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AFRICAN COLLEGE OF HEALTH (ACH)

BNS YEAR 2 SEMESTER 3; WEEK 1 NOTES:


MONDAY: Maternal-Child Nursing (pg.2)
TUESDAY:

Nutrition, Health & Wellness (pg.5)

WEDNESDAY: Maternal-Child Nursing (pg.10)


THURSDAY: Nutrition, Health & Wellness (pg.13)
FRIDAY: Maternal-Child Nursing

(pg.17)

QUESTIONS? Email: africancollegeofht@nokiamail.com

MATERNAL - CHILD NURSING (MONDAY)


What is pregnancy?
A woman is pregnant when a male's sperm reaches the
uterus of a woman, meets and fertilizes the woman's
ovum. Pregnancy lasts from 37 to 42 weeks, (40 weeks on
the average). The fertilized ovum gradually grows and
develops in the uterus of the woman and transforms
itself into a fetus.
Physical changes and signs of pregnancy;
Pregnancy is not a disease. It is a natural process for
the reproduction of mankind. However, different changes
and signs are seen on the body of the pregnant women.
The following are changes and signs that can be
observed in pregnancy.
Ammenorrhea (absent regular menustral period);
Nausea and vomiting.
Increase in the size of the breasts.
Growing or bulging of the abdomen.
Movement of the fetus.
Feeling the body of the fetus.
Hearing the heart beats of the fetus etc.
What is antenatal service?
Antenatal service is the provision of advice and
medical service to a pregnant woman by a health
professional from the time of conception to delivery.
It would be good if the following checkups are
organized for a pregnant woman;
Urine test for albumin and sugar.

Hemoglobin.
Blood pressure.
Fatal auscultation (Fetal scope)
Fetal palpation
Educate mothers about the need for a regular medical
checkups during pregnancy. The medical checkup made
during pregnancy helps mothers to get advices during
pregnancy and post delivery periods. This will help
prevent and reduce morbidity and mortality among
mothers and children. The following are the activities
that would be undertaken during first antenatal visit;
Registration, age, height, weight, last day of
menstruation. From these information, the expected date
of delivery can be calculated.
Other information that would be collected from the
mother are; number of children born, where they were
born, previous health problems, whether she had
vaccination or not.
Signs of health risks during pregnancy;
Pregnant women can face some illnesses during
pregnancy period. Unless these illness are known on
time and the necessary action is taken, the illnesses
can lead to life threatening risks. The signs of such
illness are the following:
Puffiness/ oedema of the face especially around the
eye.
Oedema of fingers.
Nausea and

vomiting.

Severe headache, abdominal pain, blurred vision.

Bleeding from the uterus.


Blood-like vaginal discharge.
Fever.
Voluminous yellowish or white vaginal discharge.

NUTRITION, HEALTH AND WELLNESS (TUESDAY)

MEDICAL AND BIOLOGICAL IMPORTANCE;


1. Food is the source of energy for humans, animals
and other living organisms.
2. Carbohydrates, fats and to some extent proteins
present in the food provides energy on oxidation.
3. Body uses energy derived from them for;
(a) Maintenance of several basic processes like
respiration, blood circulation, contraction of cardiac
and skeletal muscle, excitability of central nervous
system, secretory functions of various glands, membrane
potential, excretory function of kidney and other
cellular activities. The energy spent for this purpose
constitutes basal metabolic rate (BMR).
(b) Various physical activities.
(c) Digestion and metabolizing food.
4. Physiological conditions like pregnancy, lactation
and pathological conditions like fever, hyperthyroidism
and cancer increases BMR.
5. A sedentary worker requires 2500C of energy whereas
heavy worker requires 4500C of energy per day. However,
body energy requirement is influenced by environment.
6. Proteins, fats and carbohydrates of
required for growth and maintenance of
also. For this reason they are called
Vitamins, minerals and water are other
required by body.

food are
body tissues
nutrients.
nutrients

7. For optimal health a balanced food (diet) that meets


energy requirement as well as nutritional requirement
is essential.

