest of your respiratory
system.

 Acute laryngitis: Laryngitis is inflammation of the larynx. Short-term laryngitis may involve a sore
throat, hoarse voice, pain, coughing and sometimes fever. It can be caused by an infection or overuse
of the vocal cords. It usually lasts for one or two weeks.
 Chronic laryngitis: Long-term laryngitis lasts longer than three weeks. It can be caused by allergies or
dust.
 Laryngeal cancer: Laryngeal cancer may require surgery to remove part or all of the larynx
(laryngectomy)
 Trauma or injury: The larynx can be injured like any other part of the body. A common injury is
damage from overuse (for example, someone who speaks, sings or shouts a lot).
 Vocal cord dysfunction: Vocal cord dysfunction occurs when the vocal cords don't act or work
normally.
 Vocal cord lesions: The vocal cords can develop noncancerous lesions, nodules, polyps or cyst,
especially with overuse of the voice.
 Vocal fold paralysis: is when one or both vocal folds do no move properly.

TRACHEA- wind pipe

 Made of 15-20 C-shape cartilages L- 11.2 cm, W - 2 to 2.2 cm.
 Carina - is at the bottom of the trachea and is the point at which the trachea divides into the Left and
right main bronchus leading to the lungs
 Landmark for ET insertion
MAIN-STEM BRONCHI
 Cartilaginous
  2 mainstem bronchi
1. Left- narrow and longer, 45-55 degrees angle, more horizontal, not accident prone.
2. Right - wider and shorter, 20- 30 degrees angle, more vertical, accident prone.

ACCESSORIES INSPIRATION
1. DIAPHRAGM -Primary or main muscle of respiration. Muscle that helps your lungs pull in air and push
it out.
2. INTERCOSTAL
A. Internal
 Forced expiration and coughing muscles
 Decreases the diameter of the chest wall
B. External
 Inspiration
 Increases the diameter of the chest wall
3. PECTORALIS MAJOR AND MINOR- both increase the work of breathing.
4. Rectus Abdominis
-Forced expiration and coughing
5. Scalene
 Stabilizes the upper chest wall.
 Elevates the 19 and the 2nd ribs during inspiration, increases
 the size of the thorax
6. Sternocleidomastoid-
 Stabilizes upper chest wall. Assist in elevating the rib cage
 Elevates stemum
7. PARASTERNAL - Inspiratory muscle, increases work of breathing.
8. Trapezius - Inspiratory muscles, starts at the base of your neck, goes across your shoulders and extends to
the middle of your bac.

SUMMARY:
-Muscle responsible for supraclavicular retraction
 Sterocleidomastoid
 Scalene
 Trapezius
-Inspiratory muscle
 Parasternal
 Trapezius
 Pectoralis

EXPIRATION MUSCLES
 IC- internal
 Rectus abdorinis
ACCESSORIES: BONES (skeletal system )
1. RIBS
 7 pairs -true ribs (attached directly to sternum)
 3 pairs - false ribs- 8th, 9th, and 10th ribs (attached to one another by costal cartilages but not directly to
the sternum.
 2 pairs - floating ribs - 11' and 124 ribs ( not attached to other ribs and sternum
 Allow full expansion of the chest.
 Protect the kidneys
2. STERNUM
 Manumbrium
 Body
 Xiploid
VERTEBRAE
 T1-T7 True ribs
  T8-T10 False Ribs
 T11-T12 Floating ribs

The Accessory Expiratory Muscles are:

1. Rectus abdominis. Informally known as the abs muscle, is a long
muscle of the anterior abdominal wall. In those with low body fat, it is clearly visible beneath the skin
skin forming the 'six pack'. It extends from the rib cage rib cage all the way to the pubic bone.
2. External oblique
3. Internal oblique. is a muscle found on the lateral side of the abdomen. It is broad and thin. It forms one of
the layers of the lateral abdominal wall along with external oblique on the outer side and transverse abdominis
on the inner side.
Along with other abdominal wall muscles, the internal oblique muscle flexes and bends the trunk, assists
forced expiration by depressing the lower ribs, and helps to maintain intra-abdominal pressure in defecation,
micturition and childbirth.
3. Transversus abdominis. is located in the abdomen immediately inside of the internal oblique muscle.
It is one of the innermost muscles of the abdomen.

