HOME-BASED CARE MANAGEMENT

Course description:
Describe and demonstrate the principles in home management, housekeeping skills and techniques, the use of common household gadgets, appliances and equipment, basic household budgeting skills; beginning principles in home

COURSE OBJECTIVES: The students will be able to : 1. Provide transitional and continuing care to the children and elderly with with special needs in the home. 2. Demonstrate housekeeping tasks 3. Promote an adequate and appropriate nutrition 4. Facilitate leisure and entertainment 5. Promote a safe, secure, well-managed and comfortable environment 6. Apply first-aid measures to common injuries at home 7. Maintain professionalism at the workplace

Definition of terms: Home Management Organization Transitional Care Homemaker Hospice care

Scope of Home Based Care Management Traditional homes Hotels and inns Offices Rented houses or chartered houses

Assisted living homes Skilled nursing facility Temporary shelter Orphanages of asylums Objectives of Home Based Care management Roles of Health Care Professionals in Home Based Care Management Importance of Home Management

FACTORS AFFECTING PERFORMANCE OF TASKS

v CULTURAL BELIEFS AND PRACTICES

The cultural practices of some countries or regions affect the performance of some household tasks . Some of these are: *Sweeping at night is bad luck

*Young ladies are not supposed to sing while cooking because they will marry old men. * If you cry while cutting onions , you will never be in good terms with your in-laws. * You should bite a pin or a matchstick when slicing bitter gourd to remove its bitter taste when cooked

v AVAILABLE RESOURCES. In mostsettings, not all standard cleaning materials,

v Weather and Climate Conditions

Shoveling the snow during winter is a major task. Mopping during the rainy season is also a major task especially in countries with only two weather conditions, like the wet and dry season in the Philippines.

v Geographical Location Food storage, menu planning and food purchasing will surely be affected by geographical location. Ice cream, fish, meat and poultry products must be frozen if the grocery or the market place is too far away from the home based care facility.

v Frequency of tasks

Monthly chores ---Paying monthly bills, water lights, telephone, cable, ren tal, etc.

 Preparation of monthly budget Recording of expenses and receipts for payments

v Weekly chores - Laundry ( sorting dirty clothes, washing and drying, folding and pressing) - Car washing - Gardening - Shopping for grocery supplies

v Daily chores Cleaning and dusting rooms such as living, dining, bedroom, kitchen, family room, bathroom, laundry room, etc. Cooking meals and snacks Menu planning Marketing Food preparation and cooking Setting tables and doing after care of utensils, chinaware, silverwares,etc.

v Seasonal chores ( winter, spring, summer, and fall ) Chores done during summer

1. Harvesting vegetables and fruits 2. Cleaning and using air conditioning or room coolers 3. Storing and preparing winter clothes and beddings 4. Use of thinner clothes and blankets 5. Assisting and sun bathing 6. Broiling, grilling, or barbecuing outside the house 7. Escorting clients to picnics, hunting and parties 8. Accompanying clients to malls ( eating, strolling, shopping) 9. Accompanying clients in outdoor games or recreation Chores during spring Characterized by a gradual decline in the temperaturesnow melts and plants start to grow; birds which migrate to warmer places are now coming back. People will be busy outside in their yards doing the following:

1. Collecting dried leaves and branches of trees left on the ground before winter and disposing them. 2. Trimming plants and trees affected by winter 3. Preparing the garden for gardening of vegetables and flowers, plants, and fruits 4. Actual planting and tending of the garden 5. Cleaning the garage, disposing of discardable things that accumulated for the past year. 6. This is the best time to plant fruits and harvest early produce

Chores during fall 1. Raking and disposing of falling leaves 2. Trimming plants 3. Covering some plants to protect them from frost 4. Preparing for winter like shopping for winter clothes, buying water softener, checking home heaters, chimney and fireplaces 5. Winterizing of tires of cars, vans and trucks.

