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PROFESSIONAL TEACHERS
(Jamal-Ul-Din Lund, Syed Hameedullah Shah, Qamar_Ul_Din Bahalkani, Aijaz Ali Noonari, )
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COMMUNITY HEALTH NURSING III __________________________From the desk of writer & Composer;
The enthusiastic welcome of the Community Health Nursing III The major view of writing these notes is to provide an update , reasonably brief and comprehensive notes of the Community Health Nursing. In addition, all the other notes have been reviewed to accommodate new information, illustration and figures resulting into extensive modification. As during the past several decades, considerable progress has been made in ascertaining the correlation. An attempt has been made to write these notes, these notes are complete enough to study but also lead you towards the more interest towards the study. Community Health Nursing is developed to provide nursing students with the knowledge and skill they need to become competent, think critically and possess the sensitivity they need to become caring nurses. Professional nursing practice continues to evolve and adapt to societys changing health priorities. The rapidly changing health care delivery system offers new opportunities for nurses to alter the practice of Community Health Nursing and to improve the way to care the community and the fulfillment the Performa regarding the community assessment. I believe that the changes in health care present exciting challenges to nurses and it is felt that there is a need for good nursing notes of Pakistan origin to assist nurses to meet their challenges in the walk of study. These notes are referenced from many different books for to give new shape to notes included: Encarta Encyclopedia Britannica Encyclopedia CHN BT Basavanthappa Oxford Dictionary Previous Question papers (NEBs) Public Health & Community Medicine Basis of Community Health Nursing Different Dictionaries & different authorized Books I am aware of manifold reasons, errors might have crept in. I shall feel obliged, if such errors are brought to my notice. I sincerely, welcome constrictive criticism from both teachers and students that would help me to enrich myself and good suggestions will be incorporated in next notes.
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Minus type desk: when the edge of the desk over-hangs the edge of the seat. Plus type desk: when there is gap between the edge of the seat and edge of desk
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B. Head & Neck: Neck examination: ________________________________________ Head (Size, shape, Head circumference): ______________________ Eyes: ___________________________________________________ Ear: ____________________________________________________ Nose: __________________________________________________ Face: __________________________________________________ Mouth: ________________________________________________ Hairs: _________________________________________________ Throat: ________________________________________________ C. Respiratory System Respiratory rate: _________________________________________ Breath Sounds: __________________________________________ D. Cardio-Vascular System Pulse (Rate, Rhythm, Volume): _____________________________ Blood Pressure: _________________________________________ Chest deformity: ________________________________________ Apex beats: ____________________________________________ Heart sound: ___________________________________________ Gastro-intestinal System a. Oral Cavity: Lips: _________________________ Gums: ________________________ Teeth: ________________________ Tongue: ______________________ Mouth: _______________________ Mucus membrane: ______________ b. Abdominal Cavity: Shape: _______________________ Movement of the intestine: _______ Peristaltic movement: ___________ Tenderness: ___________________ Umbilicus position: _____________ Pubic hair: ____________________ Hernia (any) : __________________
9 BY: MUHAMMAD IBRAHIM ANSARI +92 301 3461167
E.
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F. Central Nervous System: Memory capacity: _______________ Mental function: ________________ Neurological assessment: _________
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Define Toxicology
Definition:
The study of toxics effect of the chemical substance and physical agents and their adverse effect on the body is known as toxicology Occupational diseases 1. Respiratory disorders: Asthma (due to dust-fume-vapors etc) Bysinosis (due to exposure to cotton) Silicosis (due to silica-stone cutting) Asbestosis (due to asbestos fiber) Bronchogenic Carcinoma (due to smoke asbestosis etc) Allergic (Due to dust etc) 2. Skin disorders Such as dermatitis, eczema, allergic etc 3. Motion sickness Occur due to vibration 4. Heat Stroke-heat rashes and Cramps Due to high temperature 5. erythematic Cataract Due to ionizing radiation
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Common Occupational Hazards 1. Heat and Cold Heat causes heat stroke and heat rashes Cold causes chilblain frost bite, Hypothermia 2. Light
Poor light causes strain, head ach, eye pain, and congestion of cornea.
