All topics for community: exam

Public health topic

 ANA (1980), APPA (1980/1996). ANA agree that the type of involvement pereviously
described is a synthesis of nursing practice and public health practice .
What the ANA called Community health nurse.
What the APHA called Public health nurse.

 In 1984, ANA and APHA participants aimed

 to clarify the educational preparation needed for public health nursing and
 to discuss the future of public health nursing.
 It was agreed that the term “communty health nurse” is …….an umbrella term
used for all nurses who work in a commity including those who have formal
preparation in public health nursing.

Public health nursing educational program should including:

 Epidemiology, statistics and research
 Orientation to health care systems,
 Identification of high-risk populations
 Application of public health concepts to the care of group of culturally diverse person
 Interventions with high-risk populations
 Orientation to regulations affecting public health nursing practise

This educational preparation is assumed to be complementary to basic educational nursing.

Community health nurse

 A registered nurse who works non-institutional setting has either received a diploma
or completed an associated degree nursing education program can be called a
community health nurse and practise community-based nursing

Prevention:
 Epidemiology is a science that helps to describe the natural history of specific disease
include:
 a presymptomatic period,
 a symptomatic period and
 a resolution (death, disability, complication or recovery)
 The broad concept to prevention has three level.
 Primary level prevention
 Secondary level prevention
 Tertiary level prevention

 Primary level prevention: The goal of primary prevention is the promotion of health
and prevention of the occurence of disease.
  Activities of primary prevention include
 environmental protection (such as maintaining asepsis and providing clean
water) and
 personal protection (such as providing immunizations and avoding smoking).

Secondary level prevention:

 The goal of secondary prevention is the detection (sreening) and treatment of the
disease as early as possible during the natural history of the disease.
 For example:
 Papanicolaou (Pab) smear testing allows cervical cancer to be detected earlier in
the disease process so that cure is more likely.

Tertiary level prevention:

 Tertiary prevention is geared toward preventing disabilty, complications, and death from
the disease.
 Tertiary prevention includes rehabilation
 social rehabilitation
 work rehabilitation

 All levels of prevention can be accomplished throught work with indivuduals, group,
families and communities ( law, social mores) and changes in the physical environment
(waste disposel).
 The well-being and health of the entire population within the communty is ultimate
goal of public health.

Three primary functions of public health:

 The various roles and settings for practice hinge on three primary functions of public
health:
 assessment,
 policy development,
 and assurance.
Assessment
 An essential first function in public health.
 The community health nurse must gather and analyze information that will affect the
health of the people to be serve:
 health needs,
 health risks,
 environmental conditions,
 political agendas,
 and financial and other resources.
Policy Development:
 It is enhanced by the synthesis and analysis of information obtained during assessment.
 At the community level,
  the nurse provides leadership in convening and facilitating community groups to
evaluate health concerns and develop a plan to address the concerns.
 Typically, the nurse recommends specific training and programs to meet
identified health needs of target populations.
Assurance:

 Assurance activities—activities that make certain that services are provided— often
consume most of the community health nurse’s time.
 Community health nurses perform the assurance function at the community level
 when they
 provide service to target populations,
 improve quality assurance activities, and
 maintain safe levels of communicable disease surveillance and outbreak control.

In the exam, all these roles were given with a couple of definitions, you have to match which
role belongs to which one .

The Definition of Epidemic

An epidemic is the occurrence of a disease or health condition that affects a large number of individuals
within a population, community, or region at the same time, exceeding what is typically expected based
on historical data. Examples include influenza outbreaks, measles, or foodborne illnesses.

Definition of an Epidemic:

An epidemic refers to the sudden increase in the number of cases of a particular disease beyond what is
normally expected in a specific population, community, or geographic area over a particular period of
time.

Key Characteristics of an Epidemic:

1. Exceeds Normal Expectations:

• The disease occurrence surpasses the baseline or usual frequency in a given area.

2. Time and Place Specific:

• Epidemics are defined within a particular population or region during a specific timeframe.

3. Not Limited to Infectious Diseases:

• While often associated with contagious diseases (e.g., influenza, cholera), an epidemic can also
refer to non-communicable conditions (e.g., opioid overdose or obesity).

4. May Lead to an Outbreak:

• Sometimes, a small localized epidemic is referred to as an outbreak, but both terms share the
same fundamental concept.

Examples:
• Infectious Epidemic: Ebola virus outbreak in West Africa (2014–2016).

• Non-Infectious Epidemic: Opioid crisis in the United States.

Roles of Public Health:

• Preventing disease and promoting health through education and interventions.

• Conducting research to improve public health practices.

• Advocating for policies that enhance health equity and access to healthcare.

• Managing public health crises like epidemics and natural disasters.

What is the Purpose of Public Health Core Functions?

The purpose of public health core functions is to protect and promote the health of populations through
organized efforts. These functions guide public health practice by providing a framework for identifying
health issues, developing policies, and implementing interventions to improve health outcomes.

Public Health Nursing Education Program:

Public health nursing education programs focus on preparing nurses to work in community health
settings. These programs emphasize:

• Health promotion and disease prevention strategies.

• Addressing social determinants of health.

• Developing skills to manage public health emergencies.

• Collaborating with interdisciplinary teams to improve population health outcomes.

A Public Health Nursing Education Program is typically designed to prepare nurses to address health
issues at the community or population level, rather than focusing solely on individual patient care. These
programs emphasize a broad perspective on health and often include the following components:

Types of Programs
1. Bachelor’s Degree in Nursing (BSN) with a Public Health Focus

• Some BSN programs include courses in public health, community nursing, epidemiology, and
health promotion.

• Prepares nurses for entry-level roles in public health settings.

2. Master’s Degree in Public Health Nursing (MPH-N)

• Combines nursing practice with public health principles.

• Prepares nurses for leadership roles, such as public health administrators or policymakers.

3. Doctorate Programs (DNP or Ph.D.) in Public Health Nursing

• Focus on advanced research, leadership, and specialized roles in public health.

• Suitable for those pursuing academic, research, or high-level administrative careers.

4. Postgraduate Certificate Programs in Public Health Nursing

• Shorter programs for registered nurses (RNs) to gain specialized knowledge in public health
nursing.

• Often pursued by nurses with a general nursing degree who want to transition into public
health.

Core Components of Public Health Nursing Programs

1. Health Promotion and Disease Prevention

• Training nurses to design and implement strategies that prevent diseases and promote health at
the community level.

2. Epidemiology and Biostatistics

• Understanding disease patterns and analyzing data to make informed public health decisions.

3. Policy and Advocacy

• Learning to advocate for public health policies that reduce disparities and improve healthcare
access.
 4. Community Health Assessments

• Gaining skills in assessing the health needs of communities and planning interventions.

5. Cultural Competence and Health Equity

• Addressing social determinants of health and working with diverse populations to achieve
equitable health outcomes.

6. Disaster and Emergency Preparedness

• Training nurses to respond to public health crises like epidemics, natural disasters, or
bioterrorism events.

7. Fieldwork/Clinical Practice in Public Health Settings

• Applying knowledge in real-world settings like community clinics, health departments, or non-
governmental organizations (NGOs).

DETERMINANTS OF HEALTH
 Biology is an individual’s genetic makeup, family history, and any physical and mental
health problems developed in the course of life.
 Aging, diet, physical activity, smoking, stress, alcohol or drug abuse, injury , violence, or
a toxic or infectious agent may produce illness or disability that changes an indi viduals
biology,
 Behaviors are the individual’s responses to internal stimuli and external conditions.
 Behaviors interact with biology in a common relationship as one may influence the
other.
 If a person chooses behaviors such as alcohol abuse or smokcing, his or her
biology may be changed as a result (e.g., liver cirrhosis, chronic obstructive
pulmonary disease [COPD]).
 On the other hand,
 if an individual has a history of colon cancer in his or her family, the individual
may choose to have regular screenings, thereby preventing advanced cancer and
possibly death, and changing his or her biology for the better.
 One’s biology may impact behavior;
 if a person has hypertension or diabetes, he or she may choose to begin an
exercise regimen and to eat more healthfully.

RISK AND HEALTH- exam

• A risk assessment is a systematic way of distinguishing the risks posed by potentially
harmfııl exposures,
• The four main steps of a risk assessment are
• hazard identification,
• risk description,
• exposure assessment, and
• risk estimation
THE RELATIONSHIP OF RİSK TO HEALTH AND HEALTH PR0M0TI0N ACTIVITIES:
 Health is directly related to the activities
 in which we participate,
 the food we eat, and
 substances to which we are exposed daily
 where we live and work,
 our gender,
 age, and
 genetic makeup also impact health.
 In the assessment of risk regarding health and health promotion activities, there are two
types of risks:
 modifiable risks and
 nonmodifiable risks.

