Portfolio

Community Health Nursing

BSN Generic 3rd year

Student Information

Student Name: Sumreen Kousar

Roll No: 093558

Subject: Community Health Nursing

Subject Teacher: Mam Shahnaz Dar

College of Nursing, Ameer- ud -din Medical College, Lahore

General Hospital Lahore
Acknowledgement
Successful completion of any type of work requires help from a
number of persons. I have also taken help from different people
for preparation of this portfolio. Now, there is a little effort to
show my deep gratitude to those individuals.
First of all, I would like to express my special gratitude to Allah
Almighty for giving me strength and guiding me throughout the
process.
Secondly, I convey my sincere gratitude to my Principal
Madam Shazia Khan for her kind co-operation and
encouragement that helped me a lot in this work.
I am highly indebted to my subject teacher Madam
SHEHNAZ DAR for her guidance and supervision. I would
like to thank her for providing the necessary information and
resources for this portfolio.
Lastly, I would also like to thank my parents and classmates
who helped me a lot in finalizing this portfolio within the
limited time frame.

Acknowledged by: Sumreen Kousar

Roll No: 77
Class: BSN GENERIC 3rd Year
 TABLE OF CONTENT

Sr. No Contents Pg. #

1- Introduction to community health

Nursing
2- Reproductive Health

3- Breast Feeding

4- Family Planning Visit

Methods of Family planning

5- Immunization
6-
Case Study
7-
Reflective log
INTRODUCTION TO COMMUNITY HEALTH
NURSING:
Community medicine:
WHO Definition:
A system of delivery of comprehensive health care to
the people by a health team in order to improve the health of the
community.
Community:
It is defined as a large number of individuals, living
together in a defined geographical area and having common interests,
goals and ways of life.

Medicine:
The branch of science that deals with diagnosis, treatment and
maintenance of health is called medicine.

Illness:
It is a phenomenon in which one or more natural functions of the
body are so disturbed that the affected individual cannot meet the natural
requirements of everyday life.
Types of Illness
● Acute illness
● Chronic illness

Acute Illness:
If the disturbance is severe and duration is short, it is
called acute illness and the person is said to be acutely ill.

Chronic Illness:
If the illness continues for a long duration without
disability, it is called chronic illness and the person is said to be
chronically ill.
Disease:
It is a condition in which body health is impaired. Disease
is a process. Person may not be aware of his being diseased.
Morbidity:
It is a condition of being diseased. Morbidity means
pathological changes.
Levels of Prevention
● Primordial Prevention
● Primary Prevention
● Secondary Prevention
● Tertiary Prevention
Primordial Prevention:
Primordial Prevention is actually prevention
in chronic diseases.
For Example:
Cancer, Chronic heart diseases,DM.
Primary Prevention:
It is defined as action taken prior to the onset of
disease, which removes the possibility that a disease will ever occur. It
can be achieved by:
● Health Promotion
● Specific Protection
Secondary Prevention:
It is defined as action which halts the progress
of a disease at its early stage and prevent complications. It can be
achieved by:
● Early diagnosis
● Prompt Treatment
Tertiary Prevention:
When the disease process has advanced
beyond its early stages, prevention is done by tertiary prevention. It is
defined as all measures available to reduce or limit impairments and
disabilities. It can be achieved by:
 ● Disability Limitation
● Rehabilitation
HEALTH
It is a state of complete physical, mental and social wellbeing and ability
to function and not merely absence of disease or infirmity but also the
ability to lead a socially and economically productive life.

INDICATORS OF HEALTH:

Variables that help to measure changes / How is status of a community

measured? Indicators They are defined as variables which help to
measure changes. They are only an indication of a given situation or a
reflection of that situation.
Characteristics of an Ideal Indicator
 Valid
 Reliable
 Sensitive
 Specific
 Feasible
 Relevant
DIMENSIONS OF HEALTH
REPRODUCTIVE HEALTH:
Reproductive health is defined as a condition in which reproductive
process is accomplished in a State of complete physical, mental and
social well-Being and not merely the absence of disease or Disorders of
the reproductive process.

Components of Reproductive Health:

 Safe motherhood
 Fertility regulation
 Infertility
 Prevention and control of reproductive tract
 Infections
 Sexually Transmitted Diseases (STDs) including
 HIV/AIDS
 Newborn care
 Malignancies of reproductive tract
Components of MCH:
 Antenatal care
 Intranatal care
 Post natal care
 Infant care
 Under five clinics
 Immunization
 Nutritional disorders
 Training programs
 Health education
Antenatal care:
It means care of mother during pregnancy.

Aim:
The aim of antenatal care is to achieve healthy baby at the end of
pregnancy.

