SUBJECT: NURSING & HEALTH CARE PREPARED BY : DR .SAHAR ABD El HAMEED ACADEMIC YEAR : 1429- 1430.SEMESTER : 1‘ST SEMESTER.LEVEL : 1'ST LEVEL. LECTURE' ALLOCATION : MONDAYFROM: 10-12 AM 1

1

Health*

Community*

*Community Health Nursing *Primary Health Care

2

3

Health: It is a state of complete physical, mental , social and psychological wellbeing.

Healthy person is the person who has complete physical , mental, social and psychological wellbeing , free from all diseases and his body systems working with complete competency.Community :It is a group of people who have one or more personal or environmental characteristics.Community Health Nursing.It is the practice of promoting and protecting the health of population using knowledge of nursing and public health sciences Primary health care.

It is the science that aimed for promotion of health , prevention of diseases and offering health services to satisfy that aim.

Factors affecting the health of individuals and communities .

1.Intrauterine factors .a- Malnutretion of the mother . b- Infectious diseases during pregnancy .c- Misuse of drugs during pregnancy .d- Exposure to x rays during pregnancy .e- Hereditary &chromosomal defects .

4

2 .Extrauterine factors a –Malnutrition. b –Environment. c –Accidents.

d –Exposure to infectious diseases at early childhood. e –Social and cultural factors . f-Believes and traditions. g –Economy.

h –Religion

5

Community Health Team

-Medical personnel . ( family health physicians ,nurses ,pharmacists)

-Para -medical personnel .( maintenance workers , food sanitation , social workers , counseling personnel ).

6

ELEMENTS OF PRIMARY HEALTH CARE .1 – HEALTH EDUCATION .2- VACCINATION AGAINST INFECTIOUS DISEASES .3- MATERNAL-CHILD HEALTH .4- CONTROL OF CHRONIC & ENDEMIC DISEASES .5- NUTRITION &FOOD SANITATION .6 – ENVIRONMENTAL SANITATION .7- TREATMENT OF COMMON DISEASES & INJURIES .8 – PROVISION OF ESSENTIAL DRUGS .

7

ROLE OF COMMUNITY HEALTH NURSE .

8

As community health nurse is one of important health team members she has to take an active role in the

following: 1.Health education of individuals , families & communities.

2. Vaccination of children & public against infectious diseases*.

3.Maternal & child health. -Premarital care.

Prenatal ,natal ,post natal care of mothers. -

Care of infants & children. -

Care of elderly people--

Care of children with special needs & handicapped persons .-

-Participate in prevention & control of communicable disease.( vaccination ,isolation & treatment

9

Primary Health care

Levels & Elements.

10

Primary Health Care  

Definition.…Primary Health Care is the science that aimed for health promotion of individuals & communities through prevention of diseases, early detection , control & treatment of diseases , provision of health education & health services which aimed to improve health status & creates healthful living for individuals & communities      11

 Levels of prevention 

1 .Primary prevention .2 .Secondary prevention.

3 .Tertiary prevention .4 .Restorative preventiion

12

1 .Primary prevention.Primary prevention deals with promotion of

health, protects against threats to health . It keeps the problem from occurring. It is implemented before the problem develops .It deals with well population

Primary prevention is accomplished by: -Immunization.

-Sanitary environment.-Health Education

-Avoidance of exposure to risk factors.-Chemoprophylaxis & seroprophylaxses 13

2 . Secondary Prevention.Secondary prevention detects & treats the problem at early stages. It keeps the problem from causing serious or long term effects or from affecting others It is implemented after a problem has begun .It's aim is to cure the patient & to reduce the complications. Secondary prevention can be accomplished by :

-Screening of high risk groups .1e . g ) *urine analyses of school age children to detect DM.

*Mass radiography for detection of TB.*Papenculuea smear to detect cancer cervix.

2-Periodic physical Examination.(e. g) –Measurement of nutritional status of children

to discover mal nutritional diseases.14

3 .Tertiary prevention .It limits further negative effects of the problem ,

it keeps existing problem from getting worse , it alleviate the effects of the disease & injury & restore the individual's optimum level of functioning , it is implemented after a disease or injury has occurred

Tertiary could be accomplished through:-Physiotherapy in cases of poliomyelitis.

-Training a blind person a useful work to achieve income.

-Keep bl.sugar level under control in DM by drugs or diet.

-Use radiotherapy or chemotherapy in case of cancer...

15

4 .Restorative PreventionIt aimed to restore optimum level of functioning after the problem has been occurred.Restorative prevention could be accomplished through:

-Follow up care. -Long term care.

-Rehabilitation.- Chronic care.

16

Elements of Primary Health Care1-Health Education.

2 -Vaccination against infectious diseases.3 -Control & treatment of chronic, endemic &

communicable diseases.4 -Nutrition & Food Sanitation.

5-Environmental Sanitation.6 -Treatment of common diseases & injuries.

7-Maternal child Health.8- Provision of essential drugs

17

First ElementHealth Education.Definition.Health education is defined as Translation of

health facts & information to correct healthful behavioral patterns or attitudes on a level of individual, families & communities.

18

Purposes of health education.-Promote healthful behavior.-protect health.-Strengthen community prevention.

19

Routes o learning

People learn in three ways: 1 .Visually.2. Auditory.

