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NUTRITION:
Nutrition law : PD 491
Nutrition month: July

MOST Vulnerable to Malnutrition:

C hildren L actating mothers I nfants P regnants

RA 8976 – "Philippine Food Fortification Act of 2000."

Food fortification
▪ the addition of Sangkap Pinoy or Micronutrient such as vitamin A, iron and iodine to food(CBQ)

Micronutrient deficiency (I.V.I)

I ron – causing anemia
V itamin A – causing night blindness
I odine – causing cretinism

Sangkap Pinoy Seal Program (SPSP).

▪ a strategy to encourage food manufacturers to fortify processed foods or food products with
essential nutrients at levels approved by the DOH and use its seal.
▪ The seal is a guide used by consumers in selecting nutrition’s foods.

Mandatory Food Fortification.

1. Rice - with Iron
2. Wheat flour - with vitamins A and Iron;
3. Refined sugar - with vitamin A
4. Cooking oil - with vitamin A
5. Other staple foods

*STAR Margarine (1992) - FIRST ever product to partner with Department of Health and the FIRST to receive the Sangkap
Pinoy seal.

Government support programs

1. Sustansya Para sa Masa
2. Pan de Bida (pandesal with Vit. A)
3. NUTRI BAN

SALT FORTIFICATION
RA 8172 - Act for Salt Iodization Nationwide (A.S.I.N Law)
Use salt with " FIDEL" seal (Fortification for Iodine Deficiency Elimination)

Iodine
▪ For proper functioning of thyroid, growth and development of the brain.

▪ Iodine deficiency is a leading cause of preventable brain damage and reduced IQ among children worldwide.

▪ Iodine Deficiency Disorder (IDD) during pregnancy may result in stillbirth, miscarriage, and congenital abnormalities
such as cretinism. (CBQ)
▪ For iodine supplementation give iodized oil capsule with 200mg iodine, 1 capsule for 1 year.
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Goiter
● Common in mountainous or inlands or upland areas where the iodine content in the soil, water and food are
deficient.
● Endemic goiter is more common among girls than boys and among women than men. Effect of Iodine deficiency to
fetus: may be born mentally and physically retarded.

OBESITY
▪ a risk factor for many chronic diseases including heart disease, cancer, hypertension and diabetes.

▪ ABC for healthy nutrition: (CBQ)

A – aim for fitness
B – build a healthy base
C – choose sensibly

3 Somatotypes or body types

1. Ectomorph: Lean and long(Thin), with difficulty building muscle.
2. Endomorph: Big, high body fat (central obesity), often pear-shaped, with a high tendency to
store body fat.(CBQ)
3. Mesomorph: Muscular and well-built (athletic), with a high metabolism and responsive muscle
cells.

MICRONUTRIENTDEFICIENCIES

1. Iron deficiency anemia (IDA)

Normal Hgb level
1. Males - 14 to 18 g/dl
2. Females - 12 to 16 g/dl.

NOTE: According to WHO, anemia is defined as hemoglobin (Hgb) levels <12.0 g/dL in women and <13.0 g/dL in men.

In children above 2 years old:

▪ anemia is worsened by HOOKWORM AND WHIPWORM

▪ Give Mebendazole and iron supplement. (CBQ)

Risk Individuals
W omen at childbearing age
O ld age / elderly
M enstrual and G.I. bleeding ( heavy )
E nteric parasitism ( hookworm, ascaris & trichuris)
N ot enough iron intake

Signs and Symptoms

P allor
A norexia
L ightheadedness
E asy fatiguability
N ail brittleness
E nlargement of spleen
S hortness of breath
S ore/cramps of muscles (restless legs syndrome)

PreventionandManagement
L iver products
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L ean and red meats

L egumes
L eafy green vegetables (camote, kangkong, malunggay)

TreatmentofIDA: FeSO4
▪ mainstay treatment

▪ continued for about 2 months after correction of the anemia

▪ Ferrous sulfate is the most common, and CHEAPEST form of iron utilized.

