LEVEL 2 FIRST SEMESTER
MAJOR SUBJECTS
NCM 104_G
COMMUNITY HEALTH NURSING
CHAPTER I: OVERVIEW OF PUBLIC
HEALTH NURSING
LEARNING TASK 1: DEFINITION OF
TERMS
1. Community
- A collection of people who interact with one
another and whose common interests or
characteristics form the basis for a sense of unity
or belonging (Allender et.al, 2009).
- A group of people who share common interests,
who
interact with each other and who function
collectively within a defined social structure to
address common concern (Clark, 2008).
- A group or collection of individuals interacting in
social units ns sharing common interests,
characteristics, values and goals (Maurer and
Smith, 2013).
2. Health
- A state of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity (WHO, 1947).
3. Public Health
- The science and art of preventing disease
prolonging life
and promoting health and efficiency through:
• organized community effort for the sanitation
• control of communicable diseases
• education of individuals in personal hygiene
• organization of medical and nursing services for
the early diagnosis and preventive treatment of
disease
• development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these
benefits as to enable every citizen to realize his
birthright to health and longevity. (Dr. Charles-
Edward Winslow, 1920)
4. Community Health
- It is the environmental, social, and economic
resources to sustain emotional and physical well
being among people in ways that advance their
aspirations and satisfy their needs in their unique
environment (WHO).
- The health status of a community and the
organized responsibilities of public health, school
health, transportation, safety and other tax-
supported functions with voluntary and private
actions to promote and protect the health of local
populations identified as communities (Green and
Ottoson, 1999).
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5. Public Health Nursing
- It is the practice of nursing in national and local
government health departments and public
schools. It is community health nursing practiced
in the public sector (Standards of Public Health
Nursing in the Philipines, 2005).
- It is the practice of promoting and protecting the
health of populations using knowledge from
nursing, social and public health sciences
(American Public Health Association, 1996)
6. Community Health Nursing
- It is service rendered by a professional nurse to
communities, groups, families and individuals at
home, in health centers, in clinics, in schools, and
in places of work for the promotion of health,
prevention of illness, care of the sick at home,
and rehabilitation. (Ruth B. Freeman)
- A synthesis of nursing practice and public health
applied to promoting and preserving the health of
the populations. The focus of community health
nursing: (1) prevention of illness, (2) promotion of
health and (3) maintenance of health. (American
Nurses Association, 1980)
- It is the synthesis of nursing knowledge and
practice and the science of public health,
implemented via a systematic use of the nursing
process and other processes to promote health
and prevent illness in population groups (Clark,
2005).
LEARNING TASK 2:STANDARDS OF
PUBLIC HEALTH NURSING IN THE
PHILIPPINES
A. Standards of Care
Standard 1: Assessment
- The PHN/CHN collects comprehensive data
relevant to the health status of the community.
Standard 2: Population diagnosis and priorities
- The CHN/PHN analyzes the assessment data
to determine the population diagnoses and
priorities.
Standard 3: Outcomes identification
- The CHN/PHN identifies expected outcomes
for a plan that is based on population
diagnoses and priorities.
Standard 4: Planning
- The CHN/PHN develops a plan that reflects
the best practices by identifying appropriate
strategies, action plans, and options to attain
expected outcomes.
 Standard 5: Implementation
- The CHN/PHN implements the identified plan
by partnering with others
a. Coordination
- coordinates programs, services and
other activities to implement the
identified plan
b. Health Education and health promotion
- employs multiple strategies
to promote health, prevent diseases
and ensure a safe environment
for the community.
c. Consultation
provides consultation to various community
groups and officials to facilitate the
implementation of programs and
services.
d. Regulatory activities
- identifies, interprets and implements
public health laws, regulations and
policies
Standard 6: Evaluation
- The CHn/PHN evaluates the
health status of the population/
community.
B. Standards of Professional Performance
Standard 7: Quality of Practice
- The CHN/PHN systematically enhances the
quality and effectiveness of nursing practice.
Standard 8: Education
- The CHN/PHN attains knowledge and competency
that reflects current nursing and public health
practices.
Standard 9: Professional Practice Evaluation
- The CHN/PHN evaluates one’s own nursing
practice in relation to professional practice
standards and guidelines, relevant statutes, rules
and regulations
Standard 10: Collegiality and Professional
Relationships
- The CHN/PHN establishes collegial partnership
while interacting with representatives of the
population, organizations and health and human
service professionals.
- Contributes to the professional development of
peers, students, colleagues and others.
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Standard 11: Collaboration
- The CHN/PHN collaborates with representatives of
the population, organizations and health and
human services professionals in providing for and
promoting the health of the
population.
Standard 12: Ethics
- The CHN/PHN integrates ethical provisions
in all areas of practice.
Standard 13: Research
- The CHN/PHN
integrates research findings
in practice.
Standard 14: Resource Utilization Population
- The CHN/PHN considers factors related to safety,
effectiveness, cost and impact on practice and in
the planning and delivery of nursing and public
health programs, policies and services.
Standard 15: Leadership
- PHN provides leadership in
nursing and public health.
LEARNING TASK 3: ROLES AND
RESPONSIBILITIES OF A COMMUNITY
HEALTH NURSE
ROLE
- is a sociological concept which refers to the behavior
prescribed & expected of all who perform certain
functions.
- A individual assumes a role in different
circumstances.
Various Roles of a Community Health Nurse
1. Health Monitor
- Detects deviation from health of individuals,
families, groups, and communities through
contacts/visits with them
– monitors more effectively concepts of illness
among family members.
2. Provider Provider Of Care To The Sick And
Disabled of Care To The Sick And Disabled.
- Provides direct nursing care to sick or disabled in
the home, clinic, school, or workplace
- Develops the family’s capability to take care of the
sick, disabled, or dependent member.
3. Coordinator Of Family Services
- the nature of health problem requires services of
other disciplines nurse.

- Coordinates with individuals, families, and groups
for health related services provided by various
members of the health team
- Coordinates nursing program with other health
programs like environmental sanitation, health
education, dental health, and mental health.
4. Health Educator
- health education is one of the most
frequently used intervention by the nurse.
- Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
education purposes.
5. Counselor
- giving support to personal problems.
6. Client/ Patient Advocate
- intercedes and pleads the cause of another
(client/patient
7. Change Agent Change Agent
Motivates changes in health behavior in individuals,
families, groups, and communities that also
include lifestyle in order to promote and
maintain health.
8. Community Organizer Community Organizer
.
- Stimulates and enhances the community’s
participation in planning, organizing,
implementing and evaluating health programs &
services.
- Motivates and enhances community participation
in terms of planning, organizing, implementing, and
evaluating health services
- Initiates and participates in community
development activities
9. Team Team Member Member
- as member of a health team
10. Trainer, Supervisor, Manager
- Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW), and hilots
- Conducts training for RHMs and hilots on
promotion and disease prevention
- Conducts pre and post-consultation conferences
for clinic clients; acts as a resource speaker on
health and health related services
11. Researcher
- Plans and conduct of nursing & related studies
that contribute to the improvement of nursing &
health services.
- Participates in the conduct of survey studies and
researches on nursing and health-related subjects
- Coordinates with government and non-government
organization in the implementation of
studies/research
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COMMUNITY HEALTH NURSING
12. Role Model Role Model
- Provides good example of healthful living to the
members of the community.
RESPONSIBILITY
- the obligation to perform duties, tasks or roles using
sound professional judgement and being
answerable for the decisions made in doing this.
- A nurse who is considering expanding their scope of
practice should realize that this will involve
greater responsibility.
Responsibilities of a Community Health Nurse
 Providing care to the sick
 Maintaining healthy environment
 Teaching
 Identify the needs and referring the
clients/patients for service
 Preventing and reporting neglect and abuse
 Advocating
 Collaborating
 Participating in professional development
activities
 Engaging and ensuring quality nursing research.
FUNCTION
- a set of activities and tasks expected of a
person by virtue of his position or role in the
society.
Activity is a combination of specific tasks whose
fulfillment leads directly to the performance of a
function.
Task is a piece of work assigned or done as part of
one's duties.
“Activities” and “Tasks” -are units of a function
Function: Assess the physical & mental health status
of clients and their family in a depressed area.
Activities Tasks
a. Data gathering a. Inspect home environment
b. History taking b. Conduct interview/home visit
c. Assessment of c. Obtain weight, meal plan etc.
nutritional
status of children
COMPETENCIES OF A COMMUNITY HEALTH
NURSE
Competency
- the ability to do something successfully or
efficiently.
Competence
– quality of being functionally adequate in
performing the tasks and assuming the role of a
specific position.
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COMMUNITY HEALTH NURSING

Competencies Required of A Community Health

Nurse
1. Technical Skills
2. Human Relations Skills
3. Communication Skills
4. Teaching Skills
5. Management Skills

Competency Standards in Community Health

Nursing

• Safe and quality nursing care

• Management of resources and environment
• Health education
• Legal responsibility
• Ethico-moral responsibility
• Personal and professional development
• Quality improvement
• Research
• Records management
• Communication
• Collaboration and Teamwork

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CHAPTER 2: THE HEALTH CARE
DELIVERY SYSTEM
LEARNING TASK 1: PUBLIC HEALTH IN
THE PHILIPPINES
Definition: (Dr. Charles-Edward Winslow, 1920)
Public Health - The science and art of preventing
disease prolonging life and promoting health and
efficiency through:
 organized community effort for the sanitation
 control of communicable diseases
 education of individuals in personal hygiene
 organization of medical and nursing services for
the early diagnosis and preventive treatment of
disease
 development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these
benefits as to enable every citizen to realize his
birthright to health and longevity.
1. Assessment
 Monitor health status to identify community health
problems
 Diagnose and investigate health problems and
health hazards in the community
 Evaluate effectiveness, accessibility, and quality
of personal and population-based health services
2. Policy Development
 Develop policies and plans that support individual
and community health efforts
 Enforce laws and regulations that protect health
and ensure safety.
 Research for new insights and innovative
solutions to health problems
3. Assurance
 Link people to needed personal health services
and assure the provision of health care when
otherwise unavailable
 Assure a competent public health and personal
health care workforce
 Inform, educate, and empower people about
health issues
 Mobilize community partnerships to identify and
solve health problems
INTERVENTIO DEFINITION
N provision of quality health care and the regulation
Describes and monitors health events thr
Surveillance
ough systemic collection
Locates individuals and families with iden Vision
Case Finding tified risk factors and connects them with filipinos are among the healthiest people in southeast
resources
Communicates facts, ideas, and skills th Mission
Health
at change knowledge, attitudes, values, to lead the country in the development of a productive,
Teaching
beliefs and practices of I, F, P and C
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COMMUNITY HEALTH NURSING
Identifies individuals with unrecognized h
Screening ealth risk factors and connects them with
resources
Referral and
Assist individuals, families, groups, and
communities to identify necessary resour
Follow-up
ces to prevent/resolve concerns.
Established an interpersonal relationship
Counseling with a family, community or system to e
nhance capacity for self-care and coping
Commits 2 or more persons or an organi
Collaboration
zation to achieve a common goal
Helps community groups to identify com
Community O
mon problems or goals mobilize resourc
rganizing
es and implement strategies
Pleads someone’s cause or acts on som
Advocacy
eone’s behalf to develop a community
LEARNING TASK 2: HEALTH CARE
DELIVERY SYSTEM (HCDS)
- totality of all policies, facilities, equipment,
products, human resources and services which
addresses the health need, problems and
concerns of the people.
- multi-level and multidisciplinary
Major Players
1. Public sector
a. National level (Department of Health)
b. Regional and Provincial Level (Local health
system by the LGU)
c. Municipal or City Level (Local Health system by
the LGU)
2. Private sector
- composed of both commercial and business
organization with its profit or market orientation
and non-business organizations with its service
orientation (NGOs)
Department of Health (DOH) (Kagawaran ng
Kalusugan)
- is the leader, staunch advocate and model in
promoting Health for All (HFA) in the Philippines.
- responsible for ensuring access to basic public
health services by all Filipinos through the
of all health services and products
E.O. #102 (1999) – National Health Authority
asia by 2022, and asia by 2040
resilient, equitable and people-centered health system
 NCM104
COMMUNITY HEALTH NURSING

DR. FRANCISCO DUQUE III – DOH Secretary

1st Term - June 2005 - January 2010
2nd Term – October 2017 - present

PUBLIC SECTOR c. MUNICIPAL AND CITY LEVEL

- Local Government Code of 1991 or RA 7160
a. National level (Department of Health) - mandates devolution of powers, functions and
Functions / Responsibilities: responsibilities to LGUs in terms of provision and
1. Leadership: delivery of basic health services
 Policy making Devolution – refers to the act by which the national
 Monitoring and evaluating implementation of health government confers power and authority upon the
programs various LGU’s to perform specific functions and
 Advocating for health promotion activities responsibilities
 Serving as technical authority in disease control
 Provides administrative and technical leadership in Functions / Responsibilities:
health care financing (National Health Insurance Law) - implementation level of the CHN program by the nursing
team in the health center.
2. Administrator of Specific Services:
 Serve as administrator of selected health facilities at
subnational levels (referral centers)
 Provide specific program components for conditions
that affect large segments of the population
 Develop strategies for responding to emerging health
needs
 Provide leadership in health emergency preparedness
and response services

3. Capacity Builder and Enabler

 Provide logistical support to LGUs, the private sector
and other agencies implementing health programs and
service
 Serve as the lead agency in health and medical
research
 Protect standards of excellence in the training and
education of health care providers at all levels

b. Regional / Provincial Level

Functions / Responsibilities:
 Formulation of more detailed or specific policies/
I. LEVEL OF HEALTH CARE FACILITIES:
plans to suit local conditions DOH Administrative Order 2012-0012A - “ Rules and
 Translate plans into action
Regulations Governing the New Classifications of Hospital
 Conduct of orientation program for new staff
and Other Health Facilities in the Philippines”
 In service training for nursing personnel on the job
 Planning & implementation of supervision program
for CHN personnel Hospit Level 1 Level 2 Level 3
 Assessment / evaluation of performance of CHN als
personnel in the health centers
 Implementation of standards for CHN practice Clinica Consultin Level 1 Level 2 + Teachi
 Quality control checks l Servic g + ng/
 Preparation of reports es for i specialist Departm Training with ac
n- in: entlized credited residenc
patient Medicine, Clinical y
s Pediatrics Services training progra
, m in 4 major clin
OB- ical
Gyne services
Surgery

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 NCM104
COMMUNITY HEALTH NURSING

Emergenc Respirat Physical Medicin 1 RH Nurse : 20,000 Population

y ory Unit e 1 RHM : 5,000 population
and OPD and rehabilitatio 1 BHW : 20 households
Services n
Unit Category B: Custodial Care Facility
- a health facility that provides long-term care,
Isolation General including basic services like food and
Facilities ICU shelter or in need of rehabilitation
- ex. Custodial psychiatric facilities, drug rehab
Surgical/ High Ris Ambulatory surg centers, leprosaria, nursing homes
Maternity k Pregna ical
Facilities ncy clinic Category C: Diagnostic/Therapeutic Facility
Unit - a facility for the examination of the human body,
specimens from human body
Dental Cl NICU Dialysis Clinic for diagnosis
inic - Drinking water analysis and treatment
- Further classified into:
Ancilli Seconda Tertiary Tertiary clinical Laboratory facility (Clinical lab, HIV testing,
ary ser ry clinical laboratory with Newborn Screening, Blood Services, Drug
vices Clinical laborato Histopathology Testing, water analysis) Radiologic facility (Xray,
laborato ry MRI, UTZ)
ry Nuclear medicine facility (application of radioactive
materials for diagnosis, treatment and medical
Blood Blood Bank research)
Station
Category D. Specialize Outpatient Facility
- a facility that performs highly specialized
1st Level 2nd Lev 3rd Level X-ray
procedures on an out patient basis
X-ray el X-
- Dialysis clinics
ray with
- Ambulatory surgical clinics
- Cancer/Chemotherapeutic centers
mobile
- Rehabilitation centers
Unit
Pharmac II. LEVELS OF PRIMARY HEALTH
y CAREWORKERS
1.Village or Grassroot Health Workers
 first contacts of the community and initial links of
health care.
 Provide simple curative and preventive health
HOSPITALS OTHER HEALTH FACILITIES
care measures promoting health
E.g. community/ barangay health worker,
General Cat. A :Primary Care Facility
volunteers and traditional birth attendants
Level 1 Cat B : Custodial Care Facility
2. Intermediate Level Health Workers
 represents the first source of professional health
Cat. C : Diagnostic/Therapeutic
Level 2 care.
Facility
 attends to health problems beyond the
Level 3 (Teachi competence of village workers
ng/Learn  Provide support to front-line workers in terms of
ing) supervision, training, supplies & services.
E.g. General medical practitioners, nurses &
Cat. D : Specialized Outpatient F midwives
Specialty
acility
3. First Line Hospital Personnel
 provide back up health services for cases that
Category A: Primary care facility require hospitalization
- Are the rural health units/birthing (lying-in) clinics  establish close contact with intermediate level
- first contact health care facility health workers or village health workers.
- with in-patient beds (short stay facility) E.g. Physicians with specialty, nurses with
- Health services offered at this level are to specialization, dentist, pharmacist & other health
individuals in fair health and to patient with professionals.
disease in the early symptomatic stages.
- manned by BHW (Barangay Health
Worker) under the supervision of a RHM (Rural LEARNING TASK 3: LEVELS OF
Health Midwife) CLIENTELE IN THE COMMUNITY
Ratio according to R.A. 7305 or the Magna Carta 1. Individual
for Public Health Workers (MCPHW) - (DOH 2009) - nurses provide care to specific clients/patients
stipulates: - considered as “Entry Point” in working with
1 RHU : 20,000 Population families/ community
1 RH Physician : 20,000 Population healthy/well - dying

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birth - senescence
FOCUS of Care = the person
2 Approaches or Ways of Looking at the Individual
a. Atomistic Approach b. Holistic Approach
Objectives of nursing care :
a .Promotion & maintenance of health
b. Prevention of disease, early diagnosis and
treatment of a suspected ailment
c. Recovery and/or rehabilitation from illness
d. Self reliance in personal care, or peaceful,
dignified death.
2. Family
- basic unit of society
- refers to 2 or more individuals joined or related by
ties of blood, marriage or adoption and who
constitute a single household
- interact with each other in their respective familial
roles & who create and maintain a common
culture.
3. Population Group /Aggregates
- certain population groups with common unique
health needs, are at risk of developing or have
developed certain defined health problems.
4. Community
- community as a whole is the client to whom the
nurse delivers nursing services addressed to the
community- wide health problems.
LEARNING TASK 4: WORLD HEALTH
ORGANIZATION (WHO)
 193 member countries
 WHO is directed towards providing technical
collaborations with member states in
accordance with each country's needs and
capacities.
 The Philippines is a member of the Western
Pacific Region which holds office in Manila
( WHO, 2007 as cited by Famorca)
Objective: The attainment by all people of the highest
possible level of health
Core Functions of WHO
1. Leadership - Provide leadership on matters critical
to health and engage in partnerships where joint
action is needed.
2. Research - Shape the research agenda and
facilitate translation and disseminate valuable
knowledge
3. Quality Assurance - Set norms and standards for
health and health related issues. Promote and
monitor their implementation.
4. Ethics - Articulate ethical and evidence-based
policy option
5. Technical Support - Provide technical support and
training to its member countries. Monitor health
situations and assess health trends. Develop
guidelines and tools on measurement, monitoring
and evaluation
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NCM104
COMMUNITY HEALTH NURSING
LEARNING TASK 5: PRIMARY HEALTH
CARE
International Conference for Primary Health
Care (WHO and UN Children’s Fund)
 Sept. 6 – 12, 1978 in Alma Ata, USSR
“Alma Ata Declaration on PHC”
 Declarations:
 Health is a basic fundamental right.
 There exists global burden of health
inequalities among population.
 Economic and social development is a basic
importance for the full attainment of HFA.
 Government have a responsibility for the health
of their people.
In the Philippines PHC was established
through Letter of Instruction (LOI) 949 signed on Oct.
19, 1979 by then President Marcos one year after the
First International Conference.
Theme:
“Health in the Hands of the People by 2020”
Definition of Primary Health Care (Alma Ata
Declaration)
PHC is essential health care based on practical,
scientifically sound and socially acceptable methods
and technology made universally accessible to
individuals and families in the community through full
participation and at a cost that the community and
country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-
determination.
Goal of Primary Health Care
"Health for All (HFA) by the year 2000"
Objectives of Primary Health Care
 Promotion of healthy lifestyles
 Prevention of diseases
 Therapy for existing conditions
5 Key Elements in Achieving HFA
1. Universal Coverage - reducing exclusion and
social disparities
2. Health Service Reforms - organizing health
services around people’s need
3. Public Policy Reforms – integrating health
into all sectors
4. Leadership Reforms – pursuing collaborative
models of policy dialogue
5. Increasing stakeholders participation
8 Essential Health Services (ELEMENTS)
1. Education for health
2. Locally endemic disease control
 NCM104
COMMUNITY HEALTH NURSING

3. Expanded program foe immunization responsibilities to assess, plan, manage, and control
4. Maternal and child health including response actions that are proven to be necessary.
parenthood
5. Essential drugs - Clients are not recipient of care but active
participants
6. Nutrition
7. Treatment of communicable and noncommunicable
diseases
8. Safe water and sanitation 5. Equitable distribution of health resources

- PHC advocates for care that is community-based

LEARNING TASK 6: KEY PRINCIPLES OF
PHC
1. 4 A’s of health services
Affordability – refers to the individual or family’s
capacity to pay for basic health services.
- also involves the capacity of the
government or the community can afford the
basic health services
and preventive in orientation
- There should be an inventory of health resources,
facilities and manpower
6. Appropriate Technology
- Refers to the technology that is suitable to the
community that will use it and includes tools drugs,
methods, procedures and techniques
Criteria:

- (WHO) also considers the out-of-the-pocket 1. Safety

expenses for health care. 2. Effectiveness
3. Affordability
Accessibility – refers to the physical distance of a 4. Simplicity
health facility or the travel time required for 5. Acceptability
people to get the needed or desired health 6. Feasibility and Reliability
services. 7. Ecological effects
8. Potential to contribute to individual and
- (WHO) health care facilities should be within 30 community development
minutes from the community

Acceptability – means the health care offered is in

consonance with the prevailing culture
and traditions of the population.
LEARNING TASK 7: STRATEGIES OF PHC

Availability – is a question of whether the basic 1. Utilization of the 4As of Health Services
health services required by the people are offered
in the health care facilities or is provided on a  Health services must be delivered where the
regular and organized manner. people are
 Indigenous/ resident volunteer workers must
be tapped as health care providers
 Use of traditional medicine must be used
2. Support mechanism together with essential drugs
Health programs and projects have better outputs
when there is collaboration 2. Partnership between the community & health
agencies
A multi-sectoral approach is needed for an efficient
utilization of resources.  Establishment of an effective health referral
3. Multi-sectoral approach system
 Information, education and communication
- Health and diseases are outcomes of inter-related support using multi media
factors, PHC requires 3C’s within and among various  Collaboration between gov’t and NGO
sectors
3. Community Participation
- 3 C's:
 Small group meetings
 Communication  Community building & community organizing
 Cooperation  Formation of health committees
 Collaboration
4. Self-Reliance
- Requires intra-sectoral and inter-sectoral linkages
 community gives support ( cash, kind or labor)
to the health program)
4. Community participation  use of local resources ( human, financial or
material)
- An educational and empowering process in which  training of the community in leadership and
people identify the problems, their needs and assume management skill

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5. Recognition of inter-relationship between II. Secondary Prevention

health & development
- Refers to early detection and prompt intervention
during the period of early disease pathogenesis to
 integration of the PHC into national regional,
prevent complications
provincial, municipal &
barangay development plans - Before signs and symptoms appear
 coordination of activities with economic
planning, education, agriculture, industry, Focus of Activities:
housing, public works, communication &
social services 1. Early diagnosis

2. Prompt treatment
6. Social Mobilization

 Establishment of an effective health referral

system III. Tertiary Prevention
 Information, education and communication -Targets populations that have experienced disease or
support using multi media injury and focuses on limitation of disability and
 Collaboration between gov’t and NGO rehabilitation

7. Decentralization Aims:

1. Reduce the effects of disease and injury

 Re-allocation of budgetary resources
 Re-orientation of health professionals on PHC 2. Restore individuals to their optimal level of
 Advocacy for political will & support, from the functioning
national leadership down to the barangay level.

LEARNING TASK 9: UNIVERSAL HEALTH

LEARNING TASK 8: LEVELS OF CARE
PREVENTION IN PUBLIC HEALTH
 Inequality - Unequal access to opportunities
 Equality - evenly distributed tools and
Objectives and Focus of assistance
Levels of Prevention
Activities  Equity - customs tools that identify and address
inequality
I. Primary Health Promotion  Justice - Fixing the system to offer equal
Prevention Specific Prevention access to both tools and opportunities.

Early Diagnosis (Early Universal Health Care (Kalusugan Pangkalahatan)

II. Secondary detection) or Aquino Health Agenda
Prevention Prompt Treatment
(Prompt Intervention) • A health reform program under Pres. Aquino
(2010-2016) through A.O. 2010-0036 (DOH, 2010)
III. Tertiary • the “provision to every Filipino of the highest
Rehabilitation
Prevention possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded,
fairly financed, and appropriately used by an
informed and empowered
I. Primary Prevention public”
• It is an approach to health reform implementation
- Relates to activities directed at preventing a problem deliberately focused on economically disadvantage
before it occurs by altering susceptibility or reducing Filipinos to ensure that they are given risk protection
exposure for susceptible individuals. (PhilHealth) and access to affordable and quality
Focus of Activities: health services.

1. General health promotion Goals of Universal Health Care

2. Specific protection
- The process of enabling people to increase control
over, and to improve their health (Ottawa Charter of
Health Promotion, 1986)
- Refers to behaviors in which one engages with
the specific intent to prevent disease, to detect
disease in the early stages or to maximize health
within the constraints of disease (Parse, 1990).
 Better health outcome
 Sustained health financing
 Responsive health system by ensuring that all
Filipinos especially the disadvantage group have
equitable access to affordable health care (DOH,
2010)
3 Strategic Thrusts of Universal Health Care
 Financial risk protection through expansion in
NHIP enrollment
 Improved access to quality hospitals and health
care facilities
 Attainment of the health-related MDGs

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Strategic Instruments to Achieve the Strategic  Primary care provider

Thrusts  Epidemiologic Surveillance System
 Health promotion programs
 Health financing
 Service delivery • PhilHealth (IBHS)
 Policy, standards and regulations
 Governance for health
 Human resource for health Local Health System
 Health information
• Integration of health system into province-wide and
Universal Health Care Act city-wide health system
• Republic Act No. 11223 • Pooling and management if all resources intended
• July 23, 2018 – February 20, 2019 for health “Special Health Fund”
• “An act instituting universal health care for all
Filipinos, prescribing reforms in the health care Regulation
system and appropriating funds thereof.
• Establishment of performance-based incentive
scheme for health facilities
Objectives of the Law • Licensing and regulatory system for stand alone
• Progressively realize universal health care in the health facilities
country through systematic approach and clear • Formulation of standards for clinical care (DOH,
delineation of roles of the key agencies and Professional Organization and academe)
stakeholders towards better performance in the health
system. Governance and Accountability

• Ensure that all Filipinos are guaranteed equitable • Submission of health and health-related data to
access to quality and affordable health care goods PhilHealth as requirements for all public and private
and services and protected against financial risk health related entities
• Health Impact Assessment as requisite for policies,
Key Features of the Law programs and projects
• Financing • Health Information System as requisite for all health
• Service Delivery service providers and insurers
• Local Health System
• Regulation
• Governance and Accountability

FINANCING

Membership
• Automatic inclusion if every Filipino into the National
Health Insurance Program (PhilHealth)
• Simplification of PhilHealth Membership
(Direct/Indirect contributors)

Financing Source
• Pooling of funds (Sin Tax, PAGCOR, PCSO, Gov’t
and DOH)
• Population-based health services
• Individual-based health services

LEARNING TASK SERVICE DELIVERY

Delivery of Health Services

• DOH (PBHS)
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CHAPTER 3: FAMILY HEALTH NURSING
LEARNING TASK 1: INTRODUCTION TO
FAMILY HEALTH NURSING
FAMILY HEALTH NURSING
- the practice of Nursing directed towards maximizing
the health and well-being of all individuals within a
family system (Maurer and Smith, 2009).
- It is focused on the individual family member but
within the context of the family or the family unit.
- The CH nurse establishes a relationship with each
family member within the unit and understands the
influence of the unit on the individual and society.
STRATEGIES AND PHILOSOPHIES (BASED ON
PRIMARY HEALTH CARE)
a. Holistic understanding of health ( wellness – illness)
b. Recognition of multiple determinants of health
c. Family control over health service
d. Health promotion and disease prevention
e. Equity and participation in health care
f. Research-based health care methods
g. 4A’s of health care
FUNCTIONS OF A FAMILY
A. To meet the needs of the society
1. Procreation - reproductive function and child
rearing
2. Socialization of family members - the process of
learning how to become productive members of
society
- Family is considered as the 1st teacher in
instructing the children in societal rules
3. Status placement - society permits the hierarchy
of the families into social classes.
- the family confers its societal rank on the children
4. Economic function
a. Rural – unit of production
- family members are expected to participate in
farming, fishing or cottage industry
b. Urban – unit of consumption
- economically independent members work
separately to earn wages
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B. To meet the needs of individual members
1. Physical maintenance -
- the family provides for the survival needs (food,
shelter and clothing) of its dependent members
2. Welfare and Protection
- the family is the source of motivation and morale of
its members
- family supports spouses by providing
for companionship and socioeconomic needs
Family as a Client…
 The family is a critical resource.
- provides care to members, participate in
health promotion
 In any family unit, any dysfunction that affects one
or more family members will affect the
members and the unit as a whole (“Ripple
Effect”)
 For the purpose of case finding, a health problem
or risk may be identified
 Source of improving nursing care:
- family provides feedback about health care/services
provided
Family as a System…
Based on the General System Theory
- " The family as a unit interacts with larger units
outside the family and with smaller units inside the
family.”
- Each member of is independent of other members
but in so many ways dependent on each other.
-
3 Subsystems of the Family (Parke, 2002)
1. parent-child subsystem
2. marital subsystem
3. sibling-sibling subsystem
LEARNING TASK 2: DEVELOPMENTAL
STAGES AND HEALTH TASK OF THE
FAMILY
1. Beginning family through marriage
 Formation of identity as a couple
 Inclusion of spouse in re-alignment of
relationships with extended families
 Parenthood: making decisions
 NCM104
COMMUNITY HEALTH NURSING

2. Parenting the 1st child  Initial shift towards concern for the older
generation
 Integration of children into family unit
 Adjustment of tasks; Child rearing, financial and
household management
 Accommodation of new parenting 4. Launching Family
and grandparenting roles
 Parenting a person in all stages of  Establishment of independent identities
development from pre-school to old age for parents and grown children
 Building up moral gaps between young adult
1. Pre-school Age and parents due to diverse orientation
 Re-arranging the home physically and
reallocating the resources according to the
 Child emerges as a social being
priorities of remaining family members
 Parents learn to separate themselves
 Re-negotiation of marital relationship
from growing child - allows self-
expression and initiative  Re-adjustment of relationships to include in
laws and grandchildren
 Parents promote more independence
 Dealing with disabilities and death of older
and autonomy to prepare the child for
generation
schooling
 Adapts to the critical needs, activities
and interests of pre-schooler 5. Middle-aged Family and Aging family
 Coping with energy depletion and lack of
privacy  Support and autonomy of older generation:
 Tapping resources outside the family to keeping in touch with aging parents, siblings
prevent pre-occupation with self/family and their families
 Support role of middle generation; maintaining
contact with children and their families
2. School Age
 Maintaining pleasant and comfortable home
 Psychosocial changes: use of leisure time
 Physical and emotional immaturity but
 Adjusting to retirement
considered as a calm period.
 Deciding on how to live the remaining years of
 Psychological/social changes as child
life
slowly moves away from family
 Preparation of own death and dealing with the
 Parents remain as vital part of the child's
loss of spouse and/or siblings and other peers.
school life
 Maintaining couple and individual functioning
 Child is more on intellectual pursuits
while adapting to the aging process
 Sibling rivalry is less acute, in cases of
 Biological and lifestyle changes (physical
additional siblings
changes related to aging: wrinkles, liver spots,
 Encouraging children's educational loss of hair, loss of hearing, changes in pace
attainment and agility
 Seeking into school and community in
constructive ways
 Working together to attain common
goals Health Tasks of the Family (Maglaya, 2009)

3. Living with adolescent 1. Recognizing interruptions of health or

development
 Development of increasing autonomy for - a requisite step for a family to deal purposely with
adolescents; an unacceptable health conditions
 Period of revolt from parental/adult authority or
conformity and acceptance of peer- group
standards
 Balancing freedom and responsibility as 2. Making decisions about seeking health
teenagers mature and emancipate themselves
- the family seeks the health of the health workers
when health needs are beyond its capability
Dilemmas face by a family in this stage:

 Family control or freedom for

adolescent 3. Managing health and non-health crises
 Responsibility shared with the - Crisis is a fact of life which the family has to deal
adolescent or given to him/her with.
 Emphasis on social activities
 Family mobility or stability - the family’s ability to cope with crises and
 Dedicated life/or uncommitted life develop from the experience – an indicator of a
healthy family
 Midlife re-examination of marital and career
issues
 Post parental interest and career as growing
parents
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4. Providing nursing care to sick, disabled Sum of Total Individuals

and depending members of the family
 Family is the sum total of individuals.
- caring for the very young and very old members
 Nursing care and health education is provided to
which may require home management due to chronic
the members of the family
conditions and disabilities
 Family characteristics that affect health

Biosocial Being
5. Maintaining a home environment conducive to
good health and personal development
 Family shares health risks factors (biological,
- a home should have an atmosphere of security social and cultural)
and comfort to allow for psychosocial development  Family affects the course of the illness and vice
versa

Family Health Care Paradigm

6. Utilize community resources for health care

- the family utilizes the resources in the community

and takes interest in what is happening in the
community

- gets involved in community events

LEARNING TASK 3: THE FAMILY

Definition

 A group of persons living together and

composed of the head and other persons related
to the head by blood, marriage or adoption (NSCB,
2008)National Statistical Coordination Board

 A family is an open and developing system of

interacting personalities with a structure and
process enacted in relationship among individual
members, regulated by resources and stressors,
and existing within a larger community (Smith and
Maurer, 1995).
 A family is two or more persons who are
joined together by bonds of sharing and
emotional closeness and who identify
themselves as being part of the family
( Friedman et al., 2003)
Concepts of the Family
Individual
LEARNING TASK 4: CHARACTERISTICS
OF A HEALTHY FAMILY
1. Members interact with each other.
2. Healthy families can establish priorities.
3. Health families affirm, support and respect
each other.
4. Healthy families affirm, support and respect
each other.
5. The members engage in flexible role
relationship, share power, respond to change,
support the growth and autonomy of others
and engage in decision making that affects
them.
6. The family teaches family and societal values,
beliefs and spiritual core.
7. Health families foster responsibility and value
service to others.
8. Health families have a sense of play and
humor; share leisure time.
9. Healthy families have the ability to cope with
stress and crisis.

