CHN1- LEC (MODULE)
SESSION 9 • A practical approach to making health benefits
Primary Health Care (PHC)
Overview
May 1977
• 30th World Health Assembly decided that the
Mission
• To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will
• manage their own health care.
• Two Levels of Primary Health Care Workers
• 1. Barangay Health Workers – trained community
health workers or health auxiliary volunteers or
traditional birth
• attendants or healers.
• 2. Intermediate Level Health Workers- include the
Public Health Nurse, Rural Sanitary Inspector and
midwives. main health target of the government
and WHO is the attainment of a level of health
that would permit them to lead a socially and
economically productive life by the year 2000.
September 6-12, 1978
• First International Conference on PHC in Alma
Ata, Russia (USSR) The Alma Ata Declaration
stated that PHC was the key to attain the “health
for all” goal
October 19, 1979
• Letter of Instruction (LOI) 949, the legal basis of
PHC was signed by Pres. Ferdinand E. Marcos,
which adopted PHC as an approach towards the
design, development and implementation of
programs focusing on health development at
community level.
Rationale for Adopting Primary Health Care
• Magnitude of Health Problems
• Inadequate and unequal distribution of health
resources
• Increasing cost of medical care
• Isolation of health care activities from other
development activities
Definition of Primary Health Care
• Essential health care made universally accessible
to individuals and families in the community by
means acceptable to them, through their full
participation and at cost that the community
can afford at every stage of development.
within the reach of all people.
• An approach to health development, which is
carried out through a set of activities and whose
ultimate aim is the continuous improvement and
maintenance of health status
Goal of Primary Health Care
• HEALTH FOR ALL FILIPINOS by the year 2000 AND
HEALTH IN THE HANDS OF THE PEOPLE by the year
2020.
• An improved state of health and quality of life for
all people attained through SELF RELIANCE.
Key Strategy to Achieve the Goal:
Partnership with and Empowerment of the People
• permeate as the core strategy in the effective
provision of essential health services that are
community based, accessible, acceptable, and
sustainable, at a cost, which the community and
the government can afford.
MISSION
• To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their own
health care.
Two Levels of Primary Health Care Workers
1. Barangay Health Workers
• trained community health workers or health
auxiliary volunteers or traditional birth attendants
or healers.
2. Intermediate Level Health Workers
• include the Public Health Nurse, Rural Sanitary
Inspector and midwives.
Principles of Primary Health Care
1. 4 A’s
• Accessibility
• Availability
• Affordability
• Acceptability
• Appropriateness of Health Services.
• The health services should be present where the
supposed recipients are. They should make use of
the available resources within the community,
wherein the focus would be more on health
promotion and prevention of illness.
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2. Community Participation
• heart and soul of PHC
3. People are the center, object and subject of
development.
• Thus, the success of any undertaking that aims at
serving the people is dependent on people’s
participation at all levels of decision-making;
planning, implementing, monitoring and
evaluating. Any undertaking must also be based
on the people’s needs and problems (PCF, 1990)
• Part of the people’s participation is the partnership
between the community and the agencies found
in the community; social mobilization and
decentralization.
• In general, health work should start from where the
people are and building on what they have.
Example: Scheduling of Barangay Health Workers
in the health center
Barriers of Community Involvement
• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community people
• Lack of managerial skills
4. Self-reliance
• Through community participation and
cohesiveness of people’s organization they can
generate support for health care through social
mobilization, networking and mobilization of local
resources. Leadership and management skills
should be developed among these people.
Existence of sustained health care facilities
managed by the people is some of the major
indicators that the community is leading to self-
reliance
5. Partnership between the community and the health
agencies in the provision of quality of life.
• Providing linkages between the government and
the nongovernment organization and people’s
organization.
6. Recognition of interrelationship between the health and
development
Health
• Is not merely the absence of disease. Neither is it
only a state of physical and mental well-being.
Health being a social phenomenon recognizes
the interplay of political, socio-cultural and
economic factors as its determinant. Good Health
therefore, is manifested by the progressive
improvements in the living conditions and quality
of life enjoyed by the community residents (PCF)
Development
• is the quest for an improved quality of life for all.
Development is multidimensional. It has political,
social, cultural, institutional and environmental
dimensions (Gonzales 1994). Therefore, it is
measured by the ability of people to satisfy their
basic needs.
7. Social Mobilization
• It enhances people participation or governance,
support system provided by the Government,
networking and developing secondary leaders
8. Decentralization
• This ensures empowerment and that
empowerment can only be facilitated if the
administrative structure provides local level
political structures with more substantive
responsibilities for development initiators. This also
facilities proper allocation of budgetary
resources.
8 Elements of Primary Health Care (ELEMENTS) 1.
1.Education for Health
• Is one of the potent methodologies for information
dissemination. It promotes the partnership of both
the family members and health workers in the
promotion of health as well as prevention of
illness.
2. Locally Endemic Disease Control
• The control of endemic disease focuses on the
prevention of its occurrence to reduce morbidity
rate. Example Malaria Control and
Schistosomiasis Control
3. Expanded Program on Immunization
• This program exists to control the occurrence of
preventable illnesses especially of children below
6 years old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
preventable disease are given for free by the
government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning
• The mother and child are the most delicate
members of the community. So the protection of
the mother and child to illness and other risks
would ensure good health for the community. The
goal of Family Planning includes spacing of
children and responsible parenthood.
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5. Environmental Sanitation and Promotion of Safe Water
Supply
Environmental Sanitation
• is defined as the study of all factors in the man’s
environment, which exercise or may exercise
deleterious effect on his well-being and survival.
Water is a basic need for life and one factor in
man’s environment. Water is necessary for the
maintenance of healthy lifestyle. Safe Water and
Sanitation is necessary for basic promotion of
health.
6. Nutrition and Promotion of Adequate Food Supply
• One basic need of the family is food. And if food
is properly prepared then one may be assured
healthy family. There are many food resources
found in the communities but because of faulty
preparation and lack of knowledge regarding
proper food planning, Malnutrition is one of the
problems that we have in the country.
7. Treatment of Communicable Diseases and Common
Illness
• The diseases spread through direct contact pose
a great risk to those who can be infected.
Tuberculosis is one of the communicable diseases
continuously occupies the top ten causes of death. Most
communicable diseases are also preventable. The
Government focuses on the prevention, control and
treatment of these illnesses.
8. Supply of Essential Drugs ⎯
• This focuses on the information campaign on the
utilization and acquisition of drugs.
• In response to this campaign, the GENERIC ACT of
the Philippines is enacted. It includes the
following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH
(isoniazid) and Pyrazinamide, Ethambutol,
Streptomycin, Albendazole, Quinine
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained
National Effort.
• Attaining Health for all Filipino will require
expanding participation in health and health
related programs whether as service provider or
beneficiary. Empowerment to parents, families
and communities to make decisions of their health
is really the desired outcome.
• Advocacy must be directed to National and Local
policy making to elicit support and commitment to
major health concerns through legislations,
budgetary and logistical considerations.
2. Promoting and Supporting Community Managed Health
Care
• The health in the hands of the people brings the
government closest to the people. It necessitates
a process of capacity building of communities
and organization to plan, implement and evaluate
health programs at their levels.
3. Increasing Efficiencies in the Health Sector
• Using appropriate technology will make services
and resources required for their delivery, effective,
affordable, accessible and culturally acceptable.
The development of human resources must
correspond to the actual needs of the nation and
the policies it upholds such as PHC. The DOH will
continue to support and assist both public and
private institutions particularly in faculty
development, enhancement of relevant curricula
and development of standard teaching materials.
4. Advancing Essential National Health Research
• Essential National Health Research (ENHR) is an
integrated strategy for organizing and managing
research using intersectoral, multi-disciplinary and
scientific approach to health programming and
delivery.
Four Cornerstones/Pillars in Primary Health Care
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
RA 8423 or the Traditional and Alternative Medicine Act of
1997 (10 Medicinal Plants / Herbal Medicine)
Decoction is
• boiling the part of material in water; 20 minutes is
the recommended boiling time
Infusion
• is soaking plant material in water much like
making a tea; 10-15 minutes is the recommended
soaking period
Poultice
• is applying plant material directly on the affected
part
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Self-reliance
• Use of cooperatives and community business