DEFENSE MECHANISM OF THE RESPIRATORY SYSTEM

The average person who is moderately active during the daytime breathes about 20,000 liters (more than
5,000 gallons) of air every 24 hours. Inevitably, this air (which would weigh more than 20 kilograms [44
pounds]) contains potentially harmful particles and gases. Particles, such as dust and soot, mold, fungi,
bacteria, and viruses deposit on airway and alveolar surfaces.
Fortunately, the respiratory system has defense mechanisms to clean and protect itself. Only extremely small
particles, less than 3 to 5 microns in diameter, penetrate to the deep lung
1.Nose - filters, humidifies, warms, traps
2. Mucus layer traps pathogens (potentially infectious microorganisms) and other particles, preventing them
from reaching the lungs
3. Cilia - hair like projections - columnar epithelial cells - propels particles FB to Oropharynx coughed or
swallowed
4. Goblet Cells- specialized type of epithelial cell that secrete mucins (any of the class of glycoproteins found in
mucks E,g, saliva, gastric juice, secreted by mucous membranes)
5. Cough reflex - protective mechanism rapidly expels air and particles from airway,
6. Sneeze reflex - cleans nasal passageway
7. Hering-Bruer reflex - prevents over inflation of the alveoli
8. Alveolar Macrophages -the most abundant innate immune cells in the distal lung parenchyma, located on
the luminal surface of the alveolar space.
9. Reflex Bronchoconstriction - sudden narrowing preventing foreign bodies and noxious substances to enter
the system.

Oxygenation
Respiratory Physiology: Most cells in the body obtain their energy
from chemical reactions involving oxygen and elimination of carbon
dioxide. The exchange of respiratory gases occurs between environmental air and the blood. There are 3 steps
in the process of oxygenation:
Ventilation,
Perfusion
Diffusion.
For the exchange of respiratory gases to occur, the organs, nerves and muscles of respiration must be intact
and the central nervous system able to regulate the respiratory cycle.

1. Ventilation:
Ventilation is the process of moving gases into and out of the lungs. Ventilation Requires coordination of the
muscular and elastic properties of the lung and thorax. The major inspiratory muscle of respiration is the
diaphragm. It is innervated by the phrenic nerve - the spinal cord at the fourth cervical vertebra.
Oxygenation Versus Ventilation
 Oxygenation is how we get oxygen to the tissue. Oxygen is inhaled into the lungs where gas exchange
occurs at the capillary-alveolar membrane. Oxygen is transported to the tissues through the blood
stream. Pulse oximetry measures oxygenation.
 Ventilation (the movement of air) is how we get and of carbon dioxide Carbon dioxide is cared back
through the blood and exhaled by the lungs through the alveoli Capnography measures ventilation.
A.

A.

A.

A.

A.

A.

A.

A. Inhalation. The intercostal muscles contract, lifting the rib cage up and out. At the same time, the
diaphragm contracts and pulls downward. As the lungs expand, air moves in.
B. Exhalation The intercostal muscles relax, allowing the rib cage to return to its normal position. The
diaphragm also moves upward, resuming its domed shape. As the lungs contract, air moves out.
Normal Inspiration Normal Expiration
Diaphragm - flattens and contracts relaxes and elevates
ICM-contracts relax
Rib cage - raised lowered
Thoracic - enlarged reduced

DIFFUSION
- is the process whereby gases move from an area of high pressure to low pressure. This includes during:
 Internal respiration - this is the movement in the internal tissues between cells and capillaries, and
 External respiration - when gas is exchanged between the alveoli and lung capillaries.

Once in the lungs, the air travels through a series of increasingly smaller structures called bronchioles. It
eventually reaches tiny sacs called alveoli. From the alveoli, the oxygen from the air you breathe enters your
blood in nearby blood vessels. This is a process called oxygen diffusion. Once your blood is oxygenated, it
carries oxygen throughout your body.
Another form of diffusion occurs when blood containing carbon dioxide
travels back to your lungs. The carbon dioxide moves from your blood to your alveoli. It's then expelled through
exhalation. This is a process called carbon dioxide diffusion.

Outcomes
 Explain how diffusion happens in liquids and gases
 Investigate the process of diffusion between two substances
 Justify how the rate of diffusion can be affected by different factors

1. Diffusion and breathing

Oxygen in inhaled air diffuses through the lungs and into the bloodstream. The oxygen is then transported
throughout the body.
Carbon dioxide is the waste gas produced by respiration. Carbon dioxide diffuses from lady tissues into the
bloodstream and is exhaled via the lungs. Where does gas exchange take place in the lungs?

PERFUSION
- Is the actual blood flow through the pulmonary circulation.
Perfusion refers to the blood flow to tissues and organs. Alveoli are perfused by capillaries so the diffusion of
oxygen and carbon dioxide can take place
The main difference between perfusion and diffusion is that perfusion is the delivery of blood to the pulmonary
capillaries, whereas diffusion is the movement of gases from the alveoli to plasma and red blood cells.

COMPLIANCE
 Is the elasticity and expandability of the lungs and
thoracic structures.
 describes the expandability of the lungs and chest wall. There are two types of
compliance: dynamic and static.