 In case of sickness, the family is the source of

support and affection.
 Family members are informed of the details of
care (home care)
 Family participation and support promotes
recovery and reduce complications

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CHAPTER 4: FAMILY NURSING 2 TYPES OF DATA

PROCESS
1. Primary Data - data which have not been
collected before
LEARNING TASK 1: FAMILY NURSING
ASSESMENT Methods of collection:
 Observation
 Interview
FAMILY NURSING PROCESS  Critical Components of Interview
- Manners
 A logical, systematic or scientific problem- - Therapeutic questions
solving activity utilized by nurses to deliver - Therapeutic conversations
total quality health-care services to the - Genogram and ecomap
patients. - Commending family or
individual strengths
 used as a framework or a tool; dynamic and  Focus group discussion
cyclical in nature  Physical examination
 Surveys
 It is a process since it involves a series of
steps to be followed in nurse-patient 2. Secondary Data - data which have been
interactions towards delivering quality patient collected and kept as records; records in
care. registries, health facilities, health centers or
other agencies who have worked with the
 Community health nurses use the nursing family
process as an important tool in community
health care.
TOOLS IN FAMILY HEALTH ASSESSMENT
Relating….. (FHA)

 is the process of establishing a trusting and 1. Genogram

productive relationship with the family.
 establish rapport with the family members with
the use of good communication (concern and
interest)
 develop trust and confidence
 maintain a two-way communication
 respect beliefs, values and assumptions
without compromising the total quality of care
2. Family Health Tree
 family are sources of data in community
health nursing
FAMILY HEALTH ASSESSMENT
 The first step in the nursing process where the
nurse observes the client or the family
objectively as well as subjectively
 may utilize a Family Health Assessment
Form - which serves as a guide in data
collection of information about the family,
environment or community as a whole.
3. Ecomap
Steps In Family Health Assessment
 Collection of data
 Analysis and interpretation of data
 Validation and statement of the
problem
-a tool that helps the nurse outline the family
structure.
- affirms the belief that childhood and family
background affect the planning for care of the
parent and child
- intended to identify the intergenerational trends
and patterns within the family and to find out about
the family's history, genetically, emotionally and
psychologically.
- a tool which helps the nurse by providing a
mechanism for recording the family medical
and health histories.
 Causes of death, genetically linked diseases
(lifestyle diseases)
 Environmental and occupational diseases
 Infectious diseases
 Familial risk factors for health problems
 Risk factors associated with family's methods
of illness prevention
- it portrays an overview of the family in their
situation.
- it shows the contacts that occur between the
family and the suprasystems (everything
outside the system)

- interaction of the family to other people or

sectors in the community such as types of
resources and relationships they have with
other people.

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Types of Family Data
 Family structure and characteristics (use of
tools in FHA)
 Socioeconomic data
 Family environment
 Family health and health behavior
Initial Assessment - Utilize the Initial data base for
Family Nursing Practice by categorizing the problems
or needs identified.
 Presence of a wellness condition (Potential or
Readiness)
 Health threat
 Health deficit
 Foreseeable crisis
Second Level Assessment - Typology of Nursing
Problems in Family Nursing Practice (A. Maglaya)
Scale for Ranking Health Problems according to
Priority
 Nature of the problem
 Modifiability of the Problem
 Preventive potential of the Problem
 Salience
LEARNING TASK 2: FAMILY NURSING
DIAGNOSIS
 A clinical judgement about the family's
response to actual or potential health
problems or life processes.
 Utilize the Typology of Nursing Problems in
Family Health Care
5 MAIN FAMILY NURSING PROBLEMS
 Inability to recognize the presence of the
condition/problem due to ...
 Inability to make decisions with respect to
taking appropriate health actions due to...
 Inability to provide nursing care to the sick,
disabled, dependent or at-risk member of the
family due to...
 Inability to provide a home environment which
is conducive to health maintenance and
personal development due to...
 Failure to utilize community resources for
health care due to...
A nursing diagnosis has parts:
 The statement of the unhealthful response
 The statement of factors which are
maintaining the undesirable response and
preventing the desired change
FAMILY COPING INDEX
 an alternative tool for formulating a nursing
diagnosis.
 a tool based on the premise that a nursing
action may help a family in providing for a
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COMMUNITY HEALTH NURSING
health need or resolving a health problem by
promoting the family's coping capacity.
 To provide a basis for estimating the nursing
needs of a particular family
In using the Family Coping Index, a family health
care need is present when:
 The family has a health problem with which
they are unable to cope.
 There is a reasonable likelihood that nursing
will make a difference in the in the family’s
ability to cope.
9 AREAS OF ASSESSMENT OF THE FAMILY
COPING INDEX
 Physical Independence (performance of ADLs,
mobility)
 Therapeutic competence (ability to comply
with prescribed or recommended procedures
and treatmens)
 Knowledge of health condition (understanding
the health conditions)
 Application of principles of personal and
general hygiene
 Health care attitudes (family's perception to
health care)
 Emotional competence (emotional maturity)
 Family living patterns (interpersonal
relationship with family members)
 Physical environment (home, school, work
and community)
 Use of community facilities (family's ability to
seek and utilize health services)
LEARNING TASK 3: FORMULATION OF THE CARE
PLAN (P L A N N I N G)
 The process of setting the health-care goals
and generating the plans for action to collect
specific data or make decisions on the family
care.
 Setting of health goals and making health
care plans
 It involves priority setting, establishing goals
and objectives and determining appropriate
interventions to achieve goals and objectives
 The family should benefit from the plan and
the family has the right to self-determination
and decision have to be respected
Factors to be considered in Priority Setting
 Family Safety - life threatening situations are
given top priority; cases of communicable
diseases
 Family perceptions - the need that the family
recognizes as most urgent or important
 Practicality - gives consideration to the
existing resources and constraints of the
family
 Projected effects - should give family a sense
of accomplishment and confidence

Establishing Goals and Objectives - must be set
jointly with the family
Goals - a desired observable family response to
planned interventions in response to a mutually
identified problem
Objectives - define the desired step-by step
family responses as they work towards the goal;
used to measure family achievement for
monitoring and evaluation
 Specific - family will manifest a particular
behavior
 Measurable - quantifiable indications of the
family achievement
 Attainable - in conformity with the family's
resources
 Relevant - realistic, appropriate to the family
need or problem
 Time-bounded - has specified target time or
date
LLEARNING TASK 3: DETERMINING
APPROPRIATE INTERVENTIONS
3 Types of Nursing Interventions
1. Supplemental interventions
- actions that the nurse performs on behalf of
the family when it is unable to do things for
itself
- in cases of providing direct nursing care
2. Facilitative interventions
- refer to actions that remove barriers to
appropriate health actions
- assisting the family to avail of health services
in health institution or through proper referral
3. Developmental interventions
- aim to improve the capacity of the family to
provide for its own health needs
- directed toward family empowerment
Implementation
- It is the process of carrying the health care
plan as formulated through caring, curing and
coordinating.
- Implementation is the step when the family
and/or the nurse execute the plan of action.
- The pattern of implementation is determined
by the mutually agreed upon goals and
objectives and selected course of action.
3 Skills Necessary for Community Health Nurses
1. Human skills - the ability to work with and for the
people which include communicating and
understanding others
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2. Technical skills - the ability to use the tools,
equipment, procedures and techniques of a
specialized field
3. Conceptual skills - the ability to understand all the
organization's activities, parts and how it relates to
others
NURSING ACTIVITIES
A. Utilize health action or measure according to
the level of prevention and promotion of health
 Dependent
 Independent
 Interdependent
 Supplemental
B. Apply the following approaches in line with
the nursing care plan.
 care, cure, coordination
C. Involve the family members in nursing care
D. Execute, administer and provide health care
based on allowable nursing standards and
procedures
 anticipatory guidance and service
 health education and maintenance
 medical regimen or treatment
 supervision of midwives and BHWs
 recording and documentation
 referral or coordination with other
health and non-health services = total
care
E. Teach non-sick member to perform home care
in accordance with nursing care plan
Things to remember:
Nurse should take into considerations the different
barriers during the implementation phase.
1. Family – related
- apathy and indecision on the part of the
family
2. Nurse - related
- imposing ideas
- negative labelling
- overlooking family strengths
- neglecting culture and gender implications
EVALUATION
 It is the process of determining the outcome
or result of the action taken, whether it is
successful or not in meeting the objectives of
care.
 It is considered as the final step in the nursing
process that helps the nurse decide whether
to continue with the plan of care for the
patient/client/family or not.
 It refers to the critical assessment of whether
the patient's/client's goal has been achieved
within the time frame and what changes are to
be made in the client's plan of care (de Belen,
2008).
 NCM104
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2 TYPES OF EVALUATION (Maurer and Smith,

2009)
1. Formative Evaluation
- a judgement made about the effectiveness of nursing
interventions as they are implemented.
- considered as ongoing ang continuing
- results of this evaluation guides the nurse and the
family in updating plans as necessary
2. Summative Evaluation
- determines the ends results of the family nursing
care and usually involves measuring outcomes or
degree to which goals have been achieved.
NURSING ACTIVITIES IN THE EVALUATION
PHASE
A. Evaluate outcome based on the objectives and
criteria set and the use of the following tools:
 Records of the family/community
 Research or nursing audit
 Family service and progress report (FHSIS)
 Client satisfaction interview
B. Determine if the interventions/plan of
care/objectives/desired outcomes are:
 Met - adoption
 Partially met - modification or improvement
 Not met - termination or formulation of a new
plan
C. Evaluate nursing interventions/activities based on
the standards and protocols in all of the steps in the
nursing process.

D. Evaluate the care provided by the nurse and non-

ASPECTS OF EVALUATION sick family members against the standard of care
1. Effectiveness E. Continue the nursing process like a cycle until the
optimum level of health functioning is achieved.
- determination whether the goals and objectives were
attained

- answers the questions: "Did we produce the

expected results? " "Did we attain our objectives?"

2. Appropriateness

- refers to the suitability of the goals/objectives and

interventions to the identified family health needs

- An accurate assessment of the family health needs

is the basis for appropriate goals/objectives and
interventions

- answers the question: "Are our goals/objectives and

interventions correct in relation to the family health
need we intend to address?"

3. Adequacy

- refers to the degree of sufficiency of goals/objectives

and interventions in attaining the desired change in
the family

- answers the question: "Were the interventions

enough to bring about the desired change in the
family?"

4. Efficiency

- refers to the relationship of resources used to attain

the desired outcomes.

- answers the question: "Are the outcomes of family

nursing care worth the nurse's time, effort and other
resources?"

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CHAPTER 5: FILIPINO CULTURE,
VALUES AND PRACTICES IN RELATION
TO HEALTH CARE OF INDIVIDUAL
AND FAMILY
LEARNING TASK 1: FILIPINO FAMILY
DYNAMICS
Filipino Families
 A family is considered as a social
mechanism having its own background, structure,
form, nature and classification.
 Family bonds are important to Filipinos. The
elderly are honored and respected and children
are taught to say 'po' and ‘opo,' showing respect
to their grandparents, from an early age.
 Traditional values and beliefs (from both sides)
influence the family values, beliefs and practices
pertaining to child rearing, medical care, disability,
dying and death.
 By tradition, in a Filipino family, women are
brought up to become housewives to take care of
the home and children.
 While the men will provide for their need and
protect them as head of the family.
 Filipino parents establish and enforce boundaries
and roles for every child as he or she grows up.
 More roles are given to the eldest siblings and
tolerate greater room for error for the younger
ones
 Extended families live together and even distant
members are given the title of cousin.
 Children have several sets of godparents so that
the support system is strong.
 Major festivals are celebrated together.
 If a family originates outside the city, they journey
back to the rural area where they have their roots
to celebrate.
Filipino Solidarity
 For Filipinos, family comes first and family is
everything.
 Family solidarity keeps a Filipino to be positive
amidst everything.
 Family is evidently highly valued in the Philippines,
thus, the government also strengthens Filipino
family and in great support to ensure work-family
balance.
LEARNING TASK 2 : FILIPINO VALUES
Filipino Values
- Refers to the set of values majority of the Filipino
have historically held important in their lives.
- This Philippine value system includes their own
unique assemblage of consistent ideologies, moral
code ethical practices, etiquette, and values that are
promoted by their society (Wilson).
- Values should be positive in nature.
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Importance of Values to Community Health
 Serve as standards
 Ideas of desirable characteristics of the
individual or group
 Ideals of what people want to achieve
Application of Values to Health Practice
 Values are basis for health actions or
responses to health problems, events or socio-
economic conditions.
 Values are the sources of reasons why we see
or do.
 Values are made up of beliefs and assumptions:
Communication
 Filipinos are fond of non-verbal
communications.
 Use hand gestures, pursing of lips, raising of
eyebrows and their eyes to communicate.
 They have a sharp intuitive sense
(called “pakiramdam”) for what is implied and
not stated.
 A smile is not always meant to convey
happiness but can mask embarrassment,
nervousness of feelings of insecurity.
Helping Others and Gratitude
 "Bayanihan" (Community Spirit) is a core
essence of Filipino Culture. It
is helping out one’s neighbor as a community,
and doing a task together, thus lessening the
workload and making the job easier.
 ”Utang na Loob” (Gratitude) always
recognize one’s indebtedness.
 A person owed to a person who has helped him
through the trials he had undergone and repays
that person in whatever kind, whatever time
and situation.
Respect
 Filipinos are respectful.
 Use of words such as “Po” or “Opo” when
addressing elders.
 Use of various titles in addressing older people.
 Use of the popular "mano" where younger
people reach for the hands of their elderly and
touch it to their foreheads.
Service
 Philippines workforce are some of the hardest
working and loyal people.
 Filipinos are very strong in more creative and
communication based roles such as : design,
content production, arts, and many of the
customer service oriented activities.

LEARNING TASK 3 : CULTURAL HEALTH
CARE PRACTICES
Cultural Health Care Practices
Older Adults
 Filipino older adults tend to cope with illness
with the help of family and friends, and by faith
in God.
 Complete cure or even the slightest
improvement in a malady or illness is viewed as
a miracle.
 May resort to utilizing traditional home
remedies
Breast Exams
 Women will not perform breast exams because
they believe its is a sin to touch their breasts
and violates a sense of respect for one’s body.
Pregnancy and Childbirth
 Pregnant women refuse to take vitamins
because they are afraid that vitamins could
cause deformities.
 will deliver a baby boy if her fetus have fast
heartbeat,
 When in labor, should prohibit guest/s to stand
near or at the door, and at the stairs to prevent
complications in labor,
 Must not stay under the rain and not to take in
cold drinks after giving birth so that she will not
get easily chill.
 Newborns must have a rosary beside them
when the are left by the mother alone.
 They should walk during labor to facilitate
descent of the fetus' head.
 Let their husband burry the placenta to end
labor pains and bleeding and protect their infant
from anything that might frighten him.
Pain
 Filipinos will not typically ask for pain medicine
even if they are in pain.
 Many view pain as part of living an honorable
life.
 They also believe it is a way to life a fuller
spiritual life.
Patience and Endurance (Tiyaga): the ability to
tolerate uncertain situations
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Mental Illness
 Indigenous traits
 Devastating shame (Hiya)
 Sensitivity to criticism (Amor Propio)
 Unwillingness to accept having mental illness
 avoidance of needed mental health services
due to fear of being ridiculed
 Mental illness connotes a weak spirit
Health beliefs and practices are oriented towards
protection of the body.
Heating
 Adapts the concept of balanced between “hot”
and “cold” to prevent occurrence of illness and
disorders.
 Rapid shifts from “hot” to “cold” lead to illness
 “Warm” environment is essential for
maintaining optimal health
 Cold drinks or cooling foods should be avoided
in the morning
Protection
 Safeguards the body’s boundaries from
outside influences such as supernatural and
natural forces.
Flushing
 Body is like a vessel – collects impurities and
must be cleansed
 The Filipino people have a complex system
of beliefs on flushing: Vomiting, flatulence,
stimulating sweating and menstrual bleeding.
 Believes that it removes evil from a person’s
body.
 E.g. Flushing with vinegar (mixed with salt,
water or hot peppers) to induce sweating and
cure chest cold.

CHAPTER 6: NEW TECHNOLOGIES
RELATED TO PUBLIC HEALTH
ELECTRONIC INFORMATION
LEARNING TASK 1: APPLICATION OF
E-HEALTH IN COMMUNITY HEALTH
DEFINITION OF TERMS
1. Data
- It is the raw, unorganized, unprocessed information.
- It is an individual unit that contains raw material
which does not carry any specific meaning.
2. eHealth
- It is the use of information and communication
technology for health (WHO).
- It is the healthcare practice supported by electronic
processes.
3. Electronic Health Record
- A digital record of health information; It allows a
patient’s medical information to move with them.
- It refers to past medical history, vital signs, progress
notes, diagnoses, medications, immunization dates,
allergies, lab data and imaging reports and other
relevant information, such as insurance information,
demographic data.
4. Electronic Medical Record
- A digital version of a chart.
- It refers to everything you’d find in a paper chart,
such as medical history, diagnoses, medications,
immunization dates, allergies etc.
5. Information
- A processed and organized data presented in a
given context.
- It is the processed, organized data that is beneficial
in providing useful knowledge.
6. Information and Communication Technology
(ICT)
- It is defined as a diverse set of technological tools
and resources used to communicate, and to create,
disseminate, store and manage information.
7. mHealth
- the use of mobile devices such as a mobile phone or
tablet to support the practice of healthcare.
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COMMUNITY HEALTH NURSING
8. Telehealth
- It refers to both clinical and remote non clinical
services such as providing training and continuing
medical education.
9. Telemedicine
- refers solely to remote clinical services; It functions
as a means to treat patients who were located in
remote areas.
EHEALTH
Definition of eHealth
eHealth is the use of information and communication
technologies (ICT) for health (WHO, 2020).
eHealth is recognized by WHO as the cost-effective
way of using ICT in health care services, health
surveillance, health literature, health education and
research
eHealth is an emerging field of medical informatics,
referring to the organization and delivery of health
services and information using the Web and related
technologies (Saba, 2015)
3 Main Areas of eHealth
1. Delivery of health information for health
professionals and health consumers through
the internet and telecommunication.
2. Using the power of information technology (IT)
and e-commerce to improve public health service
(training and education)
3. Use of e-commerce and e-business practices in
health systems management
LEARNING TASK 2: CURRENT
SITUATION OF THE PHILIPPINES
RELATED TO INFORMATION AND
COMMUNICATION TECHNOLOGY
Use of Information and Technology in the
Philippines
 Information technology plays and important
role in health by improving the delivery of quality,
safety and effectiveness of health care delivery
system in rural and hard to reach
communities. These communities can be
connected to or given access to medical doctors
situated in the urban areas through technology.
 It is sometimes referred to as health
information technology. The utilization of
health information technology can be a
challenged since it requires resources and
expertise which may be hard to find in rural areas.

Key Components of HIT
1. Use of Electronic health records (EHR)
2. Secure digital networks which can be used to
send and deliver up-to-date records whenever
and wherever the patient or the physicians may
need them
3. Transmittal of electronic medical test/lab
results
4. Application of Telehealth to increase access to
providers
5. Utilization of patient health portals for patients
to access their personal health information online
(confidential and secure)
6. Electronic communication between healthcare
providers (emails)
7. Electronic prescribing and ordering - which
could help avoid medical errors
8. Use of Mobile devices and tablets - for an
updated patient records
Factors Affecting the Use of ICT in the Philippines
1. Target-users are not familiar of the technology.
 Most health center personnel are not familiar
with the use of computers and other technology.
 Use of eHealth or other technology requires
training of health personnel on basic computer
skills, use of software and maintenance of the
equipment.
2. Limited health budget
 health budget allocation is relatively low
 ICT projects usually requires a big budget
3. Decentralized government
 LGUs are autonomous and in control of their
own budget
 presence of diverse and unrelated ICT projects
in different LGUs
4. Emergence of free and open source software
(FOSS)
 development and increased popularity of FOSS
which can cut cost since it can cut cost in
developing a certain software.
 An open system which can allow someone with
knowledge of programming can manipulate the
program and customize to their own need.
5. Surplus of "digital natives" (registered nurses
 employed of "digital native-nurses" since
they are familiar with digital technologies
and uses them on a daily basis
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COMMUNITY HEALTH NURSING
 aid the implementation of various ICT
projects in health care.
LEARNING TASK 3: INFORMATION AND
COMMUNICATION TECHNOLOGIES USED
IN PUBLIC HEALTH
Information and Communication Technologies
Used in Public Health
and other Innovations
Department of Science and Technology-
Philippine Council for Health Research and
Development (DOST-PCHRD)
“Health technologies are the backbone of all health
systems. They are essential tools in solving health
problems” (WHO, 2004)
Benefits of Using ICTs
1. improved dissemination of public health
information
2. Remote consultation, diagnosis and treatment
through telemedicine
3. Collaboration and cooperation among health
workers which includes sharing of learning and
training approaches;
4. A more effective health research and the
dissemination and access to research findings
5. Improved efficiency of administrative systems in
health care facilities
6. Enhanced ability to monitor the incidence of
public health threats and respond in a more timely and
effective manner
7. ICT can also help deliver health and other
related services faster.
ICTs and Other Innovations in Public Health
1. RxBox
RxBox is a device which captures medical signals
through built-in sensors, stores data in an electronic
medical record (EMR), and transmits health
information via internet.
Jointly developed by the University of the Philippines
(UP) Diliman and Manila
The device reduces unnecessary travels and
hospitalizations as it enables diagnosis, monitoring,
and treatment of patients from geographically isolated
and depressed areas of the country.
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COMMUNITY HEALTH NURSING

2. eHatid 6. WAH (Wireless Access for Health

eHealth TABLET for Informed Decision Making of
LGUs (eHATID LGU) is an android application that
provides real time health information and a facility for
direct communication between local chief executives
and rural health units (RHUs).
It was Developed by Ateneo De Manila University.
It works even without internet connection and provides
decision-making support to local government units
(LGUs) in creating sound and evidence-based health
policies and programs.
WAH is a health information system and electronic
medical record.
A digital health solution developed local governments
and small health facilities. It allows chief executives to
do multi-level governance oversight, health managers
to execute inter- and intra-facility management, and
facility supervisors to carry out multiple-users
supervision
It was implemented in 2010, in Tarlac province.

3. Biotek-M

Biotek-M, a confirmatory test for dengue diagnosis, is

as accurate as the currently available Polymerase
Chain Reaction (PCR) technology yet less costly as it
is locally developed.

It was developed by the UP Manila National Institutes

of Health Institute of Molecular Biology and
Biotechnology.

The kit saves resources for both hospital and patients

as it allows less admission for dengue-suspected
cases.

4. OL Trap

OL (OvicidalLarvicidal ) Trap is a simple but

effective vector control method to lower the population
of dengue Aedes aegypti mosquitoes, thus reducing
dengue cases and controlling dengue transmission. It
was developed by DOST-Industrial Technology
Development Institute (ITDI)

OL Trap works by trapping the eggs and larvae of A.

aegypti in their laying site with active organic solution
and killing them in the process before hatching and
going to adult stage.

An OL Trap is composed of a black canister, a lawanit

paddle, and pellets.

5. CHITS (Community Health Information Tracking

System)

CHITS is one of the two EMRs that can seamlessly

connect and interoperate with the RxBox. This
biomedical device capable of measuring a patient’s
temperature, blood pressure, heart rate, oxygen
saturation, uterine contractions, and
electrocardiogram readings.

It was developed by Dr. Herman Tolentino of UP

College-Manila and implemented in more than 48
health centers.

The program services various modules of DOH

programs (EPI, NTP etc.) and is a free open source
system (FOSS).

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NCM 105_G
NUTRITION AND DIET THERAPY
CHAPTER 1: BASIC CONCEPTS IN
NUTRITION AND DIET THERAPY
LEARNING TASK 1: BASIC CONCEPTS
A. Definition of terms:
Nutrition - is the study of food and how the body
makes use of it. It deals with the processes
of receiving and utilizing it for the growth and renewal
of the body and for the maintenance of
the different body functions.
Function of Nutrition:
Basic Function: to maintain life by allowing an
individual to grow and be in a state of
optimum health.
Reasons why nutritional science is applied to
nursing care:
1. The recognition of the role of nutrition in preventing
diseases or illnesses;
2. The concern for adapting food patterns of
individuals to their nutritional needs within
the framework of their cultural, economic, and
psychological situations and styles; and
3. The awareness of the need in specified disease
states to modify nutritional factors for therapeutic
purpose.
Nutrients - are chemical substances found in food to
provide heat and energy, to build up and
repair body tissues, and to regulate body processes.
Classification of Nutrients:
1. Function - those that form tissues in the body are
body-building nutrients while those
that furnish heat and energy are fats, carbohydrates,
and proteins
2. Chemical properties - nutrients are either organic
or inorganic
3. Essentiality - nutrients are classified based on
their significant contribution to the body’s
physiological functioning
4. Concentration - nutrients are either in large
amounts or in little amounts
1. Essential Nutrients - nutrients found only in food.
2. Food - is any substance, organic or inorganic, when
ingested or eaten nourishes the body, builds and
repairs body tissues, supplies heat and energy
and regulates body processes.
3. Enzymes - are catalysts that hastens chemical
reactions without itself undergoing change.
4. Hormones - are organic substance produced by the
endocrine glands which are discharged into the
blood to be circulated and brought to specific
organs or tissues that are remote from the source
or point of manufacture.
5. Digestion - is the breakdown of food in the body in
preparation for absorption.
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NUTRITION AND DIET THERAPY
6. Elimination - is the evacuation of waste.
7. Nutritional status - is the condition of the body
resulting from the utilization of essential nutrients.
8. Health - a range of states with physical, mental,
emotional, spiritual, and social components.
9. Wellness - a state of good health with optimal body
function (requires good nutrition).
10. Health Literacy - the capacity to obtain,
process, and understand basic health information
needed to make appropriate health decisions.
11. Health Disparities - a difference in health
outcomes among subgroups often link to social,
economic or environmental disadvantages.
B. Nutrition Concepts
Basic concepts in nutrition
1. Adequate nutrition is essential to good health.
2. The nutrients in our body are in dynamic equilibrium.
3. Dietary intake & nutrient need should be
individualized.
4. Nutrient content in food is variable, whatever is
present in the natural food should be conserved by
scientific preparation and service.
5. Human requirements for nutrients are known for
some & have to be determined as yet for others.
6. An adequate diet is the foundation of good nutrition
and it should consist of a wide variety of foods.
7. The physiological functions of food are attributed to
the roles of the nutrients.
8. Malnutrition is brought about by a faulty diet and/or
by conditioning factors like heredity, infections,
ingestion of certain drugs and parasitism.
9. Nutrition education, abundant food supply, and the
use of various resources are needed to improve
nutritional status of a population.
10. The study of nutrition is interrelated with allied arts
and sciences.
Evaluation of Nutriture
1. Dietary Survey: Evaluates the primary factor of
nutritional inadequacy.
2. Physical or Instrumental Methods: Taking the
weights and heights and other anthropometric
data; Operation Timbang.
3. Medical History: A record of the person’s past
illness and other complaints of poor physical
being may reveal conditioning factors of
nutritional inadequacy.
4. Clinical Examination: Examining the patient from
head to foot will help detect physical signs
associated with malnutrition.
5. Biochemical Tests: Includes testing the
concentration of nutrient or its metabolite in the
blood or plasma, tissue biopsy, saturation or load
tests, and urinalysis for certain nutrients or its end
products.
LEARNING TASK 2: PROCESS OF
DIGESTION
Digestion is the process of breaking down food into
substances like carbohydrates, proteins, fats, and
vitamins that aid in the body in its different functions. It
occurs primarily in the digestive tract.
 NCM105
NUTRITION AND DIET THERAPY

Parts of the Human Digestive System
I. Digestive Tract/Gastrointestinal Tract (GIT)
 Mouth - where food is broken down to pieces by
chewing. Food then mixes with saliva and
broken down into a form that the body can
absorb and use.
 Liver - produces and secretes bile which aids in
the digestion and absorption of fats and fat
soluble vitamins. It also detoxifies the blood
that comes from the small intestine which
contains the nutrients absorbed from food.
 Gallbladder - a pear-shaped organ responsible
for the storage and concentration of bile.

 Throat/Pharynx - transfers food from the mouth to

the esophagus. It warms, moistens, and filters Digestive System
air before food is moved into the trachea.

 Esophagus - a muscular tube where food pass

through from the pharynx to the stomach.

 Stomach - a sac-like organ which holds, mixes,

and grinds food. It secretes acid and enzymes
that carry on the process of breaking down
food. Food leaves the stomach in liquid or
paste consistency and moves to the small
intestine.

 Small Intestine - a long, loosely coiled tube,

which is more than 20-feet long. It is divided
into 3 parts: duodenum, jejunum, and ileum.
Duodenum continues the process of breaking
down food, while the jejunum and ileum are
responsible for the absorption of nutrients into
the bloodstream.