Chores during winter 1 .Checking insulation of homes 2. Use of thermal blankets, warm sheets and pillow cases

3. Protecting plants from frost by using blankets, hay, bark of trees, or foam cover. 4. Some plants need to be kept inside the house 5. Use boots and winter jackets when going out 6. Maintaining faucets and pipelines to avoid frost 7. Operating room and water heaters

COMMON TASKS OR CHORES DONE BY THE CAREGIVER OR HOMEMAKER IN THE HOME

Demonstrate procedures in the classroom or skills lab when necessary Cleaning Appliances - Blender/osterizer - Range or stove - Washing machine - Microwave/oven - Dryer

 Cleaning and Dusting Rooms including walls, floors, windows ,furnitures

bedroom, living room, dining room, kitchen, laundry room, carpet cleaning, vacuuming, mopping, care od blinds and curtains

Laundry. operating the w)ashingmachine and dryer, use of detergents, sorting clothes, handwashing clothes

Bed making open bed, closed bed, occupied bed

Gardening. Tools used to prepare soil, garden soil, potting mixed soil, fertilizer

Cooking.. Menu planning ( breakfast, lunch, dinner, and snacks)

Setting tablesplacemats, plates, silverwares, table napkins

COMMON TASKS OF A HOMEMAKER A familys human resources are its members. Managing human resources involves the productive and satisfying use of the members of achieving the familys dreams, goals and objectives. * Financial Management Career professional homemakers maintain the household budget, pay bills ,handle banking responsibilities, tax fillings and other financial matters. They shop/purchase food and other household needs.

Planning and organizing Career professional homemakers effectively plan the things to be achieved in the home. They anticipate important or critical events, identify resource requirements, and assign responsibility for specific work, including deadlines and performance expectations.

Operating Management - Career professional homemakers direct or coordinate the operations of a home. They keep the home clean and running smoothly; ensuring that clothing and household items are laundered , dry-cleaned, or mended as needed - Cooking and serving meals for the households , controlling supplies ,distribution, and creating schedules for family members are just a few of the many duties they perform.

HOUSEKEEPING Refers to the upkeep and maintenance of cleanliness and order in a house or lodging establishment such as inn, hotel, apartel, condominium, resort, dormitory, or a hospital. Types of housekeeping - Domestic housekeeping refers to housekeeping maintenance in a house ; covers the bedrooms, kitchen, dining, receiving area, grounds, and the surrounding areas within the house - Institutional housekeeping applies to housekeeping maintenance in cial lodging establishments like hotels, resorts, inns and apartels. Areas covered are: guests rooms.hallways and corridors.lobby.public rooms and restaurants. offices.stairwayswindows.stores, concessionaire shopsgrounds..linen and laundry area

commer

v SCOPE OF HOUSEKEEPING MAINTENANCE

* Client room maintenance covers tasks like : - Maintaining cleanliness and orderliness - Furnishing the room wuth the necessary amenities and supplies - Attending to service requests of clients / guests - Keeping the area free of safety hazards * Maintenance of public areas include the following; - Maintaining cleanliness and orderliness in all public areas - Maintaining the upkeep of the surroundings of the building by keeping it clean and free of liters - Keeping the public areas free of safety hazards - Undertaking minor repair like busted bulbs, broken furnitures, etc

* Providing linen laundry service: - Collecting and delivering laundry items - Washing, drying, ironing guest laundry, as well as linens used in banquet functions, food service, and guestrooms - Mending services

v Installation, cleaning, and maintenance of facilities like furniture and appliances. v Provision of special services like providing turn-down service ( preparing the bed for use of the client), adding of water pitcher and drinking glass near the bed of the client, butter service for the guests, etc

STANDARDS OF IDEAL HOUSEKEEPING

Cleanliness All areas are immaculately clean- corner to corner, from top to bottom, including surfaces, Closets, cabinets and storage areas are also kept clean. Furniture and fixtures are properly dusted ; doorknobs and metal fixtures are polished with the right polishing chemical. Windows and glass panels are dusted and polished. Floors are vacuumed, polished. Or shampooed when necessary .Grounds are free of liters and dirt.

Orderliness Facilities and fixtures are properly arranged and installed in appropriate location. Room amenities are properly installed in appropriate location. Beds are made up properly; Lines are neatly folded, mitered, and wrinkle free.

 Sanitation The whole area is free from all sources of bacterial contamination such as undisposed garbage and left overfood, stagnant water, etc.