DYNAMIC COMPLIANCE describes the compliance measured during breathing, which involves a combination
of lung compliance and airway resistance, decreases with increasing airflow and a faster respiratory cycle. This
is defined as he change in lung volume by the change in pressure, in the presence of flow
STATIC COMPLIANCE describes pulmonary compliance when there is no airflow, like an inspiratory pause.
This is defined as the change in lung volume by the change in pressure, in the absence of flow.

Rubber Band/Balloon Concept - A simple way to understand lung compliance is through the rubber band or
balloon concept.
 A tighter rubber band, with more resistance, would be more difficult to stretch, and can readily recoil.
 A loose rubber band, with less resistance, would easily stretch and wouldn't recoil as easily.

Surface Tension
Alveolus- where gas exchange occurs (carbon dioxide with the blood)
The spherical alveoli formed clusters. Alveoli is also lined with mucus which create surface tension
 Any factor that reduces the airway caliber (mucosal edema, inflammation, secretion, bronchospasm,
less surfactant) will raise the resistance to airflow and decrease the ventilation of the corresponding
alveoli similarly any area in which the local compliance has decreased (ie. That portion of the lung has
become more stiff) will receive less ventilation than the surrounding more expandable portion of the
lungs.

Lung Volumes: Normal lung volumes are measured through pulmonary function testing. Spirometry measures
the volume of air entering or leaving the lungs. Variations in lungs volumes may be associated with health
states such as pregnancy, exercise, obesity Or obstructive and restrictive conditions of the lung. The amount of
surfactant, degree of compliance, strength of respiratory muscles can affect pressures and volumes within the
lungs.

Pressure: Air Pressure variances- Air flows from a region of higher pressure to a region of lower pressure.

Pulmonary ventilation is the process of breathing, which is driven by pressure differences between the lungs
and the atmosphere. Atmospheric pressure is the force exerted by gases present in the atmosphere. The
force exerted by gases within the alveoli is called intra-alveolar (intrapulmonary) pressure, whereas the force
exerted by gases in the pleural cavity is called intrapleural pressure.
Typically, intrapleural pressure is lower, or negative to, intra-alveolar pressure. The difference in pressure
between intrapleural and intra-alveolar pressures is called transpulmonary pressure. In addition, intra
alveolar pressure will equalize with the atmospheric pressure.

Typically, for respiration, other pressure values are discussed in relation to atmospheric pressure. Therefore,
negative pressure is pressure lower than the atmospheric pressure, whereas positive pressure is the pressure
that it is greater than the atmospheric pressure. A pressure that is equal to the atmospheric pressure is
expressed as zero. Before entering the alveoli, inspired air mixes with gas that wasn't exhaled on the previous
expiration. Because this gas contains more CO2 and less 02 than inspired air, partial pressures change again.

The air that finally enters the alveoli for diffusion across the respiratory membrane goes to further partial
pressures changes. However it remains high in PO2 and low in PCO2. The differential in partial pressures of
02 and Co2 causes the two gases to cross the respiratory membrane toward the lower side of their respective
pressure gradients 02 diffuses into the blood, and CO2 diffuses outward, equalizing gas pressures on both
sides of the respiratory membrane

Intrapleural pressure is the pressure of the air within the pleural cavity, between the visceral and parietal
pleurae. Similar to intra-alveolar pressure, intrapleural pressure also changes during the different phases of
breathing. However, due to certain characteristics of the lungs, the intrapleural pressure is always lower than,
or negative to, the intra-alveolar pressure (and therefore also to atmospheric pressure). Although it fluctuates
during inspiration and expiration, intrapleural pressure remains approximately 4 mm Hg throughout the
breathing cycle.

OXYGEN CONTENT- Oxygen binding capacity is the is the maximum amount of oxygen that can be bound to
hemoglobin, abbreviated as Hgb, which is the main protein found inside of red blood cells, which is a main
component of blood.
1. Sa02 -is a measure of how much hemoglobin is currently bound to oxygen compared to how much
hemoglobin remains unbound.
2. Hgb. & Pa02 -Pa02 as the driving pressure for oxygen molecules entering the red blood cell and
chemically binding to hemoglobin; the higher the Pa02, the higher the Sa02.
Hbg- It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for
carbon dioxide
Pa02- is determined solely by the pressure of inhaled oxygen (the PI02), the PaCO2, and the architecture of
the lungs.