 THE RELATIONSHIP OF RİSK TO HEALTH AND HEALTH PR0M0TI0N ACTIVITIES
exam
• Modifiable risk factors are those aspects of a persons health risk over which he or she
has control.
Examples include smoking, leading a sedentary or active lifestyle, type and amount of food
eaten, and the type of activities in which he or she engages (sky- diving is risker than bowling).
• Nonmodifiable risk factors are those aspects of one’s health risk over which one has no
or little control.
Examples include genetic makeup, gender, age, and environmental exposures

 Alcohol use, particularly heavy alcohol use, is responsible for many health problems
such as liver disease or unintentional injuries.
 Excessive alcohol use is drinking more than two drinks per day on average for men or
more than one drink per day for women,
 Binge drinking, which is drinking five or more drinks on a single occasion for men or four
or more drinks in a single occasion for women.
 A drink is any drink containing 0.6 ounces or 1.2 tablespoons of pure alcohol.

• The short-term risks of alcohol consumption are usually due to binge drinking or
excess drinking and include risky sexual behavior, violence, unintentional injuries from
motor vehicle accidents, falls, firearms, and drowning. Miscarriage or stillbirth and
alcohol poisoning are also possible immediate effects of excessive alcohol use.

• The long-term risks of alcohol use are neurologic conditions

• such as dementia and stroke; cardiovascular problems such as MI, hypertension, and
cardiomyopathy; psychiatric problems
• such as depression and amdety; social problems
• such as unemployment and family dysfunction; cancer of the mouth, throat, liver,
andbreast; and liver disease ineluding cirhosis and hepatitis. pancreatitis and gastritis
are other gastrointestinal consequences of long-term alcohol consumption
DİET AND HEALTH
 Diet is one of the most modifiable of risk factors. A healthy diet contributes to the
prevention of such chronic diseases as type 2 diabetes, hypertension, heart disease, and
some cancers.
 Because;
 17% of U.S. children 2 to 19 years of age are overweight,
 66% of U.S. adults are overweight, and
 32% are obese,

1. Wash Hands Properly

• Always wash hands with soap and clean water before handling food, after using the restroom,
and after handling raw food items like meat and fish.

2. Cook Food Thoroughly

• Ensure all foods, especially meats, are cooked to their recommended internal temperatures to
kill harmful bacteria.

3. Store Food Safely

• Refrigerate perishable foods promptly and keep cold foods below 4°C (39°F). Avoid leaving
cooked or uncooked food at room temperature for extended periods.

4. Avoid Cross-Contamination

• Use separate cutting boards, knives, and utensils for raw meat and other food items to prevent
cross-contamination.

5. Clean Cooking Surfaces Regularly

• Disinfect countertops, sinks, and utensils regularly, especially after handling raw food.

6. Use Safe Water and Raw Ingredients

• Ensure water used in cooking and drinking is clean and safe. Wash fruits and vegetables
thoroughly under running water before consumption or cooking.
For a diabetic patient, dietary education should focus on managing blood sugar levels, maintaining a
balanced diet, and preventing complications. Based on the provided note, here are some key food
educational practices to recommend:

1. Monitor Carbohydrate Intake

• Teach the patient to count carbohydrates and understand how they affect blood sugar levels.
Focus on choosing complex carbohydrates like whole grains, beans, and vegetables over simple
sugars.

2. Choose High-Fiber Foods

• Encourage consumption of fiber-rich foods such as non-starchy vegetables, fruits with low
glycemic index (e.g., berries, apples), whole grains, and legumes to slow the absorption of sugar.

3. Limit Sugary and Processed Foods

 • Avoid foods with added sugars, sweetened beverages, and highly processed snacks. These can
cause rapid spikes in blood sugar levels.

4. Adopt Portion Control

• Educate on appropriate portion sizes to avoid overeating and maintain steady blood sugar
levels. Using tools like the “plate method” can help balance meals.

5. Encourage Healthy Fats

• Include healthy fats such as avocado, nuts, seeds, olive oil, and fatty fish (like salmon) while
limiting saturated and trans fats from fried and processed foods.

6. Regular Meal Timing

• Advise eating meals and snacks at consistent times each day to help regulate blood sugar levels
and prevent hypo- or hyperglycemia.

7. Stay Hydrated with Low-Calorie Options

• Recommend water, herbal teas, or sugar-free beverages instead of sugary drinks.

8. Limit Sodium Intake

• Encourage the patient to minimize salt consumption to reduce the risk of hypertension, which is
common in diabetic individuals.

9. Focus on Glycemic Index (GI)

• Choose low to medium GI foods (e.g., lentils, non-starchy vegetables) as they have a slower
impact on blood sugar levels.

10. Meal Preparation Guidance

• Teach the patient about healthy cooking methods, such as steaming, grilling, baking, or stir-
frying, rather than frying or using heavy sauces.

For an overweight patient, education should focus on sustainable lifestyle and dietary changes to
promote weight loss and overall health. Based on the note, here are some educational practices to
recommend:

1. Reduce Eating Out

• Encourage preparing and eating meals at home to control portion sizes and ingredients.

• Plan and pack healthy snacks and lunches to avoid reliance on fast food or vending machines.

2. Choose Healthier Options When Eating Out

• When eating away from home, recommend choosing healthier options like steamed, grilled,
baked, or broiled dishes instead of fried foods.

• Opt for smaller portion sizes or share meals to reduce calorie intake.

• Substitute high-calorie sides (like fries) with healthier options like salads or vegetables.
3. Limit Fast Food Consumption
• Educate on the high calorie and low nutritional value of fast food. Encourage limiting fast food to
occasional treats and making healthier choices if dining at fast-food restaurants.

4. Control Portion Sizes

• Teach the concept of portion control to avoid overeating. Explain the difference between portion
size (what you serve) and serving size (recommended by dietary guidelines).

5. Include More Fruits and Vegetables

• Recommend filling half the plate with non-starchy vegetables and fruits. These are low in
calories but high in fiber, which promotes satiety and reduces calorie intake.

6. Limit Sugary Beverages

• Replace sugary drinks like soda and sweetened teas with water, herbal teas, or other low-calorie
beverages.

7. Plan and Prepare Balanced Meals

• Teach how to balance meals using the “plate method,” ensuring the plate includes:

• Half vegetables and fruits,

• A quarter lean protein (like chicken, fish, tofu),

• A quarter whole grains or healthy carbs.

8. Increase Physical Activity

• Combine dietary changes with regular exercise to create a calorie deficit. Recommend simple
activities like walking, biking, or taking stairs.

9. Address Emotional Eating

• Help the patient identify triggers for overeating (e.g., stress, boredom) and develop healthier
coping mechanisms, such as exercise or hobbies.

10. Encourage a Supportive Environment

• Suggest involving family members in healthy eating and exercise plans to create a supportive
environment.

11. Focus on Long-Term Goals

• Emphasize gradual, sustainable weight loss of 1-2 pounds per week rather than drastic diets,
which are difficult to maintain.

Would you like me to elaborate on any of these practices or provide additional tools like a meal plan or
physical activity schedule?
Diet and Health : from note
 What about eating away from home?
 For many people, eating at home all of the time is impossible or impractical, and
food is central to many social interactions.
 In order to consume fewer calories when eating out, one may pattronize establishments
that offer a variety of food choices and are willing to make substitutions or changes
 Order lower-fat steamed, broiled, baked, roasted, or poached items, or
 ask that an item be prepared in a lower-calorie way, such as grilled rather than fried
 Choose lower-calorie sauces or condiments, or do without them altogether.
 Substitute colorful vegetables for other side dishes (such as French ffies)
 Ask for half of the meal to be boxed to take home before the meal is brought to the
table
 Share an menü with someone
 Order a vegetarian meal
 Select a fruit for dessert
 To decrease reliance on away from home foods, plan ahead and
 Pack healthy snacks to avoid the use of vending machines
 Cook a healthful dinner at home, and make extra to pack for lunch the next day.
 Purchase healthful foods when grocery shopping to pack for lunch, such as prepackaged
salads, fresh fruits, vegetables, and low-calorie soups
 Bring along nutritious foods for travel or longer excursions that will not spoil, such as
fresh fruits and vegetables, or pack a cooler with healthy foods
 There are various online communities and other support groups available to help
individuals manage their weight. Group support is helpful for some,
 Whereas others prefer to have programs that they can implement on their own. The cost
to join a weight-management community ranges from free to moderate in price.
SLEEP
 Insufficient sleep is associated with diabetes, heart disease, obesity, and depression.
Insuficient sleep contributes to 100,000 motor vehicle crashes each year and 15,000
deaths.
 Sleep requirements change as people age, and, depending on life circumstances, one
may require more than the minimum hours listed.
 If a person is so tired or sleepy that it interferes with his or her daily activities, that
person probably needs more sleep.

