ROLE OF PUBLIC HEALTH & COMMUNITY NURSEShoshas.moh.gov.my/v4/attachments/article/76/VTE2017 Role of...
Transcript of ROLE OF PUBLIC HEALTH & COMMUNITY NURSEShoshas.moh.gov.my/v4/attachments/article/76/VTE2017 Role of...
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ROLE OF PUBLIC HEALTH & COMMUNITY NURSES
Noor Aini bte KarimonKetua Penyelia Jururawat KesihatanSektor Kesihatan Ibu ,BPKK, [email protected]@gmail.com
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Are you proud to be a Nurses ???
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Public Health Nurses
• working with families
• need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members.
• Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients.
Journal of Advanced Nursing
Volume 49, Issue 2, January 2005, Pages: 182–190, Susan M. Jack, Alba DiCenso and Lynne Lohfeld
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• tenaga professional yang bertanggung-jawab dan akuntabel
memberikan kaunseling, pendidikan, panduan, asuhan dan nasihat selama masa hamil, kelahiran dan pantangserta memberikan jagaankepada bayi baru lahir.
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Tanggungjawab ini mencakup :-• Pencegahan• promosi kelahiran normal• deteksi komplikasi pada ibu dan
anak, • dan rujukan atau bantuan lain yang
sesuai, serta melaksanakan tindakan semasa kecemasan.
AnugerahAllah jgn di
siakan
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Womb to tomb – Life course perspectivePregnant women
Newborn/ infant
Children
Schoolgoing children
Adolescent
Adult male / female
Elderly
Pre-pregnant women
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Perkhidmatan Kesihatan Ibu
Penjagaan yg memberi tumpuan kepada pencegahanpenyakit dan komplikasi di samping meningkatkan tarafkesihatan ibu ke tahap yg optima.
Anggota kejururawatan di KA & hospital bertanggungjawab memastikan setiap ibu mendapatjagaan yang sewajarnya bermula drp pra kehamilan, semasa kehamilan, bersalin dan selepas kelahiran.
Menurunkan morbiditidan mortaliti di kalangan ibu
dan bayi baru lahir
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SAFE
MOHERHOOD
‘EVERY MOTHER HAS
THE RIGHT TO EXPECT
THAT HER BABY WILL
BE BORN ALIVE AND
HEALTHY, JUST AS
EVERY BABY HAS THE
RIGHT TO A LIVING
AND HEALTHY
MOTHER’
EQUITY FOR WOMEN
Fam
ily P
lan
nin
g
An
ten
atal
Car
e
The Four Pillars of Safe Motherhood
Po
stn
atal
Car
e
Pre
Pre
gnan
cy
Car
e
14/11/2014
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1933 1935 1940 1946 1950 1957 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2009 2010 2011 2012p
MMR 1080 960 770 670 530 280 240 200 150 80 60 40 20 46.9 28.1 28.1 27 26.1 26.2 25.6
0
200
400
600
800
1000
1200
MMR MALAYSIA 1933 – 2012
Source of data : Department of Statistics
: Family Health Development Division, Ministry of Health
1991 1995 2000 2005 2007 2009 2010 2011 2012p 2013 2014 2015
Matlamat (MDG 5) 44 40 35 30 28 26 23.5 21 18.5 16 13.5 11
Pencapaian 44 46.9 28.1 27.9 29 27 26.1 26.2 25.6
0
5
10
15
20
25
30
35
40
45
50
se
tiap
100,0
00 k
ela
hir
an
h
idu
p
Perbandingan Kadar Kematian Ibu di Malaysia
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CAUSES OF MATERNAL DEATH IN MALAYSIA : 2001 – 2013
Source of data : 2003 -2008 : Reports on the Confidential Enquiries into Maternal Deaths in Malaysia2009 – 2013 : FHDD, MOH
1991 to 1993 1994 to 1996 1997 to 1999 2000 to 2002 2003 to 2005 2006 to 2008 2009 to 2011 2012 to 2013p
PPH 191 162 94 79 58 74 54 38
HDP 113 98 80 49 50 61 68 25
Obs. Emb 93 107 68 81 80 84 68 43
Med. Cond 80 102 113 75 63 68 137 88
Obst. Trauma 43 35 31 45 29 17 24 5
Puerp. Sepsis 47 25 14 18 9 9 15 7
22.517.4
12.6 10.1 7.7 9.6 6.5 7.9
13.3
10.5
10.7
6.26.7
7.98.2 5.2
10.9
11.5
9.1
10.310.7
10.9
8.2 9.0
9.4
10.9
15.1
9.58.4
8.816.4 18.3
5.1
3.84.1
5.73.9
2.22.9 1.0