Arterial 02- in healthy individuals breathing room air at sea level, Sao2 is between 96% and 98%. The
maximum volume of oxygen which the blood can carry when fully saturated is termed the oxygen carrying
capacity, which, with a normal hemoglobin concentration, is approximately 20 mL oxygen per 100 mL blood.
Mixed 02 -The normal mixed venous oxygen saturation is about 70%-75%. This value reflects the fact that the
body normally extracts only 25%-30% of oxygen carried in the blood.
Week 2: NCM113 Ma’am Tierra

Features of CHN Practice:

In addition to its preventive approach to health, community health nursing is characterized by
 Its being population- or aggregate-focused,
 Its developmental nature, and existence of a prepayment mechanism for consumers of community
health nursing services.
 Unlike nurses who work in the hospital settings, community health nurses care for different levels of
clientele.

The Health Belief Model

 Initially proposed in 1958
 HBM provides the basis for much of practice of health education and health promotion today.
 HBM was developed by a group of social psychologists to explain why the public failed to participate in
screening for tuberculosis (Hochbaum, 1958).
 Hochbaum and his associates had the same questions that perplex many health professionals today:
 Why do people who may have a disease reject health screening? Why do individuals participate in
screening if it may lead to the diagnosis of disease?
Milo's Framework for
Prevention
Milio, N. (1976) A framework for
prevention: Changing health-
damaging to health-generating
life patterns. AJPH, 66(5), 435-
439.
 Nancy Milio outlined Six
propositions relating to
health promotion and
 disease prevention.
 Milio asserted that health
deficits occur when there is
an imbalance between a community's health needs, and its health-sustaining resources.
 All human beings make health choices that are the easiest for them to make, most of the time.
 Central thesis is that if we wish to support health promoting patterns, then we must focus on the
central problem of how to make health-damaging choices more difficult when health-promoting
behaviors are realistically and easily available.
Nola Pender's Health Promotion Model (HPM)
 Developed in the 1980s, revised in 1996
 Explores many biopsychosocial factors that influence individuals to pursue health promotion activities.
 HPM depicts the complex multidimensional factors with which people interact as they work to achieve
optimum health

Lawrence Green's Precede-Proceed Model

 Developed by Dr.Lawrence W. Green and colleagues
 Provide for community assessment, health education planning, and evaluation.
 PRECEDE: which stands for PREDIPOSING, REINFORCING and enabling Constructs in educational
Diagnosis and Evaluation, is used for community diagnosis.
 PROCEED: an ACRONYM for POLICY, REGULATORY, and ORGANIZATIONAL CONSTRUCT in
EDUCATIONAL and ENVIRONMENTAL DEVELOPMENT, is a model for implementing and evaluating
health programs based on PRECEDE.
DIFFERENT FIELDS
 School Health Nursing
 Occupational Health Nursing
 Community Mental health

WEEK 2: COMMUNITY HEALTH NURSING

School Health Nursing
 School health nursing aims at promoting the health of school children and preventing health problems
that would hinder their learning and performance of their developmental task.
 Is primarily determined by the characteristics of their clientele- their age, developmental stage and their
common health problems and concerns.
 Although school health nursing is primarily concerned with health concerns in the school setting, it
accept that health is affected by factors outside the school setting such as poverty, family dynamics and
lifestyle.
Occupational Health Nursing
 The specialty practice that provides for and delivers health care services to workers and worker
populations.
 The practice focuses on promotion, protection, and restoration of workers' health within the context of a
safe and healthy work environment.
 Is autonomous, and occupational health nurses makes independent nursing judgments in providing
occupational health services.
 The foundation for occupational health nursing practice is research- based with emphasis on optimizing
health, preventing illness and injury, and reducing health hazards.
Community Mental Health
 Is the application of specialized knowledge to population communities.
 To promote and maintain mental health
 To rehabilitate population at risk
 Psychiatric nurse must possess knowledge about community resources.
 Community Health Nursing: is a field that isa blend of primary health care and nursing practice with
public health nursing.
Community Health Nursing
Goals :
 Provide preventive activities to population for the purpose of promoting mental health
 Provide prompt intervention
 Provide corrective learning experiences
 Help individuals develop a sense of self worth and independence
 Anticipate emotional problems
  Identify and change social and psychological factors that influence human interactions
 Develop innovative approach to primary preventive activities
 Provide mental health education and how to assess the mental health.

Three types of communities are

 Urban- a large community with many people and large buildings, a city
 Suburb- a medium-sized community near a large city, houses are close together, you may see parks
and malls
 Rural-a community where houses are far apart, there are a smaller number of people, and you may
see farms and forests

Characteristics of a Healthy Community

 Equitable and efficient use of community resources with view towards sustaining natural resources.

People
 Population variables that affect the health of the community include the size, density, composition, rate
growth or decline, cultural characteristics, mobility, social class and educational level.

System
 A social system is the patterned series of interrelationships existing between individuals, groups, and
institutions and forming a coherent whole.
 Social system components that affect health include the family, economic, educational, communication,
political, legal, religious, recreational, and health systems (Allender et al., 2009).