 Practicing sleep hygiene will help achieve optimum sleep:exam

 Avoid caffeine and nicotine close to bedtime.
 Avoid alcohol as it can cause sleep disruptions.
 Retire and get up at the same time everyday.
 Exercise regularly, but finish ali exercise and vigorous actİvity at least 3 hours
before bedtime.
 Establish a regular, relaxing bedtime routine (a warm bath, reading a book).
 Create a dark, quiet, cooî sleep environment.
 Have a comfortable mattress and bedding.
  Use the bed for sleep only; do not read, Esten to music, or watch TV in bed.
 Avoid large meals before bedtime. (National Sleep Foundation, nd)

1. Health Belief Model (HBM)

• Developed in 1958 to explain why people fail to participate in preventive healthcare measures
like tuberculosis screening.

• Core Concepts:

• Perceived Susceptibility & Severity: How vulnerable a person feels to a condition and how
serious they think it is.

• Perceived Benefits & Barriers: Balancing the advantages of taking action against the obstacles
or effort required.

• Cues to Action: External or internal triggers prompting health action (e.g., illness in a loved one,
media campaigns).

• Self-Efficacy: Confidence in one’s ability to successfully make health-related changes.

• Application Example: Used to design interventions for disease prevention like cervical cancer
screening or smoking cessation.

2. Health Promotion Model (HPM)

• Developed by Nola Pender to encourage individuals to engage in behaviors that enhance well-
being.

• Focuses on:

• Individual characteristics (prior behaviors, personal factors).

• Behavior-specific cognitions and affect (perceived barriers, perceived self-efficacy, and

commitment to action).

• Key Features:

• Positive health promotion without relying on fear or threat.

• Supports adopting behaviors like exercising, eating healthily, or attending routine screenings.

3. Transtheoretical Model (TTM)

• Combines multiple behavior-change theories.

• Stages of Change:

• Precontemplation: Not ready for change; unaware of the need.

• Contemplation: Aware but undecided about change.

• Preparation: Intending to take action soon; making small changes.

• Action: Actively modifying behavior.

• Maintenance: Sustaining long-term behavior change and preventing relapse.

 • Processes of Change:

• Behavioral techniques (e.g., reinforcement, stimulus control).

• Cognitive strategies (e.g., awareness-raising).

4. Theory of Reasoned Action (TRA)

• Developed by Fishbein and Ajzen; focuses on intentions as the primary determinant of
behavior.

• Key Elements:

• Behavioral Intentions: Driven by attitudes and subjective norms.

• Subjective Norms: Influenced by the beliefs and expectations of significant others (family,
friends).

• Practical for designing behavior change interventions that focus on influencing attitudes or
social pressures.

5. Transcultural Model
• Developed by Madeleine Leininger to incorporate cultural understanding in healthcare
delivery.

• Focus Areas:

• Recognizing and respecting cultural beliefs in health behaviors.

• Delivering culturally congruent care that aligns with patients’ values and practices.

• Applications: Used in multicultural nursing environments to provide care that is respectful and
effective for diverse populations.

Based on the earlier provided file on disaster management, here are the duties and priorities of public
health nursing in disaster management (e.g., war, earthquake, etc.):

Duties of Public Health Nurses in Disaster Management

1. Assessment and Planning:

• Assess the community’s disaster risks and vulnerabilities.

• Create and implement disaster preparedness plans specific to the community’s needs.

• Ensure an updated record of vulnerable populations (e.g., elderly, disabled, infants).

2. Education and Training:

• Conduct public health education programs on disaster preparedness and response.

• Train community members in basic first aid and survival techniques.

• Organize disaster drills to prepare communities for potential events.

3. Coordination and Communication:

 • Serve as a liaison between community agencies, government bodies, and healthcare institutions.

• Establish clear communication systems to disseminate critical information before, during, and
after a disaster.

4. Emergency Response:

• Provide immediate medical care, including triage and first aid to victims.

• Assist in evacuation efforts and ensure proper shelter management.

• Identify and manage communicable diseases and other health risks in disaster zones.

5. Psychological and Emotional Support:

• Offer psychological care and emotional support to disaster victims and their families.

• Help individuals cope with trauma and rebuild their lives.

6. Surveillance and Monitoring:

• Monitor health trends and detect outbreaks of diseases caused by disaster conditions (e.g.,
waterborne or vector-borne illnesses).

• Evaluate the ongoing needs of the affected population and adjust care strategies accordingly.

7. Resource Management:

• Manage and distribute medical supplies, food, water, and other critical resources.

• Collaborate with other professionals to prioritize needs and allocate resources efficiently.

8. Post-Disaster Recovery:

• Facilitate community rebuilding and rehabilitation efforts.

• Conduct home visits to assess long-term recovery needs.

• Provide ongoing education about hygiene and disease prevention in the aftermath of disasters.

Priorities of Public Health Nursing in Disaster Management

1. Life-Saving Measures:

• Ensure the safety and survival of as many people as possible through quick response and
efficient resource allocation.

2. Prevention of Disease Outbreaks:

• Focus on maintaining sanitation, clean water supplies, and proper waste disposal to prevent
secondary disasters like epidemics.

3. Mental Health Support:

• Address the mental health needs of victims and disaster workers to minimize long-term
psychological impacts.

4. Collaboration with Multidisciplinary Teams:

 • Work closely with emergency responders, government officials, and non-governmental
organizations for a coordinated response.

5. Community Resilience:

• Help communities recover and prepare for future disasters by strengthening their coping
mechanisms and infrastructure.

Would you like a deeper dive into any specific area, such as psychological support, triage, or disease
prevention?

The Measurement of Health Status I

High Fertility/High Mortality

This is a population pyramid representing Stage 1 of the Demographic Transition Model (DTM).
Here’s how to interpret it:

Key Characteristics:
1. Wide Base:

• The graph shows a broad base, indicating a high birth rate. This means a large proportion of the
population is in younger age groups (0–14 years).

2. Narrow Top:

• The pyramid narrows significantly as age increases, reflecting a high death rate. Few individuals
survive into older age groups (65+ years).

3. Equal Sides:

• The male and female sides are roughly symmetrical, which is typical in many populations.

Stage 1 of Demographic Transition:

 • Description:

• This stage is characterized by high birth rates and high death rates, leading to a relatively stable
and low total population size.

• Reasons for High Birth and Death Rates:

• Limited access to healthcare.

• Lack of modern sanitation and infrastructure.

• High infant mortality rates encourage larger families.

• Subsistence agriculture or labor-intensive economies rely on children for work.

Implications:
• Low Life Expectancy:

• Few people reach older age, as seen in the pyramid’s steep tapering at the top.

• Dependence Ratio:

• A large proportion of dependents (young population) places pressure on resources and the
working-age population.

• Typical Societies:

• This stage is often associated with pre-industrial societies or those with limited access to
modern development and healthcare.

If you’d like a detailed explanation of other stages of the Demographic Transition Model or more
analysis, feel free to ask!

Key Features:
1. Wide Base: The graph has a broad base, indicating a high proportion of young people (ages 0–
14). This is characteristic of high birth rates.

2. Narrow Peak: The top of the pyramid is narrow, representing a small proportion of elderly
individuals, which is due to high mortality rates and lower life expectancy.

3. Symmetry: The graph is generally symmetrical, with males on the left and females on the right.

4. Stage 1 Population Characteristics:

• High birth rates and high death rates.

• Low overall population growth.

• Limited healthcare, sanitation, and resources to support long life expectancy.

This type of population structure is common in pre-industrial societies or regions with underdeveloped
healthcare and infrastructure.
Declining Mortality/High fertility.

This is another population pyramid, representing Stage 2 of the Demographic Transition Model
(DTM). Below is an explanation of the graph’s definition, causes, implications, and potential nursing
interventions.

Definition of the Graph

The graph shows the age and gender distribution of a population in Stage 2 of the Demographic
Transition Model, which is characterized by:

• High birth rates (wide base).

• Decreasing death rates due to improvements in healthcare, sanitation, and access to resources,
leading to a higher survival rate in younger age groups.

• Rapid population growth as the gap between birth and death rates widens.

The pyramid’s shape reflects a youth-heavy population with a broad base and gradually narrowing
middle and top, signifying a growing but young population.

Causes
1. Improvements in Healthcare:

• Introduction of vaccines and antibiotics.

• Better maternal and infant care.

• Reduction in infectious disease-related deaths.

 2. Improved Sanitation and Water Supply:

• Access to clean water and proper waste disposal reduces mortality rates.

3. Limited Family Planning:

• Lack of access to contraception or family planning services keeps birth rates high.

4. Economic Development in Early Stages:

• Agrarian or early-industrial societies may still depend on large families for labor.

Indications/Implications
1. Health and Social Challenges:

• Strain on healthcare systems due to a high number of births and the need for pediatric care.

• Increased demand for education, housing, and resources for the young population.

• Risk of unemployment in the future due to a growing workforce.

2. Economic Dependency:

• High dependency ratio: A large proportion of non-working young people dependent on the
working-age population.

3. Risk of Resource Depletion:

• Rapid population growth can overburden available natural and social resources.