MOST common side effects of IRON

1. Constipation
2. Unpleasant Taste
3. Nausea and vomiting
4. Tarry Stool (dark discolored stool)(CBQ)
▪ Normal side effect

Avoid taking Iron with:

M ilk and dairy products
A ntacids
T ea and coffee
A ntibiotics

NOTE: TAKE it with orange juice or any VIT C rich juices to facilitate absorption.
Vitamin A Deficiency (VAD)

VAD causes
1. Inadequate nutritional intake of Vitamin A rich foods.
2. Lack of fats/oils in diet
3. Rapid Utilization of Vitamin A during course of Illness
4. Liver disorders - 80-90% of Vit. A is stored in liver.
5. Long-term drinking Alcohol lowers vitamin A levels in the liver

Vulnerable groups: Infants , Preschoolers, Pregnant

VAD S/sx:
1. EARLIEST sign: Night blindness – impaired dark adaptation due to lack of rhodopsin. (CBQ)
2. Xerophthalmia: dry, thickened conjunctiva and cornea
3. Bitot spots: foamy soapsuds-like spots on white part of the eye.
4. Keratomalacia: corneal erosions and ulceration
5. END STAGE: irreversible eye BLINDNESS. (CBQ)

Vitamin A supplementation: PROVIDES PROTECTION UP TO 6 months

Schedule Infants (6-11 mos.) Preschoolers (12 – 59 mos.)

TODAY 100,000 IU 200,000 IU

(Blue capsule) (CBQ) (Red capsule) (CBQ)
AFTER 6 months 100,000 IU 200,000 IU
(Blue capsule) (Red capsule)

Treatment schedule for Xerophthalmia among children

Schedule Infants (6-11 mos.) Preschoolers (12-83 mos.)
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Given immediately upon 100,000 I.U 200,000 I.U

diagnosis give 1 capsule (Blue capsule) (Red capsule)
Given the next day 100,000 I.U 200,000 I.U
(Blue capsule) (Red capsule)
Given After 2 Weeks 100,000 I.U 200,000 I.U
(Blue capsule) (Red capsule)

Vitamin A supplementation for pregnant and postpartum mothers.

Targets Duration Remarks

Pregnant 1 capsule of 10,000 IU Start from 4th month NEVER give more than 10, 000 I.U, because it
TWICE a week pregnancy until delivery is TERATOGENIC(CBQ)

(Colorless capsule)
Postpartum 1 capsule of One dose only within 1 Lactating mothers should receive 200,000 IU
200,000 IU month after delivery up once within the first month after delivery in
(Red capsule) (CBQ) to 4 deliveries. order to supplement breast milk.

Treatment schedule for Xerophthalmia for pregnant women

Targets Preparation Duration

Pregnant women with 1 capsule of 10,000 IU 1 capsule, once a day regardless of the age of
nightblindness (Colorless capsule) gestation

PROTEIN ENERGY MALNUTRITION (PEM)

Types include:
● Kwashiorkor (PROTEIN malnutrition predominant)
● Marasmus (CALORIE DEFICIENCY intake)(CBQ)
● Marasmic kwashiorkor (marked protein deficiency and marked calorie insufficiency signs present, sometimes referred
to as the MOST severe form of malnutrition)

Nutritional indicators:

▪ Arm circumference (MUAC) – “Gold standard” (CBQ)

▪ Height for age (STUNTING)

▪ Weight for age

▪ Weight for height

TAKE NOTE: The classic indicator used by experts to diagnose marasmus

is a weight for height (WFH) Z-score of less than -3, and
this was the BEST indicator of mortality

Interpretation of Mid-Upper Arm Circumference

MUAC indicators
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● MUAC less than 110mm (11.0cm), RED COLOUR, indicates Severe Acute Malnutrition (SAM). The child should be
immediately referred for treatment.
● MUAC of between 110mm (11.0cm) and 125mm (12.5cm), RED COLOUR (3-colour Tape) or ORANGE COLOUR
(4-colour Tape), indicates Moderate Acute Malnutrition (MAM). The child should be immediately referred for
supplementation. (CBQ)
● MUAC of between 125mm (12.5cm) and 135mm (13.5cm), YELLOW COLOUR, indicates that the child is at risk for
acute malnutrition and should be counselled and followed-up for Growth Promotion and Monitoring (GPM).
● MUAC over 135mm (13.5cm), GREEN COLOUR, indicates that the child is well nourished.