Alternative Health Care Modalities

Acupressure
• A method of healing and health promotion that
uses the application of pressure on acupuncture
points without puncturing the skin.

Acupuncture
• A method of healing using special needles to
puncture and stimulate specific anatomical points
on the body.

Aromatherapy
• The art and science of the sense of smell whereby
essential aromatic oils are combined and then
applied to the body in some form of treatment.
Sentrong Sigla Movement
Certification Program: SS Seal (main Component) Chiropractic
Objectives: • A discipline of the healing arts concerned with the
• better and more effective collaboration between pathogenesis, diagnosis, therapy, and prophylaxis
DOH and LGU of functional disturbances, pathomechanical
DOH: states, pain syndromes, and neurophysiological
• as a provider of technical and financial assistance effects related to the static and dynamics of the
packages of health care locomotor system, especially of the spine and
LGU: pelvis.
• as a prime developer of health system and direct
implementers of health programs
4 Pillars:
• Health promotion
• Award
• Quality Assurance
• Grants and Technical Assistanc

Principles and Strategies of Primary Health Care

(P.R.A.M.I.S)

Provision
• of quality and essentials health services
R.A 7160: Decentralization
• political will advocacy

A’s of Health Services (Acceptable, Affordable, Available)

• Delivery of health care services to where people
are
• Use of indigenous volunteer workers as health care
provider
• Use of traditional Medication

Mobilization: social

Increase Community Participation

• Consciousness-raising on health concerns

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SESSION 10
The Family
Family
• Basic unit in society, and is shaped by all forces
surround it.
• Values, beliefs, and customs of society influence
the role and function of the family (invades every
aspect of the life of the family)
Is a unit of interacting persons bound by ties of blood,
marriage or adoption.
• Constitute a single household, interacts with each
other in their respective familial roles and create
and maintain a common culture.
An open and developing system of interacting
personalities with structure and process enacted in
relationships among the individual members regulated by
resources and stressors and existing within the larger
community (Smith & Maurer, 1995)
Two or more people who live in the same household
(usually), share a common emotional bond, and perform
certain interrelated social tasks (Spradly & Allender, 1996)
An organization or social institution with continuity (past,
present, and future). In which there are certain behaviors
in common that affect each other.
The Filipino Family
• Based on the Philippine Constitution, Family Code
with focus on religious, legal, and cultural aspects
of the definition of family.
Section 1
• The state recognizes the Filipino family as the
foundation of the nation. Accordingly, it shall
strengthen its solidarity and actively promote its
total development
Section 2
• Marriage, as an inviolable social institution, is the
foundation of family and shall be protected by the
state.
Section 3
The state shall defend –
• the right of spouses to found a family in
accordance with their religious convictions and
the demands of responsible parenthood
2. the right of children to assistance including proper care
and nutrition, and special protection from all forms of
neglect, abuse, cruelty, exploitation and other conditions
prejudicial to their development
3. the right of the family to a family living wage income 4.
the right of families or family associations to participate in
the planning and implementation of policies and programs
of that affect them
Section 4
• The family has the duty to care for its elderly
members but the state may also do so through just
programs of social security
Types of Family
• There are many types of family. They change
overtime as a consequence of BIRTH, DEATH,
MIGRATION, SEPARATION and GROWTH OF FAMILY
MEMBERS
A. Structure
NUCLEAR
• a father, a mother with child/children living
together but apart from both sets of parents and
other relatives.
EXTENDED
• composed of two or more nuclear families
economically and socially related to each other.
Multigenerational, including married brothers and
sisters, and the families.
SINGLE PARENT
• divorced or separated, unmarried or widowed
male or female with at least one child.
BLENDED/RECONSTITUTED
• a combination of two families with children from
both families and sometimes children of the newly
married couple. It is also a remarriage with
children from previous marriage.
COMPOUND
• one man/woman with several spouses
COMMUNAL
• more than one monogamous couple sharing
resources
COHABITING/LIVE-IN
unmarried couple living together
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DYAD C. Decent (cultural norms, which affiliate a person with a

• husband and wife or other couple living alone particular group of kinsmen for certain social purposes)
without children
PATRILINEAL
GAY/LESBIAN • Affiliates a person with a group of relatives who are
• homosexual couple living together with or without related to him though his father
children
BILATERAL
NO-KIN • both parents
• a group of at least two people sharing a
relationship and exchange support who have no MATRILINEAL
legal or blood tie to each other • related through mother