Objectives:
 To promote, protect and maintain health of the Mother during
pregnancy.
 To detect high-risk cases and give them special Attention
 To foresee complications and prevent them.
 To reduce anxiety associated with delivery
 To reduce maternal and fetal mortality and Morbidity.
 To sensitize mother to the need for family Planning
 To teach the mother elements of child health Care, nutrition,
personal hygiene and Environmental sanitation
 To attend the under-fives accompanying the Mother
Intra natal Care:
Intranatal care of mother during childbirth and also of child.
Children is a normal physiological process but complications may
arise.
Aims:
Clean delivery through aseptic measures. It is
Achieved by:
 Clean delivery surface
 Clean hands
 Clean cutting and
 Cutting and care of the cord
 Delivery with minimum injury to infant and
Mother
 Ready to deal with complications such as Prolonged labour,
antepartum hemorrhage,
Intranatal Services
The above aims of intranatal care are achieved by
Following services:
• Institutional care Home helps Maternity homes
• Transport facilities for midwives
 Ambulance services At home
 Blood transfusion services
• Diagnostic and laboratory facilities
• Arrangements for consultation and referrals
Domiciliary Care:
Conduct delivery at home. The care provided at home is called
domiciliary care. Mothers with normal obstetric history may be
Advised to have domiciliary care. In such cases, Delivery is
conducted by trained dai/midwife (one Midwife is for 100 births or
3000 people).
Advantages
• Domiciliary care is less expensive
• No tension of going to hospital
• Mother delivers in familiar surroundings
• It is convenient and psychologically satisfactory
• Mother can keep an eye upon her children and their
POSTNATAL CARE:
The care of the mother after Delivery is known as
postnatal or postnatal care.

Services:
• Home visiting program by health visitors:
• Day 1-3, twice a day
• Daily for 7 days
• Last visit at the end of 6 weeks
• Welfare centers for supply of milk, etc.
• Providing consultations and health education
• Postnatal clinic for mothers
• Hospital beds for complicated cases
• Family planning services
• Referral and follow up
Objectives:
• To prevent postnatal complications
• To provide family planning services
• To check adequacy of breastfeeding
• To provide basic health education to mother e.g.,
o Postnatal exercises.
Postnatal Complications:
• Puerperal sepsis
• Thrombophlebitis
• Secondary hemorrhage
• Mastitis
• Urinary tract infections
• Air embolism
CARE OF NEW BORN
Care of an infant is also very important. The immediate care of the
newborn comprises the following:
1. Resuscitation:
It becomes necessary if natural breathing fails to establish
within a minute. In such cases, resuscitation may require
suction, application of oxygen mask, intubation and assisted
respiration. APGAR (Activity, Pulse, Grimace, Appearance and
Respiration) score should be assessed for every newborn

Care of Cord:
Umbilical cord should be cut and tied when it has stopped
pulsating because in this way baby derives about 10 ml extra blood
from mother.
Care of the Eyes:

Lid margins should be cleaned with sterile swabs. Instill a drop

of freshly prepared Silver Nitrate solution (1%) to prevent
Gonococcal conjunctivitis.

Care of the Skin:

Clean the skin with a sterile cloth. First bath to child is given
with soap and warm water to remove meconium and blood
clots.

Examination of the Abnormalities:

Cyanosis of lips and skin, imperforate anus, any difficulty in

breathing, congenital heart anomalies must be examined after
birth.

Birth Weight:

Normal birth weight within pt hour of birth is 2.5 kg

Others:
After performing above examinations, late care involves:
• Home visiting • Breast feeding • Immunization
SAFE MOTHERHOOD:
It is the continuous care provided to the mother started From pregnancy
period, Pregnancy, delivery and postpartum period and it Should include
family planning services.
Aims:
• Reduction in death rate by making basic emergency and
obstetric care available to all
• Decrease incidence of high risk/unwanted pregnancy by
fertility regulation
• Antenatal care to decrease number and proportions of
complications of pregnancy trained birth attendant at
delivery

Breast feeding:
Breast milk is the ideal food for infant. Baby requires no food until 4-5
months after birth. Daily secretion is 450-600ml/day. Energy value is
65-75 kcal/100ml.
Composition of Human & Cow Milk:
Constituents Human milk Cow milk