Serum albumin
▪ Found to be a better predictor of underlying malnutrition than body mass index (BMI)

▪ Most widely used laboratory measures of nutritional status. (CBQ)

▪ Good marker of nutritional status

1. Marasmus

o “Wasting /withering malnutrition”

o Caused by TOTAL CALORIC deficiency (CBQ)

HALLMARK SIGN : Visible generalized muscle wasting /withering

C – caloric deficiency (deficiency of all nutrients)

A – active and irritable
L – liver is NOT enlarged (NO FATTY LIVER)
O – “old man look” / “chipmunk face” or “monkey face” – with lanugo
R – retarded growth (severe)
I – infants under 1 year old are commonly affected
E – eager or Voracious appetite
S – severe “MUSCLE WASTING”

TAKE NOTE: MARASMUS may also have

▪ Baggy pants appearance – refer!

▪ No hair color changes (appears normal)

▪ Loose wrinkled skin / emaciated look (CBQ)

▪ Weight loss

▪ Child is like skin and bones! (Ribs are very prominent) (CBQ)

▪ Child may also have diarrhea and dehydration.

2. Kwashiorkor
o Also known as “edematous malnutrition”
o Caused by PROTEIN deficiency (CBQ)

HALLMARK SIGN: Edema of both feet

P – pot belly/large swollen protruding belly (enlarged fatty liver)

R – ribs are NOT prominent
O – occurs in children older than 18 months to 2 years old
T – thin muscles & small MUAC (mid upper arm circumference)
E – EDEMATOUS “Moon face” appearance (CBQ)
I – increase risk of infection
N – no or lack of appetite (anorexia) (CBQ)
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S – sluggish, apathetic, lethargic, unresponsive. (CBQ)

TAKE NOTE: KWASHIORKOR may also have:

▪ Dry sparse discolored hair “FLAG SIGN” (CBQ)

▪ Growth retardation

▪ Anemia

▪ Skin lesions (e.g. hyperkeratosis, dermatoses, dyspigmentation

Situation – Many Filipinos are suffering from malnutrition. Nurse Aga knows that it is a result from poor diet or lack of food.
1. Micronutrient supplementation is included in what program of the DOH?

A. Sentrong Sigla C. Expanded program on immunization

B. Araw ng Sangkap Pinoy D. Reproductive health bill

2. You assess for a child's nutritional status using the mid-upper arm circumference (MUAC). Measurement reads 12 cm which
falls under the orange color of a 4-colored tape. This indicates that the child __________.

A. Should immediately be referred for supplementation. C. Is at risk for acute malnutrition.

B. Should be immediately referred for treatment. D. Well-nourished.

3.You compute for the ideal weight of Edward whose actual weight is 135 lbs and height is 5'10. His ideal body weight is
________ lbs.

A. 140 B. 135 C. 150 D. 170

HAMWI Ideal Body Weight

Men: 106 lbs for the first 5' (60") + 6 lb for every inch over 60 in
Women: 100lbs for the first 5' (60") + 5 lb for every inch over 60 in

4. Edward's degree of malnutrition is _______ percent of ideal body weight (IBW).

A. 108.15 B. 96.43 C. 100 D. 92.46

%IBW = ACTUAL BODY WEIGHT ÷ IBW x 100

5. The indication for Edward's degree of malnutrition is _________.

A. 3rd degree B. Obese C. 2nd degree D. 1st degree

Gomez classification based on expected weight for age

Over 90% - normal
76 – 90% - mild or first degree
61 – 75% - moderate or second degree
Less than 60% - severe or third degree.