Guests room Rooms are well ventilated and lighted. Guests are not disturbed by noise and other forms of distractions . There are sufficient amenities for the comfort of guests like linen, toiletries, drinking glass, etc.

Eye Appeal Ambience is soothing to the eyes , not dim or dull . There is suitable Interior design and proper blending of colors. No eyesore can be Found in guest- contact areas.

 Guests Relations

Requests and concerns of guests are given prompt and proper attention. Staff exhibits warm and pleasant disposition in dealing with guests, Customer feedback is solicited to determine customer satisfaction and these feedbacks are evaluated for corrective action. There is accurate and appropriate response to guest inquiries.. Guests with special problems, like those who are ill are given necessary assistance and support

 Safety The rooms and public areas are free from any safety hazards like open electrical outlet, dangling wires, damaged tiles, slippery floors, etc.. Building is provided with all required safety facilities. Safety instructions in all rooms are available. The institution is prepared for any emergency that may arise. The staff are trained on emergency procedures. Trained roving guards are available to check movements in guestrooms and to ensure protection of guests.

Material control and Preventive Maintenance There is designated budget for supplies and materials. Consumptions of supplies is always monitored. Regular requisitions and par stock is maintained and monitored. Supplies and materials consumed are within the budget. Losses, damages and breakdowns are reported, documented and accounted for. There is regular inventory supplies and materials. Staff are trained on the proper use and maintenance of equipment.

CLEANING EQUIPMENT AND PROCEDURES

CLEANING EQUIPMENT AND PROCEDURES

EQUIPMENT Vacuum cleaner Floor polisher PROPER USE AND MAINTENANCE It is used to eliminate loose soil andbe used in scrubbing, To dust particles from carpet surfaces, upholstered furniture, stripping and polishing hard floor and evenand also vinyl, wood surfaces hard surfaces. Dust bags must be emptied daily ,parquet, etc. After using, roll back the wire Use the appropriate pad for neatly on the back of and vacuum scrubbing, stripping, the Used to pick up dirtone end of cleaner. Place it on and particles polishing from the wax on the floor enough the trolley. Give the carpet. Pressto dry beforeand push time the handles polishing. towards the dirt to vacuum sweep the carpet

Carpet sweeper


HOUSEKEEPING TASKS AND CLEANING STANDARDS

According to Bill Saunders and Rick Mazzoli of Glit Inc., floor care is a 4 step process. The process begins with foundation and stripping . Floor finishes are not permanent fixtures. Floors must be stripped of their old finish for the following reasons: 1. There is a breakdown in the floor surface indicated by a worn away finish and the bare floor is exposed. 2. Show presence of a wet look or shadowy areas, usually blamed on burnishing without mopping it first, which results in a shiny dirt appearance. 3. There is staining from spills or from cleaning solutions. 4. A noticeable flaking or chipping of the surface of the floors Floor Cleaning Process * Stripping

*Sealing Smoothens rough surfaces , scratches and other types of floor abuse , thus enhancing the floors appearance. Floor abuse is the presence of spots and stains on floors due to floor spills, excessive burnishing without mopping, and improper movement of furniture leading to scratches or sharp wheels of carts and trolleys, and other equipments. *Finishing Prolongs the life of floors. Coat is applied on the floor to make it appear glossy and appealing to the eyes. *Maintaining The floor must be retouched and rebuffed to remove embedded dirt and heel marks. Use of

 Floor Care, Cleaning and Maintenance Floor in good condition should be well kept and well maintained .Proper maintenance is done according to the type of floor and these are follows:

TYPES OF FLOORS MAINTENANCE

. Marble and cemented

DAILY

Hard Floors Sweeping daily Damp mopping-as needed Plain polishing daily Stripping and finishing-periodical . Mixed:Pebbles,crazy cut Brushing with a push brush Wet mopping


. Vinyl/Resilient Floors Sweeping daily, Damp mopping as need Spray buffing and polishing as needes, vacuuming of corners daily Wood and Parquet -Sanding initial application Sweeping daily Spray buffing and polishing as needed Vacuuming of corners daily Dust mopping daily Carpet - Vacuuming daily Shampooing when heavily soiled Extraction- when the soil penetrated the inner layers which can only be removed by extraction

