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human development and human behavior

human development and human behavior

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Published by mirtch
my personal notes
hope i can help you
my personal notes
hope i can help you

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Published by: mirtch on Oct 21, 2009
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HUMAN DEVELOPMENT
NUTRITION
Normal Prepregnancy BMI is 18.5-24.9
Normal weight gain is
 – 
1lbs/month on first trimester,
 – 
1lbs/week on second and third trimester 
Underweight causes preterm labor and LBW
Overweight causes fetal deathCalories (kcal)2,2002,500Protein (g)46-5060CALORIES
Increase calories for 
 – 
fetal energy and placenta,
 – 
for elevated metabolism (thyroid function andincrease workload due to increase weight) andmilk production
Sources are from protein, CHON, fats
Decrease calories lead to ketoacidosis (causes fetal andneurologic disorder)
Indicator of adequate caloric intake: weight gainProtein
For fetus (growth, amniotic fluid, placenta)
For mother (uterus, mammary glands, RBC, plasmavolume and protein, milk protein during lactation, uterus
Protein sources are meat, poultry, fish, legumes (beans,peas, peanuts) yogurt, eggs and milk.
Women with history of hypercholesterolemia should modifydietFATS
Can be consumed through food
Linoleic acid for new cell growth
Best sources are vegetable oils (corn, olive, peanut,cottonseed)Vitamins
Vitamin A for cell development and tooth bud and bonegrowth
 – 
Deep green, dark yellow vegetables and fruits,liver 
 – 
Vitamin A toxicity can cause fetal malformation
Vitamin D for maternal-fetal bone density
 – 
Absorption of calcium and phosphorus
 – 
Milk, margarine, egg yolk, butter, liver, seafood
Vitamin E for antioxidant, prevents hemolysis of RBC
 – 
Vegetable oils, green vegetables, whole grains,liver 
Vitamin C for tissue formation and iron absorption
Folic acid found in fruits, vegetables and liver necessary for RBC formation, decrease causes megaloblastic anemia,neural tube defect
Vitamin A, B and folic acid intake should be more for women who used oral contraceptives.
No mineral oil laxative inhibits Vit ADEK absorption
Megadoses of water soluble (Vitamin C) can cause scurvyMinerals
Calcium for skeletal (12 weeks) and teeth formation (8weeks)
 – 
Maternal bone and tooth mineralization
 – 
Milk, cheese, yogurt, green leafy vegetables
 – 
Can take calcium supplement if not provided indiet or lactose intolerant (lactase enzyme)
Phosphorus for fetal skeleton and tooth bud formation.
 – 
Can be taken from protein sources
 – 
Milk, cheese, yogurt, meats, whole grains, nuts,legumes
Iodine for formation of thyroxine for increase thyroidfunction
 – 
Decrease iodine causes goiter can causehypothyroidism in infant (mental retardation) andthyroid enlargement in infant can cause airwayproblem.
 – 
Iodine best source is seafood
Iron for hemoglobin, 20 weeks fetus stores iron in liver for 3months in life, to increase red cell volume for blood lostduring delivery
 – 
Iron rich foods organ meat, green leafyvegetables, whole grains, enriched breads
Fluoride for teeth formation. Can be found in water.Excessive fluoride causes brown stained teeth.
Sodium causes water retention (increase heart strain andblood volume)
Zinc for synthesis DNA and RNA. Usually on proteinsources (meat, liver, eggs, milk, seafood),
 – 
antagonistic with iron and folic acid, causes fetalCNS malformationFluid
Remove toxins
6 glasses for moreFibers
Common constipation due to decrease peristalsis frompressure
Vegetables
Lowers cholesterols and removes carcinogensFoods to Avoid
Caffeine is CNS stimulant (increase HR, urine productionand stomach acid secretion)
> 8 cups causes stillbirth
Can be found in chocolates, softdrinks, tea
120 mg (1 cup coffee)Common Problems
Nausea and Vomiting
 – 
r/t high Hcg,
 – 
high estrogen/progesterone,
 – 
low blood sugar,
 – 
lack Vit B6,
 – 
decrease gastric motility
Intense first 3 months, usually upon rising, smelling andpreparing food
Small frequent meals, dry crackers upon rising.
Avoid skipping meals
Decrease intake of fatty foods
Avoid cooking odors
No antacids may cause fluid retention
Avoid excessive fluid early in the day or when nausea inpresentHyperemesis gravidarium/ pernicious vomiting
More than 12 weeks causes dehydration, ketonuria, weightloss
Due to increase thyroid fxn, H.pylori
Shows elevated Hct (hemoconcentration) decrease fluidretention
Hypokalemic acidosis (vomiting)
Polyneuritis due to B deficiency
Ketones in urine
Can cause intrauterine growth restriction or preterm birthdue to decrease fluid
IV fluid, antiemetic, NPO 24 hrs then clear fluid thencerealsCravings
Cravings or aversion are normal
Pica – abnormal nonfood cravings, supplement with iron.Pyrosis
Caused by decrease gastric motility causing slow gastricemptying and pressure on stomach by uterus.
Eat small frequent meal
Avoid fluid with meals but plenty of fluid between feedings
2-3 pillows sleeping, do not lie down after eating
 