 Large Intestine/Colon - is a long muscular tube

approximately 5 - 6 foot that connects the
caecum (the first part of the large intestine) to
the rectum (the last part of the large intestine).
It has five parts: the caecum, ascending colon,
transverse colon, descending colon, and the
sigmoid colon which connects to the rectum. LEARNING TASK 3: METABOLISM
Stool from the digestive processes passes Metabolism - is the chemical process of transforming
through the colon by means of contractions or food into complex tissue elements and of
peristaltic movements, first in liquid state and transforming complex body substances into simple
finally in solid form as water is removed from ones, along with the production of heat and
the stool. energy.

 Rectum - an 8-inch chamber that connects the 2 Categories:

colon to the anus. It receives stool from the
colon and holds the stool until defecation.
When gas or stool comes into the rectum,
sensors send a message to the brain which
decides if the rectal contents can be released
or not. Then the sphincters relax, and the
rectum contracts expelling the contents.
 Anus - the ending of the digestive tract which
consists of the pelvic floor muscles and the two
anal sphincters. The lining of the upper anus is
specialized to detect rectal contents. The pelvic
floor muscle creates an angle between the
rectum and the anus that stops stool from
coming out when it is not supposed to. The
anal sphincters provide control in the
elimination of stool.
1. Catabolism - the breakdown of molecules to obtain
energy
2. Anabolism - the synthesis of all compounds
needed by the cells
A. Energy from Food: (refer to the ppt)
Factors Affecting Basal Metabolic Rate
1. Surface area - the greater the body surface area or
skin area, the greater the amount of heat loss and in
turn the greater the necessary heat produced by the
body. Muscle tissue required more oxygen than
adipose tissue.
2. Sex - Women have a metabolism of about 5% to
10% less than that of men. They have little more fat
and less muscular development than men.

II. Accessory Organs
 Pancreas - secretes the following enzymes:
lipase for fat digestion, protease for protein
digestion, and amylase for carbohydrates
digestion.
3. Age - The metabolic rate is highest during the
periods of rapid growth, chiefly during the first and
second years, and peak through the ages of puberty
and adolescence in both sexes. BMR declines
slowly with increasing age to lower muscle tone
from lessened activity.

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4. Body composition - A large proportion of inactive

adipose tissue lowers the BMR. Athletes with great
muscular development show about 5% increase in
basal metabolism over nonathlete.

5. State of nutrition - a decrease in the mass of active

tissue such as in the case of undernourishment or
starvation causes a lowered metabolism often as
much as 50% below normal.

6. Sleep - during sleep, the metabolic rate falls

approximately 10% to 15% below that of waking
levels, due to muscular relaxation and decreased
activity of the sympathetic nervous system.

7. Endocrine glands - secrete hormones into the blood

stream, are the principal regulators of metabolic rate.
Male sex hormones increase the BMR about 10%-
15% and the female sex hormone a little less.

8. Fever - increases the BMR about 7% for each

degree rise in the body temperature above 98.6 F.

LEARNING TASK 4: COMPUTATION OF

DBW (DESIRABLE BODY WEIGHT)
• Physical Activity
Calorie requirements depend on the type and amount
of exercise. The more vigorous the physical work, the
greater the calorie cost. The kind of physical activity
and the amount of time spent determine the amount
of energy the body uses.

C. Classification of Nutrients

LEARNING TASK 5: MACRONUTRIENTS

I. CARBOHYDRATES (CHO) - are organic
compounds (saccharides-starches and sugars)
composed of carbon, hydrogen, and oxygen. They
provide the major sources of energy for the body or as
much as 80 to 100% of calories.

• CLASSIFICATION OF CARBOHYDRATES

MAINTENANCE OF BLOOD SUGAR LEVEL:

Normoglycemia – 90-120 mg/100ml of blood;
Insulin – only hormone which decreases blood sugar
level; secreted by Beta cells of islets of langerhans in
pancreas.
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Hormones that Increases Blood Sugar Level:
1. Glucagon – Alpha cells of Islets of Langerhans;
2. Steroid Hormone – adrenal cortex (promotes
glucose formation from CHON );
3. Growth Hormone & ACTH (functions as insulin
inhibitor); 4. T4 – thyroid gland (enhances intestinal
absorption of glucose & epinephrine (enhances fast
conversion of glycogen to glucose).
• FUNCTIONS OF CARBOHYDRATES
1.To serve as a major source of energy for the body.
2. It exert a protein-sparing action.
3. It is necessary for fat metabolism.
4. It aids in normal elimination.
5. It supply significant quantities of proteins, minerals,
and B
vitamins.
6. It encourages the growth of the bacteria, resulting in
a laxative action.
7. It is indespensable for the maintenance of the
functional integrity of the nerve tissue and it is the sole
source of energy for the brain.
• SOURCES OF CARBOHYDRATES:
1.Whole grains rich in iron, thiamine, niacin, and other
nutrients are important sources of carbohydrates.
2. Sweet potatoes and white potatoes; fruits- banana,
dried fruits and some vegetables such as corn and
lima beans.
3.Sugars and sweets, breads, cereals, cane, beet
sugars, honey, maple syrup, jellies, jams, and candies.
3. Glycogen (animal starch)
• are formed from glucose and stored in liver and
muscle tissues
• food sources include mainly meats and sea foods .
• Health Effects of Carbohydrates
1. Low metabolic rate that can lead to weight gain
2. Increased cholesterol: Heart disease
3. Cancer
4. High blood sugar: Diabetes
2. FATS/LIPIDS - are organic compounds composed
of carbon, hydrogen, and oxygen. Triglycerides or fats
and oils are fatty acids esters of glycerol. It constitute
34% of the energy in
the human body. They include substances such as
fats, oil,waxes, and related compounds that are
greasy to the touch and insoluble n water.
• CLASSIFICATION OF FATS
A. Simple lipids: triglycerides - called neutral fats
Most common type of lipid found in the body & foods:
Fats & oils in foods are mostly in the form of
triglycerides; consist of three fatty acids & one glycerol
(3-carbon alcohol) molecule which serves as a
backbone for the 3 attached fatty acids.
B. Compound lipids - are combination of fats with
other
components .
Types of Common Lipids:
1. Phospholipids - are compounds of fatty acids,
phosphoric acids, and nitrogenous bases. Another
class of lipid; like triglycerides, they are built on
backbone of glycerol. However, at least one fatty acid
is replaced with a compound containing
phosphorus (& other elements such as nitrogen);They
are:
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1.) important part of the cell membrane structure;
2.) serve as emulsifiers (allow fat & water to mix by
breaking fat globules into small droplets) to keep fats
dispersed in body fluid;
a. Lecithin - the most widely distributed; traces are
placed in liver and egg yolk and in raw vegetable
oils such as corn oil. Carries fat & cholesterol
away from plaque deposits in the arteries.
b. Cephalin - are needed to form thromboplastin for
the blood clotting process
c. Sphingomyelin - are found in the brain and other
nerve tissues as components of myelin sheath
2. Glycolipids - are compounds of fatty acids
combined with carbohydrates and nitrogenous bases
a. Cerebrosides - are components of nerve tissue
and certain cell membranes where they play a
vital role in fat transport.
b. Gangliosides - are made up of certain glucose,
galactose, and a complex compound containing
an amino sugar
3. Lipoprotein - are lipids combined with proteins.
They are formed primarily in the liver and are found in
cell and organelle membranes, mitochondria, and
lysosomes. They are insoluble in water and are
combined in protein complex for their transport and
activity in aqueous medium. They contain cholesterol,
neutral fat, and fatty acids.
Four forms of LIPOPROTEINS
1.) CHYLOMICRONS: transport absorbed fats from
the intestinal wall to the liver cells. Fats are then used
for synthesis of lipoproteins
2.) VERY LOW-DENSITY LIPOPROTEINS (VLDLs)
leave the liver cells full of fats & lipid components to
transfer newly made triglycerides to the cells
3.) LOW-DENSITY LIPOPROTEINS (LDLs) form
from VLDLs as density is reduced as fats & lipids are
released on their journey through the body. They carry
cholesterol
throughout the body to tissue cells for various
functions
4.) HIGH-DENSITY LIPOPROTEINS (HDLs) are
formed within cells to remove cholesterol from the cell,
bringing it to the liver for disposal; Health guidelines
recommend a dietary cholesterol intake of 300 mg or
less per day; If LDL cholesterol is elevated, dietary
cholesterol intake should be less than 200 mg.
C. Derived Lipids - are simple derivatives from fat
digestion or other more complex products. They are
fat substances produced from fats and fat compounds
during digestive breakdown .
1. Fatty acids - are key refined fuel forms of fat that
the cell burns for energy . They are the basic
structural units of fat and may be saturated or
unsaturated in nature .
Sources of fatty acids:
a. Saturated fats - are those into which no hydrogen
can be added. Fats high in saturated fatty acids such
as animal fats remain solid at room temperature; In
whole milk, saturated fats are suspended in liquid so
the solid nature is less apparent. Animal sources:
meats, eggyolk, dairy products; Plant sources: palm &
coconut oils (tropical oils), cocoa butter.

b. Monounsaturated fatty acids (MUFA)- are those in
which two of the carbon atoms are joined by a double
bond. Oleic acid is the most abundant
monounsaturated fatty acid. Olive and peanut oils are
especially high in oleic acid. Food sources: Canola &
Olive oils, peanuts (peanut butter & peanut oil)
c. Polyunsaturated fatty acids (PUFA) - are those in
which two or more double bonds are present. Linoleic
acid is the most common of the polyunsaturated acids.
It is abundant in most vegetable oils. Food sources:
Vegetable oils such as corn, soybean, sunflower,
sesame & safflower; fish; margarine.
2. Glycerol - is a water - soluble component of
triglycerides and is inconvertible with carbohydrates. It
comes out 10% of the fat.
3. Steroids - are a class of fat-related substances that
contain sterols. Cholesterol is a main member of
this group. It is a complex fat-like compound found
practically in all body tissues especially in the brain
and nerve tissues, bile, blood, and the liver where
most cholesterol is synthesized. The only food
sources of cholesterol are animal sources which
includes beef, pork, chicken, luncheon meats, fish,
shrimps & dairy products; The highest sources are
eggyolks & organ meats (liver & kidneys). Other
animal fat products including butter, cream,whole
milk cheese, ice cream, and meat contain small
amounts. Plant foods do not contain cholesterol not
even avocado or peanut butter.
Functions of Steroids:
1.) Vital part of all cell membranes & nerve tissue
2.) Serves as a building block for hormones
3.) Plays an important role in the synthesis of vitamin
D (when exposed to UV light, a cholesterol
substance in our skin can be converted to vitamin D
by the kidneys & liver)
4.) Has a vital role in the synthesis of bile (the liver
synthesizes cholesterol to make bile, the
emulsifying substance necessary to absorb dietary
lipids). Can be synthesized by the body & are not
essential nutrients. If dietary cholesterol is not
consumed, the liver will produce the amount
required for body functions. Generally, dietary
cholesterol accounts for 25% of the cholesterol in
the body. The rest, which is made in the liver, are
produced in relation to how much is needed.
The Omega-6/Omega-3 Ratio
Plants make omega -3 and omega -6 oils, but the
latter is more widely distributed in plants. Humans
should consume more omega -3 fatty acids from
vegetables and marine sources like cod liver oil,
mackerel, salmon, and sardines as well as crabs,
shrimps, and oysters.
• DIGESTION OF FATS
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• ABSORPTION OF FATS:
Main products of fat digestion are: fatty acids,
glycerol, & glycerides; The way the body handles
the absorption is related to the length of the carbon
chain; Long chain triglycerides are absorbed into
the epithelial cell as: monoglycerides, fatty acids, &
glycerol.
• METABOLISM OF FATS:
Occurs chiefly in the adipose tissue & liver; End
products of fat metabolism are: CO2, H2O, &
Energy (ATP).
• FUNCTIONS OF FATS
1.Fats are important sources of calories.
2. It is protein-sparing because its availability
reduces the need to burn protein for energy.
3. Maintains the constant body temperature by
providing effective insulation underneath the skin.
4. Cushions vital organs such as the kidney against
injury
5. Facilitates the absorption of fat-soluble vitamins
ADEK
6. Provides satiety and delays the onset of hunger
7. Contributes flavor and palatability to the diet
• FOOD SOURCES
A.Visible fats: lard, butter, margarine, shortenings,
salad oil, and visible fats of meat
B. Invisible fats; milk, cheese, eggs, nuts, and meat
High in Saturated Fatty Acids
• whole milk, cream, ice cream, cheese made from
whole milk, egg yolk
• medium fat or fatty meats; beef, lamb, pork, ham
• bacon, butter, coconut oil, lamb fat, lard, regular
margarine, salt pork, hydrogenated shortenings
• chocolate, chocolate candies, cakes, cookies, pies,
rich pudding
High in Polyunsaturated Fatty Acids
• vegetable oils, safflower, corn, cottonseed,
soybean, sesame, sunflower
• salad dressings made from the above oils :
mayonnaise, French dressings special margarine :
liquid oil listed first on label
• Fatty fish: salmon, tuna, herring
The essential fatty acids are not manufactured
in the body and must be supplied in the diet.
1. Linoleic acid is the primary member of the omega-6
family. It is found in vegetable oils like corn,
safflower, soybean, and cottonseed, and poultry
fats.It can be made into arachidonic acid which is
abundant in meats.
2. Linolenic acid is the primary member of the omega-
3 family. It is found in oils like flaxseed, canola,
walnut, wheat germ, and soy bean; nuts and seeds

like butternuts, walnuts, and soybean kernels; and
vegetables like soybeans.
• HEALTH EFFECTS OF FATS
1.Heart disease
2. Saturated fats: raise blood cholesterol levels
3. Monounsaturated fats: lowers risk of heart disease
4. Omega-3 polyunsaturated fats: lowers blood
cholesterol and prevent heart disease
5. High levels promotes cancer
6. Obesity
• EFFECTS OF DEFICIENCY OF ESSENTIAL
FATTY ACIDS:
1.) Flaky & itchy skin – less sebaceous oil production
2.) Diarrhea & symptoms of infection
3.) Growth & wound healing retardation
4.) Anemia can develop
• DAILY ALLOWANCE
No specific recommendation by the Food and Nutrition
Board. The requirement for
linoleic acid is low and easily met. For infant formulas,
linoleic acid should supply 3% of calories.
• CHOLESTEROL CONTENT OF FOOD
If an individual has risk factors for heart disease,
he/she should not consume more than 200 mg of
cholesterol each day. If risk factors for heart disease
exist, then cholesterol intake should be limited to not
more than 300 mg/day.
Cholesterol is only found in animal products. Fruits,
vegetables, grains, and all other plant
foods do not have any cholesterol at all.
• TRANS FAT/HYDROGENATED FAT
• Hydrogenation - process by which liquid vegetable
oil is converted into solid fat. Has high melting point
and a creamy, smooth texture, and is reusable in deep
frying.
• Are artificial fats. A small amount occurs naturally in
meat and dairy products.
• Lengthen the shelf life of food
Common Trans Fat Sources:
• Crackers
• Doughnuts
• French fries
• Cookies
• Vegetable shortening
• Hard margarine, Pastries
• HOW TO LOWER FAT INTAKE
• Don't deprive yourself of fatty foods. To avoid
craving for more fat.
• To be moderate, add more healthy foods to your diet.
• MAKING POSITIVE CHANGES
• Eliminating trans fat
• Fighting fat with fats. Opt for the real thing.
• Cleanse, rejuvenate, and supplement
• Colon cleansings, periodic liver flushes, and
revitalizing multi-vitamins
3. PROTEIN (CHON) - are chemical compounds that
contain the same atoms as CHO & lipids but it
contains Nitrogen; Comes from the Greek word
“protos“ means “to take first place”; ~ First
introduced by Mulder, a Dutch Chemist in 1838;
Mulder defined CHON as a nitrogen containing
constituent of food which is important in the
functioning of the body that without it, life would be
impossible
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NUTRITION AND DIET THERAPY
• CLASSIFICATION OF PROTEIN
A. Simple proteins - are those which yield only amino
acids upon hydrolysis.
1. Albumins - are soluble in water and coagulated
by heat
2. Globulins - are insoluble in water, soluble in dilute
salt solution, and coagulated by heat
3. Glutelins - are insoluble in neutral solvents but
soluble in weak acids and alkalis; they are
coagulated by heat
4. Prolamins - soluble in 70% to 80% alcohol but
insoluble in absolute alcohol, water, and salt
solutions
5. Albuminoids - are insoluble in all neutral solvents
and in dilute acids and alkalis.
6. Histones and protamines - are basic polypeptides,
which are soluble in water but not coagulated by
heat ; they are found in nuclei of cells
B. Compound proteins, conjugated proteins or
proteins - are combinations of simple proteins
and some other non-protein substance called a
prosthetic group attached to a molecule.
1. Nucleoproteins - are combination of simple
proteins and nucleic acids. Deoxyribonucleic
nucleoproteins are necessary for the synthesis of
proteins in the cytoplasm.
2. Mucoproteins and glycoproteins - are
combination of a protein and large quantities of
complex polysaccharides such as mucin found in
secretion from gastric mucous membranes.
3. Lipoproteins - are compounds of a protein and a
triglyceride or other lipids such as phospholipids
or cholesterol found in cell and organelle
membranes.
4. Phosphoproteins - are compounds of phosphoric
acid joined in ester linkage to protein found in
casein of milk5. Chromoproteins - are compounds
of proteins and non-protein pigments found in
flavoproteins, hemoglobin, and cytochromes.
6. Metalloproteins - are compounds or metals (Cu,
Mg, Zn, and Fe) attached to proteins found in
ferritin, hemosiderin, and transferin.
C. Derived proteins - are products formed in the
various stages of hydrolysis of a protein
molecule.
All enzymes are CHONs; many hormones are either
protein or protein derivatives.
• AMINO ACID - are building blocks of protein
CLASSIFICATIONS OF AMINO ACIDS:
1. ESSENTIAL AMINO ACIDS (EAA): Amino acids
that cannot be manufactured by the human body;
They must be supplied ready – made or preformed in
the diet (Dietary Essential)
The 9 Essential Amino Acids are:
1.) Histidine- facilitates growth, the creation of blood
cells, and tissue repair;
2.) Isoleucine- wound healing, immunity, blood
sugar regulation, and hormone production

3.) Leucine- regulate blood sugar levels and aids
the growth and repair of muscle and bone
4.) Lysine - building muscle, maintaining bone
strength, aiding recovery from injury or surgery,
and regulating hormones, antibodies, and
enzymes
5.) Methionine - flexibility of skin and hair, helps
keep nails strong
6.) Phenylalanine - helps the body use other amino
acids as well as proteins and enzymes. The body
converts phenylalanine to tyrosine, which is
necessary for specific brain functions
7.) Threonine - healthy skin and teeth, as it is a
component in tooth enamel, collagen, and elastin
8.) Tryptophan - proper growth in infants and is a
precursor of serotonin and melatonin
9.) Valine - mental focus, muscle coordination, and
emotional calm
2. NON ESSENTIAL AMINO ACIDS:
can be manufactured by the body and, therefore, are
not
as necessary for consideration in the diet. The
following are: Glycine, alanine, aspartic acid,
glutamic acid, proline, hydroxyproline, cystine,
tyrosine, serine, arginine
• FUNCTIONS of CHON:
1. For repair of worn-out body tissues
2. Building new tissue buy supplying the necessary
amino acid
3. Source of heat and energy
4. Contribute to essential body secretions and fluids,
enzymes, and proteins.
5. Maintains normal osmotic pressure
6. Aids the body to resist against infection
7. Furnish the amino acids for a variety of metabolic
function •
METABOLISM OF CHON:
1.) Body CHON are in dynamic state (there is a
constant interchange of Nitrogen from one tissue to
another & between newly absorbed amino acids &
body CHON)
2.) Tissue CHON are continually being broken down &
resynthesized.
• FACTORS AFFECTING CHON UTILIZATION:
1. Amino Acid balance
2. Caloric inadequacy
3. Injury
4. Immobility (18 g nitrogen loss/day)
5. Emotional stress (increase adrenaline results to
nitrogen loss); Inborn errors of metabolism
(Phenylketonuria)
6. Food processing (lysine is lost in toasted bread).
• FOOD SOURCES:
• Excellent sources for complete protein are of
animal origin
• Legumes are very good sources especially for
countries with limited supply of animal protein
foods
• To stretch or extend animal proteins, adding
vegetables, legumes, cereals, & rootcrops to the
meat, fish & poultry will not only reduce cost of
protein but also supplement limiting amino acids
in plant protein.
• CHON REQUIREMENT & ALLOWANCE:
The RDA for protein is 0.8g/kg body weight.
Factors affecting RDA for CHON:
Cynithhaa
NCM105
NUTRITION AND DIET THERAPY
1.) age
2.) gender
3.) body size (should be based on the DBW)
4.) physiologic state such as pregnancy & lactation
5.) sources of protein.
• CHON MALNUTRITION:
Deficiency signs due to lack of dietary protein are:
weight loss,
general weakness & malaise, reduced resistance to
infection, nutritional edema, pallor.
Prolonged protein malnutrition leads to Protein-Energy
Malnutrition (PEM = malnutrition
caused by lack of protein, energy, or both).
Protein-Energy Malnutrition (PEM): is a condition
resulting from insufficiency of protein
or energy or both in the diet
Acute PEM occurs in children who are thin for their
height.
Chronic PEM occurs in children who are short for their
age; PEM could lead to:
Forms of PEM:
1. Marasmus = a malnutrition caused by a lack of
sufficient energy (kcalorie) intake characterized
by being extremely thin, skin seems to hang on
the skeletal bones, & there is reduced muscle
mass.
2. Kwashiorkor = a malnutrition caused by lack of
protein while consuming adequate energy. The
individual has an appearance of more that sufficient
fat stores in the
stomach & face due to edema (water retention).
MICRONUTRIENTS
• CLASSIFICATION OF Micronutrients: Vitamins and
Minerals
1. Vitamins are a group of unrelated organic
compound found in food needed in minute
quantities in the diet. Essential for metabolic
reactions within the cell & necessary for normal
growth & maintenance of health. Crucial in growth,
repair & healthy functioning of body tissues. Don’t
give energy to the body, but convert food into
energy thru’ many chemical reactions. Taking extra
of it does not increase one’s physical capacity but
its shortage may lead to fatigue. Long term vit.
deficiency would result to deterioration of health.
Human body can’t manufacture its own vits. except
vit. D & niacin which are produced in the body.
Shortage of Vits A, B & C may result in loss of
appetite. These can be restored by taking more of
these vits. No caloric value; however vitamin
supplements contain few calories in their sugar
coating.
• Comes from the Latin word Vita - life and Amine -
Nitrogen Compound•
Terms Associated with Vitamins:
1. ) Precursors or Provitamins - compounds that can
be changed to active vitamins
Ex: Carotenes & Cryptoxanthin are precursors of vit A;
Ergosterol when radiated becomesVitamin D
2.) Preformed Vitamins - are naturally occurring
vitamins that are in inactive form & ready for
biological use

3.) Avitaminosis: A condition resulting from lack of
vitamins. In a later stage of this condition when
more defined signs & symptoms occur, a nutritional
deficiency disease is recognizable;
Ex: Avitaminosis A - leads to night blindness &
Xerophthalmia;
Avitaminosis C - leads to scurvy
Deficiency of vitamin B - leads to beriberi
4. Hypervitaminosis: Sometimes referred to as
“vitamin toxicity,” as a result of excessive
accumulation of a vitamin in the body
5. Vitamin Malnutrition: Too much or too little vitamins
is not good for the health
6. Vitamin – like Compounds - Some substances have
physiological roles likes vitamins. But they are
present in larger amounts & are partially
synthesized in the body
Ex: Inositol, choline, lipoic & ubiquinone;
7. Antivitamins or Vitamin Antagonists - are
substances that interfere with the normal functioning
of a vitamin. They need to be similar in chemical
composition as the vitamin they “antagonize;”
Ex: Dicumerol against Vit.amin K, Avidin against biotin,
& thiaminase against thiamine or vitamin B1
Classification of Vitamins on the Basis of
Solubility:
1.) The Fat – soluble vitamins A, D, E & K in
association with lipids are found in foods;
2.) The water soluble vitamins are B complex &
Vitamin C
Differences between Fat – Soluble Vitamins & Water –
Soluble Vitamins:
Fat Soluble Vitamins:
1. Vitamin A (Retinol)
a. Basic dietary form
1. Preformed vitamin A/Retinol - active form;
animal sources
2. Carotenoids - inactive form; found in plants
b. Stability
• stable to light and heat, but prolonged heating in
contact with air destroys it
c. Functions
1. Promotes good eyesight
2. Helps form and maintain healthy teeth, skeletal
and soft tissue, mucus
membranes, and skin.
3. Promotes normal reproduction and lactation
d. Food sources
1. Plants: dark green leafy vegetables, deep
yellow or orange fruits & vegetables,
fortified margarine
2. Animals: liver, whole milk, butter, cream, cod
liver oil
e. Requirements - RDA: 300 ug – 1300 ug; UL: 600
ug – 3000 ug.
Cynithhaa
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NUTRITION AND DIET THERAPY
f. Deficiency - S/S: night blindness, Xerophthalmia,
dry rough skin, increased susceptibility to infections
(respiratory infection), bone growth ceases
g. Excess - S/S: birth defects, hair loss, dry skin,
headaches, nausea, dryness of mucous
membranes, liver damage, bone & joint pain
2. Vitamin D (CALCIFEROL)
a. 2 Forms
1. D2/Ergocalciferol - found in plants
2. D3/Cholecalciferol - formed in the skin upon
exposure to ultraviolet rays of sunlight
(SUNSHINE VITAMIN)
b. Functions
1. Promotes absorption of calcium & phosphorus
2. Building & maintenance of normal bones & teeth
3. Prevents Tetany
c. Stability
• remarkably stable and foods containing it can be
warmed and kept for long periods without
deteriorating
d. Food sources
Animals: fortified margarine , butter, milk, cheese;
liver & other glandular organs; fish; sardines &
salmon ; egg yolk Plants: not significant
e. Requirements - RDA: 5 mg – 15 mg (5 mg = 200
IU); UL: 25 mg – 50 mg
3. Vitamin E (TOCOPHEROL)
a. Consists of: Tocopherol (alpha, beta, delta, and
gamma) and Tocotrienols
b. Functions
1. Antioxidant
2. Essential for protection of cell structure especially
RBC
c. Stability
• stable to heat and acids and unstable to alkalis,
ultraviolet light and oxygen ; also destroyed when
in contact with rancid fats, lead, and iron
d. Food sources
1. Plant: green & leafy vegetables, margarine, salad
dressing; wheat germ, vegetable oils, nuts; Only
plants can synthesize vitamin E, no biosynthesis
in man
2. Animal: egg yolk, butter, milk Readily
decomposed by ultraviolet light & oxidation;
Rancid fat reduces the potency of vitamin E
e. Requirements - RDA: 4 mg – 19 mg;
f. Deficiency
1. Destruction of RBC
2. Low levels of tocopherol
4. Vitamin K (K1 - PHYLLOQUINONE, K2 -
MENADIONE)
a. Functions
1. Maintains prothrombin level in blood plasma for
blood clot formation
2. Needed for phosphorylation which aids in the
passage of glucose through the cell membrane
b. Stability
• fairly resistant to heat, but sunlight destroys it. Not
lost in cooking or boiling water
c. Food sources
K1 - dietary sources
K2 - synthesized in the intestine by bacteria and is
found in animal food
1. Green leafy vegetables
2. Dairy products, eggs, meats, fruits, and cereals

3. Cow’s milk is much better source than human
milk Water - Soluble Vitamins
1. Vitamin C/ASCORBIC ACID
• Has antioxidant property & protects foods from
oxidation
• Is readily destroyed by heat
• Most unstable of all the vitamins
• “Fresh Food Vitamin” since it occurs in growing parts
of plants; (All raw fresh fruits & vegetables contain
ascorbic acid in varying amounts);
• Functions
1. Prevention of scurvy
2. Has important role in the formation of collagen
3. It is an iron enhancer
4. It helps the body cope with stress
5. It is an antioxidant & as a coenzyme
6. It helps build bodily resistance to infection; It is
believed to reduce the severity of colds because it
is a natural antihistamine
• Stability
• Much is lost in cooking. Bruising, cutting, and
exposure to air cause much loss of ascorbic acid.
Less destroyed when food is cooked quickly in
small amounts of boiling water and covered tightly.
Quick freezing of food preserves the vitamins;
refrigeration aids retention.
• Requirement - Average Female: 75 mg; Average
Male: 90 mg; Regular cigarette smokers are advised
to ingest 35 mg or more a day;
2. VITAMIN B COMPLEX
A. Classic Disease Factors
• THIAMIN / B1:
• Functions:
1. Essential for the metabolism of carbohydrates
and some amino acids
2. helps maintain good appetite and functioning of
the nervous system
• Food sources
• Animal: liver, kidney, heart, milk, cheese
• Plant: cereals
• Stability
• Loss depends on the pH of the food, time,
temperature, quantity of water used and
discarded, and the use of sodium bicarbonate to
enhance the green color of vegetables
• Deficiency - S/S: loss of appetite, fatigue, nervous
irritability, & constipation; An extreme deficiency
causes beriberi which is a disease that affects the
nervous, cardiovascular, & GI systems; Frequent
consumption of large; amounts of raw fish could cause
thiamin deficiency.
• RIBOFLAVIN / B2:
• Functions:
1. Essential for carbohydrates, fats, & protein
metabolism
2. Necessary for tissue maintenance, especially the
skin around the mouth , and for healthy eyes
• Stability
• Stable to heat, oxidation and acid. Little is lost in
cooking and processing of foods.
• Food sources
• Animal: cheese , milk, eggs, liver , & other
glandular organs
• Plant: whole grains, legumes , green leafy
vegetables, & seaweeds
• Deficiency - Can result to the following conditions:
Cheilosis; Glossitis; Dermatitis; eye strain in the form
of itching, burning, & eye fatigue
Cynithhaa
NCM105
NUTRITION AND DIET THERAPY
• NIACIN /NICOTINIC ACID
• Functions
1. Plays an important role in energy metabolism,
fatty acid synthesis /oxidation,
and protein synthesis /catabolism .
2. Needed for photosynthesis in plants and fixation
of CO2 in animal cells
•Stability
• resistant to heat, light, air, acids, and alkalis
although small amounts may be lost in discarded
cooking water
•Food sources
• Animals: liver, glandular organs, lean meats, fish
and poultry, milk and cheese, eggs
• Plants: legumes, nuts, whole grains, enriched
cereals, and green vegetable
B. Coenzyme Factors
• PYRIDOXINE / VITAMIN B6
•Functions
1.Plays a role in many of the complex biochemical
processes by which foods are metabolized in the
body
2. Functions in protein, fats, and CHO metabolism
3. Essential for the formation of tryptophan and for
the conversion of tryptophan into nicotinic acid
•Food sources
• Vegetable oils of corn, cottonseed, linseed, olive,
peanut, wheat and rice germ, lard, and legumes,
especially soybeans and nuts
• PANTOTHENIC ACID
•Functions
1.Essential for CHO, CHON, and fat metabolism
2. Helps maintain normal growth, healthy skin, and
integrity of the CNS
•Food sources
• Liver, other glandular organs, meats, eggs, milk,
cheese, legumes
• LIPOIC ACID
• A sulfur-containing fatty acid and is not a true vitamin
because it can be synthesized in adequate amounts in
the body. A coenzyme in energy metabolism
converting pyretic acid into CoA.
• BIOTIN
•Functions
1. Serves as coenzyme factor in CO2 fixation
2. It helps in the synthesis of purines, pyrimidines,
fatty acids, and carboxylation reactions
•Food sources
• Liver and other glandular organs, meats, egg yolk,
milk, molasses, whole grains, legumes, and nuts
C. Cell Growth and Blood-forming Factors
• FOLIC ACID
•Functions
1.Plays a vital role in the transfer of one-carbon
units to appropriate metabolites in the synthesis
of DNA, RNA, methionine, and serine.
2. Needed for the conversion of histidine into
glutamic acid
3. Essential for the formation of both RBC and WBC
in the bone marrow and for their maturation
• Food sources
• Best sources: liver, kidney, beans, lima beans, and
fresh, dark green leafy vegetables especially spinach,
asparagus, and broccoli.
 NCM105
NUTRITION AND DIET THERAPY

• Good sources: lean beef, potatoes, whole-wheat

bread, and dried beans.
• Poor sources: meats, milk, eggs, most fruits, and
root vegetables.