6. Which of the following is a condition in infants that is characterized by extreme calorie deficiency?

A. Marasmus B. Scurvy C. Kwashiorkor D. Avitaminosis

7. Nutritional status is best determined by

A. triglycerides. B. 24-hour diet recall. C. serum albumin. D. clinical manifestations.

8. Which of the following signs and symptoms would indicate malnutrition?

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a) Lips cracked and pale pink, tongue beefy red.

b) Skin color appropriate for race, intact, without evidence of dryness
c) Erect posture with symmetric gait and muscle tone appropriate for age
d) Hair dull and dry
e) Bleeding gums
Answer: a, d, e

9. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following
signs will be MOST apparent in this child?

A. Voracious appetite B. Wasting C. Apathy D. Edema

10. Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?

A. Refer the child urgently to a hospital for confinement.

B. Coordinate with the social worker to enroll the child in a feeding program.
C. Make a teaching plan for the mother, focusing on menu planning for her child.
D. Assess and treat the child for health problems like infections and intestinal parasitism.

National Deworming Program

▪ DOH launched “Oplan Goodbye Bulate (Worm),” a program designed to deworm 16 million public elementary school
students TWICE a year.
▪ STH infections are transmitted by eggs present in human feces, which in turn contaminate soil in areas where water,
sanitation and hygiene are poor.

OPLAN: “Goodbye Bulate, Hello Healthy Body”

National Deworming Month: January and July (EVERY 6 MONTHS) – (CBQ)

Target: Young children: 12–23 months old

Preschool children: 2–4 years old
School-age children: 5–14 years of age

Soil Transmitted Helminths (STH)

▪ The three major causes of intestinal parasitic infections in the Philippines are the following:

1. Ascaris/Round worms (Ascaris lumbricoides)

2. Whipworm (Trichuris trichiura)
3. Hookworm (Anclostoma duodenale and Necator americanus)

TAKE NOTE: Taeniasis/Tapeworm is NOT included. (CBQ)

1. ASCARIASIS – caused by Ascaris lumbricoides roundworms.

2. Hookworm | Ancyclostomiasis – MAINLY acquired by walking barefoot on contaminated soil. Hookworm can also be
acquired by ingesting soil or sand through dirty hands or unwashed fruits and vegetables. (CBQ)
3. Trichuriasis: Whipworm – It can cause RECTAL PROLAPSE. (CBQ)

STH Treatment: Anthelminthic – deworming every 6 months (TWICE A YEAR) (CBQ)

1. Albendazole tablet – 400mg per tablet
1 year old to 23 months – give 1/2 tab. or 200mg
2 yrs. old to 14 yrs. old – give 1 tablet or 400 mg
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2. Mebendazole tablet – 500mg per tablet(CBQ)

1-14 yrs. old – give 1 ( 500mg tablet) every 6 mos.

NOTE: antihelminthic drugs should NOT BE TAKEN with empty stomach. (Take with full stomach)
Precautionary measures(CBQ)
Albendazole and Mebendazole are NOT recommended to: Hypersensitivity to the drug and
S eriously ill child.
A bdominal pain.
D iarrhea.
S everely malnourished.

HEALTH
▪ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity. (WHO)
▪
Health triangle: Physical, Social, and Mental Health. (CBQ)

TEN DETERMINANTS OF HEALTH (CBQ)

B – behavior
I – income
G – gender and genetics

C – culture
H – health services
E – education and literacy
E – employment
S – social support network
E – environment (physical environment)

Community(CBQ)
▪ a group of people with common characteristics or interest living together within a territory or geographical boundary.

TAKE NOTE: Community is the primary client or patient in CHN (CBQ)

BEST definition of a community:

▪ People with a sense of belonging or common identity. (CBQ)

COMMUNITY HEALTH NURSING (CHN)

▪ The utilization of the nursing process in the different levels of clienteles (CBQ)

▪ Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and
functions
▪ Part of paramedical and medical intervention which is concerned on the health of the whole population.