5.5
2.71.9
2.31.2
1.21.8 1.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1991 to 1993 1994 to 1996 1997 to 1999 2000 to 2002 2003 to 2005 2006 to 2008 2009 to 2011 2012 to 2013
PPH HDP Obs. Emb Med. Cond Obst. Trauma Puerp. Sepsis
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Source: Reports on the Confidential Enquiries into Maternal Deaths in Malaysia & BPKK
MATERNAL DEATHS by STAGE OF PREGNANCY : MALAYSIA 1991-2013
60%-75% : During Postpartum15 -25% : Antenatal
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Strategi& Pelaksanaan –PKD/Hospital/KK/KD
• Memastikan Garis Panduan digunakan• Latihan kepada anggota kejururawatan• Penilaian kompetensi melalui:
- Penyeliaan berkala dan adhoc- Nursing Audit- Aduan- Laporan Penilaian Prestasi
• Mesyuarat kualiti
– PKD /JKN • Penyiasatan Epidemik dan Endemik• Bersedia bertugas di dalam bencana alam dan
malapetaka
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• Hospital Nurses Work Shoulder
to Shoulder with Public Health /
Community Nurses
• Health promotion – pra perkahwinan
- School Health
- Kem kesihatan
- Factory
- Rumah perlindungan dll
Strategi..
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Strategi – net working Hospital PKD/KK/KD
14/11/2014
Notifikasi:- Ibu Antenatal
berisiko ygtelah discaj,
Kelahiran, Ibu Postnatal
discaj kesberisikoe.g. dengan
suntikan heparin, EOD BP, Mental
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Pengendalian Ibu Hamil• Booking – early booking• Pengambilan sejarah yang betul• Pengambilan darah utk Ujian saringan Antenatal • Senarai Semak – antenatal, intrapartum &
postpartum• Pemeriksaan fizikal dan palpasi mengikut SOP• nasihat/runding cara• Rujukan• Temujanji• Lawatan ke rumah• Audit kad selepas sesi klinik• Penyeliaan
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MEMPERKUKUHKAN PERAWATAN DI RUMAH
1. Kepentingan Perawatan di rumah
2. Objektif & Komponen Perawatan
Antenatal/Posnatal
3. Aktiviti dalam persediaan lawatan Perawatan
Antenatal/Posnatal dirumah
4. Kepentingan fasa sosial dalam menentukan
kejayaan lawatan Perawatan Antenatal /
Postnatal Dirumah
5. Kepentingan ‘kontrak’ dengan keluarga
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PROTOCOL OF HOME VISIT
• Enter the house only after obtaining permission• Respect the mother and her family• Communicate well with the mother in order to
develop rapport• Describe the objective of the visit clearly• Avoid making any unfavorable comment• Educate family about personal hygiene and
sanitation.
Perinatal care manual 3rd edition 2013
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Perawatan Antenatal/Postnatal di rumah
Jadual Lawatan Antenatal Postnatal
Kes Normal Sekali semasaTrimester Pertama, Keduadan Ketiga
1,2,3,4,6,8,10,15& 20
Kes Berisiko Lebih kerapmengikutkeperluan kes
Lebih kerapmengikutkeperluan kes
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• Personalised care
• Persediaan Jururawat – pengetahuan & kemahiran
• Persediaan kenderaan
• Persediaan Beg lawatan
mengikut keperluan
Perawatan di rumahLAWATAN KE RUMAH
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Perawatan Antenatal
Tujuan:1. Gambaran sebenar status ibu (social, ekonomi, persekitaran
& taraf Kesihatan termasuk pemakanan & status mental2. Menggalakan pasangan dan keluarga mengambil bahagian
dalam penjagaan Kesihatan ibu dan bayi dalam kandungan3. Runding cara penjagaan Kesihatan semasa hamil e. g
anaemia, GDM, PIH, VTE4. Berbincang perancangan tempat bersalin5. Pendidikan Kesihatan e.g menjarakkan kelahiran, early
booking for next pregnancies, kepentingan penjagaanpostnatal dan new borns dsb
6. Defaulter tracing
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Perawatan postnatal di rumah
Penjagaan postnatal merupakan satuperkhidmatan yang sangat penting dalamKesihatan Awam.