Loose clothing
Expanded Program on ImmunizationDefinition of Terms:1) Immunization
The protection of individuals from disease by vaccinationInduction or introduction of specific protective antibodies in asusceptible person or production of cellular immunity in such a personIs the provision of an individual with antibodies, which possess thepower to destroy or inactivate disease producing agent to neutralizeits toxins
2) Immunity
A condition of being able to or the capacity to resist a particular diseaseIs the resistance that an individual has against a diseaseA condition of being secure against any particular disease,particularly, the powers to which a living organism possesses to resistand overcome infection
3) Antibodies / Immunoglobulins
Any of various body globulins that normally prevent or are producedin response to infection or administration of suitable antigens
4) Antigen
A protein substance (as a toxin, enzyme, or any certain constituent of blood), that when introduced into the body stimulates the productionof antibodies
5) Attenuated
Refers to weakening, thinning or decreasing the pathogenicity(capability of causing a disease) or vitality of microorganismsA
) PASSIVE IMMUNIZATION
Is achieved by injecting a recipient with preformed immunoglobulinsdirected against an already present infectionState of relative temporary protection produced by the injection of serum containing antibodies which have formed in another host.
B) ACTIVE IMMUNIZATION
Involves injection of modified or purified pathogens or their products,prompting the immune system to respond as if the body were beingattacked by an intact infectious microorganism
PASSIVE IMMUNITY
Immunity transferred from another person▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ ▼▼▼▼▼Natural Passive Immunity Artificial PassiveImmunityTransferred by mother to child through Antibodies producedby another milk or through the placenta person or animalis injectedExamples are gamma globulin, antitoxin and antiserum
ACTIVE IMMUNITY
Individual’s own system is the cause of the immunity▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ ▼▼▼▼▼Natural Active ImmunityArtificialActive ImmunityExample is natural exposure Deliberately introducedin a vaccineExample is measles vaccine, DPT or Toxoids like Tetanus toxoid
Formulations for Active ImmunityLive Pathogens
When live pathogens are used, they are attenuated to prevent clinicalconsequences of infection
Killed Microorganisms
Killed vaccines have the advantage over attenuated microorganismsin that they pose no risk of vaccine-associated infection
Microbial Extracts
Instead of using whole organisms, vaccines can be composed of antigen molecules (often located on the surface of themicroorganism) extracted from the pathogen or prepared byrecombinant DNA techniques.
Toxoids
These are derivatives of bacterial exotoxins that can be produced bychemically altering the natural toxin, or by engineering bacteria toproduce harmless variants of the toxin
Six (6) EPI Diseases
PoliomyelitisMeaslesDiphtheriaPertusisTetanusTuberculosis
Coverage
The three population of EPI consists of the following:Infants below one year oldSchool entrantsPregnant WomenStarts from the Manufacturer ▼▼▼▼▼Airport▼▼▼▼▼Central Vaccine Store▼▼▼▼▼Regional Store▼▼▼▼▼District Hospital▼▼▼▼▼Health Center or Outreach Service▼▼▼▼▼Discrepancy▼▼▼▼▼Immunizing Staff or Mother and Child
VaccineDose/RouteBabyMotheTT10.5 R80%TT20.5 LProtected80% 3 yrsTT30.5 RProtected90 % 5 yrsTT40.5 LProtected99% 10 yrsTT50.5 RProtected99% LifetimeVaccineContentsFormCondition whenexposed to Heat /Freezing
BCG 
Live, attenuatedbacterial vaccine;Bacillus Calmetteand GuerinFreeze dried andreconstituted witha special diluentDestroyed byheating, sunlight butnot by freezing
DPT 
DiphtheriaPertussisTetanusToxoid which is aweakened toxinKilled bacteriaToxoid which is aweakened toxinLiquidDestroyed byfreezing, heatDamaged by heat,freezingDamaged by heat
Polio Vaccine
Live attenuatedvirusLiquidEasily damaged byheat but notdestroyed by freezingMeaslesLive attenuatedvirusFreeze dried andreconstituted witha special diluentEasily damaged byheat but notdestroyed by freezingTetanusToxoidWeakened toxinLiquidDamaged by heat,freezingHepatitis BPlasma derived;RNA recombinantLiquidDamaged by heat,freezing
 