 *FLOOR CLEANING AND MAINTENANCE

KINDS OF FLOOR CLEANING EQUIPMENT NEEDED Sweeping-removing dirt and Soft broom for fine surfaces trash from floors using like cemented floors, vinyl. Sweepers and dust pan Stick broom for hard surfaces like grounds Carpet sweepers for carpets

mop with handle) *Damp mopping mopping the floor with lightly wet mop to clean the floor of dirt and soil. Mop must be squeezed tightly on the wringer to prevent dripping ( mop with handle and wringer) * Spray buffing Spraying the floor with a buff finish to retouch it and to keep the gloss. (sprayer, buff finish, steel wool, nylon pads) * Plain polishing retouching the shine of floors by polishing with a polisher. The floor does not need to undergo stripping and sealing ( floor polisher, for manual polishing use abaca foot pad or coconut husk) *Floor stripping requires application of stripping solution (Finishing solution, mop with handle, mop with wringer) * Finishing floors- performed on floors that are stripped of old wax and dirt and sealed for protection. The finishing is accomplished through the application of wax or floor shine and polishing thereafter using a floor polisher (paste/liquid wax, floor polisher

*Dust mopping dusting away dirt on floors using mops ( dry

KINDS OF FLOOR CLEANING AND EQUIPMENT NEEDED Extraction is the process of extracting deeply embedded dirt and soil in carpets especially those in inner layers that could be removed by shampooing ( carpet extractor) Shampooing removal of embedded dirt and stains using carpet shampoo either manually or by the use of a machine. The process applies to carpets ( push brush, carpet shampoo, pail of water) Vacuuming elimination of embedded dirt on floors using a vacuum cleaner ( ordinary vacuum cleaner or Hydro-vac ( wet and dry vacuum for wet and dry surfaces

*CLEANING AND MAINTENANCE OF RESILIENT FLOORS * Types of resilient floors and their maintenance . Linoleum . Vinyl . Asphalt tile . Rubber tile New resilient floor should not be waxed immediately after installation. It should be thoroughly scrubbed first before the initial polishing. For the care or resilient floors, an emulsion wax is recommended.

Steps: . Sweep the floor to remove dust . Pour small quantity of emulsion wax on the floor and spread evenly with a clean cloth. . Let it dry depending upon recommendation of the emulsion wax used . Use coconut husk, abaca footpad or floor polisher to make the floor shine

To prevent damage while removing chewing gum, candle wax, etc. from resilient floors , use an ice cube in a plastic bag and place it on the spot /area to harden the gum and then scrape the dirt with a hard edge tool. Clean by rubbing with fine steel wool or nylon dipped in detergent solution. Rinse, let dry, and apply emulsion polish. To remove black heel marks , rub the marks with fine steel wool or nylon dipped in an emulsion wax. Rub the area gently then buff. Spread the new wax over the cleaned area, blending edges and let dry. Excessive use of water or harsh cleaners causes tile to loosen. Replace loose tiles immediately. To prevent recurrence. Use a mild cleaner and avoid flooding the floor with water when cleaning.

Care and maintenance of hard floors Hard Floors a type of floor that could easily be broken, scratched, or dulled Types of Hard floors * Marble comes from quarries in Rizal, Mindoro, bulacan, and Romblom

*Mixes comes in granolithic, terrazzo, ceramic, and tile, terra cotta brick, and concrete and pebble wash out 1. Terrazzo and granolithic have basically the same composition. Made out of white marble chips and white cement that is compressed and thick slab ground that is polished to a very smooth finish. 2. Ceramic tile baked clay, unglazed or high glazed. 3. Terra cotta hard baked clay reddish or red -yello in color 4. Concrete mixture of sand and cement with gravel, broken stone 5. Pebble washout mixture of river stones and cement Care of Hard Floors 1. Protect from scratches, water-borne stains, dirt and discoloration 2. Spillage should be avoided 3. Sealer or a thick liquid wax should be used to prevent discoloration Wooden and Parquet Floors Initial Care * Have the floor properly sanded * Clean using vacuum cleaner * Fill or steal it three coats of sealer then buff between

Daily .Buff with heavy powered machine to bring out its gloss .Apply second coat of wax and then buff again .Use wax treated dust mop which should be changed often moisture .Damp mop ( only if necessary ) with just a little amount of

Periodically .Buff floor with a steel wool or nylon pads . Spot clean with damp mop and diluted solution of detergent . Rebuff. Apply light coat of wax if needed .When spill occurs on wooden floors wipe them immediately with a damp cloth or sponge. . Sometimes while spots may appear on wooden floors after waxing, remove them by pouring a little amount of wax on them then rub gently with fine steel when wax have hardened.
.