Excessive light cause blurring vision, discomfort and visual fatigue 3. Noise: May cause temporary or permanent deafness 4. Vibration: Causes motion, sickness, and vertigo 5. Radiation: Cataract erythema etc 6. Dust-fume-smoke: Cause asthma allergic and asthma 7. Asbestos: Cause asbestosis 8. Silica: Cause silicosis 9. Cotton dust: Bysinosis (lung disease) 10. Mechanical hazards: Causes injury and disability 11. Zoonatic hazard: Cause rabies, anthrax etc 12. Toxic hazards: Eg: fertilizers, antiseptic, may cause toxic effect Prevention of occupational hazards The working hour should not more than 8hours in a day and one Hour for mid day rest Periodic inspection of the industry to supervise ventilation, Cleanliness dust gases and high lights etc Periodic medical check up of worker Placing the worker in job according to their capabilities Informing and training about the job firstly before giving Handsome salary should be gifted. Cheap and well balanced diet is essential of the worker Gloves to protect from dermatitis and handling the machine According to situation of the work. An adequate lighting and ventilation avoid most of the hazards Recreational facilities and chances for good education for their Children should be provided Women worker should have three months maternity leave Provision of an adequate safe drinking water and proper sanitation Satisfactory condition for female workers
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Unit No # 04 *Rehabilitation*
Define Rehabilitation:
Definition:
The rehabilitation is process by which the disable person can achieve maximum physical, social and mental efficiencies and can live and independent life in the society.
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Role of L.H.V:
L.H.Vs are Primary Health Care provider so her functions are based on community needs and related health problems. Towards completion of her training the responsibilities of her are: Maternal and child health services. Child survival services (prevention and control). Health education. community participate co-ordinate Referral services. First aid Keeping the record and reports. Training of Dai. Identification and use of community resources. Prevention of communicable diseases.
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Line Of Authority:
It is work (messages & power) done systematically, where authority is use downward and upward, It should be/can be observed and evaluated by every on to find out the efficiency of organization.
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Group:
Definition: It is nature that individual forms group often person plans with several group at the same time to need the different needs. Some groups are found naturally (Blood relation groups) and other formed for special talk to meet desirable needs (Governmental and social organization).
Types of Group:
1. Primary Group:It is small and long lasting with close contact face to face contact relationship such as family members are close friends. There is extensive and durable interaction it is formed group .The members of this group has sense of belonging with each other family, neighbor, playmates and worker group. 2. Secondary Group:It is large and formal group they organized and related temporarily, interactions is not frequent or closed each one do work as a part of machine members are not involve emotionally PNC, PNA, WHO, UNICEF, political instruction organizations. 3. Tertiary Group:A social group which is tertiary on time and importance this group is temporary and easily under go to change. E.g around of people organized to protect against crime, corruption etc.
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To help people to achieve health by their own sources/activities. To develop the sense of responsibilities for improvement of health of individuals & families. To develop scientific knowledge, attitude and skill to develop correct habits. To alter behavior this may lead them to cause disease. To create interest in him for their own well being and community sanitation. Health education should be on principal of active interest. This should be based on principal of active learning Educate from known to un-known points. Use the language which is easily understandable. Reinforcing the messages by repeating them and using different method. Provide opportunities for the people to learn by doing. Nurse should develop good human relationship through educational approach. Community leader must be taken in the consideration.
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Demonstration Method:
This is the method in which the persons are taught practically by showing or dong experimentally. OR In this method teaching & learning are depends upon showing something. This method is also good for small group, b/c has too ensured the participation of every one & process should be under stand by every one. It is important that every member or one or two members (learners) repeat the method.
Panel Discussion:
In this method panel of the 4 to 8 experts is arranged to assess on one topic or subject under the guidance of chair person. The experts are ready to give the answer of the questions which are asked by the audience (Other group members).
Exhibition:
In this method some pictures are provided to educate the people. It needs well preparation & meaning full chart, pictures or other visual aids. The things which are to be shown should be placed on the suitable place, with having adequate light on it. There should be a person to explain or answer the questions.
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Lecture Method:
This is method of oral presentation of subject to large group of people & is one way method.
Counseling method:
Counseling method is an educational tod for helping individuals & families in their health problems. It is conversation of ideal among the two or more people having common interest & problem.
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Mass media:
This is method in which the person are instructed by the mass media e.g. T.V, Radio, charts etc. OR It is tool of communication & health education. a) Pamphlet:Pamphlets are printed message & include pictures. The pamphlets on the health topic may be prepared locally or may supply by the department/ higher authority. Pamphlets are handed over to people. b) Posters:There are so large than the pamphlet. Posters are usually provided by health department. The posters are displayed on the walls. The posters may prepare locally on the white paper the little, meaning full, short messages should be written to understand immediately. c) Flip Chart: It is series of charts bounded together such as each chart is viewed by turning back. It is presentation of many ideas that can not be presented on one chart.
Radio/ T.V:
It is vast media for communication. It is one way communication. It is useful media to keep the people well informed about social problems, current social changes, declaration publicity of health polices, environment & biological & social health hazards.
Advantages:
It is most widely available. It is popular in rural areas. It is cheap & easy to operate. Broad casting can be taped for replay
Dis-advantages:
Listener reaction to the programme is not known except when broad casting is heard by listener. This required considerable preparation of time. Available broad casting may not obtain
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Interview:
Advantages: Ensure privacy. Gives the sense of care and confidence to students.