Proteins 1-1.5%Lactalbumin 3.5%

Casein 2.1
Fats Varies with nutrition of Varies with breed
mother

Carbohydrates 6.5-7.5% 4.5%

Vitamins Sufficient Vit.A,B,E Low in Vit C, D

Energy value 20 Kcal/ounce 20kcal/ounce

Advantages of Breastfeeding:
For Baby:
 Breast milk is safe, clean, hygienic, cheap and Available at normal
body temperature.
 It fully meets requirements of infants in first few Months
 Less chances of malnutrition
 It is easily digestible, so baby is comfortable and Sleeps peacefully
 It contains anti-microbial factors (such as Lysozyme, macrophages,
lymphocytes, secretory lgA, lactoferrin and anti- streptococcal
antibodies). These provide protection from diarrheal diseases and
also from respiratory infections Reduces the risks of allergies,
obesity & Hypomagnesaemia
 It helps in development of jaws and teeth.
 It reduces IMR
 It prevents development of neonatal
 Hypocalcaemia
 Breast milk is 1ow in Vit. K contents which may Contribute to
hemorrhagic diseases, so 0.1 ml
 IM, Vit. K at birth is administered.
.
Contraindications:
In following Maternal problems breast feeding is contraindicated:
 High fever
 Septicemia
 Breast cancer
 Kidney disease
 Family Planning:
“A way of thinking and living that is adopted voluntarily, upon the basis
of knowledge, attitudes and responsible decisions by individuals and
couples, in order to promote the health and welfare of family group and
thus contribute effectively to social development of a country.”

Objectives:
Family planning refers to practices that help couples to:
 Avoid unwanted births
 Bring about wanted births
 Regulate the interval between pregnancies
 Control the time at which births occur in relation to the age of
parents
 Determine the number of children they wish to have in their
family.
 Aims:
Aim of family planning services is to improve the quality of life of
people. Family planning is a basic human right. All couples must
have the right to decide freely number of children and spacing of
children.
Methods of Family planning:
Classification
1. Conventional Methods
A. In Male
 Coitus interrupts
 Condom
B. In females:
• Diaphragm
• Female condom.
Clinical Methods
In Female
 Intrauterine devices
 Diaphragm
 Hormonal contraception
 Oral pills
 Injectable
Surgical Methods
In Male
Vasectomy
In female
Tubal ligation
 Immunization
Immunology
"Immunology deals with complex defense mechanism of the body and
also deals with equally complex invading agents."

Uses of immunology:
Subject of immunology is useful in:
1). immunization programs
2). Forecasting epidemics
3). Hypersensitivity and adverse reaction
4). Carrier detection
5). Serological diagnosis and blood grouping
Immunity:
"The reaction of the body towards the foreign substance or non-self ."
Classification of immunity:
innate or non-specific immunity
Acquired or specific immunity
1). Active immunity
2). Passive immunity
1.Innate or Non-specific immunity;
It is the resistance not acquired through contact with an antigen .it is
present in all living things irrespective of their stage in evolution. it can
be initiated immediately against an invader without any previous
contact.it includes.
. Resistance of skin and mucous membrane to invasion by organisms
. Phagocytosis by WBCs
. Acid in stomach secretion destroys organisms taken in
. Lysozymes and natural killer cells in blood
2.Aquired or specific immunity;
This occurs after exposure to an agent. it is specific and mediated by
antibody and by lymphoid cells. This type of immunity is present only in
vertebrates.
EPI Schedule
 Case study
TETANUS:
"It is an acute disease induced by exotoxin of Clostridium
tetani and clinically characterized by Muscular rigidity."

*Patient Profile:*
- *Name:* Mr. Ahmad
- *Age:* 50 years
- *Gender:* Male
- *Occupation:* Farmer
- *Medical History:* No known allergies, incomplete tetanus
vaccination history
*Chief Complaint:*
Mr. Ahmad presents to the emergency department with severe muscle
stiffness and spasms, particularly in the jaw (trismus), after stepping on a
rusty nail two days ago. He complains of difficulty swallowing and
muscle rigidity spreading to his neck and abdomen.
*History of Present Illness:*
Two days ago, Mr. Ahmad was working in his farm when he stepped on
a rusty nail. He cleaned the wound himself but did not seek medical
attention. Over the next 24 hours, he developed progressively worsening
muscle stiffness and jaw pain. His wife brought him to the hospital upon
noticing his inability to open his mouth fully and difficulty swallowing.
*Physical Examination:*
- *General:* Alert and oriented, in moderate distress due to muscle
spasms.
- *Vital Signs:* Stable.
- *Neurological:* Trismus (inability to open mouth), facial muscle
spasms.
- *Musculoskeletal:* Increased muscle tone and rigidity in jaw, neck,
and abdomen.
- *Skin:* No signs of localized infection at the wound site.

Epidemiology:

By Time: more in rainy and hot climate.

By place:
 More common in agricultural areas.
 Unhygienic customs and habits.
 Ignorance of infection.
 Lack of primary health care services.
By place:
Age: 5-40
Determinants:
Primary Determinants:
Clostridium tetani
Secondary determinants:
 Lack of interest in immunization
 Poor hygiene
 Unhygienic delivery practices
Period of communicability:
Not transmitted from person to person.
Mode of transmission:
Contamination of wound with tetanus spores.