8. Kwashiorkor and Marasmus seen in pre-school children


of several developing countries are due to consumption
of food deficient in nutrients, energy or both.
9. Parenteral feeding meets energy and nutritional
requirements of people who are unable to use
gastrointestinal tract due to several diseases.
10. Some foods contain medicines (nutraceuticals) in
addition to usual nutrients. Such foods have
preventive, protective and curative effects on diseases
like hypertension, cardiovascular diseases,
atherosclerosis, obesity, auto immune diseases and
cancers of breast, prostate, lung etc.
11. Fibre present in plant foods reduces incidence of
colonic diseases like colon cancer, piles, ulcerative
colitis as well as cardiovascular diseases and
metabolic diseases.
12. Foods acting as vaccines like banana vaccines
(edible vaccines) are being produced by using
recombinant DNA technology and soon they may be
available in market.
13. Using recombinant DNA technology genetically
modified foods (GMF) are being produced in advanced
countries. These foods have more shelf life, nutrient
quality and good texture etc. Some of them particularly
animal derived foods contain medicines also like
transgenic milk.
14. Toxins present in foods are causating agents of
diseases like lathyrism, epidemic dropsy, liver damage,
botulism and cancer.

15. In South Asian countries maternal malnutrition is


due to poverty, inadequate intake of food, false
beliefs and taboos.
16. Arsenism (Arsenic poisoning) due to exposure to
high arsenic levels in environment is seen in several
countries. Arsenic causes cancers in humans.
17. Tobacco smoke an environmental pollutant affects
health of non-smokers, children and pregnant women.
18. Mosquito repellants and therapeutic agents also
cause environmental pollution and health and ecological
hazards.

Energy:
Food energy is derived from carbohydrates, lipids and
proteins present in food. These food components are
digested, resulting molecules like glucose, fatty acids
and amino acids are absorbed and converted to chemical
energy and heat. Carbohydrates, fats and proteins
contributes to 50-55%, 30-40% and 10-15% of food energy
respectively.
Physical methods used for determination of food energy:
Energy or fuel value of food depends on amounts of
carbohydrates, fats and proteins present in them. Bomb
calorimeter is used to determine energy values of
carbohydrates, fats and proteins. The amount of energy
they release or their calorific value is determined by
oxidizing known amount of food in bomb calorimeter and
measuring the heat generated.
Energy Units:

Kilocalorie, Kcal (nutritional Calorie, C) or kilo


joules (KJ) are the units used to express energy value
of foods. Kilocalorie (Kcal or C) is defined as amount
of energy required in the form of heat to raise
temperature of 1 Kg water by 1C. It is thousand times
of calorie used in physics. One Kcal or C is equal to
4.186 kilo joules (KJ).
Determination of food energy values using Bomb
calorimeter:
Bomb calorimeter consist of steel chamber fitted with
O2 under high pressure. A fixed amount of food sample is
placed in the chamber. An electrical discharge is used
to initiate combustion of food sample. Energy (heat) is
released into surrounding which is carried away by
water flowing outside the chamber. Energy output of
food sample is calculated from difference between the
temperature of outgoing and incoming water. Energy
values obtained with bomb calorimeter for
carbohydrates, fats and proteins are given below:
1 gm of carbohydrate
1 gm of fat
1 gm of protein

4.1 C or 4.1 Kcal


9.45 C or 9.45 Kcal
5.65 C or 5.65 Kcal

Energy values for other food stuffs like bread, milk,


vegetables etc., may be obtained similarly
Physiological calorific values of foods (Animal
calorimetry):
Calorific values obtained with bomb calorimeter do not
reflect in vivo values because in bomb calorimeter food

is completely oxidized to CO2 and H2O where as in body a


fraction of food is lost in digestion and nitrogen of
protein is eliminated as urea. Furthermore bomb
calorimeter is nonliving object. Hence to get clear
picture of energy output of food in the body methods
involving humans are needed. Direct and indirect
calorimetric methods are used to determine energy
production (expenditure) in humans when a particular
food is oxidized in the body.

MATERNAL - CHILD NURSING (WEDNESDAY)


What is pregnancy?