CHN Aims:
1. Health promotion
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2. Disease prevention
3. Management of factors affecting health

Primary goal CHN:

▪ To enhance the capacity of individuals, families and communities to cope with their health needs (CBQ)

CHN Philosophy: based on the WORTH AND DIGNITY of man (Dr. Margaret Shetland) (CBQ)

MUST KNOWS about CHN:

▪ Primary focus of CHN is Health Promotion & Disease Prevention

▪ Primary goal - self reliance in health and enhanced capabilities

▪ Ultimate goal - raise level of health of the citizenry (CBQ)

▪ Unit of care is the FAMILY (CBQ)

▪ Philosophy of CHN- uphold the worth and dignity of man

▪ The COMMUNITY is the patient in CHN (CBQ)

▪ In CHN, Client- active participant, full involvement recipient care

▪ The goal of CHN is achieved through multisectoral efforts

▪ Primary Tool: Health Education (CBQ)

PUBLIC HEALTH NURSING

▪ The science and art of PREVENTING DISEASE, PROLONGING LIFE, PROMOTING PHYSICAL AND
MENTAL HEALTH and efficiency through organized community effort (Winslow,1920) (CBQ)

Lilian Wald – the FIRST PUBLIC HEALTH NURSE (FOUNDER OF PHN)

GOAL of public health: For people to attain their birthrights of health and longevity (CBQ)
MOST prominent feature:
▪ Public health FOCUSES on preventive, NOT curative services(CBQ)

Where to apply as a Public Health Nurse: Rural Health Unit

Qualifications: BSN and RN in the Philippines
TAKE NOTE: In the event that the Municipal Health Officer (MHO) is unable to perform his duties or functions or is NOT
available, the PHN will take charge of the MHO’s responsibilities

ROLES OF THE PHN

▪ Clinician – health care provider, taking care of the sick

▪ Health educator – disseminate correct information, educating people

▪ Facilitator – establishes multi-sectoral linkages by referral system

▪ Supervisor – monitors and supervises the performance of midwives

TAKE NOTE:Community/public health nurse is BEST defined as a nurse who Is employed outside of an acute care setting
Clienteles of Public health nursing:
▪ Individual – entry point

▪ Family – “UNIT OF SERVICE /CARE” (CBQ)

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▪ Population groups – point of specific care

▪ Community – primary client (CBQ)

Three CORE public health functions:

▪ Assessment: refers to systematic data collection(CBQ)

▪ Policy development: is needed to provide leadership in developing policies.

▪ Assurance: is making sure essential services are available

TAKE NOTE: Prevention is NOT a core function

1. A community/public health nurse is best defined as a nurse who

a. Applies concepts and knowledge from nursing and public health.

b. Gives care to families in the community.
c. Has a baccalaureate and previous experience in community health.
d. Is employed outside of an acute care setting.
ANS: D - The term community health nursing is an umbrella term used for all nurses who work in a community. This term
denotes the setting of practice for the nurse.

2. The only clear distinction between a community health nurse and a public health nurse is that

a. The community health nurse gives care in community settings regardless of personal education, whereas public health
nurses have specific educational preparation.
b. Community health nurse is a title that has historically been used, whereas public health nurse is the new "in" title for the
role.
c. The community health nurse is employed to give care to families and groups, whereas the public health nurse works in public
health departments.
d. Community health nurse is the broader term that includes public health nursing, school nursing, and home health nursing.
ANS: A- Public health nurses synthesize all their nursing expertise, as well as knowledge, from public health, whereas nurses
with varied educational backgrounds may be employed in community settings.

3. What is the appropriate approach for the community/public health nurse in balancing individual privacy and autonomy and
the community's needs for safety and security?

a. Fulfill agency policies first.

b. Implement professional standards of nursing practice.
c. Seek a balance between individuals' needs and the community's needs.
d. Remember that group needs outrank individual needs.
ANS: C- While the nurse's practice should be consistent with employing agency policies, legal mandates, and professional
standards, the nurse must seek a balance between individual autonomy and other individual rights and the rights of all other
community members. It is a delicate balance.