FOSTER Ackerman States that the Function of Family are:

• substitute family for children whose parents are
unable to care for them
FUNCTIONAL TYPE:
FAMILY OF PROCREATION
• refers to the family you yourself created.
FAMILY OF ORIENTATION
• refers to the family where you came from.
B. Decisions in the family (Authority)
PATRIARCHAL
• full authority on the father or any male member of
the family e.g., eldest son, grandfather 
MATRIARCHAL
• full authority of the mother or any female member
of the family, e.g., eldest sister, grandmother
EGALITARIAN
• husband and wife exercise a more or less amount
of authority, father and mother decides
DEMOCRATIC
• everybody is involved in decision making
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man’s
humanness
Physical functions of the family
• are met through parents providing food, clothing
and shelter, protection against danger provision
for bodily repairs after fatigue or illness, and
through reproduction
Affectional function
• the family is the primary unit in which he child test
his emotional reactions
Social functions
• include providing social togetherness, fostering
self-esteem and a personal identity tied to family
identity, providing opportunity for observing and
learning social and sexual roles, accepting
responsibility for behavior and supporting
individual creativity and initiative.
Universal Function of the Family by Doode
1. REPRODUCTION
• for replacement of members of society: to
perpetuate the human species

AUTHOCRATIC- 2. STATUS PLACEMENT

• of individual in society
LAISSEZ-FAIRE 3. BIOLOGICAL and MAINTENANCE OF THE YOUNG and
• “full autonomy” dependent members
4. Socialization and care of the children
MATRICENTRIC 5. Social control
• the mother decides/takes charge in absence of
the father (e.g., father is working overseas) Balance
• the parents and children have their own areas of
PATRICENTIC decisions and control.
• the father decides/ takes charge in absence of the Strongly Bias
mother • one member gains dominance over the others.

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MEPSAL MRP
STAGES: MEPSAL MoRe Pa
Stage 1: MARRIAGE & THE FAMILY 12 Behaviors Indicating a Well Family
• Involves merging of values brought into the • Able to provide for physical emotional and
relationship from the families of orientation. spiritual needs of family members
• Includes adjustments to each other’s routines • Able to be sensitive to the needs of the family
(sleeping, eating, chores, etc.), sexual and members
economic aspects. • Able to communicate thought and feelings
• Members work to achieve 3 separate identifiable effectively
tasks: • Able to provide support, security and
1. Establish a mutually satisfying relationship encouragement
2. Learn to relate well to their families of orientation • Able to initiate and maintain growth producing
3. If applicable, engage in reproductive life planning relationship
• Maintain and create constructive and responsible
Stage 2: EARLY CHILDBEARING FAMILY community relationships
• Birth or adoption of a first child which requires • Able to grow with and through children
economic and social role changes • Ability to perform family roles flexibly
• Oldest child: 2-1/2 years • Able to help oneself and to accept help when
appropriate
Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN • Demonstrate mutual respect for the individuality of
• This is a busy family because children at this stage family members
demand a great deal of time related to growth • Ability to use a crisis experience as a means of
and development needs and safety growth
considerations. • Demonstrate concern of family unity, loyalty and
• Oldest child: 2-1/2 to 6 years old interfamily cooperation

Stage 4: FAMILY WITH SCHOOL AGE CHILDREN Family Health Task

• Parents at this stage have important responsibility
of preparing their children to be able to function in
a complex world while at the same time
maintaining their own satisfying marriage
relationship.
• Oldest child: 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
• A family allows the adolescents more freedom
and prepare them for their own life as technology
advances-gap between generations increases
• Oldest child: 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
• Stage when children leave to set their own
household-appears to represent the breaking of
the family
• Empty nests
Stage 7: FAMILY OF MIDDLE YEARS
• Family returns to two partners nuclear unit
• Period from empty nest to retirement
Stage 8: FAMILY IN RETIREMENT/OLDER AGE
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH
SPOUSES
Health task differ in degrees from family to family
TASK
• is a function, but with work or labor overtures
assigned or demanded of the person
Duvall & Niller identified 8 tasks essential for a family to
function as a unit:
PSAM DR PM
Eight Family Tasks (Duvall & Niller)
si pat. sam DR na nung pm
1. Physical maintenance
• provides food shelter, clothing, and health care to
its members being certain that a family has ample
resources to provide
2. Socialization of Family
• involves preparation of children to live in the
community and interact with people outside the
family.
3. Allocation of Resources
• determines which family needs will be met and
their order of priority.
4. Maintenance of Order
• task includes opening an effective means of
communication between family members,
integrating family values and enforcing common
regulations for all family members.