A woman is pregnant when a male's sperm reaches the


uterus of a woman, meets and fertilizes the woman's
ovum. Pregnancy lasts from 37 to 42 weeks, (40 weeks on
the average). The fertilized ovum gradually grows and
develops in the uterus of the woman and transforms
itself into a fetus.
Physical changes and signs of pregnancy;
Pregnancy is not a disease. It is a natural process for
the reproduction of mankind. However, different changes
and signs are seen on the body of the pregnant women.
The following are changes and signs that can be
observed in pregnancy.
Ammenorrhea (absent regular menustral period);
Nausea and vomiting.
Increase in the size of the breasts.
Growing or bulging of the abdomen.
Movement of the fetus.
Feeling the body of the fetus.
Hearing the heart beats of the fetus etc.
What is antenatal service?
Antenatal service is the provision of advice and
medical service to a pregnant woman by a health
professional from the time of conception to delivery.
It would be good if the following checkups are
organized for a pregnant woman;
Urine test for albumin and sugar.
Hemoglobin.
Blood pressure.

Fatal auscultation (Fetal scope)


Fetal palpation
Educate mothers about the need for a regular medical
checkups during pregnancy. The medical checkup made
during pregnancy helps mothers to get advices during
pregnancy and post delivery periods. This will help
prevent and reduce morbidity and mortality among
mothers and children. The following are the activities
that would be undertaken during first antenatal visit;
Registration, age, height, weight, last day of
menstruation. From these information, the expected date
of delivery can be calculated.
Other information that would be collected from the
mother are; number of children born, where they were
born, previous health problems, whether she had
vaccination or not.
Signs of health risks during pregnancy;
Pregnant women can face some illnesses during
pregnancy period. Unless these illness are known on
time and the necessary action is taken, the illnesses
can lead to life threatening risks. The signs of such
illness are the following:
Puffiness/ oedema of the face especially around the
eye.
Oedema of fingers.
Nausea and

vomiting.

Severe headache, abdominal pain, blurred vision.


Bleeding from the uterus.
Blood-like vaginal discharge.

Fever.
Voluminous yellowish or white vaginal discharge.

NUTRITION, HEALTH AND WELLNESS (THURSDAY)


Direct Calorimetry:
In the direct calorimetry energy production of an
individual is measured by estimating his bodys heat

production. The individual is placed in an insulated


chamber then his heat production when a particular food
is oxidized in the body is measured directly by
recording amount of heat transferred to water
circulating through the chamber. The O2 in take, CO2
output and nitrogen in urine and feces are also
measured. The calorific values obtained for different
foods are given below:
Food stuff
Carbohydrates (1 g)
Fats (1 gm)
Proteins (1 gm)
Cooked rice (1 Kg)
Milk (1 L)
Bread (1 Kg)
Sugar (1 Kg)
Cake (1 Kg)

Energy value
4 C
9 C
4 C
290 C
700 C
2630 C
4100 C
4000 C

The figures obtained for carbohydrates, fats and


proteins are slightly less than those obtained with
bomb calorimeter due to loss of food (little) in
digestion and protein nitrogen as urea.
Indirect Calorimetry:
Since oxidation of food in the body is associated with
O2 consumption and CO2 release in indirect Calorimetry
energy production of an individual when a particular
food is oxidized in the body is measured by estimating
O2 consumed and CO2 released.
Respiratory quotient:
It is the ratio of the volume of CO2 produced to the
volume of O2 consumed when particular food is oxidized
in the body.

Respiratory quotient R.Q. = Volume of CO2 produced /


Volume of O2 consumed
R.Q. for carbohydrate, fat and protein are 1, 0.7 and
0.8 respectively on mixed diet R.Q. is 0.85.
Medical Importance:
1. It indicates type of food being oxidized in the
body.
2. In diabetes mellitus and starvation R.Q. decreases.
Energy Requirements of an individual:
Energy requirement of an individual is made up of
several components. They are
(1) Basal metabolic rate
(2) Specific dynamic action of food
(3) Various activities.
However, for women pregnancy and lactation are
additional components of energy requirement.
Basal metabolic rate:
It is the energy expenditure (heat output) of an
individual in post absorptive state for the last 12
hours lying at complete physical and mental or
emotional rest and having normal temperature.
Measurements of BMR have been made on humans using
indirect calorimeter. BMR of an individual can be
calculated from a formula given below.:
BMR = Weight (Kg)

24C/day

(24C/day/kg approximately)
Normal BMR :