4. In which situation would the community/public health nurse be applying the ethical principle of doing good for the greatest
number of persons with the least amount of harm?

a. Asking the agency supervisor how to approach an ethical dilemma

b. Focusing on providing basic services for everyone in the community
c. Following agency policies
d. Delivering care to families who have health insurance
ANS: B- To provide for the greatest good to the greatest number, it is often necessary to focus on basic services, such as
immunization or prenatal care, because such care has the most effect on the whole community.

5. When faced with an ethical conflict about limited resources and unlimited need, which action is the most just?
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a. Giving care to clients whose needs most closely match the nurse's abilities
b. Giving care to whichever prospective clients ask for care first
c. Working as hard as possible and not worrying about it
d. Trying to achieve the outcome of the greatest good for the greatest number of persons
ANS: D - Although option B fulfills the criteria of egalitarian (equal) justice, it is a short-term answer to an ongoing problem.
Trying to achieve the outcome of the greatest good for the greatest number of persons is a utilitarian approach to justice,
which is more helpful in dealing with large populations such as clients seen by the community/public health nurse.

6. How does a community/public health nurse provide indirect care to clients in homes, clinics, senior citizen centers, schools,
prisons, homeless shelters, and other living environments?

a. Being employed in community settings such as outpatient clinics

b. Providing anticipatory guidance and health promotion activities to community members
c. Providing care in mobile vans to citizens in their own neighborhoods
d. Being involved on a political action committee to create new client services
ANS: D - Nurses give care directly, as in all the answers given, but provide care indirectly by trying to promote health and
well-being through creating new resources, improving the environment, or using social and political mechanisms for solving
problems.

7. How would the actions of the community/public health nurse caring for a recently discharged client in his home differ from
those of the acute care nurse?

a. The community/public health nurse would assess the health and needs of all the family members.
b. The community/public health nurse would be careful to be nonjudgmental about the family's living situation.
c. The community/public health nurse would explain why each nursing intervention was being performed.
d. The community/public health nurse would help the family understand the basis for the treatment.
ANS: A - Although both nurses would give excellent care to the individual client, the acute care nurse would assess the client
individually and adapt interventions accordingly. The community/public health nurse would seek to identify others in the
family who might need intervention or referral as well. The community/public health nurse provides care from a
family-focused model, being concerned not only with the health of the identified client but also with the health of other
family members.

8. The “UNIT OF SERVICE” of a public health nursing is____________

A. Individual B. Whole population C. Family D. Community

9. Which ethical principle might be difficult for the community/public health nurse to implement?

a. Nonmaleficence b. Beneficence c. Justice d. Respect for autonomy

Rationale: The ethical principle of justice is defined as treating all people fairly. One way that community/public health
nurses would exhibit justice is by providing nursing services to all, regardless of their ability to pay. Community/public health
nurses can give care only within the limitations of third-party payer requirements. A difficulty for community/public health
nurses is coping with the disparities in our current health care system.

10. What underlying values should be a part of a healthy community?

a. Responsibility and respect c. Stability and safety

b. Connectedness and caring d. Marketability and security
ANS: B - The World Health Organization (WHO) points out that values underlying health for a community include equity,
empowerment, and cooperation. As a balance to some of the values of efficiency, materialism, and hierarchic power
structures, nurses are speaking for connectedness and caring.

Situation - As a public health nurses, Ms.Isay intends to focus on a specific population to advocate, educate, and collaborate
with members from a community to improve heath of the people.

11. Nurse Isay collects data and monitors the heath status of the population. Which of the following core public health
function is being implemented?
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A. Assurance B. Policy Development C. Assessment D. Prevention

12. Nurse Isay included in her data collection the number and proportion of person aged 25 or older with less than a high
school. Which of the following BEST describes this data

A. Health status data C. Health risk factors

B. Health care resource information D. Sociodemographic data

13. Nurse Isay also compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public
health is being implemented?

a. Assessment b. Assurance c. Prevention d. Policy development

ANS: A- Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a
core function, assurance is making sure essential services are available, and policy development is needed to provide
leadership in developing policies.