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5. Division of Labor
• who will fulfill certain roles e.g., family provider,
home manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family
member RRR
7. Placement of members into larger society
• consists of selecting community activities such as
church, school, politics that correlate with the
family beliefs and values
8. Maintenance of motivation and morale
• created when members serve as support people
to each other
5 Family Health Tasks (Maglaya, A., 2004)
1. Recognizing interruptions of health development
2. Making decisions about seeking health care/ to take
action
3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health
maintenance
Family Roles
Nurturing figure
• primary caregiver to children or any dependent
member.
Provider
• provides the family’s basic needs.
Decision maker
• makes decisions particularly in areas such as
finance, resolution, of conflicts, use of leisure time
etc.
Problem-solver
• resolves family problems to maintain unity and
solidarity.
Health manager
• monitors the health and ensures that members
return to health appointments.
Gate keeper
• Determines what information will be released from
the family or what new information can be
introduced.
ADAPTATION
PARTNERSHIP
GROWTH
AFFECTION
RESOLVE Theoretical Approaches to Family Health Care (Family
Apgar)
Family Models
• the use of family model provides a perspective of
focus for understanding the family
• have categorized according to their basic focus
as developmental, interactional structural-
functional, and systems model
Developmental Models
Duvall’s and Stevenson’s Family Development Model
Evelyn Duvall’ (1977) family developmental framework
• provides guide to examine and analyze the basic
changes and developmental tasks common to
most families during their life cycle. Although each
family has unique characteristics normative
patterns of sequential development are common
to all families
These stages and developmental tasks illustrate common
family behaviors that may be expected at specific times in
the family life cycle. The stages are marked by the age of
the oldest child however some overlapping occurs in
families with several children.
Duvall’s developmental model
• is an excellent guide for assessing, analyzing and
planning around basic family tasks
developmental stage, however, this model does
not include the family structure or physiological
aspects, which should be considered for a
comprehensive view of the family.
• This model is applicable for nuclear families with
growing children and families who are
experiencing health-related problems.
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Stevenson’s Family Developmental Model
Joanne Stevenson (1977)
• describes the basic tasks and responsibilities of
families in four stages.
• She views family tasks as maintaining a common
household rearing children and finding satisfying
work and leisure. It also includes sustaining
appropriate health patterns and providing mutual
support and acculturation of family members.
• This model is useful for nuclear families because it
examines psychosocial patterns to specific stage
of development, however, it also does not include
family structure, nor it addresses health promotion
and health-related concerns that the family may
face.
Structural- Functional Model
Friedman’s Structural- Functional Family Model
• Was developed from sociological frameworks
and systems theory by Marilyn Friedman (1986)
• The family is the focus of this model as it interacts
with supra-systems in the community and with
individual family members in the subsystem
Friedman’s Family Model Components
Structural component examines the family unit, how it is
organized and how members relate to one another in
terms of values, communication network, role system and
power while functional components refers to the
interaction outcomes resulting from family organizational
structure
The structural-functional components and parts
• all intimately interrelate and interact; the others
affect each component and part.
This model provides a broad framework for examining the
interactions among family and within the community.
This incorporates physical, psychosocial and cultural
aspects of the family along with interacting relationships.
This model is very applicable to any type of family and their
health-related problems
Systems Model
Calgary’s Family Model (System’s Model)
Is an integrated conceptual framework of several theorists.
Model is based on three major categories: family structure,
function and development. Each is further subdivided into
parts that interacts with others and changes the whole
family configuration.
This model is comprehensive and incorporates three major
areas, namely, the structure, function and development of
the family.
It is complex, with too many sub concepts for the health
worker to explore and focus.
It can be applied to any type of family with any health-
related problems.
Total Score:
7-10 = suggests a highly functional family
4-6 = moderately dysfunctional family
0-3 = severely dysfunctional family
Health as a Goal of Family Health Care
HEALTH DEFICIT
• this refers to conditions of health breakdowns or
advent of illness in the family
HEALTH THREAT
• these are the conditions that make it more likely
for accidents, disease or failure to thrive or
develop to occur.
FORESEEABLE CRISIS
• these are anticipated periods of unusual demand
on the family in terms of time or resources
WELLNESS POTENTIAL
• this refers to states of wellness and the likelihood
for health maintenance or improvementto occur
depending on the desire of the family
Roles of Health Care Provider in Family Health Care
• HEALTH MONITOR
• PROVIDER OF CARE
• COORDINATOR
• FACILITATOR
• TEACHER
• COUNSELOR
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SESSION 11
Family Health Assessment
Nursing Assessment
• includes data collection, data analysis or
interpretation and problem definition or nursing
diagnosis. These are: 1.
First level assessment
• is a process whereby existing and potential health
conditions or problems are categorized as:
a. Wellness state
b. Health threats
c. Health deficit
d. Stress points or foreseeable crisis situation
2. Second level assessment
• defines the nature or type of nursing problems that
the family encounters in performing the health
tasks with respect to a given health condition or
problems and etiology or barriers to the family ’s
assumption of these task.
Steps in family Nursing Assessment
There are three major steps in nursing assessment as
applied to family nursing practice.
Data collection for first level assessment
• involves gathering of five types of data which will
generate the categories of health conditions or
problems of the family. These data include:
1. Family structure, characteristics and dynamic-include
the composition, demographic data of the members of the
family/household, their relationship to the head and place
of residence, the type of, and family interaction
/communication and decision-making patterns and
dynamics
2. Socio-economic and cultural characteristic-include
occupation, place of work and income of each working
member; educational attainment of each family member;
ethnic background and religious affiliation; significant
others and the role they play in the family’s life; the
relationship of the family to the larger community
3. Home environment included information on housing and
sanitation facilities; kind of neighborhood and availability
of social, health; communication and transportation
facilities in the community
4. Health status of each member includes current and past
significant illness; beliefs and practices conducive to
health and illness; nutritional and development status;
physical assessment findings and significant results of
laboratory/diagnostics/screening procedures
5. Values and practices on health promotion/maintenance
and disease prevention include use of preventive services;
adequacy of rest/sleep, exercise. Relaxation activities,
stress management of other healthy lifestyle activities, and
immunization status of at-risk family members
Second-level assessment data include:
1. Specify or describe the family’s realities
2. Perceptions about and attitudes
3. Performance of health task on each health condition or
problem identified during the first level assessment
Data Gathering Methods and Tools
There are several methods of data gathering that the nurse
can select from depending on the availability of resources
such as materials, manpower, time and facilities.
The critical point in the choice is concern for validity,
reliability and adequacy of assessment data.
Poor quality /inaccurate and inadequate data can lead to
inaccurately defined health and nursing problems which,
in turn, lead to a poorly designed family nursing care plan
The following are brief description of common methods of
gathering data about a family, its status and state of
functioning;
1. Observation
This method of data collection is done through the use of
the sensory capacities- sight, hearing, smell
and touch. Through direct observation the nurse gathers
information about family’s state of being and behavioral
responses. The family’s health status can be inferred from
the signs and symptoms of the problem areas reflected in
the followings:
a. Communication and interactions pattern expected,
used and tolerated by family members
b. Role perceptions/task assumptions by each member,
including decision-making patterns
c. Conditions in the home and environment
2. Physical Examination
• significant data about health status of individual
family members can be obtained through direct
examination. This is done through inspection,
palpation, percussion, auscultation,
measurement of specific body parts and
reviewing the body system. It is essential for the
nurse to have the skills in performing physical
assessment / appraisal in order to help the family
be aware of the health status of its member.
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3. Interview Distinguishing relevant from irrelevant data

• another major method of data gathering is the
interview.
a. One type of interview is completing a health history for
each family member.
b. Second type interview is collecting data by personally
asking significant family members or relatives questions
regarding health, family life experiences and home
environment to generate data on what wellness condition
and health problems exist in the family (first level and
second level of assessment)
• to decide what information is pertinent to
understanding the situation at hand and what
information is immaterial.
Identifying patterns
• such as physiologic function, developmental,
nutritional /dietary, coping/adaptation or
communication pattern and lifestyle
Comparing patterns
• with norms or standards of health, family
functioning and assumption of health task

4. Record Review Interpreting results

• the nurse may gather information through
reviewing existing records and reports pertinent to
the client. These include the individual clinical
records of the family members, laboratory and
diagnostic reports, immunization records, report
about home and environmental conditions or
similar sources.
5. Laboratory /Diagnostic Test
• another method of data collection is through
performing laboratory tests, diagnostic
procedures or other tests of integrity and function
carried out by the nurse herself and /or other
health workers.
• of comparisons to determine signs, symptoms or
cues of specific wellness state, health deficit,
health threats or foreseeable crisis/s/stress point/
and their underlying causes or associated factors
Making inferences or drawing conclusions
• about the reasons for the existence of the health
condition or problems or risks for non-
maintenance of wellness state which can be
attributed to non-performance of family health
tasks.