4. Future Population Boom:

• A high number of young people will soon enter reproductive age, leading to further population
increases.

What Nurses Can Do to Improve This Issue

1. Promote Family Planning and Education:

• Educate communities about contraception and the benefits of family planning.

• Distribute and encourage the use of birth control methods.

2. Maternal and Child Health Initiatives:

• Provide prenatal and postnatal care to improve maternal and infant health outcomes.

• Offer immunization programs to reduce infant and child mortality rates.

3. Health Education Campaigns:

• Increase awareness about hygiene, sanitation, and nutrition to prevent diseases and improve
quality of life.

4. Advocacy for Healthcare Resources:

• Advocate for the development of healthcare infrastructure, especially in rural areas.

 • Push for government funding and programs targeting high birth rate areas.

5. Youth Health and Education:

• Focus on school health programs that teach young people about sexual health and reproductive
health.

• Encourage education for girls, as higher female education levels correlate with lower birth rates.

6. Community Outreach Programs:

• Partner with local leaders and organizations to address cultural and societal norms that
contribute to high birth rates.

• Provide mobile healthcare clinics to underserved areas.

7. Long-Term Advocacy:

• Support programs that create economic opportunities, reducing the reliance on large families
for labor.

• Engage in policy-making discussions to implement systemic changes like universal access to

healthcare and education.

By addressing the root causes and implications of this population structure, nurses can help mitigate the
challenges posed by rapid population growth and contribute to healthier and more sustainable
communities.
The graph depicts the age and gender distribution of a population in Stage 2 of the Demographic
Transition Model (DTM). Here’s a specific breakdown based on the data provided in the pyramid:

Key Characteristics (with Numbers)

1. High Birth Rates (Wide Base):

• The 0–4 age group accounts for approximately 9–10% of the total population (4.5–5% for
males and 4.5–5% for females), indicating a high number of births.

• Similarly, the 5–9 age group represents another 9–10% of the population, showing
consistently high birth rates over several years.

2. Decreasing Death Rates:

• As we move up the pyramid, each successive age group becomes smaller, but there is better
survival into middle age (30–49 years) compared to Stage 1.

• For example, the 30–34 age group makes up around 5% of the total population (2.5% males
and 2.5% females), reflecting improvements in survival rates.

3. Youth-Dominated Population:

• The majority of the population falls under the 0–24 age group, which accounts for more than
50% of the total population.

• This youth-heavy structure results from high birth rates and a lower proportion of older adults.

4. Gradual Narrowing Toward the Top:

 • Older age groups, like 60–64 years, make up around 1% of the total population (0.5% males
and 0.5% females).

• The 80+ age group is minimal, representing less than 0.5% of the population, highlighting
lower life expectancy despite improvements in healthcare.

5. Gender Distribution:

• The pyramid is relatively symmetrical, with males and females distributed almost equally across
all age groups.

• The proportion of females slightly exceeds males in older age groups due to higher male
mortality rates over time.

Implications (with Specific Proportions)

• Dependency Ratio:

• The high proportion of individuals under 15 years old (about 35–40% of the population)
creates a significant dependency burden on the working-age population.

• Workforce Challenges:

• The 15–49 age group (approximately 40–45%) shoulders the economic burden of supporting
the young population.

Specific Actions Nurses Can Take

1. Family Planning Education:

• Target areas with high birth rates (0–9 age group: 20% of the population) to promote
contraceptives and educate families on spacing births.

2. Maternal and Child Health:

• Focus on improving care for the largest age group (0–4: 10% of the population) through
vaccination programs and nutrition support to lower infant mortality.

3. Youth Health Campaigns:

• Develop school-based programs for the 5–24 age group (50% of the population) to educate
on reproductive health and hygiene.

4. Advocate for Elder Care Programs:

• Although a small group, advocate for healthcare services tailored to the aging population (60+
age group: 2–3% of the population) to improve their quality of life.

By tailoring strategies to these specific proportions and demographic challenges, nurses can effectively
address the needs of this Stage 2 population.
Reduced Fertility/Reduced Mortality.

This graph represents the population pyramid at the end of Stage 3 of the Demographic Transition
Model (DTM). Here’s a breakdown of its characteristics, causes, implications, and nursing interventions.

Definition of the Graph

The population pyramid reflects the demographic characteristics at the end of Stage 3, marked by:

1. Declining Birth Rates: The base of the pyramid is narrower compared to earlier stages,
indicating a reduction in fertility rates as families opt for fewer children.

2. Lower Death Rates: Mortality rates have stabilized at a low level, resulting in a more
rectangular pyramid shape with higher life expectancy.

3. Slower Population Growth: The gap between birth and death rates narrows, resulting in
slower but steady population growth.

4. Balanced Age Distribution: The proportion of younger and older populations is more
balanced, with a large working-age population (15–64 years).

Causes
1. Improved Access to Family Planning:

• Widespread availability of contraception and education leads to smaller families.

2. Urbanization and Economic Shifts:

• Families moving to urban areas have fewer children due to reduced reliance on agricultural
labor and higher living costs.

3. Increased Female Empowerment:

• Education and employment opportunities for women reduce birth rates.

 4. Advancements in Healthcare:

• Better healthcare infrastructure and disease prevention reduce mortality rates across all age
groups.

5. Cultural Shifts:

• Societal norms shift from valuing large families to emphasizing quality of life.

Indications/Implications
1. Economic Opportunities:

• The large working-age population (15–64 years) presents a potential “demographic dividend”
with economic productivity opportunities.

2. Aging Population on the Horizon:

• The proportion of elderly individuals (65+ years) is increasing, which may result in challenges
related to elderly care in the near future.

3. Reduced Dependency Ratio:

• Fewer young dependents (0–14 years) compared to Stage 2 reduce the economic burden on the
working-age population.

4. Health System Strain for Chronic Diseases:

• As life expectancy increases, there is a rising prevalence of chronic and age-related illnesses like
diabetes, hypertension, and cancer.

Nursing Interventions to Improve the Issue

1. Promote Healthy Aging:

• Focus on geriatric care and preventive healthcare for the growing elderly population (e.g.,
promoting regular health screenings, nutrition, and physical activity).

2. Family Planning and Reproductive Health:

• Continue educating families about reproductive health to maintain balanced birth rates.

3. Chronic Disease Management:

• Train and equip healthcare workers to handle age-related and chronic conditions, such as
cardiovascular diseases and diabetes.

• Implement community-based programs for early detection and management of chronic

diseases.

4. Advocate for Healthcare Infrastructure:

• Advocate for healthcare policies and facilities designed to meet the needs of an aging population,
including long-term care facilities and geriatric-focused services.

5. Health Education:
 • Conduct awareness campaigns for lifestyle modifications that prevent chronic diseases,
targeting the large working-age population to prepare them for healthy aging.

6. Focus on Mental Health:

• With aging and urbanization, mental health issues may rise; nurses can support mental health
services and campaigns for all age groups.

7. Support for Women’s Health:

• Ensure continued access to reproductive health services and support for women transitioning
into leadership roles in society.

By addressing these issues, nurses can play a key role in supporting healthy population transitions and
ensuring sustainable healthcare delivery as the demographic profile continues to evolve.

Yes, this Stage 3 population pyramid represents a phase of reduced fertility and mortality, which is
a hallmark of the demographic transition toward population stabilization. Here’s how both trends
manifest in the graph:

Reduced Fertility
• The narrower base of the pyramid shows a decline in birth rates compared to earlier stages
(e.g., Stage 2).

• This reduction in fertility is typically caused by:

• Increased access to contraception and family planning services.

• Greater education and employment opportunities for women.

• A shift in cultural norms prioritizing smaller families.

• Urbanization and higher costs of raising children.

Reduced Mortality
• The rectangular shape of the pyramid indicates a lower death rate across all age groups.

• Causes of reduced mortality include:

• Advancements in healthcare (e.g., vaccines, antibiotics, better maternal care).

• Improved sanitation and access to clean water.

• Better nutrition and living conditions.

• This results in higher life expectancy, with more people surviving into middle and old age.

Implications of Reduced Fertility and Mortality

1. Slower Population Growth:

• The gap between births and deaths narrows, leading to a gradual stabilization of population
growth.
 2. Aging Population:

• As fertility declines and people live longer, the proportion of elderly individuals increases,
setting the stage for potential challenges in elderly care and workforce sustainability.

3. Economic Shift:

• The reduced number of dependents (children) allows more resources to be allocated to

education, healthcare, and infrastructure development.

This stage is a transitional phase toward Stage 4, where fertility and mortality rates stabilize further,
and population growth becomes minimal or stops altogether.

Write an analysis of the percentages of the total population in the following categories: developed
countries, developing countries, underdeveloped countries, old-population countries, and
countries with a young population.

Certainly! Here’s an overview of the global population distribution by development status and age
demographics:

1. Population Distribution by Development Status

• Developed Regions:

• As of 2024, developed regions account for approximately 16% of the global population.