14. Nurse Isay also develops and implements local public health policies through partnerships with agencies, organizations,
and consumers within the community. Which of the following core public health functions is being used?

a. Assessment b. Prevention c. Assurance d. Policy development

ANS: D- Policy development deals with developing and implementing health policies. Prevention is not a core function,
assurance is making sure essential services are available, and assessment refers to systematic data collection.

15. A nurse is implementing quality performance standards in a public health department. Which of the following BEST
describes the importance of this action?

a. Quality performance standards are used to guide improvement in the public health system.
b. Quality performance standards rigidly control public health.
c. Quality performance standards guide administrators to monitor public health at the national level.
d. Quality performance standards can be used as hiring guidelines for nurses.

ANS: A - These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the
level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed
around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and
describe an optimal level of performance. They are intended to support a process of quality improvement. State and local
communities can assess their performance using certain available tools. They are not meant to control public health or be
used for hiring guidelines.

16. Working in the community with an aggregate/population, who does Ms. Isay MOST likely to interact with?

A. Students in a local high school C. Residents who play basketball

B. Patients at the local hospital D. Christians in the community

ANS: A– A population or aggregate is a collection of individuals who have one or more personal or environmental
characteristics in common. High risk groups, school or institutional setting, and geographical location within the community
all describe types of populations, not the definition of population.

17. Ms.Isay has a clear understanding of population-focused practice. Who of the following characteristics would she MOST
likely display?

A. Improving the effectiveness of care provided C. Volunteering for a community action

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B. Sponsoring a fund-raising project D. Providing health interventions for individuals

18. Ms.Isay is working to improve population-focused care in the community. Which of the following BEST describes a key
opportunity for nurses like her to accomplish this goal?

A. Assuming traditional nursing roles C. Specializing in community health practice

B. Conducting community assessments D. Influencing public health policy

19. Providing for the availability of essential personal health services for people who would otherwise not receive health care
defines which public health core function?

a. Assessment b. Prevention c. Assurance d. Policy development

20. Ms. Isay makes sure that the staff members who work in a local clinic are competent is demonstrating the public health
core function of:

a. Assurance b. Assessment c. Prevention d. Policy development

Situation - Public health nurses use their nursing skills in the application of public health functions and provisions of social
assistance to their clients.

21. Which of the following statements BEST describes Public Health Nursing?

A. Services are best implemented only in far flung and hard-to-reach areas.
B. Services are rendered free of charge to people in the catchment area.
C. It involves home care to sick people who cannot be confined in the hospital.
D. It puts emphasis on health promotive and preventive services.

22. The current emphasis for public health practice is ___________.

A. Improving environmental sanitation.

B. Controlling epidemic diseases.
C. Preventing communicable disease.
D. Advocating for social justice.

23. The public health nurse must participate in the essential services that are relevant and accessible to the family and the
community. These include:

A. Working in enforcing laws to regulate health and ensure safety.

B. Diagnosing and investigating health problems of the country.
C. Informing, educating, and empowering the people about health.
D. Monitoring health status and completing a community assessment.

24. Collecting data and monitoring the health status of the population defines which of the core public health functions?

A. Quality assurance C. Policy development

B. Assessment D. Health promotion

25. Public health services are provided by government facilities. What is the most appropriate response of a public health nurse
to the statement: The government should give these health services free of charge to people?

A. "Yes and for that reason, we should choose our government officials wisely during elections".
B. "yes, I agree. But right now, the government does not have enough resources to do that".
C. "That is an ideal situation that our government does not have enough resources to do that".
D. "Many of the health services are given free, but we people pay for them just the same through our taxes".
FAMILY
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▪ The UNIT OF SERVICE in the community (CBQ)

▪ is a small social system (2) or more people living together who are related by blood, marriage, adoption, or by
arrangement over a period of time.