Data Analysis
• Utilizing the data generated from the tool on initial
base in family nursing practice, the nurse goes
through data analysis. She sorts out and classify or
group data by type or nature (e.g., which are
wellness states, threats, deficits or stress
points/foreseeable crisis. She relates them with
each other and determines patterns or
reoccurring themes among data. She then
compares these data and the patterns or
reoccurring themes with norms or standards.

Data Analysis involves several sub-steps:

Sorting of data
• for broad categories such as those related with
health status or practices of family members or
data about home and environment

Clustering
• of related cues to determine relationships
between and among data

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SESSION 12 Salience
• To determine the salience score, evaluate the
Family Data Analysis and Family Nursing family’s perception ad evaluation of the problem
Diagnosis in terms of seriousness and urgency of attention
needed. The family’s concern and felt needs
Health problems are categorized according to factors require priority attention.
affecting priority status.
Nature:
1. Health Threat - condition
2. Health Deficit- may lead to illness
3. Foreseeable crisis

Greater weight is assigned to health deficit over health

threats because the former usually demands more
immediate intervention than the latter. On the other hand,
foreseeable crisis is given the least attention because
culture-linked factors usually provide adequate support to
cope with developmental/situational crises.

Modifiability
• The community health manager must consider
some important factors in defining modifiability of
the health problems- or probability of success in
minimizing, alleviating or totally eradicating the
problem through health intervention.
1. Current knowledge, technology and intervention to
manage the problem
2. Resources of the family (Physical, financial, manpower)
3. Resources of the community (facilities and community
organizations)
4. Resources of the community health manager
knowledge skill and time)

Preventive Potentials
• To decide on the appropriate score for the
preventive potential of the health problem- or the
nature and magnitude of future problems that can
be minimized or preventive if intervention is done,
the following factors are considered:

1. Severity of the problem

• the more severe or advanced the problem, the
lower the preventive potential

2. Duration of the problem

• the longer the problem has existed, the lower the
preventive potential.

