Public Health Services Physical Exam

• Exam of thyroid gland

Family Health Service • Breast
1.Maternal • Abdominal exam: fundic height; leopold’s
2.Child health maneuver, FHT
3.Family planning • Exam of face, hands and lower extremities for
4.Oral health edema
5.Essential health packages for adolescent, adult, • Tetanus toxoid immunization- 0.05cc, IM, deltoid, 5
men and women and older persons doses
Maternal: Stat 2000 Micronutrient supplementation: Vitamin A
Maternal Mortality
VAC SCHEDULE
25%- hypertension
10,000 IU capsule 1 capsule 2x a week from
20.3%- postpartum hemorrhage
4th month of pregnancy
9%- abortive outcomes
200,000 IU capsule 1 capsule within 4 weeks
after delivery
Underlying issues:
• Delay in taking actions
NB:
• Delay in seeking care
• Vitamin A capsule (VAC) 200,000 IU is
• Delay in making referral
contraindicated in pregnancy
• Delay in appropriate medical management
• Upon diagnosis, VAC 10,000 is given OD for 4
weeks for pregnant women with night blindness
Goal:
• Ensure that every expectant and nursing mother Micronutrient Supplementation: 60mg elemental
maintains good health, learns the act of child care, iron (EI) with 400ug folic acid
and has a normal delivery and healthy children.
• That every child, whenever possible lives and During pregnancy:
grows up in a family unit with love and security, in • 1 tablet OD x 6 months or 180 days during
healthy surroundings, receives adequate pregnancy
nourishment, health supervision and efficient
medical attention, and is taught the elements of • 2 tablets OD if parenteral consultations start in the
healthy living. 2nd and 3rd trimester of pregnancy
For lactating women:
Aspects: • 1 tablet OD x 3 months or 90 days
• prenatal care, care during labor, postpartum
care Micronutrient Supplementation: Potassium Iodide
200 mg capsule once a year for pregnant women
Prenatal Period of Pregnancy
Prevention and Treatment of diseases and other
Visits:
conditions associated with pregnancy
1st ASAP
• Assessment of high risk factors
2nd 2nd trimester
3rd 3rd trimester
Care during Labor
Every 2 weeks After 8 months of
1.Delivery by trained health personnel (DOS)-
pregnancy
domicillary obstetrical service
2.Hospital delivery (periculture center, lying-in
Assessment: clinics, hospitals)
1.history taking: family, menstrual, OB (LMP, AOG, 3.Rooming in/ breast feeding
EDC)
2.weight and height Domicillary Obstetrical Services Qualifications
3.vital signs, with special attention given to BP 1.Full term
4.physical exam 2.Not a primigravida- greater than 5 pregnancies
5.laboratory examinations 3.Without coexisting disease
4.No history of complications/abnormalities in
Identify high risk pregnancy: present and previous pregnancies and delivery
1. Age- less 15years; 35years above 5.Imminent delivery
2. Parity- higher than 5 pregnancies
Post Partum Care
3. Weight- less than 95 pounds
1.Inform, teach, counsel (MCH concerns)
4. Height- less than 4”10 a. Birth registration
5. Hgb- less than 8.5 grams b. Breastfeeding
6. Signs of hypertensive (HPN) disorder c. Newborn screening for babies
7. Poor OB history d. Delivered in RHU
8.Associate medical condition 2.Family Planning counseling
9.Vaginal bleeding; premature rupture of bag of 3.Nutrition education/ supplementation action
water 4.Post partum care everyday till cord sloughs off
a. 1st visit- 1st week
 b. 2nd visit- 6 weeks
Laws and Presidential Decree affecting MCH
• PD 996- compulsory immunization of infants and
children below 8 years old
• PD 965- a decree requiring applicants for marriage
license to receive instruction on family planning
and responsible parenthood
• PD 603- the child and growth welfare code
• PP No. 6- implementation of universal code
immunization
• RA 7600- rooming-in and breastfeeding act of
1992
• RA #51- milk code
• RA 7846- compulsory hep.B immunization for
infants and children below 8years old
• PP #46- re-affirming universal child and mother
immunization. Polio Eradication Project of the
Philippines
• RA 8172- ASIN law (iodization of salt)
• PP #1064- acute flaccid paralysis (AFP)
surveillance by all sectors
• PD 79- revised pop. Act empowers rn’s and rm’s to
provide, dispense and administer acceptable
methods of contraceptions
• RA 9288- newborn screening act
• RA 8976- food fortification act. (fortification of
cooking oil with vitamin A, wheat flour with vitamin
A and iron refined sugar with vitamin A and rice
with iron)
• PD 651- birth registration
Child Care
A. Care of below 5 years old
• Immediate care of newborn
• Detection/referral/management of high risk
newborn
a. LBW (lower than 2274 grams- not higher
than 2500 grams)
b. Born with high risk mothers
c. Problems during neonatal period
d. Born to families with psycho-social
problems
e. Chronic or recurrent illness
• Breastfeeding
• Nutrition promotion/growth surveillance
• EPI
• IMCI
G- growth monitoring (ECCDC)
O- oresol
B- breastfeeding
I- immunization
Schedule of Consultation:
1st year (0-11months) – every month
2nd year (12-23months) - every 2 months
3rd year (24-35months) – every 3 months
4th year (36-41 months) – every 6 months