• Developing Regions:

• Developing regions comprise about 84% of the world’s population.

These classifications are based on the United Nations’ categorization of countries into more developed and
less developed regions.

2. Population Distribution by Age Groups

• Global Age Distribution (2024):

• Ages 0-14: 25%

• Ages 15-64: 65%

• Ages 65 and older: 10%

These figures are sourced from the United Nations Population Fund’s World Population Dashboard.

3. Countries with Older Populations

• Characteristics:

• These countries have a higher proportion of individuals aged 65 and above.

• Examples include Japan, Italy, and Germany, where the elderly population constitutes a
significant share of the total population.
For instance, in Japan, individuals aged 65 and older make up a substantial portion of the population,
reflecting the country’s high life expectancy and low birth rates.

4. Countries with Younger Populations

• Characteristics:

• Nations with a significant proportion of their population under the age of 15.

• Predominantly found in regions like Sub-Saharan Africa.

For example, in Niger, a substantial percentage of the population is under 15, indicating high birth rates
and a youthful demographic profile.

5. Projected Trends
• Global Aging:

• The proportion of individuals aged 65 and older is expected to increase globally, reaching
approximately 16% by 2050.

• Youthful Populations:

• While the global youth population (ages 0-14) is projected to decline proportionally, certain
regions, particularly in Africa, will continue to experience youthful demographics due to higher
fertility rates.

These projections are based on data from the United Nations’ World Population Prospects.

For more detailed and specific data, you may refer to the following resources:

• United Nations Population Division Data Portal:

• World Bank Demographic Data:

• Our World in Data - Population and Demography Explorer:

These platforms offer comprehensive and up-to-date demographic statistics and projections.
PEDIATRIC NURSING

Vital signs and newborn assessment

Newborn stage
38-42. GESTATIONAL AGE IS TERM BABY
The newborn stage is the first 4 weeks or first month of life. It is a transitional
period from intrauterine life to extra uterine environment.

Definition
Majority of babies born healthy and at term
Care during first hours, days and weeks of life
determine whether they remain healthy
It includes immediate care at birth, care during
the first day and up to 28 day

Four basic needs of ALL newborns

To breath normally
To be protected
To be warm
To be fed

Essential Newborn Care Interventions

Clean childbirth and cord care
Prevent newborn infection
Thermal protection
Prevent & manage newborn hypo/hyperthermia
Early and exclusive breastfeeding
Started within 1 hour after childbirth
Initiation of breathing and resuscitation
Early asphyxia identification and management

Care of the baby at the time of birth

(Until around 1 hour after birth)
• Provide routine care at birth for all
newborns
• Identify and manage newborns who may need special care routine Care
Call out time of birth
Place baby on mother’s abdomen
Dry baby with warm clean sheet
Wipe mouth and nose with clean cloth
Assess baby’s breathing while drying
Clamp cord after 1-3 min, cut with sterile instrument, put sterile tie
Put identity label on the baby routine Care
Examine for malformations/ birth injury
Initiate breastfeeding within 1 hour
Record baby’s weight
Give Inj Vit K 1mg IM ( 0.5 mg for preterm)
Cover baby’s head with cloth.
Cover mother and baby with warm cloth

Resuscitation
All babies must be assessed for need of
resuscitation at birth
 At least 1 person skilled in providing resuscitation
must be present
Ventilation must start within 1 minute of birth
First golden minute

Immediate cord care

Clamp and cut cord with a sterile
instrument.
Tie the cord between 2 to 3 cms
from the base and cut the
remaining cord.
Observe for oozing blood.
DO NOT apply any substance to
stump.
DO NOT bind or bandage stump.
Leave stump uncovered.

Anterior fontanel
• Diamond in shape
• The junction of the sagittal, corneal and frontal
sutures forms it
• Between 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of age

Posterior fontanel
• Triangular
• Located between occipital & 2 parietal bones
• Closes by the end of the 1st month of age.

The posterior fontanelle closes between 2 and 3

months of age.
The anterior fontanelle, often called the “soft spot,”
closes between 12 and 18 months of age. The
fontanelles should be flat and soft.
Fontanelles that are bulging, sunken, or closed too
early can indicate either a neurological abnormality or
an alteration in fluid balance.

Eyes
symmetry of the eyes
Normal eye shape may vary, depending on the culture
of the infant.
Strabismus, or misalignment of the eyes, is
common in the newborn up to 6 months of age
It is difficult to assess ocular movement in a newborn.
Visual fields are not tested until around 6 months of
age, which is when infants begin to track objects.

Ears
Inspect the ears for symmetry and alignment. The top
of the pinna of the ear should be in alignment with the
outer canthus of the eye
Inspect the ear for any drainage or redness.
To inspect the tympanic membrane, pull the bottom of
the pinna down and back to insert the otoscope.

Nose
The nose, as with other facial features, should be
symmetrical.
Inspect the nares with either a penlight or an otoscope.
To inspect the nares, gently tilt the infant’s head back.
The nares should be pink with no excoriation.
Nasal congestion in infants interferes with the ability
to feed.

Normal Newborn Infant

Physical growth
- Weight = 2.700 – 4 kg
- Wt loss 5% -10% by 3-4 days after birth
- Wt gain by 10th days of life
- Gain ¾ kg by the end of the 1st month.

Weight:
They loose 5 % to 10 % of weight by 3-4 days after birth
as result of :
▪ Withdrawal of hormones from mother.
▪ Loss of excessive extra cellular fluid.
▪ Passage of meconium (feces) and urine.
▪ Limited food intake.

Height
• Boys average Ht = 50 cm
• Girls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)

Head circumference
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior).

Chest circumference
It is 30.5 to 33cm (usually 2–3cm less
than head circumference).

Physiological growth
• Vital signs
- Temperature (36.3 to37.2oC).
- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50C/min)
Assess Breastfeeding
If infant has not fed in previous hour, ask mother to put her infant to breast. Observe the
breastfeed for 4 minutes.
• Is the infant able to attach?
To check attachment, look for:
- Chin touching breast
- Mouth wide open
- Lower lip turned outward
- More areola above than below the mouth

If not well attached, help mother to position so that baby attaches well.
Is the infant suckling effectively (that is, slow deep sucks, sometimes pausing)?
If not sucking well, then look for:
- ulcers or white patches in mouth (thrush)
If there is difficulty or pain while feeding, then look for
- Engorged breasts or breast abscess
- Flat or inverted, or sore nipples.

Look for Normal Phenomena

• milia, Epstein pearls, Mongolian spots, enlarged breasts, capillary nevi etc.
• Transitional stools
• Vaginal white discharge/bleeding in female
babies
• Red rashes on skin on 2-3 days of life.
• Weight loss of 6-8% (10-12% in preterms) in first few days of life.

Cord Care
 Umbilical cord is important portal of entry for
pathogenic organism.
Instruct mother not to apply anything on cord
and keep it dry.
Umbilical stump must be inspected after 2-4
hours of clamping.
Bleeding may occur at this time due to shrinkage
of cord and loosening of ligature.

Skin and Eye Care

Babies are not bathed routinely in hospital to
prevent complications like hypothermia and
infection,
May be sponged with lukewarm water.
No routine eye care is required.

Counsel the mother

• Keep baby warm
• Breastfeed frequently and exclusively
• Advise mother to wash hands with soap and water
after using toilet and after cleaning bottom of
baby.
• Advise mother regarding danger signs and care
seeking.

IMMUNIZATION
• The baby should receive
-BCG
-OPV-0
-Hepatitis B (HB-1) - if included in immunization schedule.

Follow-up
Schedule postnatal visit within first week on day 3 and day 7 of delivery. Also visit on day 14,
21 and 28 if baby is LBW.
Assess for growth and development and signs of illnesses
Health education of parents done
Assessed at least once every month for 3 months and subsequently 3 monthly till 1 year.

SUMMARY
Basic care to support survival & well-being is ENC
Ventilation must be initiated within 1st minute of life
Help to initiate breastfeeding within 1st hr. of birth
Identify and refer neonates requiring special care
 Take all precautions to prevent infection, hypothermia and counsel the mother for the same
Counsel mother for Danger signs, immunization & follow-up

GROWTH AND DEVELOPMENT

Reflexes
• Swallowing
• Gagging
• Sucking
• Grasp
• Tonic-neck
One month-Reflexes – tonic-neck, step reflex, crawl, grasp reflexes

Motor Development
• At 2 months
• Hold head erects in mid-position.
• Turn from side back.

At 3 months, the infant can

• Hold head erects and steady.
• Open or close hand loosely.
• Hold object put in hand

At 4 months, the infant can:

• Sit with adequate support.

At 5 months, the infant can:

• Site with slight support.

At 6 months, the infant can:

• Sit alone briefly.

At 7 months, the infant can:

• Sit alone.
• Hold cup.
• Imitate simple acts of others.

At 8 months, the infant can:

• Site alone steadily.