3. Kinesthetically. (By actually performing a task or handling items) 

20

 

Domains of learning. .cognitive. 1

2 .Affective. Material is presented in a way to affect the

learner's believes, values & attitudes & feeling.i. e : people must value cleanliness before you can teach them to wash their hand

3. psychomotor.The learner processes the information by doing (by carrying out the task)All three domains are important for translation of learning to desired behaviors. 21

How to Prepare an Educational Plan

Teaching plan is apart of the care plan In order to prepare an educational plan you have to follow the following steps:

1 .Establish the learner's needs2 .Prioritize the needs

22

 3. State behavioral objectives

4. Collaborate with other health professionals involved in the process of learning

5. Impalement the plan -Provide quite place

-with few destructions.-one by one or group teaching

-Keep teaching session short -Involve the learner in the process -Incorporate teaching in daily care

-Each on going session should begin with review of has been learned previously(return demonstration

23

6 .Evaluation  -By obtaining feed back about the learning that

occurredSkills --------------------- } Retuned demonstration Information-------------- }Ask questions

-Repeat instruction if the client has not mastered the skills & information learned .

24

Second Element

Vaccination against infectious diseases

1- Definitions A-Infection It is the transmission of the microbe or the

causative agent from diseased person or carrier to a healthy person by direct or indirect method

25

b- Source of infection.It is the reservoir of the microbe which cause

the disease . c- Causative agent  

It is the microbe which has the ability to cause the infection or secrets toxins causing the disease.

26

 d –Carrier

It is a human being or an animal infected before by the microbe & did not show signs & symptoms, carry the causative organism in his body. Carrier could be more dangerous than the patient him self.

E–Mode of infection It is the routes by which infection is

transmitted. It could be -Direct infection (without the presences of

host.-Indirect infection (where there is a host). 27

f –Immunity It is the ability of the alive body to defend the

infection & to destroy any organism fighting it.

g –Cold chain system It is the process by which the vaccine is kept valid since it' manufacture till it's usage by the client.

28

 2 -Types of Immunity .

A-Natural Immunity. -Natural Passive which transmitted from the

mother to fetus through placenta (e.g. .measles) -Natural active which follow an exposure to some

diseases (e.g. .measles

b- Acquired Immunity - Acquired Passive which by giving a serum

- Acquired active which could be attained by

giving 

vaccine    

29

  3 .Diseases that could be prevented by

vaccination. a- Tuberculoses .

b- Hepatitis (B) c – Poliomyelitis

d- Diphtheria e- Pertusses

f- Tetanus g – Measles

30

4 .Main Vaccines a- BCG Vaccine:

-It is administered to protect the child from tuberculoses -It is available as a freeze dried vaccine & reconstituted just

before usage -It is sensitive to heat & light

-The reconstituted BCG vaccine is very un stable , so it should be used properly during one session (5-6 hours) .The residual vaccine should be discarded at the end of the session.

-It is stored at the refrigerator of the health center at temp. of 0 -8 degree .c.On the meddle shelf of the refrigerator

-It should be given at the day of birth & because not all children are born in the hospital, it should be given within the first month of life.

-Its dose is (O.1 ml) given intra dermally in the left upper arm.-Reaction: within two weeks a small red soft tender swelling is

formed, after 2-3 weeks the swelling become abscess, ulcerates. The ulcer heals by scaring; this scar is a sign of vaccination

  

31

 

B-Triple vaccine (DPT).-It contains: -Diphtheria toxiod

-Pertusses killed vaccine -Tetanus toxiod

-DPT is damaged by freezing.-It is stored on the second shelf of the refrigerator

(4-8degrees)

-Diphtheria &tetanus vaccines are stable vaccines where pertusses vaccine is damaged by the sun light.

-Dose: 3 doses at the age of 2, 4, & 6 months of age. With a booster dose at the age of 18-24 months.-Each dose is (0.5) ml to be injected intramuscularly

in the meddle or lateral aspect of the thigh.

32

 

C-Polio-mylitis Vaccine.There are 2 types of polio vaccine

•Injectable (Salk)

•Oral (sabin)

-Oral vaccine is mostly used as it is more effective,stimulates natural immunity & induces both circulatory & intestinal resistance

-It is least heat stable vaccine -It is kept at 0-8 degree in the health center on the top shelf of the

refrigerator -Freezing does not damage oral polio vaccine

-Dose: For primary vaccination of infants it is given in 3 doses at the age of 2, 4, & 6 months .Each dose is one drop ⁄ mouth

-Booster dose is given at the age of 8-24 months -There are no contra indications for polio vaccine; however the dose

must repeated if the child spits out the drops. - When the child has diarrhea the dose is given but not counted in

the primary 3 doses &an extra dose 4-8 weeks later is given.

 

33

 

D – Hepatitis B vaccine

-Two hepatitis B vaccines are available; one is prepared from plasma of HB positive carrier & the other which is mostly used in many countries prepared by recombinant DNA technology.

-Both vaccines are safe &highly protective against hepatitis B infection.

-Hepatitis B vaccine should be protected from being frozen.

-It is kept at 2-8 degree in the second shelf of refrigerator.

-Dose: o.5ml given by intramuscular injection at lateral aspect of the thigh.

-There are no contraindications for the vaccine -Side effects are : Soreness & erryethema at the site

of injection.    

34

E – Measles Vaccine  

-It is a live attenuated vaccine with high efficacy, with induction of active immunity in more than 95 % of susceptible individual's m possibly for life.

-It is available as freeze dried vaccine, to be reconstituted just before usage

-The reconstituted vaccine is quickly loses its potency. i.e. . If the vaccine is stored at the room temperature foe one hour , it loses 50% of it's potency

-Freezing does not damage the vaccine -It is kept at 4-8 degree on the first shelf of the refrigerator of

the health center.-Reconstituted vaccine, unused within 8 hours should be

discarded. -Dose: 0.5ml. Subcutaneously in the Rt arm. At the age of 9

months.-In some countries the vaccine is integrated in MMR vaccine

(Measles, mumps & rubella vaccine), it is given in one dose at the age of 9-12 months.

-Side effects: •Fever &rash lasting 1-2 days.

•Febrile convulsions are rarely occurring.   

35

36