5th year (48-59 months) - once a week
Breastfeeding- 1st step to raise a bright child
Philippine Nutrition Program
1. Nutrition surveillance
2. Nutrition education
3. Food assistance/feeding program
4. Food production/livelihood
5. Treatment of conditions associated with
malnutrition
Legislations:
1. RA 8172- ASIN
2. RA 8976- food fortification act 2000
a. Rice with iron
b. Wheat flour with vitamin a and iron
c. Refined sugar with vitamin a
d. Cooking oil with vitamin a
3. EO 382- nov.7- national food fortification day
Conditions associated with malnutrition
Infections: diarrhea, vomiting, fever, intestinal
parasitism
• Ascaris (giant roundworm)- nutritional
competitor
• Hookworm- blood sucker, heavy infestation in
seen as severe anemia; enters body through skin
• Enterobius/oxycuris (pinworm)- rectum, major
sign is pruritis ani, highly contagious
• Taenia saginata/solium (tapeworm)- longest
(15-25 meters)
Nutrition Assessment
1. Anthropometry- major tool index of protein-
energy malnutrition
2. Biochemical exam- more expensive; Hgb
detection, serum CHON, BUN, creatinine
3. Clinical- diagnosis of micronutrient
deficiencies
4. Dietary history
5. Health history- to determine secondary
factors with malnutrition such as diarrhea
Anthropometry:
1. Weight for age
a.Lower than 5, operation timbang
b.Not used when patient has edema
c. Used in diagnosis of:
- Chronic low nutrition = stunting
- Acute (current) malnutrition
- Overweight- obesity
- Underweight- wasting
Gomez classification of nutritional statistics
Formula for computation of % of LBW:
Actual body weight ÷ expected body weight x 100
greater than 110% - overweight
91 – 100%- normal
76 – 90% - 1° undernutrition (mild)
61-75% - 2° undernutrition (moderate)
less than or equal to 30-60% - 3° undernutrition dermatosis
(severe)
Management of PEM (protein energy
2. Weight for age malnutrition)
a.Lower than 5, diagnosis chronic undernutriton- • 1st and 2nd degree malnutrition; home
stunting management; nutrition education
b. Heredity
• 3rd degree- referral to hospital; nutrition
education
3. Mid upper arm circumference (1-4years
old)- rapid screening for malnutrition Micronutrient- substance in very small amounts of
Procedures: body (less than 0.005% of body weight)
• Determine midpoint between acromion and
olecranon Vitamin A deficiency (VAD)
• Measure circumference at midpoint Iron deficiency anemia (IDA)
Interpret: Iodine deficiency disorders (IDD)
Greater than or equal to 13cm- normal nutrition
status VAD (xerophthalmia)
Less than 13cm- acute undernutrition (wasting) Susceptible population: 1-4years old, occurs with
PEM
4. Weight for height Foods rich in Vitamin A
• Adults • Richest: liver, egg yolk and milk, retinol
• Diagnosis for acute malnutrition • dark green leafy vegetables, yellow fruits and
• Body mass index vegetables, contain carotene.
Formula: weight in kilogram ÷ height in m2
Body mass index of 20-25 is desirable Signs:
5. Skinfold thickness 1. Night blindness- lack of rhodopsin (visual
• Subcutaneous tissue purple) in rods.
• Triceps 2. Photophobia
• Femoral 3. Conjunctiva xerosis- dryness of conjunctiva for
• Abdominal 2 hours to inadequate tears
Adults to diagnosis acute malnutrition 4. Bitot’s spot- foamy, silvery spot on saliva
Harpenden caliber 5. Corneal opacity
6. Keratomalacia- softening cornea- corneal
Pt. of Kwashiorkor Marasmus rupture- eye evisceration- irreversible
difference blindness
Etymology After sickness of “wasting”
older child when IDA
next baby is Susceptible population: pregnant women and
born infants
Deficiency Sever protein Severe energy Foods rich in Iron
deficiency deficiency • Liver and other internal organs, egg yolk, dark
= qualitative = quantitative green leafy vegetables
def.conditon def. condition Major sign of IDA, palmar pallor
Age group Weaning age: Various age
affected toddler groups IDD
Health history Improper Starvation Susceptible population: woman
weaning Most serious effect mental retardation (cretinism) in
diarrhea baby: if mother does not have enough supply of iodine
Wasting Present, not Present, obvious during pregnancy.
obvious
Major feature Edema; ascites, Wasting- skin Other signs:
pedal and bones • Growth stunting
appearance • Pasty skin
Weight May be normal Abnormal = 2nd • Protruding abdomen
or 3rd degree • Deaf mutism
malnutrition
Facial Moon faces Old man faces Foods rich in Iodine: seafoods
appearance Goitrogens- interfere with Iodine use; found in
Appetite for Poor Very Good cabbage, turnips, mustard, red skin of peanuts,
food cauliflower, broccoli, cassava
________ Irritable Apathetic
outlook Prevention and Management:
Hair changes Sparse, Absent 1. Supplementation- administration of
depigmentation concentrated source of nutrient
“flag sign”
Skin changes Flaky paint Absent VAD prevention:
 • Preschoolers (12-83 months)- 200,000 IU every
6months
• Postpartum 200,000 IU within 1 mon. after delivery
of every child

VAD treatment: days 1 and 2 after 2 weeks

2. Fortification- addition of a nutrient to food

during processing

Sangkap Pinoy Seal- placed on label of fortified

foods.

Palma 2-8 ♥