At 9 months, the infant can:

• Rise to a sitting position alone.
• Crawl (i.e., pull body while in prone
position).
• Hold one bottle with good hand-mouth
Coordination.

At 10 months, the infant can:

• Creep well (use hands and legs).

At 11 months, the infant can:

• Walk holding on furniture.
• Stand erect with minimal support.

At 12 months, the infant can:

• Stand-alone for variable length of time.
• Site down from standing position alone.
• Walk a few steps with help or alone (hands held at shoulder height for balance).
• Pick up small bits of food and transfer them to his mouth.

Ambulation (motor growth)

• 9-month-old: crawl
• 10-month-old: creep
• 1 year: stand independently from a crawl &
creep position
• 13-month-old: walk and toddle quickly
• 15-month-old: can run

Emotional development:
• His emotions are instable, where it is rapidly changes from crying to laughter.
• His affection for or love family members appears.
• By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness,
pleasure, jealousy, anxiety and affection.
• By 12 months of age, these emotions are clearly [Link] development
• He learns that crying brings attention.
• The infant smiles in response to smile of others.
• The infant shows fear of stranger (stranger
anxiety).
• He responds socially to his name.
• According to Erikson, the infant
develops sense of trust. Through the
infant's interaction with caregiver (mainly the
mother), especially during feeding, he learns to
trust others through the relief of basic needs. As an infant's vision develops, he or she may
seem preoccupied with watching surrounding objects and people.

Speech Milestones
• 1-2 months: coos
• 2-6 months: laughs and squeals
• 8-9 months babbles: mama/dada as sounds
• 10-12 months: “mama/dada specific
• 18-20 months: 20 to 30 words – 50%
understood by strangers
• 22-24 months: two word sentences, >50 words,
75% understood by strangers
• 30-36 months: almost all speech understood by
Strangers.

Hearing
• BAER hearing test done at birth
• Ability to hear correlates with ability to enunciate words properly
• Always ask about the history of otitis media – ear-aiding devices.
• Early referral to MD to assess for possible fluid in ears (effusion)
• Repeat hearing screening test
• Speech therapist as needed.

Red Flags in Infant Development

• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age 1 year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.

Pediatric Medication Administration

Essential parts of a drug order

✓ The child’s name, room and bed number.
✓ Date and time the order is written.
✓ Drug name
✓ Dosage of drug
✓ Time and frequency of administration
✓ Route of administration
✓ Signature of the person writing the order.

Right medicine
✓ Right dosage
✓ Right way
✓ Right time
✓ Right patient
When not to use oral routes
• It should not be used if the child is vomiting, has malabsorption syndrome, or refuses to
swallow medication.
• Infant: Give by oral syringe or dropper • Have parent help • Never leave medication in
room for parent to give later. • Stay in room while parent gives the medication
• Toddler: • Use simple terms to explain while they are getting medication
• • Be firm, don’t offer to may choices • Use distraction • Stickers / rewards
• Preschool: • Offer choices • Band-Aid after injection • Assistance for IM injection •
reward / stickers
• School-age • Concrete explanations • Choices • Interact with child whenever possible •
Give choices • Medical play
• Adolescent • Use more abstract rationale for medication • Include in decision making
especially for long term medication administration
• Nursing Alert • For liquid medications, an oral syringe or medication cup should be used
to ensure accurate dosage measurement. Use of a household teaspoon or tablespoon
may result in dosage error because they are inaccurate.
Drug administration principles Attention points
In the supine position, the ear to be treated is The medicine is dripped into the ear wall
kept on top.

In young children, the auricle is pulled down and The dropper should not touch the ear.
back

The auricle is pulled up and back in older children The drug is kept at room temperature.

It is ensured to stay in the same position for 2-3

minutes after application.

PARENTERAL-Subcutaneous Route
➢ Into the subcutaneous tissue, just below the skin (45 angle).
➢ Used for immunization as Measles(0.5 ml in the right arm).
➢ Can administer only small volume.
➢ Not use needle more than 1.5 ml.
➢ While injecting the subcutaneous tissue, the tissue should be grasped with the thumb
and index finger.
➢ Rotation should be performed in children with continuous subcutaneous injection to
prevent atrophy.

• Hips, lateral upper arms, anterior thighs, stomach, excluding the area surrounding the
navel and above the iliac crests.
Vastus Lateralis İnjection
• Wash hands and glove
• Place the infant in the supine position
• Divide the distance between the trochanter and the patella into thirds, and locate the
middle third
• Securely stabilize the child’s leg
• Clean the site with alcohol and allow to dry
• Insert the needle
• Aspirate for the presence of blood
• If no blood is aspirated, inject slowly
• Remove the needle and dispose of
• Hold, cuddle and comfort the infant after the injection

Maxımum amounts
• Neonates: 0.5 ml
• Infants : 1 ml
• Toddlers and preschoold: 1.5 ml
• School age and adolescent: 2 ml
Check note to do the calculation.
For diabetic mellitus, check your iPhone and your slides on doc.

WOMEN HEALTH AND GYNECOLOGY NURSING

Obstetrics is a specialty that is concerned with the mother and fetus during pregnancy,
childbirth, and the immediate postpartum period. A physician performing such practice is called
Obstetrician.
Last Menstrual Period (LMP) refers to the first day (onset of bleeding) of women last menstrual
period before falling pregnant. Or it is the time elapsed since 14 days prior to fertilization
Estimated Day of Delivery (EDD)
• The average duration of pregnancy is 40 weeks or 280 days from the first day of the last
menstrual period (LMP).
• Expected date of delivery can calculate via Naegele's Rule.
• Naegele's rule formula; Subtract 3 months from the 1st day of the LMP then add 7 days
after that add 1 year.
• Example; LMP = 8 May 2022
−3 months = (April, March, February)
8 February
+7 days = 15 February
+ 1 year= 2023
Estimated date of delivery = 15 February 2023

Gravida
It is the number of times the woman has been pregnant, regardless of whether these
pregnancies were carried to term or outcome.
According to this definition, gravida is divided into 3 groups.
• Nulligravida: A woman who has never been pregnant.
• Primigravida A primigravida is a woman who is pregnant for the first time or has been
pregnant one time.
• Multigravida: a woman who is pregnant for more than once.
Gestation
➢ Gestation is refers to the the carrying of an embryo or fetus. Gestation, conception and
pregnancy are mean the same thing
➢ The time interval of a gestation is called the gestation period. The average gestation
period in humans is 280 days or 40 weeks.
Age of viability: 20th weeks of pregnancy refers age of viability. Because it is possible for a fetus
to live outside the uterus after the 20th gestational week.
Surfactant is an enzyme and secreted in the 24th GW from fetal lungs. This enzyme helps the
lungs mature.
Term
➢ Term is normal (expected) duration of pregnancy. A full-term fetus is born between 37th
weeks to 42nd weeks of the pregnancy.
Preterm
 ➢ Preterm birth it is the birth of a fetus between 20 and 37 weeks of gestational age.
Premature infants are at greater risk for short and long term complications, including
disabilities and impediments in growth and mental development.
Postterm
➢ Postmaturity is when a fetus has not yet been born after 42 weeks of gestation.
Trimester
A “normal,” full-term pregnancy is 40 weeks and can range from 37th to 42nd weeks. It’s
divided into three trimesters.
➢ The first one is from LMP up until 12 or 13 weeks.
➢ The second trimester is from 12-13 weeks until 28 weeks.
➢ The third trimester is from 28 weeks until onset of birth.
➢ Antenatal / Antepartum period
➢ Antenatal period refers duration of pregnancy between conception and labor. The
period start with conception and ends with onset of labor

Intrapartum period
➢ Intrapartum process is the time from the onset of birth until the birth of the fetus and
the placenta.
Labor=birth=delivery=childbirth

Postpartum period
➢ Postpartum period is time after birth of fetus and placenta until the woman's body
returns to her pre-pregnancy state.
➢ It takes approximately 6-12 weeks.

Abortion:
➢ Abortion is the termination of pregnancy before the 20th weeks of gestation (before
viability) either spontaneous or medical.
Stillbirth:
➢ It is the birth of a fetus after the age of viability (20th week of gestation) when it has no
vital functions at birth (no heart rate, no umbilical cord pulsation).

Prenatal /Antenatal Evaluation

• 4. Auscultation of fetal heart
• 3. Leopold's Maneuver
• 2. Measurement of fundal height
• 1. Collecting subjective data
A. Obstetric story
1. Gravida (How many pregnancies have you had?)
2. Parity (How many birth have you experience?)
3. Abortion (Have you had any abortion? Reason?)
4. Stillbirth (Have you had any stillbirth? reason?)
5. Preterm or postterm birth (Have you had preterm or postterm birth ?)
6. Number of child (Do you have how many alive child?)
7. Multiple pregnancy ( Have you experience multiple pregnancy?)
8. Duration of previous pregnancies, (If had)
9. Duration of previous labour, (If had)
10. Type of previous labour (vaginal, forceps or vacuum, c/s),
11. Previous labour complications (If had)
12. Perinatal status of previous children; birth weights, growth and development status,
complications, diet (breastfeeding, feeding bottle)
13. Blood group and Rh factor (What is your blood group?)
14. Tetanus toxoid immunization (Do you have tetanus vaccination?)