Male = 37.5C/sqm/hour
Female = 35 C/sqm/hour

FACTORS AFFECTING BMR:


Many factors controls BMR;
1. Age. BMR decreases with age. Children have high BMR
than adults, old people has low BMR than adults.
2. Surface area. BMR is directly proportional to body
surface area. Larger the surface area higher the BMR.
3. Sex. BMR is high in males than females.
4. Environment. In cold BMR is high whereas in warm
climate BMR is low.
5. Physiological conditions like pregnancy and
lactation increases BMR whereas sleep decreases BMR.
6. Exercise. Muscular exercise increases BMR.
Medical Importance:
1. In fever BMR increases. For every 1C rise in body
temperature BMR increases by 10%.
2. In hyperthyroidism BMR increases up to 80-90%.
3. BMR increases in conditions like Cushing's syndrome,
cancer, emphysema and hyper activity of pituitary.
Drugs like salicylates and amphetamines increase BMR.
4. BMR decreases in starvation, hypothyroidism,
Addisons disease and nephrotic syndrome.
Specific dynamic action (SDA) of food:

It has been observed that heat output (energy


expenditure) and oxygen consumption of an
individual increases upon eating food even when the
individual is at rest. Called post prandial
thermogenesis (PPT) or specific dynamic action of
food. It is the extra amount of energy (heat)
produced over the normal calorific value of the
food stuff when oxidized in the body or used up in
the body.
For example when protein having energy value of 100 C
is eaten it produces 130 C. This extra 30 C is due to
SDA of protein. Therefore SDA of protein is expressed
as 30% similarly SDA of carbohydrate, fat and mixed
diet are 6%, 4% and 6-10% respectively. The exact
source for SDA is unknown. However, probably it may be
a result of energy expended in digestion, absorption
and transport of ingested food. So while calculating
energy requirement for daily activities of an
individual 10% of the total calories are added to
compensate for expenditure on SDA. However several
nutritionists feel it as not necessary.

MATERNAL - CHILD NURSING (FRIDAY)


What is pregnancy?
A woman is pregnant when a male's sperm reaches the
uterus of a woman, meets and fertilizes the woman's
ovum. Pregnancy lasts from 37 to 42 weeks, (40 weeks on
the average). The fertilized ovum gradually grows and

develops in the uterus of the woman and transforms


itself into a fetus.
Physical changes and signs of pregnancy;
Pregnancy is not a disease. It is a natural process for
the reproduction of mankind. However, different changes
and signs are seen on the body of the pregnant women.
The following are changes and signs that can be
observed in pregnancy.
Ammenorrhea (absent regular menustral period);
Nausea and vomiting.
Increase in the size of the breasts.
Growing or bulging of the abdomen.
Movement of the fetus.
Feeling the body of the fetus.
Hearing the heart beats of the fetus etc.
What is antenatal service?
Antenatal service is the provision of advice and
medical service to a pregnant woman by a health
professional from the time of conception to delivery.
It would be good if the following checkups are
organized for a pregnant woman;
Urine test for albumin and sugar.
Hemoglobin.
Blood pressure.
Fatal auscultation (Fetal scope)
Fetal palpation

Educate mothers about the need for a regular medical


checkups during pregnancy. The medical checkup made
during pregnancy helps mothers to get advices during
pregnancy and post delivery periods. This will help
prevent and reduce morbidity and mortality among
mothers and children. The following are the activities
that would be undertaken during first antenatal visit;
Registration, age, height, weight, last day of
menstruation. From these information, the expected date
of delivery can be calculated.
Other information that would be collected from the
mother are; number of children born, where they were
born, previous health problems, whether she had
vaccination or not.
Signs of health risks during pregnancy;
Pregnant women can face some illnesses during
pregnancy period. Unless these illness are known on
time and the necessary action is taken, the illnesses
can lead to life threatening risks. The signs of such
illness are the following:
Puffiness/ oedema of the face especially around the
eye.
Oedema of fingers.
Nausea and

vomiting.

Severe headache, abdominal pain, blurred vision.


Bleeding from the uterus.
Blood-like vaginal discharge.
Fever.
Voluminous yellowish or white vaginal discharge.

walesonmd@gmail.com