3. Current management
• application of appropriate intervention increases
the problem’s preventive potentials

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SESSION 13
Formulating and Implementing the Plan
of Care
A plan of intervention is designed upon completion of the
assessment and the analysis and health diagnosis of the
family.
The purpose of the plan is
to elicit behavioral change in the family that will promote
health/ or prevent dysfunction. The family is expected to
be an active participant in the planning process. The
success of the planned behavioral changes depends
largely on the degree of responsibility that the family
concerned is willing to assure.
The planning process involves the following steps:
1. Determining the order of priority of existing or potential
problems
2. Identifying problems that can be handled by the
community health nurse and the family, and those that
maybe referred to others for assistance.
3. Setting goals and objectives to resolve the problems
4. Predicting actions and expected outcomes
To guide the nurse in priority setting, the following factors
need to be considered:
Family safety
• a life threatening situation is given top priority
(Maurer and Smith,2009)
Family perception
• next to life threatening emergencies, priority is
given to the need that the family recognizes as
most urgent and/or important (Maurer and Smith,
2009)
Practicality
• together with the family, the nurse looks into
existing resources and constraints.
Projected effects
• the immediate resolution of a family concern
gives the family a sense of accomplishment and
confidence in themselves and the nurse
Establishing Goals and Objectives
Specific
• the objective clearly articulates who is expected
to do what, i.e., the family or a target family
member will manifest a particular behavior
Measurable
• observable, measurable and whenever possible,
quantifiable indications of the family’s
achievement as a result of their efforts toward a
goal provide a concrete basis for monitoring and
evaluation.
Attainable
• The objective has to be realistic and in conformity
with available resources, existing constraints, and
family traits, such as style and functioning.
Time bound
• Having a specified target time or date helps the
family and the nurse in focusing their attention
and efforts toward the attainment of the objective
(Doran,1981)
Determining appropriate Intervention
Nursing Intervention categorize into three types (Freeman
and Heinrich (1981)
Supplemental interventions
• are actions that the nurse performs on behalf of
the family when it is unable to do things for itself,
such as providing direct nursing care to a sick or
disabled family member.
Facilitative interventions
• refer to actions that remove barriers to
appropriate health action, such as assisting the
family to avail of maternal and early child care
services.
Developmental interventions
• aim to improve the capacity of the family to
provide for its own health needs, such as guiding
the family to make responsible health decisions.
this type of intervention is directed toward family
empowerment.
Plan of Evaluating Care
Evaluation is determining the value of nursing care that has
been given to a family. The product of the step is used for
further decision making: to terminate, continue, or modify
the interventions.
Aspects of evaluation that are useful in family health care:
Effectiveness
• is determination of whether goals and objectives
were attained.
Appropriateness
• refers to the suitability of the goals/objectives and
interventions to the identified family health needs
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Adequacy
• means the degree of sufficiency of
goals/objectives and interventions in attaining the
desired change in the family
Efficiency
• is the relationship of the resources use to attain the
desired outcomes
Implementation
• is putting the family health care plan into action.
The implementation phase is should be flexible.
According to Maglaya (2003), there are four types of
intervention for health promotion and disease prevention.
These are:
1. Increasing knowledge and skills,
2. Increasing family strengths
3. Decreasing exposure to risk factors
4. Decreasing susceptibility.
Increasing Knowledges and skills
• includes assisting families to make informal
choice s about helpful lifestyle and behavior that
will lessen or totally eliminate harmful
environmental influences that adversely affect
their health.
• The first involves creating awareness that is
achieved by working together with the CHN to
uncover actual or potential problems.
• The second step is to learn to recognize families at
risk.
• The third step offers families at risk the benefits of
knowing how to motivate and support behavioral
changes.
Increasing Family Strength
• refers to the factors or forces that contribute to
family unity and solidarity; and that foster the
development of inherent family potentials. These
factors include the following:
1. Physical, emotional and spiritual factors
2. Healthy child-rearing practices and discipline
3. Meaningful and clear communication
4. Support security and encouragement
5. Growth-inducing relationships and experiences
6. Responsible community relationships
7. Growth with/and through children
8. Self-help and acceptance of help
9. Flexibility to family functions and roles
10. Mutual respect for individuality
11. Crisis as a measure for growth
12. Family unity and loyalty and intra-family cooperation
13. Adaptability of family strength
Decreasing exposure to risk factors
• includes making parental behavior complement
the child’s behavior. In homes where parents are
uninformed, the parent responds differently to the
child’s attempt to communicate; the same is true
with regard to their general behavior towards the
child. This may lead to a significant difference
later in the chil’d intellectual ability. For the most
part, the child well-being is influenced by the
presence or absence of physical hazards in /her
surroundings. Physical hazards present in the
home should be removed or replaced for the
child’s benefits. Raising healthy-well-rounded
children requires plenty of patience and
vigilance.
Decreasing susceptibility
• means educating the family on the principles of
prevention and disease control. It is fact that
personal hygiene and cleanliness are primary
factors in disease control and prevention. It is
expected that the family knows which signs and
symptoms need medical attention and how to
take cae of minor illnesses. Family perception of
health risks and their susceptibility will determine
how they change their behavior. If the overweight
family believes obesity to be a threat to their
health and the CHN works with them to change
their eating habits to reduce and maintain and
ideal weight, the family is likely to react positively
to change. Health workers who introduce threat
as a motivator to action are morally obligated to
reduce the threat through meaningful and
purposeful intervention.
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SESSION 14
Home Health Care and Health Education
A. Home Health Care and People centered Care aim to
develop and nurtured.
Informed and Empowerment Individuals and Families
through the following:
1. Equitable access to health system, effective treatments
and psychosocial support
2. Access to clear, concise and intelligible health
information and education that increases health literacy
and allows for informed decision-making
3. Personal skills which allow control over health and
engagement with health care system- communication,
mutual collaboration and respect, goal-setting, decision-
making, problem solving and self-care
4. Supported involvement in health care decision-making,
including health policy, programs development .resource
allocation, and health financing.
People Centered Health Care
What can be done?
• Create supportive environments aimed at
respecting protecting and fulfilling the right to safe
and quality health care.
• Advocate health policies that ensure effective,
holistic and people centered health and nursing
care.
Primary Health Care
• Key to attaining acceptable level of health for the
population
• Surest route to appropriate, accessible, affordable
care
• Best gatekeeper for the referral system
• Optimizes the power of prevention and health
promotion
• Strengthens health system (structure and
organization of health services)
• Support multi-sectoral engagement and use of
interdisciplinary teams
Primary Health Care Nurse
• Health promotion
• Prevention of illness
• Treatment
• Rehabilitation
Clients:
• Individuals
• Families
• Special groups
• Communities
Core Health Professional Competencies Needed
• A Patient-centered focus- addressing social,
emotional as well as physical health
• Partnership; interdisciplinary teamwork
• Investments in information/ communication
technology
• Shared learning accountability
• Health economics, financing
Core Health Professional Competencies
• Epidemiology, health determinants, public health
• Communication, collaboration, team-building
• Health Promotion; risk reduction
• Academic- service partnerships
• Accountability, organizational effectiveness
• Quality improvement
B. DISPENSING HOME HEALTH CARE
The Bag Technique
1. To enhance the capacity of the PHN and home health
care givers to promote the values and principles of family-
centered care, including access, safety, affordability and
satisfaction, the use of the bag technique should be strictly
undertaken. As a role model, the PHN and Home Health
Care giver should reinforce a culture of caring,
communicating and healing in the context pf
psychological, cultural and social determinants of health
2. Use of the PHN bag, or any receptacle for health care
paraphernalia brought by the health care personnel to the
patient’s home should be governed by the principle that
anything that are outside the bag is considered
contaminated, and therefore, should not touch what are
inside the bag.
3. To protect the inside contents of the bag, barrier
materials (paper or cloth) should first be placed under the
bag before it is placed down inside the client’s home. The
health worker must therefore, wash his/her hands before
opening and getting out the bag contents for use in
nursing procedures.
4. Once the needed bag contents are taken outside the
bag (also placed on top of the barrier materials), the bag
is closed until after the procedure for nursing care is
accomplished
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5. After any equipment used is cleaned, waste materials
disposed of and the hands of the health worker washed,
the bag is reopened for returning the used equipment and
then closed. The barrier materials may be disposed of or
folded “inside out” or its contaminated side in and placed
on the top of the closed bag for disposal later.
The Thermometer Technique
1. Digital thermometer
• that features large displays are easier to read,
which may be more convenient. These
thermometers also tend to give result quicker than
standards thermometer. Always check for the low
batteries so accuracy can be assured.
2. Aseptic technique
• must be constantly in the health worker’s mind
while dispensing care from the client and from the
home to home. A dispenser of cotton or tissue
papers to be moistened with disinfectant should
be kept handy to prevent transfer of infections via
the thermometer. The principles of “clean to dirty”
and “proper waste disposal should be the rule to
follow.
Wound Care
1. Any wound should be considered ineffective and all
materials and equipment used for wound care at home
should be properly disinfected before leaving the client’s
home
2. The principles of “Clean to Dirty” should be the rule in the
cleaning the wound of the client.
Clean gloves
• can be used for large infected wounds,
sterile gloves and forceps
• should be used for surgical wound care.
Equipment used can be sterilized chemically or by boiling
for 15 minutes after cleaning with soap and water. These
should be done before replacing the used equipment into
the health worker’ bag.
Home Isolation Techniques
1. Isolation technique
• isolates or separates the offending
microorganisms but must not necessarily isolate
the client.
2. The health worker