Reservoir of infection:
 Soil and dust
 Faeces of animals and man
Types of Tetanus:
 Traumatic Tetanus
 Puerperal tetanus
 Otogenic Tetanus
 Tetanus Neonatorum
 Idiopathic
Clinical Features:
• Onset is usually insidious, heralded by stiffness
 Of muscles in the jaw or neck
 Difficulty in swallowing
 Spasm of the cheek and face muscles
 Opisthotonous develops
 Apprehension present
• Cyanosis
 Respiratory obstruction and laryngospasm
• Asphyxia
 Stimuli may cause generalized spasm for several Minutes
 •CSF opening pressure is slightly increased
 Sensorium remains unaltered

Complications:
 Aspiration pneumonia
 Atelectasis
 Pneumothorax
 Apnoea
 Mediastinal emphysema
 Laryngospasm
 Muscular hematomas
 Rib fractures
Medical management treatments for tetanus ¹ ² ³:
- Hospital care: Tetanus is a medical emergency that requires
hospitalization, often in an intensive care unit (ICU).
- Medicines: Drugs are given to ease symptoms, target the bacteria,
target the toxin produced by the bacteria and boost immune system
response.
- Antitoxin therapy: This treatment, called passive immunization, is a
human antibody to the toxin.
- Sedatives: Sedatives that slow the function of the nervous system can
help control muscle spasms.
- Vaccination: Tetanus vaccination helps the immune system fight the
toxins.
- Antibiotics: Antibiotics, given either orally or by injection, may help
fight tetanus bacteria.
- Wound care: Cleaning the wound to remove dirt, debris or foreign
objects that may be harboring bacteria. Dead tissue that could provide an
environment in which bacteria can grow will also be removed.
- Supportive therapies: Treatments to make sure your airway is clear
and to provide breathing assistance. A feeding tube into the stomach is
used to provide nutrients. The care environment is intended to reduce
sounds, light or other possible triggers of generalized spasms.
Prevention:

Active immunization:
 Combined vaccine
 Monovalent Vaccines
Passive immunization
TIG:
It is best prophylactic.
ATS:
It is prepared from horse serum.
Prevention:
• Thoroughly clean the wound soon after injury. Keep prepared
adrenaline solution 1 in 1000 and Hydrocortisone (steroid) 100 mg for
coverage of Anaphylactic reaction.
• 0.05 ml ATS is given S/C at test dose Observe the patient carefully at
least for half an Hour for any evidence of general reaction
• If there is no reaction, give 1500 IU ATS, S/C
• In case of reaction, give TIG, I/M
• In case of tetanus spasm give muscle relaxant Like Diazepam,
Phenobarbitone or Phenytoin
• General care of the patient Done:
The patient should be strictly
 Bed rest in a quiet room
 Avoidance of any stimulus
 Airway should be patent
 Adequate fluid and caloric plan
 Good nursing care.

Tetanus Toxoid Schedule:

For Pregnant Mother
1 Dose: 7th month of pregnancy
.2nd Dose: 8” month of pregnancy
2. For all the. Mothers of child bearing age
o 1st Dose: Anytime
o 2nd Dose: One month after
o 3rd Dose: Six months after 2nd dose
o 4th Dose: One year after 3rd dose
o 5th Dose: One year after 4th dose
Recommendations for Tetanus:
• Provide complete bed rest to the child.
• Keep the infant in dim lighted, quiet and well ventilated room, as
spasms can be precipitated by bright light, noise or even touch.
• Minimum external stimuli.
• Prompt suctioning and oxygen administration is essential.
• Fluid and electrolyte balance should be maintained.
• Due to spasm and increased muscle activity, patients are exhausted and
need extra calories, so provide high calorie & protein diet to patient.
Reflective log:
Description:
In this case study, I encountered a patient diagnosed with Tetanus with
symptoms of difficulty in swallowing and stiffness in the neck and jaw
muscles .The diagnosis was confirmed by external examination.
Feeling:
Initially, I felt concern for the patient’s wellbeing, as Tetanus can be
particularly dangerous for swallowing of food.
Evaluation:
Reflecting on the situation I realized the importance of prompt diagnosis
and treatment to prevent further spread of disease especially in the
vulnerable population.
Analysis:
Upon further analysis, I recognized the broader implications of Tetanus
outbreaks, including a potential for serious complications. This led me to
contemplate the importance of public health measures.
Conclusion:
In conclusion, this case study highlighted the critical zone of health care
professionals in diagnosing, treating and preventing infectious diseases.
Action plan:
Moving forward, I plan to provide awareness about the disease spread
and personal hygiene and other preventable diseases, both in my
professional practice and within my community, I also aim to stay
updated on emerging infectious disease threats and strategies for
mitigating their impact.