• COBALAMIN
• Functions
1. Essential for normal metabolism and growth of
cells in the GIT, bone marrow, and nervous tissue
2. Aids in the transfer of methyl groups in the
synthesis of nucleic acids, purines, and
pyrimidine intermediates
3. Involved in myelin formation
4. Essential for carbohydrates, protein, and fat
metabolism
•Food sources
• Animal protein
D.Pseudo-vitamins

• INOSITOL
• Occurs in meat and meat extractives, muscle and
glandular organs, brain, legumes and nuts, fruits,
vegetables, and grains
• Abundant in the diet

• CHOLIN
•Mobilizes fat and prevents the build up of fatty acids
• Helps in the transmission of nerve impulses
• Food sources
• Richest food source: egg yolk
• Good sources: liver, brain, kidney, heart, meats,
legumes and nuts, yeast and wheat germ

II. Minerals - Pertains to elements in their simple

inorganic form. In nutrition they are
commonly referred to as mineral elements or for those
present or required in small amounts
they are called as trace elements or trace minerals .
CLASSIFICATION
1. Major Minerals – generally required in milligram
quantities and stored in the body in similar amounts.
2. Trace Minerals – generally required in much smaller
quantities.
There are traces:
Barium Aluminum
Bromine Bismuth
Strontium Gallium
Gold Arsenic
Silver Others

Cynithhaa

CHAPTER 2: NUTRITION CARE
PROCESS (ADIME)
LEARNING TASK 1: DEFINITION OF
TERMS
I. Nutrition Care Process (ADIME)
What is the Nutrition Care Process?
o The NCP is a systematic problem solving method
that dietetics and nutrition professionals use
to critically think and make decisions to address
nutrition related problems and provide safe, effective,
high quality nutrition care.
Use of the NCP does not mean that all clients get
the same care. Use of the nutrition
- care process provides a framework for
professionals to customize care, taking into account
the client's needs and values and using the best
evidence available to make decisions. Use of the NCP
can lead to more efficient and effective care, nutrition
research, and greater recognition of the role of
dietetics and nutrition professionals in all settings.
It consists of four distinct yet interrelated steps:
1.) Nutrition Assessment;
2.) Nutrition Diagnosis;
3.) Nutrition Intervention;
4.) Monitoring and Evaluation.
1. NUTRITION ASSESSMENT:
Involves a collection and analysis of health
related information in order to identify specific
nutrition problems and their underlying causes. The
assessment data are used to develop a plan of
action to prevent or correct energy or nutrient
imbalances, or to determine whether a care plan is
working.
2. NUTRITION DIAGNOSIS:
Consist of identification of nutritional problem for
which nutrition-related activities provide the primary
intervention. Each nutrition problems is formatted as
a PES statement, which includes a
specific problem (P), etiology or
cause (E) and signs and symptoms that provide
evidence of the problem (S).
For example a potential nutrition diagnosis might be:
“Unintentional weight gain (problem) to long term of
use of corticosteroids (the etiology or cause) as
evidence by involuntary weight gain of 10% of body
weight over the past six months (signs and symptoms).
Note: The Nutritional Diagnosis often changes during
the course of an illness.
3. NUTRITION INTERVENTION:
After nutrition problem has been identified, the
appropriate nutrition care can be planned and
implemented.
A nutrition intervention may include:
 counselling or education about appropriate
dietary and life style practices, a change in
medication and other treatment, or adjustments in
the meal services provided to a hospital patient.
 Consider the individual’s food habits, life style
and other personal factors.
Cynithhaa
NCM105
NUTRITION AND DIET THERAPY
 Goals are stated in terms of measurable
outcomes; for example, the goals of an
overweight person with diabetes might include
improvements in blood glucose level and body
weight.
 Other goals may be positive changes in dietary
behaviors and lifestyle; for example, a diabetes
patient may learn how to control carbohydrate
intake or portion sizes or begin a regular exercise
program.
4. NUTRITION MONITORING AND EVALUATION:
The effectiveness of the nutrition care plan must be
evaluated periodically: the patient progress must be
monitored closely, an updated assessment data or
diagnosis may require adjustments in goals or
outcome measures.
 Sometimes a new situation alters nutritional
needs; for example a change in the medical
treatment or a new medication may alter a
person’s tolerance to certain foods.
 The nutrition care plan must be flexible enough to
adapt to the new situation
 If progress is slow or a patient is unable or
unwilling to make the suggested changes, the
care plan should be redesigned and take into
account the reasons why the earlier plan was not
successful.
 The new plan may need to include motivational
techniques or additional patient education.
 if the patient remains unwilling to modify
behaviors despite the expected benefits, the
health care provider can try again at a later time
when the patient may be more receptive.
A. Assessment of Nutritional Status
The information in the assessment may be
obtained through the 5 standardized domains:
1. Food Nutrition -Related History (includes snack
patterns, food intake data, 24 hr . dietary recall,
knowledge / beliefs/ attitudes etc.)
2. Anthropometric measurement (height, weight, body
mass index, growth pattern, weight history and weight
changes)
3. Biochemical data, Medical test, and Procedures
( e.g., fasting glucose, cholesterol, lab data,
electrolytes)
4. Nutrition-focused Physical findings (loss of
subcutaneous triceps fat; deltoid muscle atrophy;
interosseous hand muscle atrophy.
5. Client History - current and past information related
to personal, medical, family and social history (e.g.,
Education, medical treatment/therapy, socioeconomic
factors
1. Food Nutritional-Related History
1. Dietary Intake Data- Obtaining more or less
accurate data of food but it is so challenging since
the result may vary depending on individual’s

memory and honesty and the assessor’s skill and
training.
2. Nutrient Intake Analysis - nutrient analysis will
assess current intake of different components of
your diet to find deficiencies or excesses of needed
nutrients in our body.
3. Food Frequency - surveys the food and beverages
consumed during a specific time period.
4. Food Diary - a detailed log of food during specified
time period, usually several days; also called food
Record. It may also include information regarding
medications, disease symptoms, and physical
activity.
5. 24-hour recall - an individual recounts of all the
foods and beverages consumed in the past 24
hours or during the previous day. It includes
questions about the times when meals or snacks
were eaten, amounts consumed, and ways in
which the foods were prepared.
2. Physical Assessment
1.1. Anthropometric Data: related to physical
measurements of the human body, such as height,
weight, body circumference, and percentage of body
fat. Can reveal problems related to both protein
energy malnutrition (PEM) and overnutrition.
 Height (or Length).
 Body Weight.
height – weight tables and growth chart or used to
calculate the body mass index (BMI).
ü Head Circumference.
ü Circumference of Waist and Limbs.
ü Anthropometric Assessment in Infant and
Children.
ü Anthropometric Assessment in Adults.
BMI (Body Mass Index) = an index of a person’s
weight in relation to height determined by dividing the
weight (in kilograms) by the square of the height (in
meters).
BMI = Weight (kg) or Weight (lb.) X 703
Height (m)2 Height (in)2
To convert pounds to kilograms divide by 2.2. To
convert inches to meters divide by 39.37.
ü Healthy Individual: BMI = 18.5 to 24.9
ü Underweight = below 18.5
ü Overweight = above 25
ü Obese = above 30
 Body Composition refers to your body wt.
 Mid – Arm Circumference
 Fat – Fold or Skin – Fold Thickness
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B. Nutrition Diagnosis and Plan of Care
1. Nutrition Problems and / or Needs
The purpose is to identify and describe a
specific nutrition problem that can be resolved or
improved through treatment / nutrition intervention by
a food and nutrition professional.
 A nutrition diagnosis (eg: inconsistent
carbohydrate intake) is different from a medical
diagnosis (eg: diabetes)
 Problem (P) related to Etiology (E) as
evidenced by signs and symptoms (S)
Problem / Nutrition Diagnos
is label describes alterations in the patients / clients
nutritional status.
Related to
Etiology is the cause / contributing risk factors and
is linked to the nutrition diagnosis label by the words
“related to”, Etiology may be social, situational,
physical, developmental, cultural, psychological,
pathological and / or environmental nature.
As evidenced by Signs (objective) / Symptoms
(Subjective)
is data used to determine that the patient / client
has the nutrition diagnosis specified and is linked
by the words “as evidenced by.”
Terms divided into 3 categories: Intake,
clinical and behavioral – environment
1. Intake: too much or too little of a food or nutrient
compared to actual or estimated needs
2. Clinical: nutrition problems that relate to medical or
physical conditions.
3. Behavioral – Environmental: Knowledge,
attitudes, beliefs, physical environment, access to
food, or food safety.
Example of PES:
1. Excessive Energy intake related to poor knowledge
of appropriate portion sizes as evidenced by excess
weight with BMI of 40 (ie: Obese).
2. Excessive Energy intake related to frequent
consumption of large portions of high - fat meals as
evidenced by average daily energy intake exceeding
recommended amount by 2 MJ and 6 kilogram weight
during the past 18 months.
3. Altered nutrition –related laboratory values related
to alteration in GI function as evidence by abnormal
Glomerular Filtration Rate (GFR).
2.Planning the Diet with Cultural Competency
An appropriate diet is adequate and balanced
and considers the individual’s characteristics such as
age and stage of development, taste preferences, and
food habits.
It also reflects the availability of foods,
socioeconomic conditions, cultural practices and
family traditions, storage and preparation
facilities, and cooking skills.
An adequate and balanced diet meets all the
nutritional needs of an individual for maintenance,
repair, living processes, growth, and development.

It includes energy and all nutrients in proper
amounts and in proportion to each other.
The presence or absence of one essential nutrient
may affect the availability, absorption, metabolism, or
dietary need for others.
The recognition of nutrient interrelationships
provides further support for the principle of
maintaining food variety to provide the most complete
diet.
3.National Guidelines for Diet Planning
Eating can be one of life’s greatest pleasures.
People eat for enjoyment and to obtain energy and
nutrients. Although many genetic, environmental,
behavioral, and cultural factors affect health, diet is
equally important for promoting health and preventing
disease.
Yet within the past 40 years, attention has been
focused increasingly on the relationship of nutrition to
chronic diseases and conditions. Although this interest
derives somewhat from the rapid increase in number
of older adults and their longevity, it is also prompted
by the desire to prevent premature deaths from
diseases such as coronary heart disease, diabetes
mellitus, and cancer. Approximately two thirds of
deaths in the United States are caused by chronic
disease.
Current Dietary Guidance
Increased attention was being given to prevention
of hunger and disease. Guidelines directed toward
prevention of a particular disease, such as those from
the National Cancer Institute; the American Diabetes
Association; the American Heart Association; and the
National Heart, Lung, and Blood Institute’s cholesterol
education guidelines, contain recommendations
unique to particular conditions. The American Dietetic
Association supports a total diet approach, in which
the overall pattern of food eaten, consumed in
moderation with appropriate portion sizes and
combined with regular physical activity, is key.
Cultural Aspects of Dietary Planning
To plan diets for individuals or groups that are
appropriate from a health and nutrition perspective, it
is important that registered dietitians and health
providers use resources that are targeted to the
specific client or group. Numerous population
subgroups in the United States and throughout the
world have specific cultural, ethnic, or religious beliefs
and practices to consider.
Attitudes, rituals, and practices surrounding food
are part of every culture in the world and there are so
many cultures in the world that it defies enumeration.
Many world cultures have influenced American
cultures as a result of immigration and intermarriage.
This makes planning a menu that embraces cultural
diversity and is sensitive to the needs of a specific
group of people a major challenge. It is tempting to
simplify the role of culture by attempting to categorize
dietary patterns by race, ethnicity, or religion. However,
this type of generalizing can lead to inappropriate
labeling and misunderstanding.
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When faced with planning a diet to meet the needs
of an unfamiliar culture, it is important to avoid forming
opinions that are based on inaccurate information or
stereotyping. Some cultural food guides have even
been developed for specific populations for helping to
manage disease conditions.
Another example of the complexity of diet and
culture in the United State is that of African Americans.
“Soul food” is commonly identified with African
Americans from the South. Traditional food choices
include grits, collard greens prepared with ham hocks
and lard, with a side of corn bread. But this by no
means represents the diet of all African Americans.
African Americans may be eating the foods of their
homeland. An Ethiopian meal might consist of a
vegetable stew served atop bread known as injera,
whereas someone eating the food of Ghana would
probably be eating a stew atop rice or yams.
Religion and Food
Dietary practices have been a component of
religious practice for all of recorded history. Some
religions forbid the eating of certain foods and
beverages; others restrict foods and drinks during holy
days. Specific dietary rituals may be assigned to
members with designated authority or with special
spiritual power (e.g., medicine men, priests).
Sometimes dietary rituals or restrictions are observed
based on gender. Dietary and food preparation
practices (e.g., halal and kosher meat preparation)
can be associated with rituals of faith.
Fasting is practiced by many religions. It has been
identified as a mechanism that allows one to improve
one’s body, to earn approval (as with Allah or Buddha),
or to understand and appreciate the sufferings of
others. Attention to specific eating behaviors such as
overeating, use of alcoholic or stimulant-containing
beverages, and vegetarianism are also considered by
some religions. Before planning menus for members
of any religious group, it is important to gain an
understanding of some traditions or dietary practices.
In all cases, discussing the personal dietary
preferences of an individual is imperative (Kittler and
Sucher, 2008).
3.Resources needed in planning and
implementing Dietary Regimen
Agency in the Philippines known as the Nutrition
Council of the Philippines created the program PPAN
(Phil. Plan of Action for Nutrition 2017-2022 A call to
urgent action for Filipinos and its leadership.
It is an integral part of the Philippine Development
Plan 2017-2022. It is consistent with the Duterte
Administration 10-point Economic Agenda, the Health
for All Agenda of the Department of Health (DOH), the
development pillars of malasakit (protective concern),
pagbabago (change or transformation), and kaunlaran
(development), and the vision of Ambisyon 2040. It
factors in and considers country commitments to the
global community as embodied in the 2030
Sustainable Development Goals, the 2025 Global
Targets for Maternal, Infant and Young Child Nutrition,
the 2014 International Conference on Nutrition.
1. It is a results-based plan with SMART results
at different levels designed in a results framework.

2. It consists of 12 programs and 46 projects
serving as a framework for actions that could be
undertaken by member agencies of the National
Nutrition Council (NNC), other national
government agencies, local government units,
non-government organizations, academic
institutions, and development partners. For better
accountability, a member agency of the NNC
Governing Board has been designated as lead for
one or more of these programs.
The National Nutrition Council Secretariat led and
coordinated plan formulation. Plan formulation started
with the conduct of a nutrition landscape analysis
commissioned by NNC with support from
Micronutrient Initiative and the United Nations
Children’s Fund (UNICEF). A team of Filipino
consultants conducted the assessment from August to
October 2016 using landscape analysis based on
document reviews, focus group discussions, key
informant interviews, inter-sectoral consultations and
validation meetings with a wide range of stakeholders.
The results of the analysis are contained in a separate
document “Situation Analysis of Nutrition.
Plan formulation was participatory, inter-
sectoral, and multi-level. It engaged the participation
of the NNC member agencies and their department
senior officials at the national and regional levels as
well as members of provincial and municipal nutrition
committees of LGUs
C.Nutrition Intervention
C.1. Food and Nutrient Delivery - An individualized
approached for food/nutrient provision including meals
and snacks, enteral.parenteral, nutrition, supplements,
feeding assistance, feeding environment, and
nutrition-related medication management.
C.2.Food Administration
C.2.1. Oral Nutritional Supplements (ONS) are sterile
liquids, semi-solids or powders, which provide macro
and micro nutrients. They are widely used within the
acute and community health settings for individuals
who are unable to meet their nutritional requirements
through oral diet alone.
C.2.2. Enteral nutrition generally refers to any
method of feeding that uses the gastrointestinal (GI)
tract to deliver part or all of a person's caloric
requirements.
Short-term enteral access tubes are placed into the
nares or, sometimes, orally, usually at bedside.
The short-term access provides a means to meet
patient nutrient needs and can provide a chance to
assess tolerance of the tube feedings if more
permanent long-term placement is determined to be
required.
Long-term enteral access options include endoscopic
or surgical gastrostomy tubes.
2 common Types of tubes use in eternal nutrition:
 Gastrostomy tube (G tube).The end of the G
tube is placed through the abdominal wall into
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your child’s stomach. A port remains outside the
child’s body. The G tube is placed so that liquid
food is sent straight into stomach.
 Gastro-jejunum tube (G-J tube).This tube is
often used if your child vomits when large
amounts of food are in the stomach. Like the G
tube, the G-J tube is placed through the
abdominal wall. The end of the G-J tube is put
into part of the small intestine called the jejunum.
A port remains outside the child’s body. The G-J
tube is placed so that liquid food is delivered
straight into your small intestine.
It can include a normal oral diet, the use of liquid
supplements or delivery of part or all of the daily
requirements by use of a tube (tube feeding). .
C2.3. Parenteral nutrition refers to the delivery of
calories and nutrients into a vein. This could be as
simple as carbohydrate calories delivered as simple
sugar in an intravenous solution or all of the required
nutrients could be delivered including carbohydrate,
protein, fat, electrolytes (for example sodium and
potassium), vitamins and trace elements (for example
copper and zinc).
There are many reasons for enteral and parenteral
nutrition including GI disorders such as bowel
obstruction, short bowel syndrome, Crohn's disease,
and ulcerative colitis; as well as certain cancers or in
comatose patients.
D.MONITORING NUTRITIONAL STATUS
1. Strategies to Address Age-Related
Changes Affecting Nutrition
Elderly
 Encourages healthier food choice. Helped your
loved one limit his or her intake of solid fats,
sugars, alcoholic beverages and salt. Suggest
ways to replace less healthy foods with healthier
choices.
 Snacking on healthy foods is a good way to get
extra nutrients and calories between meals. It
may be especially helpful for older adults who
quickly get full at mealtimes.
 Make food taste good again. If on restricted diet,
herb and spices can help restore flavor to bland
foods. Avoid herb or spice blends that are heavy
in salt.
 Consider adding supplements to your loved one’s
diet. He or she may benefit from a supplement
shake or other nutritional supplements.
 Encourage exercise. Even a little bit of exercise
can help improve one’s appetite and keep his or
her bones and muscles strong.
Children
You need to get a variety of foods from the
main groups, including:
 Plenty of fruits and vegetables.
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 Plenty of starchy foods such as bread, rice, CLEAR LIQUID DIET

potatoes, pasta.  Foods that have no or low residue and fat
 Some milk and dairy foods or non-dairy  Nutritionally inadequate
alternatives.  Not to be given more than 2 days unless
 Some sources of protein, such as meat, fish, ordered by doctor
eggs and beans.  Aims to prevent dehydration or to clear the GIT

COLD LIQUID (TONSIL DIET)

SELECTED THERAPEUTIC DIET
What is a Therapeutic Diet?
A therapeutic diet is a meal plan that controls the
intake of certain foods or nutrients. It is part of the
treatment of a medical condition and are normally
prescribed by a physician and planned by a dietician.
A therapeutic diet is usually a modification of a
regular diet.
What disease requires a therapeutic Diet?
 Any liquid that could be served cold and iced
 Aims at giving relief to fresh mouth sores and
surgery
 Not nutritionally adequate
 Prescribed to patients for not more than 2 days
Some tips for Tonsil diet:
 Shift to mechanical soft diet gradually
subsisting on cold liquids and intravenous fluid
 Plan and choose liquid that are good sources of
CHON, CHO, fats, vitamins and minerals

 cardiovascular disease such as coronary artery Designed to attain or maintain optimal nutritional
disease, hypertension, heart attacks, and stroke. status in persons who do not require modified or
Diabetics can benefit from a therapeutic diet as therapeutic diets.
can people with gastrointestinal diseases such as 1. General diet
Crohn's disease, ulcerative colitis and celiac 2. Clear diet
disease. 3. Full Liquid Diet
FACTORS TO BE CONSIDERED IN PLANNING 4. Medical Liquid Diet
THERAPEUTIC DIETS
 The possible duration of the disease. Type of diet that aims at giving relief to fresh
 The factors in the diet which must be altered mouth sores and surgery.
to overcome these conditions. 1. Cap free diet
 The patient's tolerance for food by mouth. 2. Clear Liquid
 The normal diet may be modified too. 3. Cold Diet
4. Balanced Diet
BALANCED DIET - a food preparation which provides
complete nutrients as well as supplies carbohydrates, CONSTIPATING DIET (Anti- diarrhea diet)
proteins, fats, vitamins, minerals and fiber in their  Aids in stool formation
normal proportions.  Recommended to LBM
 Basis for all diet modifications  Combination of low-residue, low fiber & low-fat
 Food preparation that is complete in nutrients diets
in their normal proportions
Some tips on Constipating diet:
Other terms:  Eat low-cellulose veggies
 General Diet  Avoid fatty meats
 Full Diet  Avoid leafy veggies & high fiber fruit temporarily
 Complete Diet  Eat more bananas, apples and star apples
 Eat small frequent meals
Some tips on Balanced diet:  Drink more liquids; boil water
 Eat 3 meals a day instead of frequent ones or  Drink strained juice or fat-free broths as desired
eating between meals.
 Add salt and sugar in the diet
 Establish a regular eating habit
 Avoid milk for at least 2 days
 Eat heavy breakfast, moderate lunch and light
 Gradually change from constipating diet to
supper
usual diet
 Eat food of right kind; at the right time and
interval, in the right amount and the right condition FULL LIQUID DIET
of mind.
 General Liquid Diet
Avoid tea, coffee, alcoholic and carbonated
 Medical Liquid Diet
beverages
Drink at least 8 glasses of water a day between  More liberal diet than clear liquid diet; allows
meals only food on liquid form or those which readily
become liquid at room temp.
BLAND DIET (CAP- free diet)  If planned, may supply a good amount of
 Provides food that are not irritating to the essential nutrients
digestive tract and do not increase acid
production in the stomach Some tips on Full Liquid Diet:
 C – affeine  Don’t give this diet for a long period of time
 A – lcohol  Plan and choose liquids that are good sources
of nutrients
 P – epper
 Use bended straw for convenience

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 Administer this diet in small frequent feedings
 Avoid coffee, tea, alcoholic beverages & soda
drinks
 Avoid coffee, tea, alcoholic beverages & soda
drinks
DIABETIC DIET (Calculated Diet)
 Basically it is a balanced diet measured to
provide the number of exchanges or servings
based on the individual’s caloric requirement.
 Concentrated sweets and simple
carbohydrates are avoided.
 The diabetic diet is high in fiber and low in fat.
Some Tips:
 Consult a licensed nutritionist- dietitian for your
specific nutrient needs
 Ask for a calculated diet plan
 Plan, experiment, and present your diet plan to a
licensed nutritionist-dietitian for approval.
 Do not eat too much or too little
 Avoid sugar and high-sugar containing food items
such as candies, sweets, softdrinks, rich desserts,
chocolates, sweetened juices, ice creams and
cakes.
 Eat a heavy breakfast, moderate lunch, and a
light supper. Sometimes snacks are prescribed.
 Eat regularly
 Increase your fiber intake by including a generous
amount of leafy vegetables daily in your diet.
 Use legumes and whole grains more than
processed meat alternatives. They will help
increase dietary fiber and contain no cholesterol.
 Limit fruits to 3 exchanges per day. The fresher
the better. Processed and refining make natural
sugars in fruits more readily absorbable which
may lead to rapid rise in blood sugar.
 Drink a cup of low-fat milk a day
 Avoid coffee, tea, alcoholic beverages including
wine and liquor.
 Drink 6-8 glasses of water in between meals.
 Apply the low-salt and low-fat diets, and low-
cholesterol diet suggestions. Diabetes may lead
to hypertension and hypercholesterolemia when
uncontrolled.
 Monitor and record your weight and blood sugar.
 Give a good attention to your diet, attitude,
medication and physical activity. Control of blood
sugar is better when these things are well-
balanced.
HIGH CALORIE DIET (Up-building Diet, High
Carbohydrate Diet)
 allows food and drink with an energy value of
50% to 100% above the caloric requirement or
above the actual food intake
Some Tips:
 Increase total food intake by making bigger
servings or adding snacks to make a high calorie
diet.
 Eat in between meals if you are not used of
eating much during regular mealtimes.
 Choose nutritious and wholesome foods for
snacks
 Choose nutritious drinks like fruit juices, fruit
shakes, milk and milk shakes. Avoid coffee, tea,
alcoholic beverages, softdrinks.
 Establish a regular eating habit.
 Eat more fresh fruits.
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 Eat at least one serving of dark green leafy
vegetables a day
 Eat more unrefined, unprocessed foods.
 Drink at least 6 glasses of water in a day in
between meals.
 Include a variety of foods each meal
HIGH-FIBER DIET
 modified balanced diet with higher fiber
content. This is effected by including more
fruits, nuts, vegetables, and whole grains in
meal preparation.
Some Tips:

o Fish, milk, meat and eggs contain no
fiber. It can only be taken from fruits, nuts,
vegetables, cereals, whole grains, and
legumes.
o The more the food is in its natural form
(unrefined), the higher is its fiber
content. Processing reduces fiber content.
o Increase fluid intake. Drink at least 8 – 10
glasses of water daily between meals.
o Eat fruits, vegetables, cereals and grains
with seeds, skin and membrane when
possible.
o Avoid apple, banana, guava, star apple
and the like if you have
constipation. Instead, eat papaya, prunes,
oranges or watermelon.
o Avoid tea, coffee, alcoholic and carbonated
beverages.
HIGH-PROTEIN DIET
o A high-protein diet calls for 1.5 g OF
PROTEIN/KG IDEAL BODY
WEIGHT. This diet is prescribed for growth
and repair such as in pregnancy, tissue
and bone regeneration, inflammatory
conditions and injury.
o Consider not only the amount of protein but
its quality as well, include protein foods
with high biological value.
Some Tips
o Eat enough serving of protein-rich daily.
o Drink at least one glass of milk daily.
o Always eat a balanced diet plus extra protein
– rich
o Drink 6-8 glasses of water daily between
meals.
o Avoid coffee, tea, alcoholic beverages and
softdrinks.
o Eat at least one serving of dark green leafy
vegetables a day.
HYPOALLERGENIC DIET
o Eliminates foods that contain identified
allergens. Allergens are substances causing
allergy.
o The diet depends on the person’s
sensitivity. Individualization is important
because reaction to a certain food may vary
from person to person.
Some tips:
o Avoid foods known to be allergenic
o Include vegetable dish at least twice daily
o Have an “Allergy Diary” to help your
doctor identify allergens
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o Read labels for hidden allergens. LOW-PROTEIN DIET

o Be careful not to be over-
restrictive. You may end up malnourished
o Avoid coffee, tea, alcoholic beverages
and softdrinks. Drink 6-8 glasses of
water between meals
LOW-CHOLESTEROL DIET
o A balanced diet limiting food choices to only
those with little or no cholesterol. This diet is
planned so that cholesterol intake is no more
than 300 mg. per day.
Some Tips:
o Avoid foods high in cholesterol
o Limit all cooked meat up to a maximum of 2
exchanges per day. Cut off fatty portions of
meat.
o Use plant proteins as often as possible in
place of meat. By nature they do not contain
cholesterol.
o Use sparingly polyunsaturated fats such as
corn oil, soybean oil, and peanut oil because
they are cholesterol-free but are fat rich
o Avoid egg and egg products.
o Boil, pan- or oven – broil, or bake food.
o Skim the fat off stews and soups. Avoid
bulalo and gravies
o Eat fruits rather than rich desserts.
o Eat more fruits, vegetables, unrefined cereal,
nuts, and grains. High fiber diet helps in
lowering blood cholesterol.
o Drink 6-8 glasses of water daily. Avoid milk
shakes, chocolate drinks, coffee, tea and
alcoholic beverages.
o Do not overeat.
o Allows a minimal amount of dietary protein
which ranges from 20 to 40 grams per day
Some Tips:
o - Limit protein rich food to 1-2 exchanges
or standard servings per day. Although of
small quantity but should be of high
biological value.
1. Recording and reporting of Nutrition Status
Monitoring
 Provide evidence that the nutrition intervention
is changing / not changing patients behavior
or status?
 Ensure patient understands goals and their
importance. Not doing it “just because”
 Discuss problems questions and concerns with
patients regarding goals.
 Continue on path or needs to change
 Continue to Document, update data to patient’s
file and continue to measure in
order to assess progress.
E. Evaluation:
 The systematic comparison of current findings
with the previous status.
 Compare the current findings to intervention
goals / reference standards and evaluate overall
impact.
 Compare new data to old and compare the
obtained results to the desired goals.
 Assess whether goals are being obtained, and if
they are truly helping to improve the health of
the patient. If not, discuss alternatives.
 Decide to discharge pt. / continue counselling.

LOW FAT DIET

o A low fat diet allows a minimal amount of
dietary fat which comprises < or = 15% of the
total caloric requirement of the person.
o This diet is prescribed to persons with liver
disorder, gallbladder problem, hyperlipidemia
and heart disorder. This is not a No-fat diet
but a low-fat diet.

Some Tips:
o Avoid pork, fatty meats, animal fats and
animal skin
o Substitute meat with fish or legume and grain
combination
o Eat more unrefined or unprocessed foods.
o Drink fruit juices instead of full cream milk,
milk shakes, and chocolate drinks
o Eat fruits instead of rich cakes and sweets for
dessert.
o Use and drink only soymilk, skim, low fat, or
non-fat milk
o Boil, bake or broil as often as desired
o Deep fry rather than fry with little oil when
frying is unavoidable. In deep frying the food
absorbs less oil
o Prefer plain rice over fat-rich bakery products
o Minimize dining out
o Choose low fat soups. Limit creamy soups
o Take note of salad dressings and sauces
o Avoid coffee, tea, alcoholic beverages and
softdrinks. Drink 6-8 glasses of water daily

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CHAPTER 3: NUTRITION FOR HEALTH
AND FITNESS
Good nutrition is an important part of leading a healthy
lifestyle. Combined with physical activity, our diet can
help to reach and maintain a healthy weight, reduce
the risk of chronic diseases (like heart disease and
cancer), and promote overall health.
Frequent studies are indicating healthy food intake as
the most important part of our fitness programs.
Meal planning helps to make the best use of the
material, time and financial resources to obtain meals
that can help to meet the physical, social and
psychological needs of the individual and families.
Dietary Modification and Dietary Therapy
A. General diet ( regular, normal or house diet) - most
fequently used of all diets. Patient’s failure to eat a
normal diet could lead to loss of body tissues and a
prolonged convalescence.
Normally diet may modified for:
 Consistency and texture
 flavor
 energy value
 nutrient such as fats, protiens, carbohydrates,
sodium and others
 food categories such as types of fats or
eliminations diet for allergeis.
B. Diets Modified in Consistency
A modified consistency diet involves the consumption
of foods that have undergone a change in their
consistency. Examples of modifications include
chopped, ground up and pureed foods.
This diet is use for:
Gastro intestinal tract difficulty of swallowing/ chewing,
elderly, babies.
C. Diets Modified in Composition
1. Low Calorie diet
2. High Calorie Diet
3. Low Protein Diet
4. High Protein Diet
5. Low Carbohydrates Diet
6.High Carbohydrates Diet
7. Low sodium Diet
Diet to loose weight
 Low Calorie Diet
Women- lose weight on diets restricted to 1,000-
1,500 calories
Men - lose weight satisfactorily on restricted diet to
1,200-1,800 calories
In obesity, an imbalance occurs between food intake
energy expenditure, which leads to an excess fat
accumulation and negative health consequences.
Losing weight simply means balancing food calorie
intake with the body’s needs for calories.
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1 pound of fat is equivalent to about 3,500
calories. If one has 500 calories less everyday, he/
she will lose about 1lb /week.
As a nurse teach patient “heart healthy meal plan”- to
decrease number of complications of diabets:
coronary heart disease.
 A low fat diet with carbohydrates from whole
grains, fruits and vegetables are recommended.
 Encourage Mediteranian type diet with high
consumption of fiber-rich fruits, legumes,
vegetables, increased intake of monounsaturated
fats, lean meat, low-fat dairy products and
lowered intake of processed meat. The nurse can
suggest brown rice than white rice, whole wheat
flakes or oatmeal than cornflakes.
Low Calorie diet:
 Diet is high in protein than normal -
*provides feeling of satisfaction
* helps correct the greater losses of muscle
tissues that occur during reducing.
 meals should be attractive and palatable.
 meat should be lean, and prepared by boiling,
broiling, roasting and stewing.
 freshed fruits or canned can be unsweetend.
A metabolic disease that affects the endocrine system
of the body and the use of carbohydrates and fats:
1. Diabetes Mellitus
Characteristics of Diet:
 The diet is essentially normal
 sources of CHO should be whole grains, legumes,
vegetables, fruits and milk products.
 Refined sugars and added sugars should be
limited.
 Choose food with low glycemic index.
 Increased omega 3 fatty acids to increase
lipoprotein profile.
 the amounts of food and their distribution in
meals are controlled from day to day. monitoring
of the amount of carbohydrates consumed
remains the key strategy in achieving ideal
glycemic control.
 Overweight diabetics are initially placed on low-
calorie diets.
Food Preparation and Service for Diabetic Diet:
 All food items in the diet are measured according
to the amounts in the food exhange lists. levels
measures with standard measuring cups and
spoons ae used.
 No extra flour, bread crumbs, butter
 meats maybe broiled, baked roasted or stewed
 frozen or canned fruits packed with sugar must
be avoided.
 Concentrated sweets and desserts are avoided:
sugar, candies, jellies, jams, marmalades, syrup,
honey, molasses, softdrinks, cakes cookies, pies,
pastries, sweet rolls. Etc
Foods and beverages that provide about 20 grams of
high- quality protein:
Tuna fish 3oz
chicken (no skin) 3oz
 NCM105
NUTRITION AND DIET THERAPY

Beef lean 2 1/2 oz

Pork lean 3oz Protein Energy-Malnutrition
Egg whites 3 Is a condition resulting from insufficiency of protein or
Yogurt, low fat 1 1/2 cups energy or both in the diet.
skim milk 2 cups
skim milk powder 1/2 cup 2 Forms:
Dried beans (cooked) -1 1/2 cups Marasmus - severe deprivation of food over a long
Protein bar 1-2 period of time characterized by insufficiency of protein
Soybeans, cooked 3/4 cups and energy intake

Kwashiorkor - reflects an abrupt and recent

deprivation of food which develops rapidly as a
consequence of protein deficiency or an illness.