. Work with the grain whenever possible when applying liquid/pastel wax . Buffing waxes need not be applied everyday as these waxes give floors long lasting protection . Apply waxes in areas located near entrances and exits since these are the areas that are often subjected to wearing out and becoming dull . Stubborn spots on wooden floors maybe removed during waxing . Alkaline stains on wooden floors appear when sudsy cleaning solutions are spilled and allowed to dry. To eliminate these dark spots the following steps maybe done: 1. Remove all wax with naphtha or kerosene 2. Thoroughly wash area with vinegar 3. Wipe dry with a clean cloth

 REMOVING SPOTS ON CARPETS SOURCE OF SPOTS OR STAINS SOLUTION

Sugar and starch Wipe spot with a cloth or sponge. Rinse with clean water. Use dry cleaning fluid or powder cleaner. Use dry cleaning fluid or absorbent powder cleaner. Milk Sponge with solution of water and detergent, then with clean water. Ink If spot is caused by washable ink, use damp absorbent cloth. It it comes from a ballpoint mark, use dry cleaning fluid.

Pet spots

disappears. Wax If the wax has dried ,use stiff bristle brush to remove soiled matter. Spots from self polishing floor wax should be cleaned with warm water and detergent.

Sponge urine spots thoroughly with clean water then dry quickly. Repeat until discoloration

Cigarette burns If burns appear on the surface of the rug, use a sharp scissor to snip away the blackened ends of tuft. Sponge with a solution of wax, detergent, and sponge again with clean water.or consult a professional carpet service

 Cleaning Standards for Floors . Floor Finishing Floor finishes are not allowed to build up in corners, baseboards or underneath furniture. Stripping and removing of old floor finish is done to avoid yellowing and build up in corners, baseboards, or underneath furniture. .Mopping Water is used sparingly. Cleaning solutions are rinsed quickly and the floor is dried at once. Sweeping All swept floor do not have dust streaks nor does show mark where dirt was picked up . Vacuuming All carpeted areas or upholsteries are kept clean, free of dust and spots which are immediately removed upon discovery. Floor Cleaning Swept or vacuumed carpet is shampooed as necessary. Floor should be free from obstructions. All floors after a thorough stripping and scrubbing are applied with a thin and smooth wax to have an even finish

BED MAKING, LAUNDRY, AND SETTING TABLES

Bedmaking is defined as the process of applying or changing bed linens. The main objective for this is for the students to learn how to make apprppriate beds for clients. A wrinkle free bed that remains intact when the client moves around does a great deal for physical and psychological comfort. * Principles Observed during bed making . Asepsis - clean to clean, sterile to sterile . Hand washing before bedmaking Proper handwashing removes many of the microorganisms that would be transferred by the hands from one item to another. .Handle line carefully Microorganism move through space via air currents. Because of this movement , avoid shaking or tossing the linen, thus creating air currents on which microorganisms may be transferred.

from the uniform Microorganism are transferred from one surface to another whenever one object touches another * Application of Good Body Mechanics in Bed Making . When you must bend , bend with your knees not your

.Both dirty and clean linen should be held away

back

. Point your toes and face in the direction that you are moving. Avoid twisting . Make as few trips around the bed as possible. . Raise the bed to an appropriate height level (waist level) for your maximum working comfort. * Types of Bed . Open Bed the bed making process when the occupant or when the client is up and is able to leave the bed while the bed is being made. Also the type of bed made for admitting a client