Dis-advantages:
Time consuming. Require experience.
Flannel Graph
A board is prepared which is covered with flannel or rough cloth. The pictures are ready in order to place on board through the pins. The picture may be removed again. The board should be placed at good light/site, so that all the viewers see & can understand properly.
Seminar
Refer to group of person who have prepared themselves on particular topic or problem & will speak to audience.
Symposium
In this person speak on selected subject each expert presents as aspect of subject briefly & there is no discussion among the members.
Buzz session
Refers to large group into several small groups & discuss assigned topic.
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Evaluation
Evaluation of health education
The evaluation is the process of finding out how things are being done.
Purpose of Evaluation
To find out the achievement and efforts of health education. To observe awareness change of behavior of client. To determine the limitation of health education. Vital part of learning.
What to Evaluate
Knowledge gained by learners. Practice is healthy or not. Number of health session Number of the people attended to health education programme. Effectiveness of health education How much understanding by audience. Attitude is changed or not.
Technique of evaluation
Self evaluation. Teacher & student evaluate each other. Silent observation. Instructor asks questions. Test & examination. Short evaluation at the ends of the session. By health workers while visiting of homes. Survey & community visiting. Meeting with individuals, families, leader etc.
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2. Demographic Information:
The total information about total population with reference to age, sex, caste, education, occupation & income. Total families e.g. nuclear fail, joint family etc Vital health events i-e C.B.R, C.D.R, I.M.R, morbidity etc. Specific vulnerable groups i-e infant, toddler, expecting and lactating mother.
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3. Environmental information
i. Physical Factors: house = numbers type open space etc Water = potable, not potable, safe or unsafe etc Sanitation= Disposal of waste and waste water etc. Social organization = school, college, temples, Mosque etc. Community organization Leader ship structure as M.P.A, M.N.A etc.
iii. Environmental communication: Common meeting places. Media = T.V, radio, newspapers, cinema etc.
iv. Environmental resources: Economic resources = Occupation, income etc. Institutional resources = Health institution, industrial & commercial agencies. Human resources = Doctor, Engineer, Teachers, nurses, lawyers etc.
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Demography
Definition:
It is the science of population & it is concern with size, structure, distribution & changes which occurs due to birth, death, in migration, out migration is called demography.
Population Dynamics
There are four ways in which the number of peoples in area can change. 1. No: of live birth (B) in the area. 2. No. of deaths in the area (D) 3. No. of persons moving into area. 4. No. of persons moving out of the area. Thus population of the area may change due to natural reason. (B-D) called natural increase & due to migration (IM-OM) called net migration So: Population growth = natural increase + net migration. OR Population growth = (B.D) = (IM-OM)
Dependency Ratio
This is the ratio of population who are economically in active to those who are economically active & can be expressed by the Eq: as follow: Dependency ratio children + elders x 100 Working age = Dep: ratio = population below 15 +65 years or above Population15 to 64 The dependency ratio of Pakistan in 1995 was Pak (1995) 58192000 + 4179000 x100 7.388600 = 84.4/100 =
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Basic Definitions
Fertility:This is actual reproductive performance of woman or couple.
Sex Ratio:This is the ratio of male to the females in the population & can be obtained by dividing male population by female population & multiplied by 100 i-e Sex ratio = male population x100 Female population
Vital static
A science which deals with the applications of numerical method to vital facts.
Bio statistics
It is science for collection, analysis & interpretation of data in relation to vital events i-e births, deaths & sickness.
Health statistics
It is the study of life history of the community in relation to health i-e prevention & control of disease, control of population problem & family planning & programme planning & developing & preventing & curative services.
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3.
Age specific fertility rate (A.S.F.R) It is adjusted for the age & determines the fertility rate of woman in each age group. Thus A.S.F.R = No. of live births to woman age in a year x x 100 No. of woman aged x Control of high fertility Introduction of family planning services Effectiveness of family planning methods Provide health education by showing facts & Dis-advantages of high fertility Controlling of early marriage Breast feeding to babies for two years.
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2. Age Specific Death Rate (A.S.D.R) This is the number death person of specific age group in a population in a year divided by total no. of person of that age multiplied by 1000 A.S.D.R = no. of person of age X in a year x 1000 No. of person that age Example: no. of death under five year age Total no. of children under five year A.S.D.R According to the formula A.S.R.D = 40 X 100 1000 =10 = 40 = 4000 = ?