Calculating Diets and Meal Planning

Ex: (2000kcal)

Distribute the total energy allowance among CHO,

CHON and FATS
CHO 50-65% Note: Some books differ in
percentage for macronutrients
CHON 15-20%
FATS <=20-30%

*Corresponding energy distributions of the three

2. Liver Cirrhosis nutrients in your diet are as follows:
 Is a chronic degenerative disease - there is build- Carbohydrates =2000kcal x 0. 50 = 1000kcal
up of fibrous connective tissue replaces the liver Proteins = 2000 kcal x 0.20 = 400 kcal
cells following fatty degeneration. Fats = 2000kcal x 0.30 = 600 kcal
-------------------------
 Causes the liver cells to die and form new cells. = 2000kcal
Scarring can lead to congestion of hepatic *
circulation, contributing to the further decline in Calculate the number of grams of carbohydrates,
liver function. protein and fats by dividing the calories for each by
 Diet Therapy - High CHO Decrease fat and corresponding physiologic fuel values
CHON 1.5g /kg of wt) (4 kcal/g CHO, 4kcal/g protein, 9kcal/g fat)
diets are restricted to 250 mg sodium to control the
edema in the presence of ascites (fluid in the CHO =1000 kcal /4 =250g ( total allocation of
abdomen) carbohydrates per day)
 Patients with liver cirrhosis are often depleted of CHON =400kcal/4 =100g (total allocation of
protein. A protein intake of 100 g. at a sodium protein per day)
level 250mg is possible when low-sodium milk in FATS =600kcal/9 =66.66g 0r 65g (total allocation
the 500 mg sodium, 1800-calorie diet plan is of fats per day)
used.
 Alcohol is strictly forbidden to avoid continued For simplicity and practicality of diet prescription round
irritation and malnutrition. off calories to the
nearest 50, and CHO, CHON and FATS to the
3. Hypertension nearest 5
 Also known as high blood pressure For simplicity and practicality of diet prescription round
 common among males rather than females, 55 off calories to the nearest 50, and CHO, CHON and
years and below. FATS to the nearest 5
 Diet Therapy -DASH diet (Dietary approach to
stop hypertension), low fat diet (7% of kcal) 1. How to round of calories to the nearest 50:
 Mild restriction of sodium.- 1500mg/day Ex: CHO = 1,137.24kcal
 Weight reduction may facilitate lowering of blood CHON = 262.44 kcal
pressure. Fats = 349.93 kcal
 Low-fat diet with emphasis on unsaturated oils is 1,749.61 kcal = 1750 kcal ( 1700
recommended 1,750 1800 1850…. )

Always round off the final answer.

4. Chronic Renal Failure (End Stage Renal Disease) For simplicity and practicality of diet prescription round
Is the decline of kidney function off calories to the
nearest 50, and CHO, CHON and FATS to the
Diet Therapy: nearest 5
 Protein low to moderate according to tolerance:
30-50g
 Carbohydrates relatively high for energy: 300- 2. How to round off to the nearest 5 grams:
400g Ex: CHO = 284.31 g or 285g (80 81 82 83
 Fat relatively moderate: 70-90g 84 85)
 Calories adequate for maintenance to prevent
tissue breakdown: 2,000 - 2,500 g daily CHON = 65.61 g or 65g (65 66 67
68 69 70)
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 NCM105
NUTRITION AND DIET THERAPY

FATS = 38.88 g or 40g ( 35 36 37 38

39 40)

Distribution of CHO, CHON and Fats for every

meal:

CHO =1000 kcal /4 =250g

(total allocation of carbohydrates for 3 meals)

CHON=400/4=100g
(total allocation of protein for 3 meals)

FATS=600/9=66.66g or 65g
(total allocation of fats for 3 meals)

In making meal plan for breakfast, lunch and dinner,

distribute the number of grams per nutrients for each
meal. Since breakfast is the most important meal of
the day you need to allocate 50% for breakfast , 30%
for lunch and 20% for dinner.

Example:
CHO - (250g x.50 =125g (CHO for
breakfast)
(250g x.30= 75g (CHO for lunch)
(250 x .20 = 50g CHO for dinner)

 The same computations for Protein and fats.

Food Exchange List- is a grouping of foods in which

the carbohydrates, protein and fat values are about
equal for the items listed

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 NCM105
NUTRITION AND DIET THERAPY

with out premarket review or research as

CHAPTER 4: LEGAL MANDATES
RELATED TO NUTRITION AND DIET
THERAPY
LEARNING TASK 1: TRENDY DIETS DISCUSSION
Trendy diet/ Fad diet or Novelty diet are very popular
nowadays because it promotes fast weight loss with
magical combinations of foods or ingredients.
Combination diets, rotations diets, and diets where
certain foods are believed to cause weight loss. Often
such diets are accompanied by books written by
celebrities who have nutrition background. Social
Media rise in popularity has opened up an online
forum that’s reflective of our diet culture. While ads
target specific audience wherein being thin
matters. Like for instance Instagram has close 130
million post under the hashtag “Diet & weight
Loss” Scroll through these hash tag and you will find
images of men and women showing off their fit bodies,
before-after weight loss. Many post and ads in the
social media promote the message that thin is
beautiful and its acceptable to try any means to lose
weight.
proof since regulation of dietary supplements
allows for marketing that confines label claims
to normal functions of the body, such as
metabolism, while avoiding a claim of medical
cure. Labels claims that a product boosts
energy and commonly denote that a stimulant
ingredients is part of the product. Stimulants
can increase heart rate and elevate blood
pressure that can lead to fainting, heart
attack and stroke in people taking dietary
supplements.
o Green Tea -a component of many weight loss
product has no significant effect on weight
maintenance.
Adverse events have occurred with some weight loss
supplements that have led to organ failure and even
death. And may interact with prescription drugs that
risk specific individuals such as pregnant women, or
patients with cardiovascular disease.
(Module 5 discussion of Group Vlog)

Other manipulations in diet have been studied that do

not alter energy balance or macronutrient
intake. Eating frequency is often touted as a way to
“boost metabolism” on one hand with more frequent
eating or alternatively cause weight gain because of
snacking, but there is no evidence that eating more
frequently or avoiding snacks is independently linked
to weight management unless total calorie intake is
affected.

The primary factor in successful maintenance of

weight loss is long-term adherence to a diet strategy.
Simpler plans that offer permissive goals, such as
more fruits and vegetables, rather than complicated
plans with restrictive rules as the method to achieving
a specific calorie intake are felt to be helpful in
achieving healthy lifestyle behaviors.

Physical activity - regular physical activity into

lifestyle habits contributes to weight management by
increasing energy expenditures.

Behavior modification that contributed to weight gain

is essential for long term management. The nurse can
assist the patient in identifying personal factors that
contributed to weight gain or regain and engage in
problem-solving solutions.

Medication and dietary supplements -

o Pharmacotherapy for weight loss is used as

an additional approach to weight
management like Ortistat it works by causing
excretion rather than absorption of about one-
third of the dietary fat in a meal. Some
dietary supplements are labels as energy
booster, appetite control, fat burner and
calorie blocker. Such claims can be made

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NCM 106_G
PHARMACOLOGY
CHAPTER 1: FUNDAMENTAL
CONCEPTS OF PHARMACOLOGY
LEARNING TASK 1: UNDERSTANDING
THE FUNDAMENTAL CONCEPTS OF
PHARMACOLOGY
Pharmacology- the branch of medicine concerned
with the uses, effects, and modes of action of drugs.
Paracelsus- is the Father of Pharmacology.
Branch of Pharmacology
 Pharmacodynamics- What the drug does to body
 Pharmacokinetics- What the body does to drug
 Pharmacotherapeutics- The study of the use of
drugs
 Pharmacy-Preparing suitable dosage forms
 Posology-The study of drug dosage
 Toxicology-The study of nature, effects and
detection of poisons
 Dose - Refers to the quantity of drug administered
at one time (ex: 500mg PARACETAMOL)
 Dosage - Refers to the amount of drug that
should be given over time (ex: 500mg
PARACETAMOL three times a day for 3 days)
 Drugs - Dutch droog, meaning dry; are chemical
substances that have an effect on living
organisms.
 Medicines - therapeutic drugs used in the
treatment of diseases.
Naming Drugs in 3 Ways (Drug Nomenclature)
1. Chemical Name - are the scientific names based
on the molecular structure of the drug.
The exact formula of the drug. Describes the drug’s
chemical structure. Includes chemical constitution of
the drugs.
2. Trade Names a commercial name granted by a
naming authority for use in marketing a drug/device
product in a particular jurisdiction.
or,
Brand Names- the brand name is developed by the
company requesting approval for the drug and
identifies it as the exclusive property of that company.
When a drug is under patent protection, the company
markets it under its brand name. Also known as
proprietary name, is chosen by the drug company and
is usually a registered trademark owned by that
specific manufacturer.
3. Generic Name - means the name of a genus. This
term is usually used to name a class or category of
products or services. Common or general name
assigned to the drug; Is the official or non-proprietary
name for the drug.
Cynithhaa
NCM106
PHARMACOLOGY
Nice story to know:
Drug Information
Indications: A list of medical conditions or diseases
for which the drug is meant to be used.
Action: A description of the cellular changes that occur
as a result of the drug.
Contraindication: A list of conditions for which the
drug should not be given.
Cautions: A list of conditions or types of patients that
warrant closer observation for a specific side effects
when given the drug.
Side Effects and Adverse Reactions: A list of
possible unpleasant or dangerous secondary effects,
other than the desired effects. (listing is quite
extensive)
Interactions: A list of other drugs or food that may
alter the effect of the drug and usually should not be
given during the same course of therapy.
Sources Of Drug Information
 Drug Handbook
 Physician Desk Reference (PDR)
 Packet Insert
 Nursing Journal
 Medical Let
 MIMS (Monthly Index of Medical Specialties)
Drug Standards and Legislations
Drug Standards
 Are rules set to assure consumers that they get
what they pay for.
 The law says that all preparations called by the
same drug name must be of uniform strength,
quality and purity.
1906 Pure Food And Drug Act
 First government attempt to establish
consumer protection in the manufacture of
drugs and foods.
 Required all drugs marketed to meet minimal
standards of strength, purity and quality. (US)
Federal Legislations
 The primary purpose of this legislation is to
ensure safety. America’s 1st law to regulate
drugs was the Federal Pure Food and Drug Act
of 1906, which did not include drug
effectiveness and drug safety.

Food and Drug Administration (FDA)
 Concerned with general safety standards in
the production of drugs, foods, and cosmetics.
 Responsible for approval and removal of
products on the market.
1938 Food, Drug and Cosmetic Act
 Establish to prevent adulteration of and tampering
with drugs, food and cosmetics:
 All labels must be accurate and must include the
generic names.
 All new products must be approved by the FDA
before public release.
 “Warning” labels must be present on certain
preparations, for example, “may cause
drowsiness”, may cause “nervousness”, and
“may be habit forming”.
1952: Durham-Humphrey Amendment to the
1938 Act
The Durham-Humphrey Amendment to the Food,
Drug and Cosmetic Act of 1938 distinguished
between drugs that can be sold with or without
prescription and those that should not be refilled
without a new prescription, such as narcotics,
hypnotics, or tranquilizer must be so labelled.
1962: Kefauver-Harris Amendment to the 1938 Act
The Kefauver-Harris amendment to the Food,
Drug and Cosmetic Act of 1938 resulted from the
widely publicized thalidomide tragedy of the 1950s
in which pregnant European woman who
took thalidomide the sedative-hypnotic thalidomide
during the first trimester of pregnancy gave birth to
infants with extreme limb deformities.
The Kefauver-Harris amendment tightened
controls on drug safety, especially experimental
drugs, and required that adverse reactions and
contraindications must be labelled and included in
the literature.
1970: The Controlled Substances Act
 In 1970 The Controlled Substances Act (CSA) of
the comprehensive Drug Abuse Drug Abuse
Prevention and Control Act, Title II, was
passed by Congress.
 This act, designed to remedy the escalating
problem of drug abuse, included several
provisions:
1. The promotion of drug education and
research into the prevention and treatment of
drug dependence;
2. The strengthening of enforcement authority;
3. The establishment of treatment and
rehabilitation facilities;
4. The designation of schedules, or categories,
for controlled substances according to abuse
liability.
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NCM106
PHARMACOLOGY
1978: Drug Regulation Reform Act
This reform act shortened the time in which new
drugs could be developed and marketed.
1992: Drug Relation Act
The regulation were changed to increase the
approval rate of drugs used to treat AIDS and
cancer. The pharmaceutical companies pay a user
fee at the time they file the application for the new
drug. The fee is for the FDA drug approval process.
1997: The Food and Drug Administration
Modernization Act
There are five provisions in this act, which include the
following:
1. review and use of new drugs is accelerated;
2. drugs can be tested in children before
marketing;
3. clinical trial data is necessary for experimental
drug use for serious or life-threatening health
conditions;
4. drug companies are required to give
information on “off-label” drugs (non-FDA
approved drugs) and their uses and costs; and
5. drug companies that plan to discontinue drugs
must inform health professionals and clients at
least 6 months before stopping drug production.
Nurse Practice Act
Every state has its own laws regarding drug
administration by nurses.
 Generally, nurses cannot prescribe or administer
drugs without a health care provider’s order,
but state laws vary. A practicing nurse should
request a copy of the nurse practice act in the
state in which she or he is licensed.
 In some states, a nurse who administers a drug
without a physician’s order is in violation of the
nurse practice act and could have her or his
license revoked.
 In a civil court, the nurse can be prosecuted for
giving the wrong drug or dosage, omitting a
drug dose, or giving the drug by the wrong
route
Nursing Practice Act
 Offenses related to wrong administration of drugs
 RA 9173- An act providing for a more responsive
nursing profession, repealing for the purpose of
RA no. 7164, otherwise known as "The
Philippine Nursing Act of 1991
The legal terms for these offenses are the
following:
 Misfeasance. Negligence; giving the wrong
drug or drug dose that results in the client’s
death
 Nonfeasance. Omission; omitting a drug dose
that results in the client’s death
 Malfeasance. Giving the correct drug but by
the wrong route that results in the client’s death.

CHAPTER 2: DRUG ACTION:
PHARMACEUTIC, PHARMACOKINETIC,
PHARMACODYNAMIC PHASES
I. PHARMACEUTIC PHASE
- otherwise called as "Dissolution"
- first phase of drug action
1. Disintegration- is the breakdown of a tablet into
smaller particles.
2. Dissolution- is the dissolving of the smaller
particles in the GI fluid before absorption.
Rate Limiting - is the time it takes the drug to
disintegrate and dissolve to become available for
the body to absorb it.
Liquid forms of medication can bypass this
process and are more readily available for absorption.
In general, drugs disintegrate and absorb faster in
acidic fluids with a pH of 1 or 2 rather than in alkaline
fluids.
***Enteric Coated Drugs- resist disintegration in
the gastric acid of the stomach, so disintegration does
not occur until the drug reaches the alkaline
environment of the small intestine.
***Do not crush enteric- coated drugs or time
release capsules because it would alter the place and
the time of absorption.
II. PHARMACOKINETICS PHASE
- the process of drug movement to achieve drug
action.
Four Process are:
1. Absorption (Bioavailability)
is the movement of drug particles from GI
tract to body fluids by passive absorption, active
absorption, and pinocytosis.
a. Passive absorption- this occurs mostly by
diffusion; movement from higher concentrations
to lower concentrations. No energy is required
to move across the membranes.
b. Active absorption- this required a carrier such as
an enzyme or protein to move the drug across
the concentration gradient. (water-soluble
drugs)
c. Pinocytosis- a process by which the cells carry
the drug across the membrane by engulfing the
drug particles. Think pack-man!
Cynithhaa
NCM106
PHARMACOLOGY
Factors affecting Drug Absorption
a. Ph Type- Drugs of a slightly acidic nature (ex.
Aspirin and tetracycline) are absorbed well
through the stomach mucosa. Drugs of an
alkaline pH are not absorbed well through the
stomach, but are readily absorbed in the alkaline
environment of the small intestine.
b. Drugs that are lipid soluble (nonionized) are
absorbed faster than water-soluble (ionized
drugs).
c. Blood flow, pain, stress, hunger, fasting, food, and
pH affect drug absorption.
d. Poor circulation as a result of shock,
vasoconstrictor drugs, or disease hampers
absorption.
e. Drugs given intramuscularly are absorbed faster in
muscles that have more blood vessels, such as
the deltoid, than in those that have fewer blood
vessels, such as the gluteal. Subcutaneous
tissue has fewer blood vessels, so absorption is
slower in such tissue.
Bioavailability- the proportion of a drug or other
substance which enters the circulation when
introduced into the body and so is able to have an
active effect.
Factors that alter bioavailability include:
1.Drug form (tablet, capsule, sustained-release,
liquid, transdermal patch, rectal suppository, inhalation)
2.Route of administration (oral, rectal, topical,
parenteral)
3.GI mucosa and motility
4.Food and other drugs
5.Changes in liver metabolism caused by liver
dysfunction or inadequate hepatic blood flow.
2. Distribution
-this is the second pharmacokinetic phase and is
the process by which the drug becomes available
to body fluids and body tissues.
-The movement of a drug from the bloodstream
into the tissues and fluids of the body is also
affected by specific properties of the drug.
- Some drugs pass the “blood-brain barrier” or
the “placental barrier”, whereas others do not.
-Drugs with larger volume of drug distribution
have a longer hal-life and stay in the body
longer.

-Drug distribution is influenced by blood flow, the
drugs affinity to the tissue and protein-
binding effect.
Drugs that are greater than 89% bound to protein are
known as highly protein-bound drugs.
Drugs that are 61%-89% bound to protein
are moderately highly protein-bound.
Drugs that are 30%-60% bound to protein
are moderately protein-bound.
Drugs that are less than 30% bound to protein are low
protein –bound drugs.
***The thing to remember is, the more the drug is
bound to protein, and it creates less of a “free drug” to
cause a pharmacologic response.
3. Metabolism (Biotransformation)
- this is the third pharmacokinetic phase.
-primary site of drug metabolism is in the "Liver".
- When transformed in the liver
(biotransformation), a drug is broken down and altered
to more water-soluble by products. Thus, the drug
may be more easily excreted by the kidneys.
- Most drug are are inactivated by liver enzymes
and are then converted or transformed by
hepatic enzymes to inactive metabolites or water
soluble substances for easy excretion.
Half-life (t1/2) is the time it takes for one half of the
drug concentration to be eliminated. Thus, metabolism
and elimination affect the half-life of a drug.
Aspirin 650mg and half-life is 3hours
***after 3 hours Aspirin 325mg is eliminated,
***after 6 hours Aspirin 162mg, and so on.....
Note: Short half-life is 4-8 hours, and long one is
24hours. If the drug has long half-lifem it takes several
days for the body to completely eliminate the drug.
4. Excretion/Elimination
This is the fourth and final pharmacokinetic phase.
- the main route of drug elimination is through the
"Kidneys" (Urine)
Other Elimination Routes:
a. bile
b. lungs
c. saliva
Cynithhaa
NCM106
PHARMACOLOGY
d. sweat
e. breastmilk
-If a drug is not excreted properly before repeated
doses are given, a cumulative effect may eventually
occur.
Cumulative effect
- is an increased effect of a drug demonstrated
when repeated doses accumulate in the body.
Toxicity
- refers to a condition that results from exposure to
either a poison or a dangerous amount of a drug
that is normally safe when given in a smaller
amount.
Creatinine Clearance
- most accurate test to determine renal function.
-when creatinine clearance is decreased, drug
dosage likewise may need to be decreased.
-this is usually perform by collecting the urine for 12-
24 hours and a blood sample
-normal level is 85 to 135ml/min
***Nurse assessment for possible adverse drug
effects is very important in the phase.
III. Effects of Drugs
1. Systemic effect
Reaches widespread areas of the body (ex.
Acetaminophen (Tylenol) suppository, although given
rectally, has the ability to be absorbed and distributed
throughout the body to cause a general reduction in
fever and pain)
2. Local Effect
Is limited to the area of the body where it is
administered (ex. Dibucaine ointment (Nupercainal),
applied rectally affects only the rectal mucosa to
reduce hemorrhoidal pain).
Other Variables affecting Drug Processes
A. Age
Metabolism and excretion are slower in older
adults, and therefore attention must be paid to
possible cumulative effects. Children have a lower
threshold of response and react more rapidly and
sometimes in unexpected ways; therefore, frequent
assessment is imperative.
B. Weight
Generally, the bigger the person, the greater the
dose should be. However, there is a great individual
variation in sensitivity to drugs. Many drug dosages
 NCM106
PHARMACOLOGY

are always calculated on the basis of the patient’s 3. Paradoxical

weight.
Opposite effect from that expected
C. Sex
4. Hypersensitivity
Women respond differently than men to some
drugs. The ratio of fat per body mass differs, and so  Immune response (allergy) to a drug may be of
do hormone levels. If the female is pregnant or varying degrees.
nursing, most drugs are contraindicated, or the
dosage must be adjusted.  Maybe mild with no immediate effects; rash or
hives may appear after three to four days of drug
D. Psychological State therapy

It has been proven that the more positive the
patient feels about the medication he or she is taking,
the more positive the physical response. This is
referred to as the placebo effect.
 May develop after uneventful previous uses of a
drug
 More likely to exist in patients with other known
allergies

IV. Pharmacodynamics- is the science dealing with

interactions between chemical components of living 5. Anaphylactic Reaction
systems and the foreign chemicals, including drugs.
 severe, possibly fatal, allergic response
Drug Interactions
 Drugs usually work in one of four ways:
Whenever more than one drug is taken, it is
possible that the combination may alter the normal  Categories of Drug Action
expected response of each individual drug. One drug
may interact with another to increase, or cancel out
the effects of the other.
1.Stimulation or depression

The rate of cell activity or the secretion from a gland

The following terms are used to describe drug increases.
interactions:
In drug action that depresses, cell activity and function
1. Synergism of a specific organ are reduced.

The action of two drugs working together in which one 2.Replacement

helps the other simultaneously for an effect that
neither could produce alone. Drugs that work together
are said to be synergistic.
2. Potentiation/Additive
The action of two drugs in which one prolongs or
multiplies the effect of the other. Drug A may be said
to potentiate the effect of drug
3. Antagonism
The opposing action of two drugs in which one
decreases or cancels out the effect of the other. Drug
A may be referred to as an antagonist of Drug B.
Example, insulin replace essential body compounds
3. Inhibition
drugs that inhibit or kill organisms interfere with
bacterial cell growth ( penicillin exerts its bacterial
effects by blocking the synthesis of bacterial cell wall)
4. Irritation
Drugs can also act by mechanism of irritation
(laxatives irritate the inner wall of the colon, thus
increasing peristalsis and defecation)

Unexpected Responses to Drugs

1. Teratogenic Effect

Effect from maternal drug administration that causes

the development of the physical defects in fetus

2. Idiosyncrasy

Unique, unusual response to a drug

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 NCM107
CARE OF MOTHER, CHILD, AND ADOLESCENT

NCM107
CARE OF MOTHER, CHILD AND QSEN Competencies Required for MCN
1. Patient Centered
ADOLESCENT 2. Teamwork & Collaboration
3. Evidence- Based Practice
CHAPTER 1: FRAMEWORK FOR 4. Quality Improvement
5. Safety
MATERNAL AND CHILD HEALTH
6. Informatics
NURSING
4. Research
Nursing Research
LEARNING TASK 1: GOALS AND
 the systematic investigation of problems that
PHILOSOPHIES OF MATERNAL AND
have implications for nursing practice usually
CHILD HEALTH NURSING carried out by nurses.
 Nursing Research can influence nursing
Primary Goal :Promotion and maintenance of practice
optimal family health.Scope of practice:
a. Preconception health care Maternal and Child Health Goals and Standard

b. Care of women during the three trimesters of  the UN and the WHO established a millennium
pregnancy and the p health goals in an effort to improve health
c. Care of infants during the perinatal period. worldwide.
D. Care of children from birth to late  established in 2000 and reviewed every 10 Years.
adolescentoduerperiume  The two main national health goals set every 10
e. Care in a variety of hospital and home care settings. years :
.
Philosophy of Maternal and Child Health Nursing 1. To increase quality and years of healthy life
2. To eliminate health disparities
1. Family centered
2. Community centered
3. Evidence based Global Health Goals:
4. Challenging role for nurses  To end poverty and hunger.
 To achieve universal primary education.
 To promote gender equality and empower
women.
MCN can be visualized within a framework in  To reduce child mortality.
which nurses use the:  To improve maternal health.
1. Nursing Process  To combat HIV/AIDS, malaria, and other
2. Nursing Theory and diseases.
3. Quality and Safety Education for Nurses  To ensure environmental sustainability.
( QSEN ) competencies and Research to  To develop a global partnership for
care for families during the childbearing and development.
childrearing years.
4. And through the Four Phases of Health Care A new objective added in 2010
 Recommends that 100% of prelicensure
programs in nursing must include:
FOUR PHASES OF HEALTH CARE  core content on counseling for health
1. Nursing Process
promotion and disease prevention
 a scientific form of solving nursing problem.
 cultural diversity including for (LGBT)
 serves as the basis for assessing, formulating
populations
a nursing diagnosis, planning, implementing and
 evaluation of health sciences literature
evaluating care.
 environmental health, public health systems
and global health
2. Nursing Theories
The 2020 National Health Goals are intended:
 Are designed to offer helpful ways to view
1. To help citizen more easily understand the
patients so nursing activities can be created to
importance of health promotion and disease
best meet patient’s needs:
prevention.
1. Calistra Roy’s theory 2. To encourage wide participation in improving
2. Dorothea Orem’s theory health in the next decade.
3. Patricia Benner’s theory
3. Quality and Safety Education for Nurses (QSEN) Roles and responsibilities of maternal and child
nurse
 the goal of this QSEN is to address the challenge 1. Considers the family as a whole and as a
of preparing future nurses with the abilities partner in care when planning or
necessary implementing or evaluating the effectiveness
 to continuously improve the quality and safety of of care.
the health care systems in which they work

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2. Serves as an advocate to protect the rights of

all family members including the fetus.
3. Demonstrates a high degree of independent
nursing functions.
4. Promotes health and disease prevention
5. Serves as an important resource for families
during childbearing and child-rearing.
6. Respects personal, cultural and spiritual
attitudes and beliefs.
7. Encourages developmental stimulation during
both health and illness.
8. Assesses family for strengths as well as
specific needs or challenges.
9. Encourages family bonding through rooming in
and family visiting in maternal and child
healthcare setting.
10. Encourages early hospital discharge options
to reunite families as soon as possible.
Encourages families to reach out to their
community.
17 SUSTAINABLE DEVELOPMENT GOALS
Goal 10: Reduced Inequalities - Reduce inequality
within and among countries
Goal 11: Sustainable Cities and Communities -
Make cities and human settlements inclusive, safe,
resilient and sustainable
Goal 12: Responsible Consumption - Ensure
sustainable consumption and production patterns
Goal 13: Climate Action - Take urgent action to
combat climate change and its impacts
Goal 14: Life Below the Water - Conserve and
sustainably use the oceans, seas and marine
resources for sustainable development
Goal 15: Life on Land - Protect, restore and promote
sustainable use of terrestrial ecosystems,
sustainably manage forests, combat desertification,
and halt and reverse land degradation and halt
biodiversity loss

Goal 16: Peace, Justice and Strong Institutions -

Promote peaceful and inclusive societies for
sustainable development, provide access to justice
for all and build effective, accountable and inclusive
institutions at all levels

Goal 17: Partnerships for the Goals - Strengthen

the means of implementation and revitalize the
global partnership for sustainable development

Goal 1: No poverty - End poverty in all its forms

everywhere

Goal 2: No Hunger - End hunger, achieve food

security and improved nutrition and promote
sustainable agriculture

Goal 3: Good Health - Ensure healthy lives and

promote well-being for all at all ages

Goal 4: Quality Education - Ensure inclusive and

equitable quality education and promote lifelong
learning opportunities for all

Goal 5: Gender Equality - Achieve gender equality

and empower all women and girls

Goal 6: Clean Water an Sanitation -Ensure

availability and sustainable management of water and
sanitation for all

Goal 7: Affordable and Clean Energy - Ensure

access to affordable, reliable, sustainable and
modern energy for all

Goal 8: Good Jobs and Economic Growth -

Promote sustained, inclusive and
sustainable economic growth, full and productive
employment and decent work for all

Goal 9: Innovation and Infrastructure - Build

resilient infrastructure, promote inclusive and
sustainable industrialization and foster innovation

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CHAPTER 2: REPRODUCTIVE AND 3. Labia Minora (smaller lips)

SEXUAL HEALTH
hairless folds of tissue within the labia majora,
extending from clitoris to the fourchette

LEARNING TASK 1: PROCREATIVE 4. Clitoris

HEALTH
PROCREATION
process that permits two living beings to produce a
third one that is different from each of them
5. Vestibule
REPRODUCTION
is the biological process by which new individual
organisms are produced.
The known methods of reproduction are broadly
grouped into two main types: sexual and asexual.
ASEXUAL REPRODUCTION
an individual can reproduce without involvement with
another individual of that species.
6. Fourchette
o small ( approx 1-2 cm ) rounded organ of erectile
tissue at the upper end of labia minora
o Prepuce - Skin covering
o Smegma - epidermal secretion with strong odor
o almond-shape space between the labia minora,
clitoris and fourchette
o contains structures:
a. Urethral meatus - Skene’s glands
(paraurethral glands )
b. Vaginal introitus- Bartholin’s glands
(vulvovaginal glands )
c. Hymen – crescent-shaped membrane