• must know the nature of the client’s disease and
how this may be transferred from person to person.
3. After this, the family should be informed on steps to take
to prevent transmission from one family member to another
or to visitors/neighbor.
4. Families with member who are sick with diseases
transferred via the respiratory tract should be taught the
respiratory precaution techniques:
• Avoid droplet infection
• Droplets are dispersed by coughing, sneezing or
talking
• Microorganism can remain suspended in the air
and are dispersed by air current,
• Disinfections of eating and drinking utensils of the
sick member
5. Those with diseases transmitted via the gastrointestinal
tract should be taught enteric precautions
• Proper handwashing techniques and use of gloves
to dispose of fecal materials and things that came
in contact with the client’s vomitus and feces
FOMITES – DOON NA TUMITIRA ANG ORGANISM
6. Those diseases form organisms transferred through the
skin or bldy fluids should practice contact precautions.
There are also organisms which inhabits inanimate hosts or
vectors before transfer to other people. These include:
• Dengue fever
• Malaria
• Leptospirosis
• These are special precautionary measures such as
mosquito net use, insect repellants, detour from
risky wooded areas, floods and crowds
7. Strict isolation or combined precaution
• is required for diseases which can be transferred
through multiple body orifices or have multiple
routes of transmission. Family members who are
either elderly or are very young have lower
immune resistance and thus need most precaution
isolation measures applied, and should therefore
into consideration
Common Problems that Affect the Quality of Care
Health worker skills:
1. Incomplete examinations and counseling
2. Poor communications between health workers and
parents
3. Irrational use of drugs
Health System Issues:
1. Location of health services and responsibility
2. Availability of appropriate drugs and vaccines
3. supervision/decision of labor/ organization of work
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Community and Family Practices
1. Delayed care seeking
2. Poor knowledge of when to return to a health facility
3. Seeking assistance from unqualified providers
4. Poor adherence to health worker advice and treatment
SESSION 15
Family Health Care Evaluation and
Records in the Family Health Nursing
Evaluation
• is interwoven in every nursing activity and every
step of the health nurse. Concerned with the
determination of whether the objectives set were
attained or to what degree they were attained.
• is always related to objectives.
• when address to the result or outcome of care
answers the question “did the intended results
occur?”
• There is always an element of subjectivity in
evaluation; the process involves value judgement
which is subjective
• also involves decision-making. “did nursing make
a difference?” or “what results came out of the
nursing activity?” decisions have to be made on
whether the objectives have to be formulated,
approaches and strategies modified, resources
increased and the like.
• If evaluation shows that the objectives was not
achieved, the nurse has to find out the reason why;
the objectives may be unrealistic, nursing actions
may be inappropriate or uncontrollable
environment factors may be operative in this
situation.
Dimensions of Evaluation
EE AA
EFFECTIVENESS
• focus is attainment of the objectives
EFFICIENCY
• relates to cost whether in terms of money, time,
effort, or materials
APPROPRIATENESS
• is the ability to solve or correct existing problem
situation, a question that involves professional
judgement.
ADEQUACY
• pertains to its comprehensiveness whether all
necessary activities were performed in order to
realize the intended results.
Criteria and Standard
CRITERIA
• refer to the signs or indicators that tell us if the
objective has been achieved. They are names
and description of variables that are relevant
indicators of having attained the objectives. They
are free from any value judgement and are
independent to time frame.
STANDARD
• once a value judgement is applied to a criterion;
it acquires the status of a standard. It refers to the
desired level of performance corresponding with
a criterion against which actual performance is
compared. It tells us what the acceptable level of
performance or state of affairs should be for us to
say that the intervention was successful
Activity and Outcomes
ACTIVITIES
• are actions performed to accomplish an
objective. They are the things the nurse does in
order to achieved a desired result or outcome.
Activities consume time and resources. Examples
are health teachings, demonstration and referrals.
OUTCOME
• is the results produced by activities. Where activity
is the cause, outcome is the effect. They can also
be immediate, immediate or ultimate outcomes.
Patient care outcomes can be measured along three
broad lines:
1. PHYSICAL CONDITION
• decreased temperature or weight and change in
clinical manifestations
2. PSYCHOLOGICAL OR ATTITUDINAL STATUS
• decreased anxiety and favorable attitude towards
health care personnel.
3. KNOWLEDGE ON LEARNING BEHAVIOR
• compliance of the patient with instructions given
by the nurse.
Records in Family Health Nursing Practice
1. Records
• are necessary for the continuation of delivery of
family health care services and its evaluation while
evaluation of family health services is necessary to
identify the new and continuing family health
needs.
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2. Family records
• include information based on factual events,
observation results or measurements taken such
as height, weight, body circumference or
laboratory examinations carried out like
hemoglobin, urine test, stool test and sputum
examination depending upon the problem of the
family. These also includes records of
immunization, nutritional status, medical
prescription and curative procedures carried out.
Demographic data and individual personal history
are also included in the family folders.
3. Health records
• refer to forms on which information about an
individual and family is noted. Information varies
from socio-economic, psychological,
environmental factors etc. Records are a practical
and indispensable aid to the doctor, nurse and
other health care workers in giving best service to
individual, family or community. Recorded facts
have value and scientific accuracy and are
guidelines for better administration of family health
services. Contributions of health team members
are reflected in case records. Records are also a
means of communication between a health
worker and the families.
Types of Records and Reports
1. Cumulative or Continuing Records
• This is found to be time saving, economical and
also it is helpful to review the total history of an
individual and evaluate the progress of a long
period. (e.g.) child’s record should provide space
for newborn, infant and preschool data.
• The system of using one record for home and clinic
services in which home visits are recorded in blue
and clinic visit in red ink helps coordinate the
services and saves the time.
2. Family records
• The basic unit of service is the family. All records,
which relate to members of family, should be
placed in a single-family folder. This gives the
picture of the total services and helps to give
effective, economic service to the family as a
whole.
• Separate record forms may be needed for
different types of service such as TB, maternity etc.
all such individual records which relate to
members of one family should be placed in a
single-family folder.
The records may be grouped according to:
1. Age of the family member for whom records are used
• a New boll1 care
• Road to health card -e
• Toddler card e
• Old age or elderly card e
• Mother-child link card
2. Health care requirement cards as per health conditions
and morbidity status
• Pregnant women or antenatal card
• Intra natal card or labor record
• Person with illnesses (e.g., Tuberculosis record,
Diabetes record, Hypertension case card)
• Drug addicts or alcoholics’ record
• Any chronic care records
• Immunization record
FILLING OF RECORDS
• Different systems may be adopted depending on
the purposes of the records and on the merits of a
system. Records could be arranged in the
following ways:
1. Alphabetically
2. Numerically
3. Geographically
4. With index cards
REGISTERS
• It provides indication of the total volume of service
and type of cases seen. Clerical assistance may
be needed for this. Registers can be of varied
types such as immunization register, clinic
attendance register, family planning register, birth
register and death register.
REPORTS
• Reports can be compiled daily, weekly, monthly,
quarterly and annually.
• Report summarizes the services of the nurse and/or
the agency and may be in the form of an analysis
of some aspect of a service. These are based on
records and registers and so it is relevant for the
nurses to maintain the records regarding their daily
case load, service load and activities. Thus, the
data can be obtained continuously and for a long
period.
PURPOSES OF WRITING REPORTS
• To show the kind and quantity of service rendered
over to a specific period.
• To show the progress in reaching goals.
• As an aid in studying health conditions.
• As an aid in planning.
• To interpret the services to the public and to other
interested agencies
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SESSION 16
Maternal, Newborn and Child Health and
Nutrition
Nutrition
• may be defined as the science of food and its
relationship to health and concerned primarily
with the part played by nutrients in body growth,
development and maintenance
Nutritional status
• is the current body status, of a person or a
population group, related to their state of
nourishment (the consumption and utilization of
nutrients).
A. Nutritional Requirement During Pregnancy
1. FOLIC ACID
• If you’re planning to become pregnant you need
800 MICROGRAMS OF FOLIC ACID A DAY – which
you can find in up to six cups of fortified, cereal or
three cups of boiled spinach. You should continue
to consume this amount of folic acid during your
entire pregnancy.
2. CALCIUM
• You need 1,000 MILLIGRAM OF CALCIUM
EVERYDAY – or a little more than 3 cups of milk. If
your developing baby is lacking the calcium it
needs, it may take it from your bones.
3. IRON
• In your second trimester, your blood volume
increases by 50 percent, so you need 27
MILLIGRAMS OF IRON DAILY- equivalent to almost
seven cups of kidney beans
4. VITAMIN D
• You need 600 IU OF VITAMIN D EVERYDAY – the
same amount you’ll find in 13 hard boiled eggs.
Vitamin D is important during your entire
pregnancy but if you’re avoiding the sun it
becomes even more crucial,
Concerns for Maternal Nutrition and Weight Do Not End at
Delivery
Nutrition after delivery
• If breastfeeding, still consume additional calories
(500 kcal/day)
• Vitamin supplements if deficiencies noted
Weight after delivery
• Up to 75% of women weigh more than their pre-
pregnancy weight at one year postpartum
• Postpartum weight retention
• Increases the risk for adverse outcomes in future
pregnancies
• Influences a woman’s long-term health by
increasing risk for developing other conditions
such as hypertension and diabetes.
B. Newborn Nutritional Requirement
Schedules of Newborn Feeding:
A. First feeding.
• May be breastfed immediately following delivery
(colostrum – ANTIBODIES) is not irritating if
aspirated and is absorbed by the respiratory
system).
• Feed in the first hour of life.
• Latest to start feeding is 2–3 hours (when normal
low blood sugar occurs).
First feeding
• many facilities give sterile water, a few swallows to
half ounce to evaluate feeding capability.
(Glucose water no longer recommended for first feeding
due to danger of aspiration pneumonia.)
Give full-strength formula or breast milk as soon as
newborn shows an interest.
B. Subsequent feeding.
• Routine schedule: 2- to 4-hour feedings.
Self-demand:
• Baby is fed according to needs, when hungry,
usually every 3–4 hours. (Breastfeeding may be
1½–
• 3 hours.)
Calories and Fluid Needs
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A. Fluid: 140–160 mL/kg of body weight in 24 hours. ➢ Difficulty in school