METHODSARTIFICIAL-TemporaryHormonesPillsEstrogen/Progesterone PatchImplantsDMPA InjectionsBarriersSpermicidesDiaphragmCervical CapsFemale CondomMale Condom-PermanentTubal LigationVasectomy-NaturalCalendar (Rhythm) MethodBasal Body TemperatureCervical Mucus (Billings) MethodSymptothermal MethodLactation Amenorrhea MethodCoitus InterruptusNATURAL FAMILY PLANNING METHODCalendar (Rhythm) Method
Requires couple to abstain from coitus during menstrualcycle where conception is possible (3 days before or after ovulation)
Keep 6 months diary of menstrual cycle
Subtract 18 from shortest cycle (25 days) represents thefirst fertile day
Subtract 11 from longest cycle (29 days) represents lastfertile day
Use contraceptive or avoid coitus on fertile daysBasal Body Temperature
A day before ovulation the temp drops 0.5 F
On the ovulation day it rises to 1 F because of progesterone and is maintained throughout the cycle
Take the temperature every morning upon waking upbefore any activity
Refrain from sex for 3 days (life of ovum), once notices aslight drop and rise
Temperature can be affected by illness (fever), daily activity(metabolism rate)
Women working at night must take temperature onceawake from longer sleep period, no matter what time of theday.Cervical Mucus (Billings) Method
Before ovulation, cervical mucus is thick, non stretchable.
Peak ovulation mucus becomes copious, thin, watery, andtransparent. Feels slippery and stretches atleast 1 inchbefore it breaks (Spinnbarkeit properties).
Breast is also tender 
3 days after peak days or until mucus is copious isconsidered fertile days and avoid coitus.
Vaginal secretion after intercourse is unreliable and cangive watery consistency because of the seminal fluid andcan be mistaken as fertile.Symptothermal Method
Combination of cervical mucus and BBT
Abstain 3 days after rise of temperature or 4 days after peak of mucus change
Ovulation Kit
Detects Luteinizing Hormone in urine 12-24 hours beforeovulation.
ExpensiveLactation Amenorrhea Method
As long as woman breastfeed, there is natural suppressionto ovulation.
Must be exclusive breastfeeding (may ovulate withoutmenstruate while breastfeeding)Coitus Interruptus
Man withdraws and sperm emitted outside the vagina
May fertilized during preejaculation fluid.ARTIFICIAL FAMILY PLANNING METHODPills / Oral Contraceptives/ Combination Oral Contraceptives
Combination of synthetic estrogen and progesterone
Estrogen suppress FSH and LH, suppressing ovulation
Progesterone decreases permeability of cervical mucus,prevents transport of ovum tubal transport and endometrialproliferation to prevent implantation.
Must be given only after Papanicolaou Smear and pelvicexamination.
Not effective on first 7 days must take other contraceptivemethods
Take 21 pills everyday at the same time then rest for 1week (mense begins on 4th day) then start new 21 packs.Some have 28 pills (7 are placebo to prevent forgetting thegap) (menstrual flow begins on 7th day of placebo)
If woman does not want to have a menstrual flow, she canimmediate take the new 21 day pill or do not take the 7days placebo and start with 28 days pills immediately oncethe previous pills are consumed.
Decreases incidence of:
Dysmenorrhea (due to lack of ovulation)
Iron deficiency anemia (reduce menstrual flow)
Pelvic Inflammatory Disease (PID) and tubalscarring
Endometrial and ovarian cancer/cysts
Fibrocystic breast disease
Osteoporosis and uterine myomata
Colon cancer 
Side effects
Weight gain (estrogen interferes with lipidmetabolism lowers LDL and increase HDL)
Nausea (r/t estrogen)
Headache
Breast tenderness
Breakthrough bleeding (spotting outside menseperiod)
Monilial vaginal infections
Mild hypertension
Depression
Danger signs of myocardial or thromboemboliccomplication
Chest pain (MI/TE)
Shortness of breath (Pulmonary embolism)
Severe headaches (CVA)
Severe leg pain (thrombophlebitis)
Blurred vision (HPN, CVA)
Contraindications:
Breastfeeding/ < 6 weeks postpartum (weightloss in brestfeed infants, estrogen decreasesbreast milk)
>35 years old and smoker (>15 cigarettes/day)
Risk factor for arterial cardiovascular disease (oldage,smoking, diabetes, hypertension)
HPN >160 mmHg systolic or 100 mmHg diastolicor higher 
History of deep vein thrombosis or pulmonaryembolism
Major surgery with prolonged immobilization
History of ischemic heart disease

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