SEXUAL REPRODUCTION o thin fold of tissue formed where labia

minora meet
requires the involvement of two individuals, typically o Episiotomy site:
one of each sex.
During production in humans, each parent transmits
to the child one of the two copies of his or her A. INTERNAL GENITALIA
genetic material, located on the parent’s 23 pairs of
chromosomes .
1. Vagina
The transfer is made by the parent’s gametes ,
reproductive cells that contain only 23 o organ of copulation / “birth canal”
chromosomes as a result of a special kind of cell o hollow, musculomembranous canal
division : meiosis. o (8-12 cm) 4cm diameter
o Fornix

LEARNING TASK 2: REPRODUCTIVE o anterior, posterior and lateral

SYSTEM o space surrounding the cervix

Reproductive System o Doderlein’s bacilli- keep vagina acidic

Female Reproductive System
o Functions of the Vagina:
External Genitalia
1. Organ of copulation
 Collectively called Vulva (Pudenda)
 Refers to the externally visible structure of the
2. Passage in delivery & menstrual blood
female reproductive system extending 3. Secretory duct during menstruation
from symphysis pubis to the perineum

2. Uterus
1. Mons Pubis (mons veneris) - fatty pad over the
symphysis pubis; cushions & protects pubic bone
o “the womb”
o pear-shaped, hollow muscular organ
o anteverted, directed forward 7-8 cm long
2. Labia Majora (labium majus)
o Functions of the uterus:
o longitudinal folds of pigmented skin extending 1. menstruation
from mons pubis to the perineum; covered with 2. environment for pregnancy
thick, curly hair 3. labor & delivery
o Escutcheon
o Layers:
1. perimetrium/parametrium
o outermost

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2. myometrium 2. Secretion of hormones

o middle layer o Estrogen
o layers of smooth muscle fibers that o Progesterone
interlaces
o contraction *Pelvis – passageway of fetus
o “living ligature”
3. Endometrium  formed by:
o innermost  the innominate bones
o rich in gland and blood vessels o ilium (crest of ilium)
o sloughs off as menstruation o ischium (ischial tuberosity)
o pubis
o Parts of Uterus:  sacrum - wedge shaped, forms the back part
1. Corpus (body) of the pelvis
o main contractile portion  coccyx
o forms bulk of muscles
o uppermost part (FUNDUS)  Pelvic sections:
o Important role of fundus in OB:
2. Isthmus  false pelvis
o joins the corpus to the cervix o larger, shallow
o contains uterine canal o lies above the inlet
o aids in supporting abdominal viscera
3. Cervix
 true pelvis
o forms the main opening of the uterus o low, deep
o pelvic inlet - entrance to the true pelvis
o midpelvis - mid portion of pelvis; contains
o 2-4 cm long
ischial spine
o operculum
o pelvic outlet - exit of the true pelvis
o internal os - opens into uterine cavity * Linea Terminalis
o external os - opens into vagina

Measurements:
Uterine ligaments:

 Broad - 2 wing-like structures that extends from  Diagonal conjugate

the lateral margin to the uterus to the pelvic walls
 Round - 2 fibrous cords from the uterine walls o anterior sacral promontory to
that helps hold the uterus in its forward position the INFERIOR margin of symphysis pubis
 Uterosacral - 2 cord-like folds of the peritoneum o 12.5 – 13 cm
from the lower cervix to the sacrum
 True conjugate
*Transverse – Mackenrodt’s Ligaments (or Cardinal
Ligaments) o Conjugate Vera
o from anterior sacral promontory to
4. Fallopian tubes “salphinges” the SUPERIOR margin of symphysis pubis
o 11 – 11.5 cm
o serves as a passageway for the expelled ovum
o 10-12 cm long  Obstetric Conjugate
o Sacral promontory to INNER SURFACE of
o Parts: symphysis pubis
a. interstitial - part of tube that lies in the o 10.5 - 11 cm
uterine wall
b. isthmus - part that is cut or sealed during  Biischial diameter
tubal ligation; attach tube to uterus
c. ampulla- site of fertilization o distance between ischial spines
d. infundibulum o 10 cm
o most distal portion
o its funnel-shaped opening encircled
 Tuberischial diameter
with

*FIMBRIAE - finger-like projections which anchor o transverse diameter of outlet 8 cm

the ovary to the fallopian tube

5. Ovaries Breast - Mammary Glands

Parts:
o female gonads
o the sex glands sized and shaped like almonds 1. Acini cells -- milk-producing cells
o Functions: 2. Collecting duct/ Lactiferous duct
1. Ovulation 3. Lactiferous sinus – storage

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4. Nipples o passes the prostate gland

Areola - * Montgomery’s Tubercles 5. Accessory structures

Hormones:
o Seminal vesicles
 Prolactin - hormone for milk production
 Oxytocin - hormone for milk expression  located along the lower posterior surface
of the bladder
 30% semen produced

Male Reproductive System o Prostate gland

A. External Genitalia
 surrounds the prostatic urethra
1.Mons pubis - area over symphysis pubis  60% semen produced
2.Penis - organ of urination & copulation
o Bulbourethral gland
o Shaft
 corpus spongiosum
 corpus cavernosa  Cowper’s gland
o Glans penis - distal end of organ  located below the prostate
o Prepuce - protects glans at birth  5% semen production

3. Scrotum 6. Urethra

o wrinkled pouch of thin skin, covering a tight o passageway for urine and semen
muscle o 18-20 cm hollow tube
o protects the testes from trauma and changes in
temperature
o Cremasteric reflex Semen (seminal fluid)
o protect testes and maintain the temperature of
the testes 2 degrees lower than body  thick, whitish fluid ejaculated by the man during
temperature.
orgasm
 Alkaline
 mixture of secretion from epididymis, seminal
B. INTERNAL GENITALIA vesicle, prostate, and bulbourethral gland.

1. Testes
Major constituents of semen:
o male sex glands or gonads
o 2-3 cm wide that lie in the scrotum  Sperm
o Parts:  Fructose
 semineferous tubules  Clotting and anticoagulant factors
o site of spermatogenesis  Prostaglandins
 Leydig’s / interstitial cells
o secretes testosterone  Spermine
 Sertoli cells

o provide nourishment to the sperm
2. Epididymis
Prostaglandins
o storage site for maturing sperm
o approx 20 ft. long
o it absorbs about 90% of the fluid secreted by
the testis
o sperm remain stored here for 40-60 days and
are absorbed if not ejaculated prior to that time.
 Sperm cells from epididymis are present at a
count of 50-120 million sperm/ml
 < 20-25 million/ml = infertility (sterility)
 produced by the prostate and seminal
vesicles
 stimulate peristaltic contractions of the female
reproductive tract that may help draw semen
into the uterus.

3. Vas deferens/ Ductus deferens Spermine

o passage way for sperm from epididymis is a base that reduces acidity of the female
to seminal vesicles vagina, increasing the survival rate of sperm.
o Vasectomy
Secondary sex characteristics
4. Ejaculatory duct Features not essential for reproduction but
attract the sexes to each other.
o allows the sperm to enter the urethra and then
exit the body Male Sexual Response

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the female vagina\ and gradually turned into “corpus
 ejaculation, expelling semen into the vagina albicans” (white body).
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4. Uterus: (Undergo uterine changes)
 Initiated by sympathetic nerve impulses
 The ducts and accessory glands contract,
o The Changes has Four
emptying their contents into the urethra.
Phases:
 The urethral sphincters constrict.
 The bulbospongiosus muscles of the penis
contract rapidly and rhythmically, propelling A. First phase (Proliferative)
semen from the urethra
 immediately after menstrual flow, first
Fate of sperm cells 4-5 days of the cycle
Capacitated:  also called Estrogenic, Follicular,
 viable for 2 days (egg: 12-24 hr) or Postmenstrual.
 only ~ 100 reach the destination.
 only one sperm fertilizes the egg B. Second Phase (Secretory)

Refractory Period  6-14 days

 a period following ejaculation and lasting  also termed as Progestational, Luteal,
anywhere from 10 minutes to a few hours Premenstrual.
 impossible to attain another erection and  the lining of the endometrium is rich
orgasm with capillaries and thick, vascular,
spongy layers

C. Third phase (Ischemic)

LEARNING TASK 3: PHYSIOLOGY OF  15-28 days
MENSTRUATION  at 8- 10 days, the corpus luteum
begins to regress
Menstruation – periodic shedding of blood, mucus &  the endometrium of the uterus
epithelial cells from uterus begins to degenerate (app. at
day 24 or 25 of the cycle)
Menstrual Cycle  Capillaries rupture

 Time between the beginning of one period & D. Fourth phase (Menses)
beginning of next period.
 Menstrual cycles begin at menarche and end with
 actual menstrual flow - which is
menopause.
the end of a defined menstrual
 An episodic uterine bleeding in response to cyclic
cycle
hormonal changes
 the only external marker of
 Purpose: bring ovum to maturity & renew uterine
the cycle,
tissue bed responsible for its growth.

Components of Menstrual Flow:

 Four Structures Involve: o Blood

o Mucin
1. Hypothalamus: Releases the GnRH o Fragments of endometrial tissue
2. Pituitary Gland: Anterior Pituitary gland o Atrophied and unfertilized ovum

o Adenohypophysis  Characteristics of Menstrual Cycle

o Produces Two hormones: FSH & LH
o Average length – 28 days
3. Ovary: Premordial follicles is o Average flow – 2-7 days
activated by FSH until it matures termed o Normal color – dark red
as Graafian follicle. With the increase of o Average flow – 30-80 ml.
LH from the PG – “Ovulation” takes place o Menarche – first menstrual period
(on the 14 day). o Menopause – marks end of reproductive life
as a result of estrogen depletion
o Corpus luteum - o Climacteric – transitional period during which
yellow body produces lutein which ovarian function & hormonal production
is rich with Progesterone decline (35y/o)
o if with fertilization, corpus
luteum remains for 16 to 20 weeks of
gestation
o if fertilization does not occur ,
the unfertilized ovum atrophies after 4-
5 days and the corpus luteum

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LEARNING TASK 4: OVARIAN CYCLE 3. ORGASM - 3rd stage climax

Ovulation
 expulsion of an ovum from the ovary on
spontaneous rupture of a mature follicle as a
result of cyclic ovarian and pituitary endocrine
function.
 It usually occurs on the fourteenth day after the
Women  female has no refractory period
Men  REFRACTORY PERIOD: ( 30 min )
WOMEN  strong vaginal contractions
 (8-15 contractions at interval of 0.8’’)
MEN  occurrence of ejaculation (3-7 propulsive
ejaculatory contractions at same interval
with women)
 shortest stage of sexual response cycle
4. RESOLUTION - 4th stage - phase of relaxation
 the reproductive organs return to their
unstimulated state

first day of the last menstrual period and often

causes brief, sharp lower abdominal pain on the
side of the ovulating ovary
 rupture of graafian follicle & formation of the ovum
 occurs 14 days before the onset of menstruation

 28 day cycle
 20 day cycle
 45 day cycle

o that leads to arterial dilation and venous

constriction in the genital area;
o with resulting vasocongestion and increasing
muscular tension

LEARNING TASK 5: SEXUAL RESPONSE

PATTERN

1. EXCITEMENT - 1st phase

 Physical & Psychological stimulation causes

parasympathetic nerve stimulation

o that leads to arterial dilation and venous

constriction in the genital area;

with resulting vasocongestion and increasing

muscular tension
WOMEN  vaginal lubrication
 vaginal barrel lengthens and distends
 cervix and fundus are pulled upward
 clitoris increase in size

MEN  erection
 scrotal skin becomes congested and
thick

BOTH there is an increase HR, RR and BP

2. PLATEAU – 2nd stage; the entry & coitus

phase

WOMEN  clitoris retracts under the hood

 vagina becomes greatly engorged along
with labia minora
MEN  pre-orgasmic emission
 testes continues to elevate until they are
situated close to the body to facilitate
ejaculatory pressure

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CHAPTER 3: PREGNANCY Second Trimester

LEARNING TASK 1: DEFINITION OF
TERMS
Definition of terms:
Para - the number of pregnancies that have reached
viability, regardless of whether the infants were born
alive
Gravida - a woman who is or has been pregnant
Primipara - a woman who has given birth to one child
past age of viability
Primigravida - a woman who is pregnant for the first
time
Multigravida - a woman who has been pregnant
previously
Grand multipara - a woman who has carried five or
more pregnancies
Multipara - a woman who has carried two or more
pregnancies to viability
Nulligravida - a woman who has never been and is not
currently pregnant
- alternate feelings of emotional well being and lability
- acceptance of pregnancy
- possible increase in sex drive
- adjustment to change in body image
The Psychological Tasks of Pregnancy:
- Accepting the fetus
- “A baby is growing inside me”
Third Trimester
- feelings of awkwardness & clumsiness
- fears & tension about labor
- spurt of energy during the last month.
The Psychological Tasks of Pregnancy:
- Preparing for parenthood
- preparing the baby and end of pregnancy
- arranging for infant’s care
- developing economic patterns
- reevaluation of household assignments
- acquisition of knowledge about pregnancy, childbirth
and parenthood
- expectant father
C. Physiologic Changes of Pregnancy
1. Breasts
- increase in size
- enlarged Montgomery’s tubercles
- veins become prominent
- precolostrums can be expressed from nipples as
early as 12th-14th weeks

LEARNING TASK 2: MATERNAL 2. Uterus

ADAPTATION DURING PREGNANCY - increase in vascularity
- presence Hegar’s sign
A. Diagnosis of Pregnancy (Affirmation & - enlarged (50 to 1000 grams)
confirmation of Pregnancy) - amenorrhea

Presumptive Signs: 3. Cervix

▪ Amenorrhea ▪ Quickening - formation of mucus plug or operculum
▪ Fatigue ▪ Breast changes - presence of Goodell’s sign
▪ Uterine enlargement ▪ Nausea & Vomiting
▪ Urinary Frequency ▪ Darkening of face,breast 4. Vagina
and abdomen - Chadwick’s sign
- Leukorrhea - whitish, viscuous vaginal discharge or
Probable Signs: an
▪ Uterine changes: increase in the amount of normal vaginal secretions.
- Chadwick
- Goodell’s 5. Cardiovascular System
- Hegar’s - increase in blood volume
▪ Enlargement of uterus ▪ Pregnancy Test - increase in cardiac output
▪ Ballottement ▪ Braxton Hicks - varicosities
- supine hypotension
Positive Signs: - edema of lower extremities
▪ Demonstration of a fetal heart separate from the - palpitations
mother’s - physiologic anemia
▪ Fetal movements felt by an examiner - increase in WBC, fibrinogen
▪ Visualization of the fetus by ultrasound - heart rate increases 10- 15 beats / min.

B. Psychological Changes of Pregnancy 6. Respiratory System

First trimester - increase O2 demand
- ambivalence - dyspnea
- fear - displacement of the diaphragm
- fantasies about motherhood & about having a - nasal stuffiness & or congestion
“dreamchild”
- possible decrease in sex drive 7. Gastrointestinal System
- Morning sickness and Pyrosis
- Ptyalism
The Psychological Tasks of Pregnancy: - Softening of gums
- Accepting the pregnancy - Pica
- “I am pregnant” - Constipation
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▪ HYALURONIDASE
8. Urinary System - proteolytic enzyme released by the spermatozoa
- urinary stasis - acts to dissolve layer of cells protecting the ovum
- urinary frequency • corona radiata – cells that encircles the zona
- asymptomatic bacteriuria pellucida
- reduced bladder tone • zona pellucida – protective covering of the ovum

9. Musculoskeletal System FERTILIZATION / CONCEPTION /

- lordosis (pride of pregnancy) IMPREGNATION
- characteristics waddle
- diastasis recti – overstretching & separation of the - the beginning of pregnancy
abdominal vasculature - the union of ovum and sperm
- zona reaction - ovum becomes impenetrable to other
10. Integumentary System sperm
- chloasma/melasma - fertilization is never a certain occurrence because it
- linea nigra depends on at least three separate factors:
- striae gravidarum - Equal maturation of both sperm and ovum
- erythematous changes on palms and face - Ability of the sperm to reach the ovum
- diaphoresis - Ability of the sperm to penetrate the zona pellucida
11. Endocrine System and
- Secretion of estrogen and progesterone by the cell
corpus luteum during the first 3 months membrane and achieve fertilization
- slight hyperthyroidism and hyperplasia of the thyroid • life span of ovum – 24-48 hours
gland • life span of sperm – 48-72 hours
- increased size of parathyroid
- increased melanocyte stimulating hormone
- addition of the placenta as an endocrine gland
- gradual increase of Insulin
- increase BMR
- suppression of FSH/LH
- increase production of growth hormone
- production of Oxytocin late in pregnancy
- production of Prolactin

COUVADE SYNDROME
- group of physiological & behavioral manifestation
experienced by the husband
- are often the result of
stress, anxiety & empathy for the pregnant women • Sex Determination
▪ ovum – 23 chromosomes:
LEARNING TASK 3: PROCESS OF • 22 autosomes
PREGNANCY (STAGES OF FETAL • 1 x sex chromosome
DEVELOPMENT) ▪ sperm – 23 chromosome:
Typically Divided into Three Periods: • 22 autosomes
1. Preembryonic • 1 x or y sex chromosome
2. Embryonic • Zygote
3. Fetal - fertilized ovum to implantation
- single cell, the product of fertilization
Common Terms Used to Describe Fetal Growth:
1. Ovum - from ovulation to fertilization 3. Implantation
2. Zygote - from fertilization to implantation - Takes 8-10 days after fertilization
3. Embryo - from implantation to 5- 8 weeks - Zygote migrates at 3-4 days toward the body of the
4. Fetus - from 5-8 weeks until term uterus
5. Conceptus - developing embryo and placental - (+) mitotic cell division = Cleavage [24h]
structures throughout pregnancy
6. Age of viability - the earliest age at which fetuses a. Blastomere – 2nd day
survive if they are born is generally accepted as 24 b. Morula – 3rd day
weeks or at the point a fetus weighs more than 16-50 cells “mulberry”
500–600 g c. Blastocyst
- 4th day
1. Prefertilization - signals differentiation of embryo
- ovum moves to the ampulla by means of peristaltic - mass of cells form to a periphery with fluid space
movement Trophoblast – outer portion
- sperms move into the ampulla by means of their tail Embryoblast – inner portion
▪ before the sperm can penetrate the ovum, the cap
must • By the 3 rd or 4 th day of free floating ( 7-10 days )
be removed - the blastocyst brushes against the uterine
▪ capacitation – physiologic removal of the acrosome endometrium called “Apposition”
❑ final process that sperm must undergo to be ready - then attaches to endometrium called “ Adhesion”
for fertilization - and finally settles down into the soft folds of the
▪ Acrosome Reaction endometrium called “ Invasion “ Implantation - the

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process wherein the zygote burrows into the
endometrium.
D. Embryonic and Fetal Structures
The Decidua
• because of the influence of human chorionic
gonadotropin (HCG), a hormone secreted by the
trophoblast cells, the corpus Luteum continues to
function after fertilization.
• the endometrium, instead of sloughing off, continues
to grow in thickness and vascularity. It is now called
Decidua.
Chorionic Villi
– fingerlike projections that reach out from the
trophoblast cells into the uterine endometrium to begin
formation of the placenta.
– this is about the 11th or 12th day after fertilization
– at term nearly 200 are formed
The Placenta
• arises out of the trophoblast tissue (fusion of
chorionic villi and decidua basalis
• endocrine organ throughout pregnancy
• functions of the Placenta:
Endocrine Function of the Placenta:
1. Human Chorionic Gonadotropin
- first hormone to be produced by placenta
- present in maternal blood and urine as early as
before the first missed menstrual period (on the 6th or
7th day after implantation) and its peak level @ about
16th day of pregnancy then diminished its level by the
20th week
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- Functions:
▪ hCG’s purpose is to act as a fail-safe measure to
ensure the corpus luteum of the ovary continues to
produce progesterone and estrogen so the
endometrium of the uterus is maintained.
▪ hCG also may play a role in suppressing the
maternal immunologic response so placental tissue is
not detected and rejected as a foreign substance
2. Estrogen (estriol)
– Functions:
▪ contributes to the development of mammary gland in
preparation for lactation after birth
▪ stimulates the uterus to grow to accommodate the
developing fetus
3. Progesterone
– Functions:
▪ maintains the endometrial lining for its growth
▪ reduce the contractility of the uterus during
pregnancy,thus preventing premature labor.
4. Human Placental Lactogen
– Functions:
▪ both growth-promoting and with lactogenic
properties (milk producing)
▪ regulates maternal glucose, protein and fat levels to
ensure adequate amount of these are always
available to the fetus.
E. Origin and Development of Organ Systems
1. The Membrane
The chorionic villi on the medial surface of the
trophoblast gradually thin and leave the medial
surface of the smooth structure which eventually
becomes the chorionic membrane
Function:
▪ Support the sac that contains amniotic fluid
Amniotic Membrane/ Amnion
Functions:
▪ offer support to the amniotic fluid.
▪ produces the amniotic fluid.
▪ it produces a phospholipids that initiates the
formation of prostaglandins
2. The Amniotic Membranes
• dual-walled sac with the chorion as the outmost part
and the amnion as the innermost part
• the two fuse together as the pregnancy progresses,
and by term, they appear to be a single sac.
3. The Amniotic Fluid
The most important purpose of amniotic fluid is:
- to shield the fetus against pressure or a blow to the
mother’s abdomen.
- because liquid changes temperature more slowly
than air, it also protects the fetus from changes in
temperature.
- it aids in muscular development, as amniotic fluid
allows the fetus freedom to move.
- it protects the umbilical cord from pressure, thus
protecting the fetal oxygen supply
4. The Umbilical Cord
• formed from the
fetal membranes, the amnion and chorion
• Functions
• Length
• Contains: Arteries and Veins
• Wharton’s Jelly
– Function of Wharton’s Jelly:
• Amniotic Membrane
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• Rate of blood flow ▪ end of 4 th week - septum begins to divide

• Nerve supply esophagus & trachea
▪ 7 th week of life - the diaphragm is starting to divide
5. Amniotic Fluid/Liquor Amnii the thoracic cavity from the abdomen
Functions : ▪ 24th to 28th week - alveoli and capillaries begin to
- protective mechanism for the fetus form surfactant - a lipoprotein produce by alveolar
- it shields against pressure or blow to the mother’s cells
abdomen ▪ Two components:
- it protects the fetus from changes in temperature
- it aids muscular development because it allows the Nervous System
fetus to move ▪ by the 3 rd week of gestation - a neural plate is
- protects the umbilical cord from the pressure, apparent in the developing embryo (forming the CNS
protecting fetal oxygenation. & PNS)
- Average amount - ▪ all parts of brain form in uteru
- Polyhydramnios ▪ brain waves can be detected on an
- Oligohydramnios electroencephalogram
- Ph - Alkaline (EEG) by the 8 th week
▪ from the beginning of fetal growth, development
proceeds in a Cephalocaudal (head to tail) direction Endocrine System
which continues after birth ▪ as soon as endocrine organs mature in intrauterine
▪ at the time of implantation, the blastocyst already life,
has differentiated to a point at which three separate function begins
layers of these cells are present: the ectoderm, the ▪ the function of endocrine organs begins along with
endoderm, and the mesoderm neurosystem development.
• fetal pancreas
6. Primary Germ Layers • thyroid / parathyroid glands
• at the time of implantation, the blastocyst forms 2 • fetal adrenal glands
separate cavities appear in the inner structure:
– a large one, the AMNIOTIC CAVITY Digestive System
– a smaller cavity, the Yolk Sac ▪ by the 4th week - digestive tract separates from the
– between the amniotic cavity and the yolk sac forms respiratory tract and after that, begins to grow
a third layer of primary cells the mesoderm. extremely rapidly.
▪ by 16th week- meconium starts to form.
Origin of Body Tissue Components:
• each germ tissue develops into distinctive body ▪ GIT is sterile before birth
systems ▪ the liver is active but still immature at birth
– Ectoderm ▪ sucking and swallowing reflex are not mature until
• the nervous system (CNS – Brain & Spinal Cord, about 32 weeks or weighs 1500 g
PNS)
• skin, hair, nails, and tooth enamel Musculoskeletal System
• sense organs ▪ by 11th week - seen to move by utz
• mucous membranes of the anus, mouth and ▪ quickening by 20th week.
nose
• mammary glands
Reproductive System
▪ by 6th week - the gonads are formed
– Mesoderm ▪ Testosterone is produced from wollfian duct or
• supporting structures of the body (connective mesonephric duct
tissue, bones, cartilage, muscle, ligaments, and ▪ male genitalia is developed
tendons) ▪ on the 8th week female hormones is produced from
• upper portion of the urinary system (kidneys & mullerian duct or paranephric duct – female genitalia
ureters) is formed
• reproductive system
• heart, lymph and circulatory system and blood Urinary System
cells ▪ end of 4th week - rudimentary kidney is present
– Endoderm ▪ by 12th week - urine is formed
• lining of the pericardial, pleura, and peritoneal ▪ by 16th week - urine is excreted in the amniotic fluid
cavities ▪ at term - urine is being excreted at the rate of
• lining of the gastrointestinal tract, respiratory 500ml/day
tract, tonsils, parathyroid, thyroid, and thymus
glands Integumentary System
• lower urinary system (bladder & urethra) ▪ at 36th weeks - skin appears thin and translucent
and fat begins to be deposited
Cardiovascular System ▪ lanugo - soft, downy hairs
▪ one if the first systems to become functional in ▪ vernix caseosa - a white-cream cheese like
intrauterine life substance
▪ its development is a progression from simple blood
cells Immune System
▪ by 3 rd trimester - maternal antibodies cross the
Respiratory System placenta
▪ 3rd week of life - the respiratory and digestive tracts ▪ the level of passive immunity is peak at birth
exist as a single tube
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Fetal Circulation
▪ contains mixed blood with less than maximal O2
concentration; the only exception is the umbilical
vein upon its immediate entrance into the liver
▪ fetus receives O2 thru the placenta since the lungs
do not function as organs of respiration; to meet this
situation, the fetal circulation contains special
vessels
Special Vessels of a Fetal Circulation
1. Ductus Venosus - is a connection between the
umbilical vein & ascending vena cava, bypassing
the fetal liver.
2. Ductus Arteriosus - a connection between the
pulmonary trunk & aorta, bypassing the fetal lungs.
3. Foramen Ovale - is an opening between the right &
left atria during fetal life, also bypassing the fetal
lungs.
F. Milestone of fetal growth and development
Conception - the sperm fertilizes the ovum, which
then divides and burrows into the uterus
End of 4th Gestational Week
• Human embryo is a rapidly growing formation cells
but does not resemble a human being yet.
• Spinal cord formed & fused at the midpoint
• Head will shortly fold forward & become prominent,
comprising about 1/3 of the entire structure.
• Back is bent so the head touches the tip of the tail.
• Heart appears as aprominent bulge on the anterior
surface.
• Arms and legs are bud-like structures.
• Rudimentary eyes, ears, and nose are discernible.
• Length is 0.75 cm to 1 cm.
• Weight is 400 mg.
End of 8th Gestational Week
• Length is 2.5 cm (1 in.)
• Weight is 20 grams
• Organogenesis is complete.
• Heart has a septum & valves & is beating
rhythmically.
• Facial features are definitely discernible
• Legs, arms, fingers, toes, elbows, & knees have
developed.
• External genitalia are present but male & female
are not distinguishable by simple observation.
• Primitive tail is undergoing retrogression.
• Abdomen bulges forward because the fetal
intestine is growing so rapidly.
• A sonogram done at this time demonstrates a
gestational
sac & is diagnostic of pregnancy
End of 12th Gestational Week (First Trimester)
• Length is 7 to 8 cm.
• Weight is 45 grams.
• Nail beds are forming on fingers & toes.
• Capable of spontaneous movements although too
faint to be felt by the mother.
• Some reflexes, such as Babinski reflex are
present
• Bone ossification centers begin to form
• Tooth buds are present.
• Sex is distinguishable on outward appearance.
• Urine secretion begins but may not yet be evident
in amniotic fluid.
• Heartbeat is audible through Doppler Technology
End of 16th Gestational Week
• Length is 10 to 17 cm.
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• Weight is 55 to 120 g.
• Fetal heart sounds are audible by an ordinary
stethoscope.
• Lanugo is well formed
• Liver & pancreas are functioning.
• Fetus actively swallows amniotic fluid; urine is
present in amniotic fluid
• Sex can be determined by ultrasonography.
End of 20th Gestational Week
• Length is 25 cm.
• Weight is 223 g.
• Spontaneous fetal movements sensed by the
mother.
• Antibody production is possible
• Hair, including eyebrows, forms on the head;
vernix caseosa begins to cover the skin.
• Meconium is present in the upper intestine.
• Brown fat begins to form behind the kidneys,
sternum, & posterior neck.
• Passive antibody transfer from mother to fetus
begins.
• Definite sleeping & activity patterns are
distinguishable
End of 24th Gestational Week (Second Trimester)
• Length is 28 to 36 cm.
• Weight is 550 g.
• Passive antibody transfer from mother to fetus (if
born before will have no natural immunity).
• Vernix Caseosa begins to form.
• Meconium present as far as rectum.
• Active production of hung surfactant begins.
• Eyelids, previously fused since the 12th week,
now open; pupils react to light.
• Membrane that had fused the eyelids dissolves so
eyes can now open & pupils are capable of
reacting to light.
• Low-end age of viability. (or 601g.)
End of 28th Gestational Week
• Length is 35 to 38 cm.
• Weight is 1200 g.
• Lung alveoli are almost mature, surfactant can be
demonstrated in amniotic fluid.
• In male fetus, the testes begin to descend into the
scrotal sac from the lower abdominal cavity.
• Blood vessels of the retina are extremely
susceptible to damage from high oxygen
concentrations.
End of 32nd Gestational Week
• Length is 38 to 43 cm.
• Weight is 1600 g.
• Subcutaneous fat begins to be
deposited in the fetus.
• Fetus responds by movement to sounds outside
the mother’s body
• Active Moro reflex is present.
• In some cases, has assumed delivery position.
• Iron stores begin to be built.
• Fingernails reach the end of fingertips.
End of 36th Gestational Week
• Length – 42-48 cm
• Weight is 1,800-2,700g (5-6 lb).
• Body stores of glycogen, iron, carbohydrate, and
calcium are deposited.
• Additional amounts of subcutaneous fat are
deposited.
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• Sole of the foot has only one or two crisscross

creases compared with a full crisscross pattern
evident at term.
• Amount of lanugo begins to diminish.
• Most fetuses turn into a vertex (head down)
presentation during this month

End of 40th Gestational Week (Third Trimester)

• Length is 48 to 52 cm.
• Weight is 3000 g. (7- 7.5 lbs.)
• At this time, the sole of the foot has only one or
two crisscross creases.
• Lanugo begins to diminish
• Kicks actively.
• Vernix Caseosa is fully formed.
• Fetal hemoglobin begins its conversion to adult
hemoglobin.
• Fingernails extend over the tips of fingers.
• Creases on the soles of the feet cover at least 2/3
of the surface.
• Lightening for primiparas (experience by the
women as the fetus sinks into the birth canal and
giving the pregnant woman a feeling that her load
is being lightened)

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• Should be cautioned to avoid undercooked meat

CHAPTER 4: ANTEPARTUM • Should be careful not to change a cat box or
work in soil
where cats defecates
• Taking a new cat is unwise
LEARNING TASK 1: EFFECTS OF
TERATOGENS ON A FETUS • Lyme - a multi system disease caused by bacteria
carried
Teratogen - is any factor, chemical or physical, that by ticks and transmitted through tick bites
adversely affects the fertilized ovum, embryo, or fetus. S/S:
Factors that influence the amount of damage a teratogen • Rashes spreading around the bite
can cause: • Fever, chills, muscle pains,
• Strength of the teratogen • Lyme arthritis
• Timing of the teratogenic insult • Nerve and heart problems
• The teratogen’s affinity for specific body tissue
▪ Lead • Other Viral Diseases (rubeola/measles, mumps,
▪ Mercury varicella/chicken pox, polio, influenza, viral
▪ Thalidomide hepatitis, HIV)
▪ Tetracycline - may cause: fetal death, severe anemia and
▪ Rubella virus congenital
heart disease
LEARNING TASK 2: TERATOGENIC
MATERNAL INFECTIONS LEARNING TASK 3: TERATOGENIC
MATERNAL INFECTIONS
• Malaria
- caused by Plasmodium protozoa (bite of infected Infections that cause Illness at Birth
female - are maternal infections not harmful to the fetus
anopheles mosquito) during pregnancy but harmful if they are present at
- maternal anemia, fetal loss, premature delivery, time of birth.
intrauterine growth retardation, and delivery of low
birth weight infants (<2500 g or <5.5 pounds), a risk Gonorrhea
factor for – caused by bacteria Neisseria Gonorrheae
death. – effects on the fetus: miscarriages, premature birth
and low birth weight, premature rupture of
• Herpes Simplex Virus (Genital Herpes Infection) membranes, and chorioamnionitis.
- Herpes 1 virus is the causative agent of the common
cold Candidiasis
sore – a monilial infection cause by CANDIDA ALBICANS
- Herpes 2 virus- is generally the cause of genital – effects in the fetus: prematurity or an underlying
lesions infection.