Ia merangkumi penjagaan ibu dan anak yang berterusan dirumah mengikut hari tertentu untukmemastikan ibu dan anak mendapat penjagaankhusus dirumah.
Ia dilaksanakan oleh pelbagai kategori jururawatmengikut keperluan-Personalised care
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KOMPONEN LAWATAN PERAWATAN DI RUMAH
Persediaan Lawatan
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• Mengumpul maklumat sebelum membuat
lawatan
• Melaksanakan lawatan & menilai ,
menganalisa dan mengumpul maklumat
• Menetapkan tarikh lawatan – bersamakeluarga
• Beg Lawatan
• Kenderaan untuk lawatan
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• Jururawat perlu memakai pakaian seragamlengkap untuk identiti diri dalam masyarakat.
• Elakkan membawa wang yang banyak.
• Jangan memakai barang kemas yang berharga
• Mematuhi etika kejururawatan.
• Tulis alamat rumah/landmark, kawasan yang hendak dilawat.
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Kontrak Dengan Keluarga
Jururawat dan keluarga
ada persetujuan keputusan :
• Perubahan yang boleh dilakukan
• Faedahnya
• Halangan mungkin berlaku
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Prosedur Perawatan postnatal
• Holistik
• Peralatanyang lengkap
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Prosedur – Jagaan Bayi
• Pemeriksaan fizikal
• Mangambil suhu badan
• Menilai tahap jaundis
• Jagaan tali pusat
• Temujanji
• Penyusuan bayi
• Mengambil berat bayi Memberi maklumbalas
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TATACARA PEMERIKSAAN FIZIKAL IBU POSTNATAL
1. Pemerhatian dan Pemeriksaan Tanda Vital :Mengambil suhu badan, nadi dan pernafasan serta skor
kesakitanMengesan awal tanda-tanda jangkitan sistemik. Dalam
masa 24 jam selepas bersalin suhu badan akan naiksedikit, ini adalah fisiologi yang normal
Jika suhu badan naik sehingga 38.4°C pada hari ketigapuerperium, ini menunjukkan ibu mempunyai risikomendapat Puerperal Sepsis dan lain komplikasi.
Menilai keadaan ibu secara am termasuk keadaankebimbangan (post partum blues) dan kemurungansemasa dalam puerperium
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Prosedur – Jagaan Ibu
Pemeriksaan fizikal
• Memeriksa payudara – kaunseling
• Memeriksa luka pembedahan
• Mengukur tinggi rahim – pastikan ibu buangair kecil
• Memeriksa perineum
• Memeriksa lokia
• Tanda-tanda VTE
• Memberi maklumbalas
• Pengendalian sisa klinikal
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Pemeriksaan Payu Dara:
Lakukan setiap hari Kesan masalah seperti :
- sakit , bengkak payudara,puting merekah, puting tenggelam dan kurang pengaliran air susu
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iii. Ketinggian Fundus
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2. Kebersihan Diri Kepentingan menjaga kebersihan diri, terutama di bahagian perineum
adalah penting untuk mengelakkan dari berlakunya jangkitan
Penjagaan luka episiotomi dan luka pembedahan adalah penting untukmengelakkan ‘wound breakdown’. Pemerhatian penting terutama dilipatan kulit.