* Occupied bed the bed making process in which the bed is made while the cllient is occupying it. Procedure: . Gather linen to be used and place in order of use . Explain procedure to the client . Place a chair at the foot of the bed. Remove one pillow from the bed and remove the pillowcase and place it over the back of the chair ( the pillow case will serve as the laundry hamper for the soiled/dirty linens ) Place pillow on the chair. .Raise one side rail . Move client to the far side of the bed ,making sure that pillow is moved with him. If possible the client should be on his side , facing away from you. . Loosen all tucked linens from the mattress cover to the top sheet, this includes the underpad or rubber sheet. . Fanfold the linens toward the center of the bed , with the last fold toward the back of the client and tucked under the clients back or bottom. . Place the bottom sheet on the bed. . Tuck the sheet under the top, miter the corner, and tuck it along the far side of the mattress to the foot of the bed.

the bed. . Place the new rubber draw sheet and cotton draw sheet. Tuck them under the mattress. Fanfold the other half toward center of the bed, tucking it under the clients back and buttocks. . Assist client to turn to the side of the bed that is already made.Loosen all tucked linens on this side of the bed. Remove the soiled linens. . Place it in the pillow case, which serves as laundry hamper. . Straighten, pull, and tuck the bottom sheet. . Pull and tuck the rubber and cotton draw sheet snugly and smoothly. . Help the client to move in the center of the bed in a comfortable position. . Place the new top sheet over the soiled one . Remove the soiled sheet, instructing the client to hold the new one as you pull the soiled sheet from the top to bottom. Place soiled linen in a laundry bag.

.Fanfold the other half of the sheet toward the center of

Unoccupied Bed/Close Bed a bed prepared for the reception of a newly admitted client. Procedure . Gather the linen to be used and place it in order of use. . Place bottom sheet on the bed centerfold ( right side uppermost

CARE OF CHILDREN WITH SPECIAL NEEDS Newborn Screening (NBS): A procedure to determine a newborn infant has a heritable congenital metabolic disorder that may lead to serious physical health complications, mental retardation and even , and even death if left undetected and untreated. Under the NBS, the newborn is a child from the time of complete delivery to 30 days old. Objectives of NBS 1. To ensure that every newborn has access to newborn screening for certain heritable conditions that can result in mental retardation, serious health complications or death if left undetected and untreated. 2. To establish and integrate a sustainable newborn screening system within the public health delivery system.

3. To ensure that all health practitioners are aware of the advantages of newborn screening and of their respective responsibilities in offering newborns the opportunity to undergo newborn screening 4. To ensure that parents recognize their responsibility in promoting their childs right to health and full development , within the context of responsible parenthood, by protecting their child from preventable causes of disability and death through newborn screening.

LEGAL BASIS: Newborn Screening Act of 2004 ( R.A. 9288) enacted in order to: 1. protect rights of children and full and healthy development as normal individuals

provide for a comprehensive, integrative and sustainable newborn screening system to ensure that every baby born in the Philippines is offered the opportunity to undergo newborn screening and be spared from heritable conditions.
2.

PERFORMANCE OF NEWBORN SCREENING ( R.A. 9288) 1. Performed after 24 hours of life but not later than three days from complete delivery of the newborn; ideally done on the 48th hour

2. If done earlier than 24 hours, the baby must be screened again after two weeks for more accurate results 3.High-risk newborn in NICU maybe exempted from the 3 day requirement but must be tested by 7 days.

SCREENING PROCEDURE 1. Explanation of the procedure 2. Collection of blood specimen.

. Done by the physician, medical technologist , or after training by the nurse or midwife . Heel prick method to obtain few drops of capillary blood from the babys heel and blot on a special absorbent filter paper . Drying time of blood: 4 hours . NBS fee: P550.; maximum allowable fee for specimen collection: P50.

3. Send specimen to the Newborn Screening Laboratory ( hospitals, lying-ins. RHU and health centers). For home deliveries, babies maybe brought to the nearest institution offering newborn screening. 4. Follow up results. Results are available within seven to fourteen working days after the NBS screening samples are submitted to laboratory.