• Rubella (German Measles) Note:

- the worst viral infection that causes extensive fetal ▪ newborns are tested to see if antibodies against the
damage. The greatest risk to the embryo from this common infectious teratogenic diseases are present
virus is during organogenesis T - Toxoplasmosis
- effects to fetus: hearing impairment, cognitive and O - Other infections (HBV, Chlamydia, syphilis)
motor challenges, cataracts, cardiac defects, R - Rubella
restricted intrauterine growth, thrombocytopenic C - Cystomegalovirus
purpura, and dental and facial clefts, such as cleft lip H - Herpes Simplex Virus
and palate
Potentially Teratogenic Vaccines
• Cytomegalovirus - Cystomegalic Inclusion – Live virus vaccines (measles, HPV, mumps, rubella,
Disease (CID) polio)
- a salivary gland disease, transmitted by droplet Teratogenic Drugs
infection – Thalidomide Antidepressants
- effects to fetus: severe neurologic challenges or with
eye – Cytotic drugs Antidiabetic agents
damage, hearing impairment, or chronic liver disease – Analgesics (Aspirin, NSAID) Antischizophrenic

• Syphilis - a spirochete infection and a STD – Antineoplastics Antibiotics

- Effects to fetus: congenital anomalies, extreme – Androgens Antithyroid
rhinitis, rash
– Antconvulsants Antihelmentics
• Toxoplasmosis - a pathogen infection contracted by – Anticoagulants Antivirals
eating
undercooked meat; it is spread through cat stool in
soil or litter Teratogenic Drugs
- Effects to Fetus: hearing impairment, cognitive • Angiotensin converting enzyme inhibitors
challenge, • Caffeine
osteochondritis, and fetal death • Hypoglycemics
- Health Instructions: • Nicotine
• Radiopharmaceuticals
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• Narcotics d. Past medical history

• Tranquilizers – Cardiac, kidney, STD’s, DM, Thyroid, Respiratory,
• Vaccines (live) Surgical procedures, Injuries, Childhood Diseases,
• Vitamin A derivatives Allergies/ drug sensitivities

Teratogenicity of Alcohol e. Social profile

– Fetal alcohol syndrome • Information of woman’s lifestyle
– Exercise
Teratogenicity of Cigarettes – Hobbies
– fetal growth restriction – Smoking
– Low birth weight – Drinking habits
– a fetus may be at greater risk for being stillborn – Medication history
– after birth, may be at a greater risk than others for – Recreational drugs
sudden infant death syndrome
f. Gynecologic history
Environmental Teratogens - Reproductive tract
– impure air or water – fetal growth restriction - Breast problem
- Menarche
Metal & Chemical hazards - Menstrual cycle (interval, duration, amount,
– Pesticides, Carbon Monoxide, Mercury, Fluoride, discomfort)
Lead - Past surgery on reproductive tract
• ingestion may cause mental retardation and - Reproductive planning method
CNS - Sexual history
damage to fetus
– Toxic Waste g. Obstetric history
• may cause fetal malformation and leukemia G - # of pregnancies
later in life P- # of delivered full term
T – term pregnancy
Radiation P – preterm pregnancy
– produces a range of malformations depending on A – abortion
the stage L – living children
of development of the embryo or fetus and the M – multiple pregnancies
strength and
length of exposure
LEARNING TASK 5: ASSESSMENT OF
Hyperthermia and Hypothermia FETAL GROWTH AND DEVELOPMENT
– advise pregnant women not to use hot tubs, saunas,
or
tanning beds during pregnancy. Tests for fetal growth and development are commonly
– effect of hypothermia is not well known done for a variety of reasons, including to:
▪ Predict the outcome of the pregnancy
Teratogenic Maternal Stress ▪ Manage the remaining weeks of the pregnancy
– anxiety and worry beyond the usual amount could ▪ Plan for possible complications at birth
produce ▪ Plan for problems that may occur in the newborn
physiologic changes through their effects on the infant
sympathetic division of the autonomic nervous system. ▪ Decide whether to continue the pregnancy
▪ Find conditions that may affect future pregnancies

Nursing responsibilities for these assessment

procedures include:
▪ verifying that a signed consent form has been
LEARNING TASK 4: HEALTH obtained as needed
ASSESSMENT DURING THE FIRST ▪ being certain the woman and her support
PRENATAL VISIT: person are awareof what the procedure will
entail and any potential risks
Antepartum Assessment & Care ▪ preparing the woman physically and
a. Demographic Data psychologically, providing support during the
– name, age, address, telephone number, procedure
race/ethnic group, religion, ethnicity, type and ▪ assessing both fetal and maternal responses
place of employment and health insurance during and after the procedure
information ▪ providing any necessary follow-up care, and
managing equipment and specimens.
b. Family Profile
– identify support system, size of house, her age & Health History
partner’s age, educational levels, occupation ▪ any prepregnancy illnesses
▪ drugs a woman takes
c. Family History ▪ nutritional intake
– Inherited disease ▪ personal habits
– Congenital Anomalies ▪ exposure to teratogens
▪ unintentional injuries or intimate partner violence

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Physical Examination Assessing the fetal heart tones:

▪ vital signs 1. Fetal heart tones
▪ height & weight – a very rapid, somewhat muffled ticking sound
▪ pelvic measurement – normal: 120-160 bpm
▪ abdomen 2. Uterine bruit / Souffle
Fundal Heights: – a soft murmur caused by the passage of blood
▪ at the symphysis pubis – 12 weeks thru the uterine vessels
▪ at the umbilicus – 20 weeks – synchronous with maternal pulse
▪ at xiphoid process – 36 weeks 3. Funic Souffle
– hissing sound produced by passage of blood thru
Mc Donald’s rule the umbilical arteries
▪ lunar months: – synchronous with FHB
– fundal height(cm) x 2/7
– ex: 14 cm x 2/7 = 4 months Variations in F H B
▪ weeks: 1. Early deceleration
– fundal height (cm) x 8/7 – caused by fetal head compression
– ex: 14 cm x 8/7 = 16 weeks – Management: no intervention required
2. Late Deceleration
Naegele’s Rule – caused by uteroplacental insufficiency
EDC – Estimated Date of Confinement – delayed until 30-40 secs after the onset of
EDB – Estimated Date of Birth contraction.
Tanya first came to the prenatal clinic on February 29, – Management
2020 • change the woman’s position to left side
and told the nurse she had her last menstrual period • admin O2 , IV
from 3. Variable Deceleration
December 14 to December 19. What would be her – caused by umbilical cord compression
child’s – Management: change the woman’s position to
EDB? relieve pressure on the cord

Laboratory Tests Genetics - the study of individual genes and their

1. Blood grouping impact on relatively rare single gene disorder.
– to determine the blood type • Assessment:
2. Hgb/Hct 1. History
– to detect anemia 2. Physical Assessment
– Hgb < 11 g/dl or Hct < 32% requires iron a. Inspection of body areas
supplementation 3. Diagnostic Test:
3. CBC a. Karyotyping
– to detect infection or cell abnormalities b. Maternal Serum screening - AFP
4. Rh factor 4. Chorionic Villi sampling
– for possible maternal-fetal blood incompatibility 5. Amniocentesis
5. VDRL or RPR (Rapid Plasma Reagin) 6. Percutaneous Umbilical Blood Sampling
– serologic test for syphilis 7. Fetal Imaging
6. Urinalysis a. Computed tomography Scan
7. Antibody titers for rubella & Hepatitis B b. MRI
8. HIV Screening c. UTZ
9. Glucose Tolerance test 8. Fetoscopy
10.Tuberculosis Screening 9. Pre-Implantation diagnosis
11. Ultrasonography
Genetic Counseling - an educational process that
• Schedule of Pre- visits up to 32 weeks once / 2 seeks to assist affected individuals of getting an
months inherited condition to understand the nature of the
• 32- 36 weeks – 2x / months genetic disorder, its transmission and the options
• 36 weeks to delivery - once a week there might be for prevention and or testing

Leopold’s Maneuver Purpose of Genetic Counseling

– a systematic way of observation & palpation to
determine fetal position
Preparation:
1. Let the patient void.
2. Position the mother supine with knees flexed
Steps:
1. Palpate what is lying in the fundus. “Fundal Grip”
▪ BREECH – round, hard, mobile
▪ CEPHALIC – irregular, soft, non- mobile
2. Palpate fetal back in relation to the right & the left.
“Umbilical Grip”
3. Locate presenting part at pelvic inlet & check for
engagement. “Pawlik’s Grip”
4. Palpate just above the inguinal the relationship of
the presenting part to the pelvis. “Pelvic Grip”
1. Provide concrete, accurate information about the
process of inheritance and inherited disorders
2. Reassure people who are concerned their child
may inherit a particular disorder that the disorder
will not occur
3. Allow people who are affected by inherited
disorders to make informed choices about future
reproduction
4. Allow people to pursue potential interventions that
may exist such as fetal surgery
5. Allow families to begin preparation for a child with
special needs

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LEARNING TASK 6: ASSESSMENT OF • NON-REACTIVE:

FETAL WELL-BEING & MATURITY – FHR does not increase to fetal activity
– Less than 3 responses in 20 minute recording
Fetal Heart Rate
– heard and counted as early as the 10th to 11th week Oxytocin Challenge Test (Oct) / Contractions
of pregnancy by the use of an ultrasound Doppler STRESS TEST (CST)
technique – done for evaluation of the ability of the fetus to
– Done routinely at every prenatal visit past 10 weeks. withstand the stress of uterine contractions
Indication:
Daily Fetal Movement Count (Kick Counts) – If the woman has a non reactive non stress test
– occurs at approximately 18 to 20 weeks of Procedure:
pregnancy – Diluted IV Oxytocin is given via infusion pump
and peaks in intensity at 28 to 38 weeks. Interpretation:
• NEGATIVE:
Daily Fetal Movement Count (Kick Counts) – 3 contractions in 10 min
▪ Lie in a left recumbent position after a meal. – * No Late Deceleration
▪ Observe and record the number of fetal • POSITIVE:
movements (kicks) – presence of Late Deceleration in response to
their fetus makes until they have counted 10 uterine
movements. contractions
▪ Record the time (typically, this is under an hour). * Indicates Placental Insufficiency
▪ If an hour passes without 10 movements, they
should walk around a little and try a count again.
▪ If 10 movements (kicks) cannot be felt in a second Ultrasonography
1-hour period, they should telephone their primary Uses:
healthcare provider. The fetus could be healthy ▪ Diagnose pregnancy as early as 6 weeks gestation.
but sleeping during this time, so lack of typical ▪ Confirm the presence, size, and location of the
movements may not be serious, but it is an placenta and amniotic fluid.
indication for further assessment ▪ Establish a fetus is growing and has no gross
anomalies such as hydrocephalus; anencephaly; or
Amniocentesis spinal cord, heart, kidney, and bladder concerns.
– done during the 26th week of gestation ▪ Establish the sex if a penis is revealed.
– early 1st trimester: to detect congenital ▪ Establish the presentation and position of the fetus.
abnormalities ▪ Predict gestational age by measurement of the
– 3rd trimester: determine fetal lung maturity biparietal diameter of the head or crown-to-rump
measurement.
a. Lecithin/Sphingomyelin (L/S) Ratio ▪ Discover complications of pregnancy
– measures maturity of fetal lung
– the protein component of the enzyme surfactant Health Education
– Normal Ratio 2:1 1. WEIGHT
▪ Normal weight
b. Alpha-Feto Protein • 2-5 lbs – 1st trimester
– major plasma of early fetus • 1 lb/week – 2nd & 3rd trimester
– decrease after 13 weeks of gestation ▪ Total Weight Gain: 25-35 lbs
– with AFP: neural tube defect
Components of Weight Gain
c. Color of Amniotic fluid Fetus 7.5 lbs
Placenta 1-1.5 lbs
Post Amniocentesis: Amniotic Fluid 2 lbs
– Let the mother drink 2-4 glasses of water within 2 Uterus 2.5 lbs
hours Breast tissue 3 lbs
– Monitor vital signs Blood Volume 4 lbs
Maternal stores 4-8 lbs
Non Stress Test (Nst) 24 – 28 lbs
– used to evaluate FHR in response to fetal 2. NUTRITION
movement ▪ Calories – increase 300 Kcal/day
– non stress because the fetus is not challenged or ▪ CHON – 4 servings of meat recommended or 60
stressed by uterine contractions g/day
– Indications: ▪ Ca – 1200 mg/day
▪ women with prolonged pregnancy ▪ Folate – 0.4 mg/day
▪ diabetes ▪ Iron – 30 mg/day
▪ hypertensive disorders
▪ history of stillbirth 3. REST
▪ encourage mother to sit down & elevate the feet
Interpretation: ▪ 10 hours of sleep
• REACTIVE: ▪ modified Sim’s
– FHR increase 15 bpm in response to fetal activity
for 4. EXERCISE
15 seconds ▪ amount & type of exercise depend on the physical
– 5 responses in 20 minute recording condition of the woman & stage of pregnancy

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a. Walking - most ideal exercise because it stimulates ▪ Management:

muscular activity of the entire body & does not – increasing the amount of rest and sleep
result in fatigue or strain. – elevate the feet
b. Kegels exercise aid in restoration of perineal
muscles & prevent stress incontinence E. Hemorrhoids
▪ due to smooth muscle relaxation effect of
c. Tailor sitting progesterone, constipation, pressure of the
– for relief of backache gravid uterus
– Stretches perineal muscles ▪ Management:
– hot sitz bath
d. Pelvic tilt – for relief of backache – avoid constipation
– drinking adequate fluid, eating adequate fiber,
e. Shoulder circling – for relief of backache – rest / sleep in sim’s position
– avoid long standing or walking
5. SEXUAL RELATIONS – topical anesthetic agents as prescribed
▪ no restrictions
▪ CI: vaginal bleeding, ruptured membranes, strong F. Leg cramps
uterine contraction after orgasm ▪ caused by decreased serum calcium levels,
increased serum phosphorus levels
LEARNING TASK 6: COMMON ▪ Management:
DISCOMFORTS OF PREGNANCY – to relieve cramps, extend the affected leg,
keeping knees straight, bend your foot toward you
A. Breast Tenderness /or ask someone to help you flex your foot.
▪ often one of the first symptoms noticed in early – diet rich in calcium, (↓phosphorous)
pregnancy and may be most noticeable on exposure – B-complex supplement.
to cold air.
▪ Management: G. Frequent urination
– encourage a woman to wear a bra with a wide ▪ due to pressure of the gravid uterus on the bladder
shoulder strap for support and to dress warmly to ▪ Management:
avoid cold drafts if cold increases symptoms – will be resolved without intervention. However,
you
B. Varicosities can use Kegel exercises to lessen the discomfort
▪ due to pressure of the gravid uterus to the large – void every 2hrs / or as necessary
veins – avoid caffeine
▪ Management:
– avoid constricting clothing H. Backache
– avoid crossing legs at the knees ▪ caused by the enlarging uterus/ lordosis
– frequent rest periods with legs elevated ▪ Management:
– wear support (elastic stockings) – tailor sitting
– keep within the recommended weight gain – shoulder circling
– avoid prolong standing (change position – pelvic rock
frequently if standing ) – squat rather than bend when lifting
– exercise
I. Leukorrhea
▪ profuse whitish viscous vaginal discharge
C. Nausea & Vomiting ▪ cause: in response to high estrogen level and the
▪ No definite cause has been established for this increased blood supply to the vaginal epithelim
symptom of early pregnancy, but it may be and cervix in pregnancy
related to: ▪ Management:
– sensitivity to the high level of chorionic – daily bath or shower
gonadotropin hormone produced by the – clean perineal area always (front to back)
trophoblast cells – wear perineal pads
– high estrogen or progesterone levels – wear cotton underwear
– lowered maternal blood sugar caused by the
needs of the developing embryo J. Hypotension
– lack of pyridoxine (vitamin B6) ▪ occurs when a woman lies on her back and the
– diminished gastric motility uterus presses on the inferior vena cava,
▪ Management: impairing blood return to her heart
– traditional solution: to keep dry crackers by their ▪ Management:
bedside and eat a few before rising – a woman turns or is turned onto her side
– sucking on sour candies – rising slowly and avoiding extended periods of
– eat small but frequent meals rather than large standing
infrequent ones. – advise pregnant women to always rest or sleep
– avoid greasy or highly seasoned food. on their side, not their back (prevention)
– delay breakfast until nausea passes (eat snacks
before bedtime) K. Dyspnea
– avoid sudden movements and fatigue because ▪ difficulty of breathing
these may increase or cause nausea. ▪ Management:
– elevate head of bed
D. Fatigue – avoid having a full stomach
▪ due to increased metabolic requirements – avoid physical exertion

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L. Ankle Edema 3. Alcohol

▪ reduced blood circulation in lower extremities 4. Marijuana
▪ Management: 5. Cocaine
– avoid constricting clothing
– open, flat footwear Danger Signs of Pregnancy
– elevate leg while resting a. vaginal spotting / bleeding
– avoid long standing or walking b. leaking of fluid from the vagina
c. abdominal or chest pain
M. Cravings ▪ 1st trimester- ectopic pregnancy
▪ are so common they are considered a normal part ▪ 3rd trimester- abruptio placenta
of adaptation to pregnancy. d. persistent headache, blurring of vision
▪ associated with Iron Deficiency Anemia e. marked swelling of hands & feet
▪ Management: f. painful, burning urination discharge
– help plan an intake that includes the food, at g. foul smelling vaginal discharge
least in moderation, to help her enjoy her h. chills & fever
pregnancy without feeling guilty i. persistent nausea & vomiting
– iron supplements
– small, frequent meals Preparation for Labor and Delivery
Pica - cravings for nonfood substance Childbirth Education:
Goals - To prepare the expectant parents emotionally
N. Palmar Erythema / Plantar Pruritus and physically for childbirth while promoting wellness
▪ cause: increased estrogen levels behavior that can be used by parents and their
▪ Management: families for life.
– explain that this type of itching in early 1. childbirth exercise
pregnancy is 2. reduce and manage pain
normal 3. increase enjoyment and satisfaction
– use of calamine lotion 4. with childbirth exercise
5. Birthing
O. Heart Palpitations
▪ cause: circulatory adjustments necessary to Plan Exercise Guidelines for Preparation of Labor
accommodate her increased blood supply. 1. Always rise from the floor slowly.
▪ Management: 2. To rise from the floor, roll over to the side then push
– gradual, slow movements will help prevent this up.
from happening. 3. When exercising the leg, never point the toes
(extend the heel) instead.
4. Do not attempt exercises that hyper extend the
Teaching Self-Care Needs During Pregnancy lower back.
1. Bathing 5. Do not withhold breath while exercising.
2. Breast Care 6. Do not continue with exercise if any danger signs of
3. Dental Care pregnancy occurs.
4. Perineal Hygiene 7. Never exercise to a point of fatigue.
5. Dressing 8. Never practice second stage pushing.
6. Sexual activity
7. Exercise Preparation for Labor and Delivery
8. Employment 1. Childbirth exercises:
9. Travel a. Tailor sitting
10. Nutrition b. Squatting
c. Kegel exercises
I. Discomforts of Pregnancy (First Trimester) d. Abdominal contraction
1. Breast tenderness e. Pelvic rocking
2. Palmar Erythema/ Pruritus
3. Constipation 2. Pain management:
4. Morning Sickness ▪ Based on 3 principles:
5. Fatigue a. discomforts during labor can be minimized if the
6. Leg cramps woman comes into labor well-informed.
7. Supine Hypotension b. discomforts during labor can be minimized if the
8. Varicosities woman’s abdomen is relaxed.
9. Hemorrhoids c. pain perceptions can be altered by distraction
10. Heart palpitations techniques such as the Gating Control
11. Frequency of urination
12. Leukorrhea Theory of Pain Perception.
A. Gating Theory of Pain Control:
II. Discomforts of Pregnancy (Middle to Late Stimulus > peripheral nerve fiber > cells of dorsal
Pregnancy) horns of spinal cord > substantia gelatinosa (a dense
1. Backache interfacing network of cells in the spinal cord) creates
2. Headache a sudden synapse > motor nerve > impulse > spinal
3. Dyspnea cord > hypothalamus and cortex of the brain (where
4. Ankle edema the impulse is interpreted as pain)

Substances and Drugs to Avoid:

1. Caffeine
2. Tobacco/ Cigarettes
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Techniques that can assist gating mechanisms

include:
a. Cutaneous stimulation
b. Distraction
c. Reducing anxiety
d. Lamaze Method (Psychoprophylaxis)
▪ a combination of two words which are:
– “prophylaxis’’ and ‘’psyche’’
– based on the theory “stimulus-response conditioning

d. 6 Major Concepts of the Lamaze Method:

1. Labor should begin on its own, not be induced.
2. Women should walk, move around, and change
positions throughout labor.
3. Women should bring a loved one, friend, or doula
for continuous support.
4. Interventions that are not medically necessary
should be avoided.
5. Women should be allowed to give birth in other
positions than on their back and should follow
their body’s urges to push.
6. Mother and baby should be kept together after birth;
it is best for the mother, for the baby, and for
breastfeeding

d. 3 Main Principles of the Lamaze Method:

1. If a couple understands the process of labor and
birth, they can enter labor with decreased tension.
2. Concentrating on breathing patterns or imagery or
focusing can block incoming pain sensations.
3. Conditioned reflexes, or reflexes that automatically
occur in response to a stimulus, can also be used
to displace pain during

d. Common Features in Lamaze Method:

1. Conscious relaxation - this is done by relaxing body
parts.
2. Cleansing breath - done to begin all breathing
exercises
▪ Purpose:
3. Consciously controlled breathing - a woman uses
different rates in labor depending on the intensity of
contraction

Consciously controlled breathing:

A. Level 1 or A - Low and rhythmic chest breathing.
B. Level 2 or B - a shallow chest breathing & lighter
breathing than level 1.
C. Level 3 or C - breathing is shallower mostly at the
sternum.
D. Level 4 or D - the woman uses a ‘’pant blow’’
pattern of breathing.
E. Level 5 – is chest panting. A continuous shallow
panting

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This component supports LGUs in establishing and

CHAPTER 5: SCOPE AND STANDARDS mobilizing the service delivery network of public and
private providers to enable them to deliver the
integrated maternal-newborn service package.

LEARNING TASK 1: SCOPE AND Component B: National Capacity to Sustain

Maternal-Newborn Services
STANDARDS
Contents
OPERATIONAL AND REGULATORY GUIDELINES
a. Scope and Standards of Maternal and Child Network of Training Providers
Practices in the Philippines Monitoring, Evaluation, Research, and Dissemination
b. Legal Considerations of Maternal Child Practice with support from the Epidemiology Bureau and
c. Ethico-moral Considerations of Maternal Child Health Policy Development and Planning Bureau
Practice
d. Ethical and Social Issues in Perinatal Nursing Policies and Laws
e. Contraception Republic Act No. 10354: Responsible Parenthood and
f. Advances in Genetics and Genetic Technology
Reproductive Health Law (RPRH Act of 2012)
g. Alternative Methods of Birth
h. Common Reproductive Issues
i. Reproductive Health Bill and other existing DOH 1. Administrative Order 2008-0029:
Programs on Maternal and Child Care Implementing Health Reforms to Rapidly
Reduce Maternal and Neonatal Mortality
REPUBLIC ACT NO. 10354
2. Department Order 2009-0084: Guidelines
AN ACT PROVIDING FOR A NATIONAL POLICY
Governing the Payment of Training Fees
ON RESPONSIBLE PARENTHOOD AND
relative to the Attendance of Health Workers
REPRODUCTIVE HEALTH
to Basic Emergency Obstetric and Newborn
Be it enacted by the Senate and House of
Care Skills Training Course at Duly
Representatives of the Philippines in Congress
Designated Training Centers
assembled:
3. Administrative Order 2011-0011:
Section 1. Title. – This Act shall be known as "The
Establishment of Basic Emergency Obstetric
Responsible Parenthood and Reproductive Health
and Newborn Care (BEmONC) Training
Act of 2012″.
Centers in Regional Hospitals and Medical
NATIONAL SAFE MOTHERHOOD PROGRAM
Centers
Vision
For Filipino women to have full access to health
4. Administrative Order 2015-0020: Guidelines in
services towards making their pregnancy and delivery
the Administration of Life Saving Drugs
safer
During Maternal Care Emergencies by
Mission Nurses and Midwives in Birthing Centers
Guided by the Department of Health Formula One
Plus thrust and the Universal Health Care Frame, the 5. Administrative Order 2016-0035: Guidelines
National Safe Motherhood Program is committed to on the Provision of Quality Antenatal Care in
provide rational and responsive policy direction to its All Birthing Centers and Health Facilities
local government partners in the delivery of quality Providing Maternity Care Services
maternal and newborn health services with integrity
and accountability using proven and innovative 6. Administrative Order 2018-0003: National
approaches Policy on the Prevention of Illegal and
Unsafe Abortion and Management of Post-
Objectives Abortion Complications
The Program contributes to the national goal of
improving women’s health and well-being by: Program Accomplishments/Status

The Department of Health through the National Safe

 Collaborating with Local Government Units in
Motherhood Program shall continue to update its
establishing sustainable, cost-effective approach
strategies to address critical reproductive health
of delivering health services that ensure access of
concerns including control of sexually transmitted
disadvantaged women to acceptable and high
infections and mother to child transmission of
quality maternal and newborn health services and
HIV while confronting both demand and supply side
enable them to safely give birth in health facilities
obstacles to access for disadvantaged women
near their homes
including indigenous women of reproductive age.
 Establishing core knowledge base and Among the changes:
support systems that facilitate the delivery of
quality maternal and newborn health services in
the country. a. Strategic Change in the Design of Safe
Motherhood Services
b. An Integrated Package of Women’s Health and
Safe Motherhood Services
PROGRAM COMPONENTS c. Reliable Sustainable Support Systems
Component A: Local Delivery of the Maternal-
Newborn Service Package

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d. Stronger Stewardship and Guidance from the
DOH Program Manager and Regional
Coordinators
DOH provides stewardship and guidance through:
1. evidence-based guidelines and protocols on
maternal-newborn services;
2. a system for recognizing providers of
emergency obstetrics and newborn
care training program; and
3. monitoring, evaluation and research on the new
maternal-newborn strategies.
Program Accomplishments/Status
The Program shall continue to monitor the
implementation of its policies and evaluate
effectiveness in improving maternal outcomes and
consequently translate these to maternal and newborn
mortality reductions. LGUs shall be continuously
encouraged to address local health system’s gaps
identified during maternal death reviews.
Relevant policies that responds to maternal needs
have been passed that include among others:
1. for 2018, the policy of prevention of illegal and
unsafe abortions and management of post-
abortion complication. Implementation of this
policy is expected to reduce maternal death by at
least 21%. The Program shall continue to pass
policies based on death review results.
 To date, 95% of Birthing Centers have teams
trained on basic emergency obstetric and
newborn care
Calendar of Activities
 Conduct of BEmONC (Basic Emergency
Obstetric and Newborn Care) Training by
Training Centers – on-going
 Conduct of Maternal Death Surveillance and
Response – on-going
 Safe Motherhood Week Celebration at Regional
level every 2nd week of May
 Enhancement of Positive Birthing Experience
Protocol: First Quarter of 2019
 BEmONC Updates tentatively May 2019
 Maternal Sepsis Elimination Campaign: May 2019
 Program Implementation Reviews: third quarter
and 4th quarter of 2019
LEARNING TASK 2:RH BILL
The RH Bill aims to achieve the following primary
Objectives:
1. It will help give parents the opportunity to exercise
their rights to freely and responsibly plan the
number of spacing of their children. The bill is
truly right-based.
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2. It will help improve maternal, newborn and child
health and nutrition and reduce maternal, infant
and child mortality. The bill is primarily a health
measure.
3. The RH bill will give women more opportunity to
finish their education and secure productive work
by freeing them from unremitting
pregnancies. Access to family planning
information and services ensures maternal health
and allows women to pursue opportunities in
education and employment and thus will enhance
their social and economic status and that of their
families. The RH bill will help women become
self-reliant and acquire self-esteem.
4. It will help reduce poverty and achieve
sustainable human development.
5. The RH bill will most definitely help lower the
incidence of abortion by preventing unplanned,
mistimed and unwanted pregnancies. The
pregnancies which are the ones usually
terminated.
Promotion of reproductive health is cost effective. It is
much less expensive than the mega projects of
government but has more beneficiaries. The
improvement of maternal and infant health and
reduction of maternal and infant mortality will generate
savings for the government which could be channeled
to education and other basic services.
The UNICEF asserts that “family planning could bring
more benefits to more people at less cost than any
other single technology now available to human race.
(UNICEF State of the World’s Children Report, 1992)
The Philippine Reproductive Health Bill
 knowing the details of the proposed law is
essential in having a healthy debate on the issue.
 here are the pertinent details of the proposed bill,
which was introduced during a session of the
current Congress by Honorable Edcel C. Lagman,
Janette L. Garin, Narcio D. SantiagoIII, Mark
Llandro Mendoza, Ana Teresa Hontiveros-
Baraquel and Elandro Jesus F. Madrona.
 popularly known as the RH Bill aims to guarantee
universal access to methods and information on
birth control and
 maternal care
 promotes information on and access to both
natural and modern family planning methods,
which are medically safe and legally permissible.
 it assures an enabling environment where women
and couples have the freedom of informed choice
on the mode of family planning they want to adopt
based on their needs, personal convictions and
religious beliefs.