BEST definition of family: A group of people who live together.(CBQ)

Genogram
▪ displays pertinent family information in a family tree format, the family can see the family structure, its members and
their RELATIONSHIPS. (CBQ)
▪ diagram of family relationships

Ecomap
▪ Used to identify family relationships between members of the community. (CBQ)

Pedigree chart
▪ Chart/diagram of the GENETIC HISTORY of a family over several generations(CBQ)

CLASSIFICATION OF FAMILIES

1. Nuclear family – TRADITIONAL type, consists of husband and wife (and perhaps one or more children).
2. Extended family – includes relatives (aunts, uncles, grandparents, and cousins)
3. Single-parent family – consist of one parent and children
4. Blended family- married couple, their children and their children from previous marriages
5. Alternative family – Relationships include multiadult households, "skip-generation" families (grandparents caring for
grandchildren), communal groups with children, "nonfamilies" (adults living alone), cohabitating partners, and homosexual
couples.
6. Beanpole - Family comprised of 4 or more generations
7. Same Sex/Homosexual – Family comprised of Gay/Lesbian partner w/ adopted/biological child
8. Communal – Unrelated individual/family in one roof

AUTHORITY:
▪ Patrifocal/Patriarchal – Father has main authority

▪ Matrifocal/Matriarchal – Mother has main authority

▪ Egalitarian – Equal authority of both parents

▪ Matricentric - Prolonged absence of father (OFW), Mother gets the dominant power

LOCALITY:
▪ Patrilocal – Newly wed living nearby father's side

▪ Matrilocal – Newly wed living near mother's side

▪ Bilocal – Newly wed living near both side

FAMILY CARE PLAN

▪ blueprint of the care to the family

First Level Assessment

1. Health Deficits – FAILURE in health maintenance ( disease, disorders and disability)

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Score: 3
Disease/ illness – hypertension, DM, heart diseases, URTI, marasmus, scabies (CBQ)
Disabilities – deaf, mute, blind, polio, stroked patient with paralysis.
Disorders – problems like mental retardation, down syndrome (CBQ)

2. Health Threat – conditions conducive to disease, accidents or failure to realize one’s health potential. (Score:2)
B roken glasses and scattered sharp objects
A bsence or lack of prenatal visits or clinic visits(CBQ)
S afety hazards: fires, falls and accident
U nhealthy lifestyle – faulty eating, sedentary
R odents and insects
A bsence or lack of immunization
S anitation issues and family history of diseases.

3. Stress Points/ Foreseeable Crisis(CBQ)

▪ anticipated periods of UNUSUAL DEMAND on individual or family in terms of adjustment or family resources (SCORE:
1)

Pregnancy
Abortion
Parenthood
Additional family member (Newborn) (CBQ)

Income loss (loss of job) (CBQ)

Separation or break ups and courtship

Divorce and annulment

Entrance in school(CBQ)
Adolescence (circumcision, menarche, puberty.)
Death of love ones.

PRIORITIZING HEALTH PROBLEMS

NATURE OF THE PROBLEM – health deficit, health threat and foreseeable crisis
▪ Health deficit 3

▪ Health threat 2

▪ Foreseeable crisis 1

MODIFIABILITY OF THE PROBLEM –the PROBABILITY OF SUCCESS of success in minimizing, alleviating or totally eradicating the
problem through intervention (CBQ)
▪ Easily modifiable 2

▪ Partially modifiable 1

▪ Not modifiable 0

PREVENTIVE POTENTIAL –refers to the nature and MAGNITUDE of future problems that can be minimized or totally prevented
if intervention is done on the problem under consideration
▪ High 3

▪ Moderate 2

▪ Low 1
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SALIENCE – refers to the family’s PERCEPTION and evaluation of the problem in terms of
seriousness and urgency of attention needed (CBQ)
▪ A serious problem, immediate attention needed – 2

▪ A problem, not needing immediate attention – 1

▪ NOT seen as a problem – 0