5. Follow institution policy on communication of results. . Negative screen: extremely low risk of having any of the disorders being screened

. Positive Screen : increased risk of having one of the disorders being screened; refer immediately to the nearest hospital or specialist for confirmatory testing and management. HERITABLE CONDITIONS:

1. Heritable Condition: any condition that can result in mental retardation, physical deformity or death if left undetected and untreated and is usually inherited from the genes of either both or biological parents. Disorders tested in NBS: . Congenital Hypothyroidism: endocrine disorder also referred to as cretinism or dwarfism; results from the absence or lack of development of thyroid gland causing absence or lack of THYROXINE, needed for metabolism and growth of the body and the brain; is not detected and if hormone replacement is not initiated within 4 weeks , the babys physical growth will be stunted he may suffer from irreversible mental retardation; treatment: oral hormone (SYNTHROID, PROLOID ) replacement taken as a single morning dose for life. .

Congenital Adrenal Hyperplasia (CAH):

An endocrine disorder caused by an inborn defect in the biosynthesis of adrenalCORTISOL that causes severe salt or sodium losses, dehydration and abnormally high levels of male sex hormones in both boys and girls; symptoms begin shortly after birth: anorexia, progressive weight loss, vomiting, dehydration, disturbances in cardiac rate and rhythm, cyanosis and dyspnea; if not treated early babies may die within a few weeks.; treatment : continued hormonal replacement of HYDROCORTISONE. . Phynelketonuria (PKU): Inborn error of metabolism characterized by lack of enzyme PHENYLALANINE HYDROXYLASE needed to breakdown phenylalanine > elevated serum phynelalanine >brain damage and mental retardation; later physical signs reflect the absence of adequate melanin pigment: blond hair , fair skin and blue eyes; dietary treatment ---milk-free, phynelalanine-free formula taken usually for 6-8 years, or until the brain is fully developed.

. Galactosemia (GAL) Inborn error of metabolism: . Type 1: deficient GALACTOKINASE > inability to convert galactose to glucose > galactosemia> galactosuria; complications: mental deficiency, cataract and death; dietary treatment: galactose-free diet ( galactose: high in milk and milk products). . Type 2: Classic galactosemia: serious deficiency of URIDYL TRANSFERASE > early symptoms: jaundice, vomiting , enlarged liver and spleen and hypoglycemia, convulsions and feeding difficulties > complications: liver cirrhosis and irreversible mental retardation; dietary treatment: exclusion of galactose from the diet to prevent severe liver cirrhosis, mental retardation, cataracts and recurrent hypoglycemia. . Glucose-6-phosphate-dehydrogenase deficiency ( G6PD ): deficiency in G6PD > red blood cells lack protection from the harmful effects of oxidative substances found in drugs , foods, beverage > severe anemia and hyperbilirubinemia > kernicterus ( jaundice of the brain ) and mental retardation, convulsion, coma and even death.

BREASTFEEDING Breastfeeding is the healthiest way to feed most newborn babies buring the first 6 months , and along with other food , breast milk can be a major part of the childs for 2 years or more.

MATERNAL CONTRAINDICATIONS TO BREASTFEEDING 1. Life threatening conditions, such as severe cardiac disease, cancer. Breastfeeding is incompatible with chemotherapeutic agents. 2. Severely debilitating disease/ condition as extensive surgery 3. Acute, contagious diseases like hepatitis C virus in the mother is a contraindication, but not Hepatitis B virus 4. Drug abuse, such as narcotic addiction . There is possibility of the infant receiving substantial amount of the drug through breast milk. 5. Positive test for the HIV antibody to avoid postnatal transmission. HIV maternal infection to prevent prenatal transmission

BREASTFEEDING BENEFITS TO THE MOTHER 1. Promotes maternal infant bonding, protective behaviors, psychosocial advantages as emotional satisfaction and increased feeling of maternal well-being resulting from the increased serum level of oxytocin that coincides with more even mood responses 2. Promotes uterine contraction, thus prevents postpartum hemorrhage and speeds up involution. 3. Reduces rate of ovarian cancer and premenopausal breast cancer. 4. Decreases maternal morbidity and mortality. 5. Provides social and economic benefit

6. Saves time, money and effort 7. Delays fertility

BREASTFEEDING BENEFITS TO THE INFANT 1. Promotes attachment 2. Provides the perfect food that contains all necessary nutrients. 3. Causes fewer incidence of allergies, vomiting, diarrhea, constipation, and aspiration 4. Enhances brain development because of taurine content 5. Decreases infant morbidity and mortality