This Act declares the following as basic guiding
principles:
a. In the promotion of reproductive health, there
should be no bias for either modern or natural
methods of family planning;
b. Reproductive health goes beyond a demographic
target because it is principally about health and
rights;
c. Gender equality and women empowerment are
central elements of reproductive health and
population development;
d. Effective reproductive health care services must
be given primacy to ensure the birth and care of
healthy children and to promote responsible
parenting;
e. The limited resources of the country cannot be
suffered to, be spread so thinly to service a
burgeoning multitude that makes the allocations
grossly inadequate and effectively meaningless;
f. Freedom of informed choice, which is central to
the exercise of any right, must be fully guaranteed
by the State like the right itself;
g. Free and full access to relevant, adequate and
correct information on reproductive health and
human sexuality guided by qualified State workers
and professional private practitioners;
h. Reproductive health, including the promotion of
breastfeeding, must be the joint concern of the
National Government and Local Government
Units (LGUs);
i. Protection and promotion of gender equality,
women empowerment and human rights,
including reproductive health rights, are
imperative;
j. Development is a multi-faceted process that calls
for the coordination and integration of policies,
plans, programs and projects that seek to uplift
the quality of life of the people, more particularly
the poor, the needy and the marginalized;
k. Active participation by and thorough consultation
with concerned non- government organizations
(NGOs), people’s organizations . organizations
(NGOs), people’s organizations (Pos) and
communities are imperative to ensure that basic
policies, plans, programs and projects address
the priority needs of stakeholders;
l. Respect for, protection and fulfillment of
reproductive health rights seek to promote not
only the rights and welfare of adult individuals and
couples but those of adolescents’ and children’s
as well; and
m. The government shall ensure that women seeking
care for post-abortion complications shall be
treated and counseled in a humane, non-
judgmental and compassionate manner.
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Contraceptives as Essential Medicines.
Hormonal contraceptives, intrauterine devices,
injectables and other allied reproductive health
products and supplies shall be considered under the
category of essential medicines and supplies which
shall form part of the National Drug Formulary and the
same shall be included in the regular purchase of
essential medicines and supplies of all national and
local hospitals and other government health units.
Mandatory Age-Appropriate Reproductive Health
Education.
Reproductive Health Education in an age-appropriate
manner shall be taught by adequately trained teachers
starting from Grade 5 up to Fourth Year High School.
The implementation of Reproductive Health Education
shall commence at the start of the school year one
year following the effectivity of this Act.
The POPCOM, in coordination with the Department of
Education, shall formulate the Reproductive Health
Education curriculum, which shall be common to both
public and private schools and shall include related
population and development concepts in addition to
the following subjects and standards:
Reproductive health and sexual rights
Reproductive health care and services; Attitudes,
beliefs and values on sexual development, sexual
behavior and sexual health; Proscription and hazards
of abortion and management of post-abortion
complications; Responsible parenthood; Use and
application of natural and modern family planning
methods to promote reproductive health, achieve
desired family size and prevent unwanted, unplanned
and mistimed pregnancies; Abstinence before
marriage; Prevention and treatment of HIV/AIDS and
other, STIs/STDs, prostate cancer, breast cancer,
cervical cancer and other gynecological disorders;
Responsible sexuality; and Maternal, pre- natal and
post-natal education, care and services.
Additional Duty of Family Planning 0ffice.
Each local Family Planning Office shall furnish for free
instructions and information on family planning,
responsible parenthood, breastfeeding and infant
nutrition to all applicants for marriage license.
Certificate of Compliance
No marriage license shall be issued by the Local Civil
Registrar unless the applicants present a Certificate of
Compliance issued for free by the local Family
Planning Office certifying that they had duly received
adequate instructions and information on family
planning, responsible parenthood, breastfeeding and
infant nutrition.
Ideal Family Size
The State shall assist couples, parents and individuals
to achieve their desired family size within the context
of responsible parenthood for sustainable
development and encourage them to have two
children as the ideal family size. Attaining the ideal
family size is neither mandatory nor compulsory. No

punitive action shall be imposed on parents having
more than two children.
Penalties
Any commission of the foregoing prohibited acts or
violation of this Act shall be penalized by
imprisonment ranging from one (1) month to six (6)
months or a fine of Ten Thousand (P 10,000.00) to
Fifty Thousand Pesos (P 50,000.00) or both such
fine and imprisonment at the discretion of the
competent court; Provided That, if the offender is a
public official or employee, he or she shall suffer the
accessory penalty of dismissal from the government
service and forfeiture of retirement benefits. If the
offender is a juridical person, the penalty shall be
imposed upon the president or any responsible officer.
An offender who is an alien shall, after service of
sentence, be deported immediately without further
proceedings by the Bureau of Immigration
LEARNING TASK 2: TYPES OF
CONTRACEPTIVES
NATURAL FAMILY PLANNING
- also called “periodic abstinence”
A. Abstinence
A. Advantages:
A. the most effective way to prevent STIs
B. Disadvantages:
A. it is difficult for many couples to adhere to
B. Coitus Interruptus (withdrawal)
 the couples proceed with coitus until the
moment of ejaculation, then the man withdraws
 82% effective
 Advantage: male controlled method
 Disadvantage:
 sperm maybe present in pre-ejaculatory fluid
 can lead to STI’s
C. Lactation Amenorrhea (LAM)
 when a woman is breastfeeding, there is
natural suppression of both ovulation and
menses.
 failure rate is 1 to 5%
 is a safe birth control method if:
 infant is:
 under 6 months of age
 totally breastfeed at least every 4hrs during the
day and every 6hrs at night
 receives no supplementary feedings
 Menses has not returned
D. Postcoital Douching
 no matter what solution is used - is ineffective
as a contraceptive measure as sperm may be
present in cervical mucus as quickly as 90
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seconds after ejaculation, long before douching
could be accomplished.
E. Fertility Awareness Methods
 rely on detecting when a woman will be
capable of impregnation (fertile) so she can use
periods of abstinence during that time.
WAYS TO DETERMINE A FERTILE PERIOD:
1. Calendar Method (Rhythm)
o requires the couple to abstain from coitus on
the days of a menstrual cycle when a woman
is likely to conceive
o a woman should keep a diary of about 6
menstrual cycles and record the shortest and
longest cycle
o Reason for failure: irregular menstrual cycles,
miscalculation, or disregard for predicted
fertile days
o to calculate “safe” days:
o Formula: longest period minus 11; shortest
period minus 18
o Advantage: No cost
o Disadvantage: Requires motivation and
cooperation
2. Basal Body Temperature ( BBT )
o the woman takes her temperature orally or
with tympanic thermometer each morning
before she rises from or undertakes any
activity, this is her BBT.
o the temperature of her body at rest, falls
about 0.5°F
o at the time of ovulation, her BBT rises to
0.2°F
o Advantage: no cost
o Disadvantage:
 Requires motivation and cooperation of
male partner
 BBT can be affected by factors like; rise
of temp. due to illness and of a woman’s
daily schedule, or a change in a woman’s
daily schedule (such as starting an
aerobic program or getting up earlier than
usual)
 Combined with calendar method
3. Cervical Mucus/ Billing’s Method
o Predicting the ovulation by noting the
changes in cervical mucus
 without ovulation- thick/does not stretch
 just before ovulation – mucus secretion
increases
 on the day of ovulation (the peak day)
copious, thin, watery & transparent
 Spinnbarkeit - feels slippery (like egg
white) and stretches at least 1 inch
before the strand breaks
 Advantage: No cost
 Disadvantage:
 requires motivation & cooperation by
the male partner
 difficulty in interpreting mucus status

 Should be combined with calendar
method
4. Two-Day Method
o a woman assesses for vaginal secretions
daily. If she feels secretions for 2 days in a
row, she avoids coitus that day and the day
following as the presence of secretions
suggests fertility.
o Advantage: No cost
o Disadvantage: requires conscientious daily
assessment and results in about 12 days per
month in which she should avoid coitus
5. Symptothermal Method
o Combines the cervical mucus & BBT methods
o She also analyzes her cervical mucus every
day and observes for other signs of ovulation
such as mittelschmerz (midcycle abdominal
pain) or if her cervix feels softer than usual.
o Advantages
 No cost
 More effective than either BBT or Billing’s
method
o Disadvantage: It requires motivation and
cooperation from male partner.
6. Standard Days Method (Cycle Beads Method)
o designed for women who have menstrual
cycles between 26 & 32 days
o the first bead on the ring (red bead), marks the
first day of menstrual flow, followed by 6
brown beads which indicate “safe days”, 12
beads that glow in the dark (white beads) mark
fertile days and 13 additional brown safe dayS
o 95% / 88% effectivity
7. Standard Days Method (CycleBeads Method)
 Advantages:
 Visual aid can improve compliance
 Available as iphone app
 Disadvantages:
 Initial cost
 Need to mark a calendar ( just have to
move a bead rather than rely on memory.
8. Ovulation Detection
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 an over the counter ovulation detection kit
 this kit detect the midcycle surge of LH that
can be detected in urine 12 to 24 hours
before ovulation
 98 to 100% accurate in predicting ovulation
 combine a cervical mucus assessment and
ovulation detection kit to mark the peak of
fertile day
 Advantage: Becoming the method of choice
for many families
 Disadvantage: Expensive and not
intended to be used as contraceptive aid.
7. Marquette Model
 developed in the late 1990’s by nurses and
doctors at Marquette University in Wisconsin
 this method combines the use of ovulation
detection with other signs of ovulation
(cervical mucus, BBT, cervix position and
softness)

BARRIER METHODS OF CONTRACEPTION
these are forms of birth control that place a chemical
or latex barrier between the cervix and advancing
sperm so sperm cannot reach and fertilize an ovum
1.Spermicides
o an agent that causes the death of spermatozoa
before they can enter the cervix
o also change the vaginal pH to a strong acid
level, a condition not conducive to sperm
survival
o Advantages:
 Purchase without a prescription or
appointment with the health care giver
 When used in conjunction with other
contraceptive, they increase the other
method’s effectiveness
 Comes in various preparation; (gels,
creams, sponges, films, foams & vaginal
supp.)
 applied 1 hour before coitus and wait 6
hours after coitus
o Side Effects & Contraindications:
 Cervicitis
 Vaginal leakage might be bothersome
2. Male & Female Condoms
o Male condoms - a latex or synthetic sheath
that is placed over the erect penis before
coitus to trap sperm
 Advantages:
 A ”male responsibility” birth control
measures

 it prevents the spread of STI’s if
properly used
 no prescription is necessary
 Disadvantages:
 requires interruption of sexual activity
 may cause leakage of semen if not
used properly
o Female Condoms - are sheaths made of
latex or polyurethane, pre-lubricated with a
spermicide.
 Advantage:
 protection against conception, STI’s,
& HIV
 Disadvantages:
 insertion maybe difficult
 sensitivity / allergy to latex
3. Diaphragm
o circular rubber disk that is placed over the
cervix before intercourse to mechanically halt
the passage of sperm
o Advantage: Easy to insert
o Disadvantages:
 prescription needed
 shape of cervix changes with pregnancy,
miscarriage or cervical surgery &
infection
o Side Effects and Contraindications
 not be effective if a uterus is prolapsed,
retroflexed, or anteflexed to such a
degree the cervix is also displaced in
relation to the vagina.
 Intrusion on the vagina by a cystocele or
rectocele where the walls of the vagina
are displaced by bladder or bowel may
also make insertion of a diaphragm
difficult.
 Users of diaphragms may experience a
higher number of urinary tract infections
(UTIs) than nonusers probably because
of pressure on the urethra.
 Diaphragms should not be used in the
presence of acute cervicitis, herpes virus
infection, or a papillomavirus infection
because the close contact of the rubber
and the use of a spermicide can cause
additional irritation.
o Other contraindications include:
 History of toxic shock syndrome (TSS; a
staphylococcal infection introduced
through the vagina)
 Allergy to rubber or spermicides
 History of recurrent UTIs
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4. Cervical Caps - is made of rubber shaped like a
thimble which fits snugly over the uterine cervix.
o Contraindications for its use:
 abnormally short or long cervix
 current abnormal pap smear
 history of toxic shock syndrome
 allergy to latex or spermicide
 history of cervicitis / infection
 history of cervical cancer
 undiagnosed vaginal bleeding
5. Intrauterine Device (IUD)
o is a small plastic device that is inserted into the
uterus through the vagina. It could either be
hormonal or non- hormonal.
o Types of IUD:
a. Copper T380 (Paragard) - a plastic T-
shaped device with copper
b. Levonogestrel - releasing intrauterine
system 52mg IUD, (Mirena or Liletta). It
reduces indometrium proliferation and
thickens cervical mucus. It also has the
potential to reduce indometrial CA.
c. Levonogestrel - releasing intrauterine
stem 13.5mg (Skyla) IUD; has a lower
dose of progesterone in the stem. It
works similar to Mirena and is effective
for 3 years.
d. Levonogestrel - intrauterine system
19.5mg (Kyleena) has a lower dose of
progesterone as compared to Mirena but
higher than that of Skyla. It works for 5
years and has a bleeding profile similar to
Mirena.
HORMONAL CONTRACEPTION
 are hormones that when taken orally,
transdermally, intravaginally or intramuscularly,
cause fluctuations in a normal menstrual cycle
that ovulation or sperm transport does not occur.
1.Oral contraceptives / Combination Oral
Contraceptives
o commonly known as the pill
o are composed of varying amounts of:
1. natural estrogen (17B-estradiol, estradiol
valerate)
2. synthetic estrogen (ethinyl estradiol)
3. synthetic progesterone (progestin)
o Popular COC Prescribed:
1. monophasic pills
2. Biphasic
3. triphasic and tetraphasic
2. Progestin only pills - mini pills like combination
type must be taken conscientiously every day
o Benefits of Oral Contraceptives in Addition
to Preventing Pregnancy:
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1. Dysmenorrhea (lack of ovulation) o “What do I do if I forget to take an oral

2. Premenstrual dysphoric syndrome and contraceptive pill?”
Acne (increased progesterone levels)
3. Iron deficiency Anemia (reduced amount 1. If the pill omitted was one of the placebo
of menstrual flow) ones, ignore it and just take the next pill on
4. Acute PID (pelvic inflammatory disease, time the next day.
and resulting tubal scarring
5. Endometrial and ovarian cancer, ovarian 2. If you forgot to take one of the active pills,
cyst and ectopic pregnancies take it as soon as you remember. Continue
6. Fibrocystic breast disease the following day with your usual pill
7. Possibly osteoporosis, endometriosis, schedule. Doing so might mean taking two
uterine myomas / fibroid uterine tumor pills on one day if you don’t remember until
and rheumatoid arthritis the second day, but that’s all right. Missing
8. Colon CA. one pill this way should not initiate
9. May also lower the concentration of LDL ovulation.
and increase the HDL level (estrogen
interferes with lipid metabolism) 3. If you miss two consecutive active pills,
take two pills as soon as you remember.
o Side Effects of COC: Then, continue the following day with your
usual schedule. You may experience some
1. nausea breakthrough bleeding (vaginal spotting)
2. weight gain with two forgotten pills. Do not mistake this
3. headache bleeding for your menstrual flow. Missing
4. breast tenderness two pills may allow ovulation to occur, so
5. monilial vaginal infection an added contraceptive such as a
6. breakthrough bleeding spermicide should be used for the
7. mild HPN remainder of the month.
8. Depression
4. If you miss three or more pills in a row,
throw out the rest of the pack and start a
new pack of pills. You might not have a
period because of this routine and should
o Advice all Women taking COC to see their
use extra protection until 7 days after
Healthcare Provider if S/S of
starting a new pack of pills.
Myocardial/Thromboembolic
Complications Occur:
5. If you think you might be pregnant, stop
taking pills and notify your healthcare
1. Chest pain provider.
2. Shortness of breath
3. Severe headache
3. Estrogen/Progesterone Transdermal Patch
4. Severe leg pain
(Transdermal Contraception)
5. Eye problem/ blurred vision

o refers to patches that slowly but continuously

o Contraindications to Estrogen-Based Oral
release combination of estrogen and
Contraceptive Use:
progesterone
o Site of Application:
1. Breastfeeding and less than 6 weeks
postpartumAge 35 years or older &
 Upper outer arm
smoking 15 or more cigarettes/day
 Upper torso (front or back, excluding the
2. Arterial cardiovascular disease; diabetes,
breast)
moderate to severe HPN
 Abdomen
3. Current or history of deep vein thrombosis
 Buttocks
or pulmonary embolism
4. Major surgery that requires prolonged
immobilization 4.Vaginal Estrogen/ Progestin Rings (Nuva Ring)
5. Current or history of Ischemic heart
disease or CVA o an Etogenestrel/Ethinyl estradiol vaginal ring is
6. Complicated valvular heart disease a flexible silicone vaginal ring that, when placed
7. Migraine with neurologic symptoms in the vagina, continually releases
8. Current breast CA or diabetes of more combination of estrogen and progesterone.
than 20 years with nephropathy,
retinopathy, neuropathy, vascular disease o Advantages of Nuva Ring:
9. Severe cirrhosis or liver tumors
10. Women taking anti-seizure or anti-TB  indicated for women with liver disease
drugs\  rings do not need to be removed for
11. Women prescribed with certain broad- intercourse
spectrum antibiotics.  effectiveness is equal to COC

o Disadvantages:

Cynithhaa
  may need to mark a posted calendar to
remind a woman to remove and replace
the ring
 may need to be encouraged to use
vaginal ring as introducing it vaginally
may at first seem complicated than taking
a pill everyday.
 some women may experience vaginal
discomfort or infection
1. offers an effective and reliable alternative
to COC’s estrogen- related side effects.
2. sexual enjoyment is not inhibited NCM107
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3. can be used during breastfeeding without
an effect on milk production.
4. rapid return to fertility after removal when
they become ready to begin a family
o Disadvantage:

5.Subdermal Hormone Implants 1. Expensive - but this procedure might be

covered by health insurance (Affordable
o a Progestin-filled miniature rod no bigger than a Care Act)
matchstick
o Etonogestrel Implant (Nexplanon) can be
embedded just under the skin on the inside of
the upper arm where it will slowly release
progestin over a period of 3 years.
o the implant is able to effectively suppress
ovulation, thicken cervical mucus, and change
the endometrial lining, making the implantation
difficult.

6.Intramuscular injection:

o a single IM injection of depot

medroxyprogesterone acetate or DMPA
(Depo-Provera) - a progesterone given every
12 weeks, inhibits ovulation, alters the
endometrium, and thickens the cervical
mucus so sperm progress is difficult.

o Advantages of Hormonal Injection:

 the effectiveness is almost 100%

 with long term reliability
 can be used during breastfeeding
 reduction of ectopic pregnancy,
endometrial CA, endometriosis, & for
unknown reasons, frequency of sickle cell
crises.

o Disdvantages:

1. the woman must return to a health care

provider for a new injection every 12
weeks

o Side effects of IM Injection:

1. headache, weight gain, depression,

irregular or heavy menstrual flow cycles
for one year, or no menstrual flow the
first year
2. may also impair glucose tolerance in
women at risk for diabetes
3. may increase the risk of osteoporosis

o Contraindications:

1. Not to use this method for long term (not

over 2 years)

o Advantages of Subdermal Implants:

Cynithhaa

CHAPTER 6: FILIPINO CULTURE,
VALUES AND PRACTICES IN RELATION
TO MATERNAL AND CHILD CARE
LEARNING TASK 1: FILIPINO CULTURE,
VALUES AND PRACTICES IN RELATION
TO MATERNAL AND CHILD CARE
Pregnancy
 According to some Filipino beliefs, cravings for
food during pregnancy should be satisfied.
 Some pregnant women may avoid eating black
foods to avoid the birth of an infant with a dark
skin tone.
 Some pregnant women may place great
emphasis on being tidy and beautiful, believing
that these practices will influence the beauty of
their child.
 Unpleasant emotions experienced by pregnant
women may be blamed for causing birthmarks
Birth
 The most common birthing position is to lie down.
 Some women may prefer a squatting position.
 In some regions of the Philippines, it is believed
that putting squash leaves on the abdomen of a
laboring woman can facilitate labor.
 Some women believe that drinking coconut water
can facilitate a fast labor.
 Some fathers may prefer to be close to their
laboring wife, so they can bury the placenta.
After Birth
 In some regions a father is responsible for the
burial of the placenta.
 He usually buries the placenta very quickly,
because the burial of the placenta indicates the
end of the labor, and therefore the end of pain
and blood loss experienced by the laboring
woman.
 The placenta should be offered to the postpartum
woman or the father.
 Traditional custom in the Philippines dictates that
women should not bathe for about ten days after
giving birth and during menstruation.
 Bathing during these times is seen as a cause of
ill health and rheumatism in old age.
 Sponge baths and steam baths could be used as
alternatives. Women may object to having a
shower immediately after giving birth. Traditionally,
after labor, women wear heavy clothes or wrap
themselves in blankets to prevent exposure to
‘cold’ and ‘wind’.
 Some Filipinas bind their abdomen tightly,
believing that this practice helps to prevent
bleeding and helps the uterus to retract.
 New and lactating mothers are often given rice
porridge (rice boiled soft to a consistency halfway
between soup and puree).
 This may be served with sweet, salty or spicy
accompaniments. Soup made of meat and
vegetables is also believed to help promote
lactation.
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 Women fear what is referred to as a ‘relapse’
if they become active too soon. This involves
extreme tiredness, weakness and chronic
headache.
 In the Philippines when a woman has a baby,
she usually rests while her relatives do all the
housework and cooking. Many women can have
difficulty coping with the daily routine of looking
after a baby in a country where they may not have
the support of an extended family.
Postpartum
 Women may be massaged with coconut oil,
with the aim of restoring their lost health,
expelling blood clots from the uterus, returning
the uterus into a normal position, and
promoting lactation.
 Some women perform various practices for the
purpose of ‘drying out’ the womb.
 For example, ‘mother roasting’ can involve lying
beside a stove for up to 30 days, squatting over
a burning clay stove, sitting on a chair over a
heated stone or a pot with steaming water, or
bathing in smoke from smoldering leaves.
 In Australia, these practices may be replaced
by hot water bottles and placing a postpartum
woman close to a heater.
Infant Care
 Infants and small children are thought to be
susceptible to fright, which causes crying and
trembling.
 A traditional belief is that an infant may be hexed
by an admiring glance, but many Filipinos in
Australia are likely to be ambivalent or doubtful
about such beliefs.
 Colds and rashes may be accepted as natural in
young children, although some may be regarded
as serious.
 In rural Philippines, women will often take a child
with a cough to a traditional healer. Filipino
women should be educated to contact health
services if they notice any unusual symptoms.
 Traditionally, parents sleep with their children or
have their children sleep with another relative,
and do not separate them when they are ill.
Infant Feeding
 Colostrum is usually considered ‘dirty milk’ and
discarded.
 Some women may be reluctant to feed colostrum
to their newborn, despite encouragement by
health professionals.
 Breast feeding on demand is normal practice for
rural Filipinas.
 Women may adopt mixed feeding because of the
demands of work outside the home.
 Some mothers believe that a mother’s mood can
be transmitted through breast milk and therefore
do not feed if they feel sorrow or anger.
 Breast feeding may also cease if the child
contracts diarrhea, in case the illness becomes
worse.
 Of the 459 Philippines-born women who delivered
in Queensland Health facilities in 2006, at the time
of discharge, 78% (358) exclusively breastfed,

12% (55) breastfed and formula fed and 10% (45)
exclusively formula fed.
LEARNING TASK 2: NURSING CARE
PLANNING TO RESPECT CULTURAL
DIVERSITY
 is the existence of a variety of cultural groups
within a society
 language, religion, race, sexual orientation,
gender, age and ethnicity.
 helps dispel negative stereotypes and personal
biases about different groups
 helps us recognize and respect “ways of being”
that are not necessarily our own
Samples (Pregnancy)
 what foods to eat, how much exercise is good
during pregnancy, and whether fetal tests for well-
being are ethical
 is it wrong to have a photograph taken during
pregnancy because that will alert unknown spirits
that the woman is pregnant
 some religions also do not support a full range of
contraception options; in these instances, the
nurse can assist by recommending other natural
family planning options that align with the
woman’s preferences.
Samples (Labor & Delivery)
 language barrier / patient is hearing challenged –
find interpreter
 touch – assess whether woman like or not
 placenta – bring home or not?
o burying placenta ensures the child will
continue to be healthy
o China – cooked, powderized and eaten to
ensure continued health of the mother
 Cord blood sample – banked for stem cell
transplantation in the future
Samples (Genetic Disorders)
 β-thalassemia - families of Greek or
Mediterranean heritage
 α-thalassemia - Philippines or Southeast Asia.
 Sickle-cell anemia - African ancestry
 Tay-Sachs disease - eastern Jewish ancestry.
It is important that families who are at high risk for
particular genetic disorders such as these be
informed of the incidence of these disorders among
those of their ethnic heritage and offered genetic
screening as appropriate during preconception
counseling.
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LEARNING TASK 3: FILIPINO
PREGNANCY BELIEFS
Filipino Pregnancy BeliefsPamahiin: Pinoy
Pregnancy BeliefsMYTH
MYTH#1: “’Pag matulis ang tiyan ng nanay, lalaki ang
anak. ’Pag mabilog naman, babae.”
FACT: Belly shape is merely an indication of the
baby’s position inside the uterus or baby’s
movements as he develops.
MYTH #2: “Ang laki ng ilong mo! Babae ’yan.”
FACT: Physical changes are normal - regardless of
whether they’re expecting a boy or a girl.
MYTH #3: Did you say severe morning sickness?
Congratulations, you’re having a girl!
FACT: A Swedish study found that 56 percent of
women who suffered from severe nausea and
vomiting of pregnancy (NVP) gave birth to baby girls,
though many obstetricians argue that the percentage
is too small to confirm the link between morning
sickness and female fetuses. So yes, you may have
a slightly bigger chance of having a girl if you’re
experiencing unbearable NVP, but 44 percent is still
enough to prove you wrong.
MYTH #4: “Nangingitim ba ang kili-kili at leeg mo?
Ah lalaki ‘yan!”
FACT: “Hyperpigmentation has absolutely nothing to
do with the baby’s gender,” confirms Dr. Nucum.
MYTH #5: You’ll twist your child’s umbilical cord
around his neck if you hang a towel over your
shoulder.
FACT: Entanglement or cord coil is not in any way
related to hanging a towel over your shoulder.
MYTH
#6: “Huwag kang uminom ng malamig o maligo sa g
abi. Magkaka-sipon ang anak mo.”
FACT: Babies can’t develop a cold while inside the
womb. The amniotic fluid helps stabilize the
temperature, so he doesn’t feel the difference if
you’re hot or cold.
“Pregnant women feel [warmer] because they
undergo a lot of metabolic changes due to the
increasing demands of the fetus. For this reason,
they are all the more advised to take regular baths,”
says Dr. Nucum.
MYTH #7: “I watched Leonardo di Caprio movies all
throughout my pregnancy, so I know my baby will
be tisoy, gwapo, and talented!”FACT: A pregnant
woman’s pinaglilihian will not affect her baby’s
physical appearance. A baby’s looks are developed
from the parents’ DNA
MYTH#8: “Kung mahaba ang buhok mo, mahihirapa
n kang manganak.”
FACT: “Delivering a baby is affected by a lot of
factors that may be summed up by the three P’s: the
‘passenger,’ [which is] determined by the size of the
baby, the ‘passage,’ [or] the adaptation of the fetus to
the mother’s bony pelvis, and the mother’s ‘push.”
MYTH #9: If you’re giving birth at home, lie down
with your legs facing the door. The bigger the door,
the easier it will be for you to give birth.
FACT: Just remember the three P’s.

Advantages:
MYTH #10: A baby born at nighttime will stay awake
during the evening. So when giving birth, try to hold it
until the next morning.
FACT: Newborns are usually asleep 90 percent of
the day, and their sleeping patterns continue to vary
as they grow older.
MYTH #11: More pregnant women experience labor
pains or give birth when the moon is full.
FACT: There is no scientific truth to this claim.
LEARNING TASK 4: MATERNAL AND
CHILD CARE ENTREPRENEURIAL
OPPORTUNITIES
Day Care Center
Maternal and Child Care Entrepreneurial
Opportunities
Birthing Center
 A birthing center is a cross between a home birth
and a hospital.
 Birthing centers offer a homelike setting but with
close proximity to a hospital in case of
complications.
 Midwives often are the sole care providers in
freestanding birthing centers, with obstetricians as
backups in case of emergencies.
 Birthing centers usually have fewer restrictions
and guidelines for families to follow and allow for
more freedom in making decisions about labor.
 The rates of cesarean birth and the costs are
much lower than those of a hospital (Steppe,
2006).
 The normal discharge time after birth is usually
measured in hours (4 to 24 hours), not days.
 Birthing centers aim to provide a relaxing home
environment and promote a culture of normalcy.
 Birth is considered a normal physiologic process,
and most centers use a non-interventional view of
labor and birth.
 The range of services for the expectant family
often includes prenatal care, childbirth education,
intrapartum care, and postpartum care, including
home follow-up and family planning.
 One of the hallmarks of the freestanding birthing
center is that it can provide truly family-centered
care by approaching pregnancy and birth as a
normal family event and encouraging all family
members to participate.
 Education is often provided by such centers,
encouraging families to become informed and
self-reliant in the care of themselves and their
families (Bainbridge, 2006).
 Birthing centers provide an alternative for women
who are uncomfortable with a home birth but who
do not want to give birth in a hospital.
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 A non-interventional approach to obstetric care,
freedom to eat and move around during labor,
ability to give birth in any position, and the right to
have any number of family and friends attend the
birth.
Disadvantages:
 are that some centers have rigid screening
criteria, which may eliminate healthy mothers from
using birth centers; many have rigid rules
concerning transporting the mother to the hospital
(e.g., prolonged labor, ruptured membranes); and
many have no pediatrician on staff
 Alternative Titles: crèche, day nursery, nursery
school
 Day-care centre, also called day
nursery, nursery school, or crèche (French:
“crib”), institution that provides supervision and
care of infants and young children during the
daytime, particularly so that their parents can hold
jobs.
 Such institutions appeared in France about 1840,
and the Société des Crèches was recognized by
the French government in 1869.
 Day-care centers were established in most
European cities and industrial centers during the
second half of the 19th century; the first in Great
Britain, for example, was established in 1860.
 In the United States, the terms day nursery, day-
or child-care center, and nursery school are often
used interchangeably to identify various types of
day care for children and for preschool
educational programs.
 Services to young children and their families have
a longer history in European and Asian countries
than in the United States, where day-care centers
are generally private and of varying quality.
 In many countries, day-care facilities are
associated with the mother’s place of work. Infant
care and preschool programs are a normal
provision in many developed countries, and in
some countries, such as France and Italy, they
are included in the regular public-school system.
 However, the United States has developed no
societal consensus about the appropriateness of
day care, and the resulting unevenness of
standards of care is cause for concern. Both the
importance and the availability of day care
increased in the 20th century owing to the rising
proportion of women in the workforce.
 NCM107
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LEARNING TASK 4: MATERNAL AND Interprofessional Map – divided in 5 Columns:

CHILD CARE ENTREPRENEURIAL
OPPORTUNITIES
Interprofessional Care Map
a collaborative practice process which includes
communication and decision-making, enabling a
synergistic influence of grouped knowledge and skills.
Collaboration and Practice:
Interpersonal collaboration - is a partnership
between a team of health care providers and a client
in a participatory collaborative and coordinated
approach to shared decision-making around health
and social issues
Collaborative Practice - a process which includes
communication and decision- making enabling a
synergistic influence of grouped knowledge and skills.
Elements of Collaborative Practice:
 Responsibility
 Coordination
 Cooperation
 Autonomy
 Accountability
 Communication
 Assertiveness
 Mutual Task and Respect
Interprofessional Care:
 is the provision of comprehensive health services
to patients by multiple care givers who work
collaboratively to deliver quality care within and
across settings.
Benefits of Interprofessional Collaboration:
A. Team member responsible
B. Assessment
C. Intervention
D. Rationale
EXPECTED OUTCOMES
Family Assessment: Rosann has been married for 2
years. Present pregnancy intended. Husband, 34
years old, owns a car dealership. Rosann works as
salesperson in dealership office. Finances rated as
“no problem.”
Patient Assessment: Patient, gravida 1, para 0, in
latent stage of labor. Cervix dilated 4 cm, 80% effaced.
Contractions every 5 minutes, with peak strength at
20–25 mmHg and a duration of 10 seconds. Fetal
heart rate (FHR) at 130–140 beats/min with beat-to-
beat variability present. Patient and partner visibly
apprehensive, watching monitor intensely. Patient vital
signs within normal parameters. Normal saline IV
solution infusing at 150 ml/hr via infusion pump.
Patient drinking sports beverage “to keep up strength.”
Oxytocin prescribed at 1 milliunits/min; increase 1
milliunits/min at 30-minute intervals
Nursing Diagnosis: Risk for injury (maternal and fetal)
related to prolonged labor with ineffective contractions
and requiring oxytocin augmentation
Outcome Criteria: Patient’s vital signs and FHR
remain within acceptable parameters; contractions
increase after oxytocin administration without
becoming hypertonic; labor progresses without signs
and symptoms of maternal or fetal distress. Urine
output is at least 30 ml/hr; urine specific gravity,
1.010–1.030.

1. Improved patient outcomes

2. Fewer preventable errors
3. Reduced health care cost
4. Improved relationships with other disciplines

Components / Parts of Interprofessional Map:

1. Brief history of present condition

2. Family Assessment
3. Patient Assessment of Client’s condition
4. Nursing Diagnosis
5. Outcome Criteria
6. Plan of care with sub-components

Sub-components of Plan of care:

1. Activities of daily living

2. Teamwork and collaboration
3. Procedures/medications for quality
improvement
4. Nutrition
5. Patient-centered care
6. Psychosocial/ Spiritual/ Emotional needs
7. Health care planning

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