• Fluid needs are high because the newborn is
unable to concentrate urine.
• More fluids should be given in hot weather or when
the baby has an elevated temperature.

B. Energy
• Healthy term babies grow well with intake of 90-
120 kcal/kg/D 125 - 140 kcal/kg/D

C. Protein
• Recommended allowance:15-20 % of daily
calories

D. Fat
• Recommended daily intake: 30-40% for term Complementary Feeding
• Fat intake of 9 kcal/g triglycerides Means complementing solid/semi-solid food with breast
• Infancy: 30-50% of total kcal milk after child attains age of six months.
• It should be timely,
E. Carbohydrates • Adequate, safe
• Carbohydrate constitutes 40-50% of total daily • Should be prepared with locally available food
calories
• Almost all the CHO in the human milk and infant Purpose:
formula is lactose • After the age of 6 months, child is ready to start
eating semi-solid food
F. Minerals • Breast milk alone is no longer enough for the
• Accretion of Ca, Phosphorus, Mg and iron is baby’s nutritional needs
maximal at the third trimester of pregnancy. • Breastfeeding must continue along with
complementary feeding
G. Supplements
1. Vitamin K: What Type of Food Should be Given?
• All infants receive at birth • 7. ≥ 4 food groups
2. Vitamin D: • Grains, roots and tubers
• Breastfed infants or infants who take <500 ml/day • Legumes and nuts
of vit. D fortified formula • Dairy products (milk, yogurt, cheese)
3. Iron: • Flesh foods (meat, fish, poultry and liver/organ
• Breastfed infants meats)
• Eggs
Fe absorption • Vitamin-A rich fruits and vegetables
• is good from human milk, but concentration is low. • other fruits and vegetables

4. Fluoride: NTD – NEUTRAL TUBE DEFECTS

• May be dependent on water supply 1. MENINGOCELA
2. MENINGOMYELOCELE
C. Child Nutritional Requirement.
Nutritional status of children during the critical period is of LAM- LACTATIONAL AMENORRHEA METHOD
paramount importance for later physical, mental & social • Family planning method during lactation
development.
Postpartum – after pregnancy
Outcomes of inadequate diet:
➢ Poor muscle development VITAMIN K INJECT : VASTUS LATERALIS
➢ Reduced work capacity
➢ Poor social development COMPLEMENTARY FEEDING AFTER 6 MONTHS = BF + SEMI
➢ High rates of illness SOLIDS FOODS

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