3. INFANT MORTALITY RATE (I.M.R) This is the number of death of children under one year in a population divided by no. of live birth in that year multiplied by 100
I.M.R= No. of death of infants under one year of age in year X 1000
No of live births in a year No: of deaths of children under one year = 36 Total no: of live births = 400 I.M.R = ? According to the formula: I.M.R = 36/400X 1000 = 90/1000 Example:
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4. Neo-Natal Mortality Rate (N.M.R): This is the number of death of children less than one month in a year, divided by no. of live birth in that year multiplied by 1000
N.M.R= No. of death of infants under one month of age in year X 1000
No of live births in that year a. Early Neo-Natal Mortality Rate (E.N.M.R): This is the number of death of children less than one week in a year, divided by no. of live birth in that year multiplied by 1000
.E.N.M.R= No. of death of infants under one week of age in year X 1000
Total no: of live births in that year b. Late Neo-Natal Mortality Rate (L.N.M.R): This is the number of death of children from one week to four week, divided by no. of live birth in that year multiplied by 1000
L.N.M.R= No. of death of infants from 1-4 week X 1000
Total no: of live births in that year c. Post Neo-Natal Mortality Rate (P.N.M.R): This is the number of death of children from 4-52 weeks or 01-12 months in a year, divided by no. of live births in that year multiplied by 1000
P.N.M.R= No. of death of infants during 4-52 weeks X 1000
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5. Peri-Natal Mortality Rate (P.M.R): This is the number of deaths under one week plus still births, divided by total no. of live births plus still births multiplied by 1000
P.M.R= No. of deaths of children under one week + still births in a year X 1000
Control of Infants deaths: Immunization against the seven target diseases Breast feeding should be encouraged for all infants till two years In all diarrheal cases O.R.S should be given to children to prevent from severe dehydration Appropriate feeding i-e: weaning diet should be started at 4-5 months Milk feed should not be diluted Domestic pots should be clean Avoidance of usage of anti-diarrheal and anti-spasmodic drugs, in the under five years of age
The milk should be pasteurized and water should be boiled before giving to children.
General hygienic care should be given to infants Family planning should be applied to reduce the rate of mortality
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6. Maternal Mortality Rate (M.M.R): M.M.R= No. of deaths of women due to pregnancy; its complication or after delivery (child birth) X 1000
Total live births in a year
Causes of M.M.R:
Hemorrhage (APH, PPH) Anemia Septicemia Pre-eclampsia Repeated Pregnancy Mal-nutrition Mal-position of child Puerperal sepsis Toxemia
Prevention of M.M.R:
Adequate ante-natal and post-natal care Proper nutrition and well balanced diet Training of Midwives and other staff Introduction of family Planning Use of sterile equipments Delivery at safe and clean place
Incidence:
This is measures the probability that healthy people will develop a diseases during a specific period of time. This tells new cases in the population. Incidence Rate This is No: of new cases of disease in population at risk at a point in time multiplied by 1000. I.R = No: of new cases of disease x 100 Population at risk
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8. Prevalence Rate (P.R): Prevalence: This measures the old & new cases of the disease in the population Prevalence Rate: This is No: of old & new cases of the disease in the population divided by the population multiplied by 10000. P.R = No: of new & old cases in a year x100 Total population Example in a population of 1671 children under 5 years of age we find 48 children with server mal-nutrition express P.R? P.R = No: of old & new cases of mal-nutrition< 5 years x 1000 Population of < 5 years children According to the formula: P.R = 48/1671x 1000 P.R = 28/1000 In the same population if new cases about 10 are suffered with mal-nutrition than incidence rate will be: Firstly 48 cases will be subtracted (because these cases are old & already mal-nourished) i-e 1671 48 = 1623 Incidence = 100/1623 x 1000 Incidence = 62/ 1000 9. Age Specific death Rate (A.S.D.R): This is number of deaths of specific age or age group divided by number of persons in the population of that age multiplied by 1000 A.S.D.R = No: of deaths of specific age or age group x 1000 No: of persons in the population of that age 10. Cause Specific Death Rate (C.S.D.R): This is number of deaths of specific cause during specific period of time per No: of people during that period multiplied by 1000 C.S.D.R = No: of deaths of specific cause during specific period x 1000 No: of persons in the mid point of that period
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11. Case Fatality Rate (C.F.R) This is No: of peoples dying from a specific disease during a specific period divided by No: of people with the specific disease during that period multiplied by 1000 C.F.R = No: of people during from specific disease during specific period of time No: of people with the specific disease during that period. THE END
1(a): Define School Health Services, Purposes, Components, functions & problems of School Health Services? (b): Define Health education, aims, Principles, barriers, steps & methods of Health education? 2(a): Define PHC? Elements and principles of the Primary health care? (b): Define MCH? And role of Nurse in the MCH? 3(a): Define causes of fertility, infant mortality & maternal mortality (any five)? (b): Health indicators? And different questions in the M.C.Qs about the survey (community assessment)? (d): Define the following? Demography Net migration Population pyramids Bio-statistics Prevalence Incidence N.B: Preliminary and Second year prescribed course should be revised to revision for the purpose to secure maximum marks in the examination.