Lokia adalah media terbaik untuk pembiakan bakteria
Luka pada kulit, mukosa dan otot adalah tempat yang paling mudahdijangkiti bakteria
Kehilangan darah semasa bersalin, kurang rehat, kurang tenaga, kurangpengambilan makanan berzat dan cecair akan mendorong kepadaberkurangnya pertahanan badan.
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3. Pemeriksaan Payudara
• Tujuan mengesan sebarang masalah dalampenyusuan seperti bengkak payudara, putingmerekah, puting tenggelam dan kurangpengaliran air susu
• Lakukan pemeriksaan pada setiap hari. Payudara sepatutnya lembut dan pengaliransusu lancar
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4. Penyusuan Susu Ibu
Perhatikan cara ibu menyusukan bayi
Pastikan:-
i. Bayi melekap dengan betul
ii. Bayi menyusu sehingga berhenti
iii. Ibu memegang bayi dengan betul
iv. Ibu tidak merasa sakit semasa menyusu
v. Bayi menyusu di kedua-dua payu dara.
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5. Ketinggian Fundus Diukur dengan pembaris/pita pengukur setiap hari bagi
mengesan involusi uterus
Dalam masa 24 jam ketinggian fundus berada di paras pusatibu disebabkan oleh pembentukan semula servik
Setiap hari penurunan fundus diantara 1.25 cm hingga 2.5 cm
selepas 12 hari bersalin, tidak boleh dirasai melalui abdomen
Jika involusi tidak berlaku, kemungkinan berlaku Retained Product of Conception (POC)
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6. Lokia (Nifas)
Bertujuan untuk mengesan lokia yang luar
biasa
Terdapat 3 jenis lokia :-
i. Rubra ( 1 – 4 hari) mengandungi darah dan
berbau darah
ii. Serosa ( 5 – 9 hari) berwarna merah coklat
dan sedikit
iii. Alba ( 10 – 15 hari) berwarna putih kelabu
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Ingatan:
Jika masih tetap keluar darah menunjukkan tanda luarbiasa iaitu secondary PPH. Rujuk Doktor dengan segera
Lokia yang abnormal :
i. Jumlah yang berlebihan – menunjukkan retained
POC
ii. Warna yang sentiasa merah menunjukkan PPH
iii. Berwarna coklat dan berbau busuk –
menunjukkan infeksi
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7. Memeriksa Tanda dan SimptomVTE
Sakit dada
Susah bernafas
Bengkak dikedua kaki tidak seimbang(unilateral leg swelling)
saiz beza 2.0 cm
Redness/Inflamation of lower limbs
Calf Tenderness (sakit betis)
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8. Eliminasi
Ibu digalakkan buang air kecil dalam masa 6 hingga 8 jam selepas bersalin untukkeselesaan ibu dan menggalakkan kontraksiuterus dengan berkesan
Ibu dinasihatkan untuk buang air besarselepas 24 jam bersalin, jika tidak buang air besar selepas 48 jam perlu diberi rawatan.
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9. Melegakan sakit (after pain)
Rawatan yang diberi ialah Tab Paracetamol1000mg stat/PRN
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11. Ambulasi Awal
Bertujuan untuk menggalakkan pengeluaranlokia dan membantu mengembalikan tonus ototorgan reproduktif dan pengaliran darah yang baik
Ambulasi awal yang digalakkan:-
i. senaman ringan postnatal
ii. senaman pelvic floor
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Aktiviti Kawalan infeksi
Semasa Prosedur Rawatan
• Kebersihan tangan
• PPE
• Kebersihan Persekitaran
• Pengurusan linen terpakai
• Pengendalian sisa klinikal
dan bahan tajam
• Disinfeksi dan Sterilisasi
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Perlu ketabahan dan minat mendalam utk Bertugas di KA
Aku buat bruanak buah
ikutJalan
sungai..!!
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Situasi Jururawat di kesihatan awam
Pendalaman
Felda
Bandar
Rumahtransit di KK
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Bencana & Malapetaka
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Menyelamatkanvaksin
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Penyiasatan Epidemik dan Endemik
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GARIS PANDUAN
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videos
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Portal MyHEALTH
Layari Portal MyHEALTH
You Tube
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TERIMA KASIH