PRIMARY NURSING CARE RELATED TO BREASTFEEDING 1. HEALTH EDUCATION: Teaching mother feeding techniques and care of the breasts 2. DEMAND FEEDING 3. POSITION 4. ROOTING REFLEX STIMULATION BEFORE STARTING 5. ESTABLISH EYE TO EYE CONTACT IN FEEDING 6. BUBBLE OR BURP FREQUENTLY 7. KEEPING INFANT UPRIGHT FOR 30 MIN. MORE AFTER FEEDING BEFORE PUTTING HIM DOWN IN RIGHT SIDE-LYING POSITION 8. CONTINUE ABSOLUTE BREASTFEEDING FEEING FOR 4 TO 6 MONTHS; MAY EXTEND BREASTFEEDING UP TO 2 TTO 2 YEARS 9. THE QUANTITY OF BREASTMILK INTAKE IS SIMILAR TO THAT OF BOTTLE FEEDING INTAKE.

FEEDING 1. Breastfeeding is the best infant feeding. Maintain roomingin to promote breastfeeding. 2. Demand feeding is the best feeding schedule. This is fee

COMMON AGING CHANGES AND ADAPTATION

CHANGES

ADAPTATION

SENSORY Decreased pupil size Narrowing of visual fields Yellowing, opacity, rigidity of lens Presbyopia ( farsightedness ) High-frequency hearing loss Tone discrimination loss Increased production of cerumen Decreased elasticity of tympanic membrane

INTEGUMENTARY Epidermis thins and atrophies Increased vascular fragility Loss of subcutaneous fat Decreased perception to touch, pain etc. Lower wound healing

Provide direct, adequate lightning Avoid monochromatic color schemes Provide educational materials in large print Address safety concerns in the environment Correct use of glasses and hearing aids Lower the pitch of your voice Face the patient at eye level Check for and remove cerumen impaction

Assess risk of pressure ulcers Use appropriate pressure reduction devices Avoid the use of tape on fragile skin Avoid frequent bathing; use emollients

COMMON AGING CHANGES AND ADAPTATION

CARDIOVASCULAR Decreased stroke volume and cardiac output Decreased ability to increase heart rate in response to stress Increased amount of collagen and fat Thickening and rigidity of heart valves

Frequent small meals Avoid extremes and sudden changes in temperatures Provide frequent rest periods Be aware of effect of fever, stress on limited cardiac reserve Schedule rest periods with activities Careful assessment of respiratory status Aggressive pulmonary toilet postoperatively Monitoring of pulse oximetry

RESPIRATORY Decreased elasticity and number of alveoli Decreased vital capacity Decreased mobility of bony thorax Weakening of respiratory muscles Decreased ciliary action

GASTROINTESTINAL Poor dentition Decreased taste sensation and appetite Decreased emptying time Decreased gastric acid and hepatic enzyme Increased incidence of malnutrition

Careful assessment of nutritional status Minimize dietary restrictions Encouraged upright position for meals Appropriate texture and consistency of meals

COMMON AGING CHANGES AND ADAPTATION

GENITOURINARY Decreased blood flow to kidneys Decreased number of nephrons Decreased creatinine clearance Bladder capacity decreased from 500 250ml Decreased bladder elasticity MUSKULOSKELETAL Decreased muscle strength and symmetrical muscle wasting Demineralization of bones with loss of height (2 in between 20 and 70 years.) Decreased flexibility and mobility Increased risk for falls Changes in gait

Encourage adequate fluid intake Investigate incontinence for cause Monitor for atypical presentation of fluid and electrolyte imbalance Monitor medications closely, especially those cleared through the kidneys Avoid diapers

Avoid bed rest, promote early mobilization and involvement of physical therapy Initiate fall prevention strategies when appropriate Proper fitting and use of assistive devices Proper fitting and use of shoes; proper nail care Modify the environment of safety

COMMON AGING CHANGES AND ADAPTATION

NEUROLOGIC Decreased number of neurons Decreased size and weight of brain, but dementia is not normal aging Change in sleep pattern Slower response to stimuli Decreased sensation

Assess baseline cognitive function Teach in multiple, short sessions Adjust care to avoid disturbing sleep Use schedules and memory aids as needed Change positions frequently