B. Current Pregnancy
➢ The date of the last menstrual period should be determined (LMP)
➢ According to LMP estimated day of delivery (EDD) must be calculated.
➢ Complaints of danger signs during pregnancy must be evaluated (Vaginal bleeding, high
fever, abdominal pain, difficulty breathing or frequent breathing, inability to perform
daily activities)
➢ Women's views towards pregnancy (Is pregnancy planned? or desired?)

C. Gynecological Story
➢ Infections (vaginal, cervical, tubal)
➢ Sexually transmitted diseases.
➢ Surgical procedures
➢ First menarche age,
 ➢ Duration, frequency and order of menstruation,
➢ History of dysmenorrhea
➢ Using contraceptive method
➢ Last pap_smear date, presence of any abnormal findings in pap_smear

D. Medical And Surgical Disease Story

➢ Childhood diseases and immunization (especially rubella)
➢ Treatment or surgical interventions due to any disease condition
➢ Presence of chronic diseases such as diabetes, hypertension, cardiovascular and renal
problems
➢ Previous infection
➢ Bleeding disorder or tendency to bleed
➢ Anemia status and treatment
➢ Bladder and bowel functions
➢ Previous or current daily use of alcohol, tobacco or caffeine (especially coffee, tea, cola
and chocolate)
➢ Allergies to drugs or other substances
➢ Drugs currently used
➢ Drugs used before conception

E. Family Medical History

➢ Diabetes,
➢ Cardiovascular disease,
➢ Hypertension,
➢ Hematological disorders,
➢ Tuberculosis,
➢ Presence of multiple pregnancy
➢ History of congenital disease or anomaly
➢ Cultural beliefs and behaviors that affect health
➢ Father's blood type
➢ The wrong habit of baby’s father

F. Individual Information
➢ Age,
➢ Education,
➢ Race,
➢ Ethnic group
➢ Living conditions and economic level
➢ Violence and abuse
➢ Emotional problems
➢ Support systems
➢ Acceptance of pregnancy
Calculation of Gestation Week (The Mcdonalds Rule )
➢ The Mcdonalds rule is determination of fetal age in weeks compared to uterine/fundus
size.
➢ The week of gestation is determined by multiplying the fundal height in centimeters by
eight and dividing by seven.
➢ Formula: Symphysis pubis to fundus (cm)×8/7=Gestational week
➢ Example: 21cm×8=168/7=24 weeks
➢ Example; The distance between symphysis pubis and fundus is 35 cm. Week of
pregnancy = ?

Leopold maneuvers consist of 4 steps

• First Maneuver (Fundal Grip)
• Second Maneuver (Umbilical Grip)
• Third Maneuver (Pawlick’s Grip)
• Fourth Maneuver (Pelvic Grip)

➢ Because of Supine Hypotensive Syndrome pregnant women should never be kept in the
supine position for a long time.
➢ Where supine position is required, back and hip should be supported with pillows
➢ Symptoms of Supine Hypotensive Syndrome are; dizziness, shortness of breath, faint,
sweating

Fetal bradycardia
❖ Fetal bradycardia is defined as a baseline heart rate of less than 100 bpm.
❖ Causes of prolonged severe bradycardia include:
• Prolonged cord compression
• Cord prolapse
• Epidural and spinal anaesthesia
• Rapid fetal descent
• Postdate gestation
• Occiput posterior or transverse presentations
•
• Baseline heart rate : 110 to 160 bpm
• Baseline variability: 5 to 25 bpm
 • Deceleration is not expected in a normal NST recording or early deceleration is
considered normal.
• Two accelerations are expected in a normal NST recording.

FOR POSTPARTUM PERIOD AND NURSING CARE

FOR GENITOURINARY INFECTIOM SEXUALLY TRANSMITTED INFECTION YOU ALREADY PREPARE
NOTE CHECK

NURSING CARE FOR PATIENT WITH PRECLAMPSIA

A- Pre-eclampsia
• Definition: Preeclampsia is a pregnancy-specific syndrome that affects many organ
systems and is recognized by new onset of hypertension and proteinuria that occur after
20 weeks’ gestation.
• Incidence: The incidence is estimated to be between 3 and 10% of all pregnancies.
• Etiology: Although eclampsia had been described since 200 years, no definite etiology is
found for PIH and it is still a disease of theories.

Predisposing factors Of pre-eclampsia:

• Chronic hypertension.
• Previous pre-eclampsia or eclampsia
• Family history of pre-eclampsia.
• Primigravidae more than multigravidae.
• Obesity
• Multiple pregnancy
• Hydatidiform mole,
• Uncontrolled diabetes mellitus

Complications of Preeclampsia
The complications of Preeclampsia is vary, therefore it divided into two groups:
• Complications
Maternal complications
Neonatal complications

• Maternal Complications
• Convulsions and coma in eclampsia
• Cerebral haemorrhage.
• Renal failure.
• Heart failure.
• Liver failure.
• Disseminated intravascular coagulation (DIC).
• Abruptio placentae.
• Residual chronic hypertension in about 1/3 of cases.
• Recurrent pre-eclampsia in next pregnancies.
• Fetal Complications
• Intrauterine growth retardation (IUGR): Approximately 12 to 25% of fetal growth
restriction and small for gestational age infants are attributable to preeclampsia.
• Prematurity and its complications: It is reported that approximately 15-20% of preterm
births are associated with preeclampsia.
• Intrauterine foetal death

Pre-eclampsia
Diagnosis:
The diagnosis of preeclampsia is made according to the;
❖ Symptoms of the disease,
❖ Complete urine examination, (proteinuria)
❖ Coagulation status
❖ Eye fundus examination
❖ Tests for fetal well being: as
*Ultrasound,
*Daily Fetal Movement Count,
*Non-stress Test,
 Treatment and Nursing Management in mild pre-eclampsia:
❖ After detailed evaluation, preeclampsia patients are followed up with outpatient
antenatal controls.
❖ Antihypertensives, Low dose aspirin are given as medical therapy.
❖ Blood pressure should be measurement twice daily.
❖ Urine volume and proteinuria should be evaluated weekly
❖ Edema should be evaluated daily,
❖ Body weight should be check twice weekly,

Treatment and Nursing Management in mild pre-eclampsia (Cont…):

❖ Blood picture including platelet count, liver and renal functions particularly serum uric
acid should be evaluated on admission and every antenatal visit.
❖ Fetal movements should be count daily
❖ Non-stress test (NST) should be evaluated on admission and every antenatal visit.
❖ Psychological support should be provided for women and family

Treatment and Nursing Management in severe pre-eclampsia:

❖ The pregnant woman is definitely hospitalized and appropriate treatment is planned.
❖ MgSO4 is used as an anticonvulsant in the treatment.
❖ Magnesium sulfate is the only drug that can be used in treatment. However, its toxicity is
high. Therefore, a urinary catheter should be inserted. The patient's urine should be
measured hourly, along with the oral and IV fluids.
❖ By preventing light and sound stimuli, the patient is taken to bed rest in a quiet and calm
environment.
❖ Left lateral position is given to ensure utero-placental perfusion.
❖ Vital signs are monitored every 4 hours.

Treatment and Nursing Management in severe pre-eclampsia:

❖ Edema is checked daily.
❖ Body weight should be measured
❖ Protein-rich diet is given
 ❖ Women should be supported psychologically.
❖ It should be monitored for complications. If the patient's condition is becoming
progressively worse, delivery should be started immediately.

Eclampsia
❖ Definition: Eclampsia refers to convulsions (seizures) that occur in a preeclamptic
woman which cannot be attributed to other causes.

Definition:
❖ HELLP syndrome is defined by the presence of hemolysis, elevated liver transaminases,
and low platelets.
❖ This may or may not occur in the presence of hypertension and is often considered a
variant of preeclampsia.

Hemolysis
ELevated liver Enyzmes
Signs and Symptoms:
❖ The signs of eclampsia and HELLP SYNDROME are the same as pre-eclampsia.

Low Platelets
Treatment and Nursing Management:
❖ The treatment and nursing management of eclampsia and HELLP SYNDROME are the
same as severe pre-eclampsia.
❖ Pregnancy is immediately terminated by cesarean section regardless of its week.
❖ Maternal and newborn post-op monitoring is done in intensive care units.

For a pregnant patient with bradycardia and umbilical cord prolapse, prompt and effective nursing
care is essential to ensure the safety of both the mother and the fetus. The nursing interventions focus
on maintaining adequate perfusion and oxygenation for the fetus while preparing the patient for
possible emergency delivery. Below are the nursing care steps:

Assessment:
1. Monitor maternal and fetal vital signs:

• Continuously assess maternal heart rate and blood pressure.

• Perform continuous fetal heart rate monitoring to detect signs of distress.

2. Assess the umbilical cord:

 • Check if the cord is visible or palpable in the vagina.

3. Document findings:

• Record the onset, duration, and progression of cord prolapse and maternal bradycardia
symptoms.

Interventions:

Cord Prolapse Management:

1. Call for Emergency Help:

• Activate the emergency response team immediately and notify the obstetric provider.

2. Relieve Cord Compression:

• Place the patient in Trendelenburg or knee-chest position to shift the fetus off the cord.

• Use a sterile-gloved hand to gently lift the presenting fetal part (e.g., head) off the cord without
manipulating the cord itself.

• Keep the cord moist and warm using sterile saline-soaked gauze if it is visible outside the vagina.

3. Administer Oxygen:

• Provide high-flow oxygen via a non-rebreather mask to improve fetal oxygenation.

4. Monitor Fetal Heart Rate:

• Ensure continuous fetal heart rate monitoring to assess the effectiveness of interventions.

Bradycardia Management:

1. Support Maternal Cardiac Function:

• Position the mother on her left side to optimize cardiac output and uterine perfusion.

• Administer intravenous fluids to address potential hypovolemia.

2. Monitor Maternal Response:

• Monitor for symptoms of fatigue, dizziness, or altered level of consciousness associated with
bradycardia.

• Collaborate with the healthcare team to consider pharmacological interventions if maternal

bradycardia worsens (e.g., atropine).

Preparation for Delivery:

1. Prepare for an Emergency Cesarean Section:

• Cord prolapse typically necessitates immediate delivery to prevent fetal hypoxia.

• Ensure intravenous access is established and prepare for anesthesia.

2. Provide Emotional Support:

 • Reassure the patient and family, explaining the urgency of the situation calmly.

• Use clear and concise communication to reduce anxiety.

Post-Delivery Care:
1. Neonatal Resuscitation:

• Ensure a neonatal team is present to manage potential complications in the newborn, such as
hypoxia.

2. Monitor Maternal Recovery:

• Continue to monitor the mother for any cardiac issues postpartum.

• Provide support for physical and emotional recovery.

Timely and effective communication with the multidisciplinary team is critical to ensuring positive
outcomes in this emergency situation.

FUNDAMENTAL OF NURSING

Topic 1: Medication dosage and fluid flow rate check youtube/ online

Topic 2: Vital signs measurement and evaluation:

Drug application areas starts from slides 134-243

The phrase “Vital signs measurement and evaluation” refers to the process of systematically assessing
and interpreting a patient’s vital signs to monitor their health status. This includes:

1. Measurement:

• Temperature: Assessing body heat via oral, rectal, tympanic, axillary, or temporal methods.

• Pulse: Counting heartbeats per minute and noting rhythm and strength.

• Respiration: Observing breathing rate, rhythm, and quality.

• Blood Pressure (BP): Measuring the force of blood against arterial walls (systolic/diastolic).

• Pain Assessment: Sometimes referred to as the fifth vital sign, using pain scales or observing
patient behavior.

2. Evaluation:

• Comparing results to normal ranges (e.g., temperature: 96.8–100.4°F, pulse: 60–100 beats/min
for adults).

• Monitoring changes over time for trends or abnormalities.

 • Determining if vital signs indicate potential medical conditions or emergencies (e.g.,
hypertension, tachycardia).

• Making clinical decisions based on results, such as notifying healthcare providers or initiating
interventions.

If you’d like more details or examples related to this, let me know!

Here’s the information on vital signs measurement and evaluation extracted directly from the
uploaded file HCC 1920 Vital Signs:

Vital Signs Measurement:

1. Vital Signs to Measure:

• Temperature: Measurement of body heat.

• Pulse: Expansion and contraction of an artery; measured in beats per minute.

• Respirations: The process of breathing, involving gas exchange in the lungs.

• Blood Pressure: Force of blood against artery walls.

• Pain: Often referred to as the “fifth vital sign.”

2. When to Measure Vital Signs:

• On admission to a healthcare facility.

• Regularly during hospitalization (as ordered, e.g., every 4 or 8 hours).

• Before and after procedures (e.g., surgeries, blood transfusions).

• When there is a change in a patient’s condition.

• Before administering medications that affect the respiratory or circulatory system.

• Anytime a patient reports feeling unwell, such as experiencing pain or shortness of breath.

3. Guidelines for Measuring Vital Signs:

• Ensure equipment is functional.

• Know the patient’s baseline and normal ranges.

• Reduce environmental factors that may affect readings.

• Be organized and consistent in measurement techniques.

• Increase the frequency of measurements if the patient’s condition worsens.

Vital Signs Evaluation:

1. Normal Ranges to Compare Against:

• Temperature: 96.8–100.4°F (36–38°C), varying by site (oral, rectal, etc.).

• Pulse: 60–100 beats per minute for adults.

 • Respirations: 12–20 breaths per minute for adults.

• Blood Pressure: 120/80 mmHg average for adults.

• Pain: Assessed with scales like 0–10 or visual analog scales.

2. Abnormal Findings and Actions:

• Document and report vital signs outside the normal range.

• Look for patterns and compare with previous readings.

• Notify the appropriate healthcare provider of significant deviations.

3. Common Influencing Factors:

• Age, activity, emotions, medications, time of day, environment, and illness.

4. Documentation:

• Record vital signs accurately on flow sheets or electronic systems.

• Use standardized abbreviations (e.g., T for temperature, P for pulse, BP for blood pressure).

This information is directly sourced and summarized from the file you uploaded. If you need further
clarification or more detailed insights, feel free to ask!

I’ll extract the necessary details from the file you uploaded and expand on the topic of “Drug application
areas, angle, and ml dose.” Let me process it for more clarity. One moment, please.

The uploaded file provides the title: “Drug application areas, angle, ml dose”. Below is a detailed
explanation and guide based on this topic:

Drug Application Areas

1. Intramuscular (IM) Injection:

• Areas: Deltoid muscle (upper arm), vastus lateralis (thigh), ventrogluteal (hip), dorsogluteal
(buttocks).

• Angle: 90 degrees.

• Volume (ml dose): Usually up to 3 ml for adults (1 ml for the deltoid muscle).

2. Subcutaneous (Sub-Q) Injection:

• Areas: Abdomen (away from the navel), outer upper arm, anterior thigh, upper back, and upper
buttocks.

• Angle: 45–90 degrees depending on the needle length and patient’s body mass.

• Volume (ml dose): Up to 1 ml.

3. Intradermal (ID) Injection:

• Areas: Inner forearm, upper chest, upper back (below the scapula).
 • Angle: 10–15 degrees.

• Volume (ml dose): 0.1 ml.

4. Intravenous (IV) Administration:

• Areas: Veins in the arm or hand (cephalic, basilic, or median cubital veins).

• Angle: 25 degrees.

• Volume (ml dose): Varies; dependent on the drug and infusion requirements.

5. Topical Application:

• Areas: Skin, mucous membranes.

• Angle: Not applicable.

• Volume (ml dose): Based on the prescribed amount (often measured in mg or cm for creams).

Key Considerations
• Always sanitize the site before administration.

• Choose the correct needle size based on the application area and patient’s body composition.

• Rotate injection sites to prevent tissue damage.

• Confirm drug dosage and administration method to prevent errors.

If you’d like me to refine this further or add case-specific examples, let me know!

This question was given in final community exam

Secondary prevention education for prostate cancer patients focuses on early detection, regular
monitoring, and managing risk factors to prevent disease progression or complications. Here are key
points for secondary prevention education:

1. Screening and Monitoring

• Encourage regular prostate-specific antigen (PSA) testing and digital rectal exams (DRE) to
monitor the progression of the disease.

• Educate patients on the importance of scheduled follow-ups with their healthcare provider for
timely intervention.

2. Symptom Awareness
• Teach patients to recognize warning signs of progression, such as:

• Difficulty urinating.

• Blood in urine or semen.

• Pain in the lower back, hips, or pelvis.

 • Emphasize the importance of reporting any new or worsening symptoms immediately.

3. Lifestyle Modifications
• Dietary Recommendations:

• Encourage a diet rich in fruits, vegetables, and whole grains.

• Reduce intake of red and processed meats.

• Promote foods rich in antioxidants, such as tomatoes (lycopene) and green tea.

• Exercise:

• Advise regular moderate exercise (e.g., walking, swimming) to improve overall health and
reduce cancer-related fatigue.

• Weight Management:

• Maintain a healthy weight, as obesity is linked to poor outcomes in prostate cancer.

4. Medication and Treatment Adherence

• Educate patients on adhering to prescribed medications or treatments (e.g., hormone therapy or
radiation).

• Discuss potential side effects and how to manage them (e.g., incontinence, erectile dysfunction).

5. Psychological Support
• Encourage participation in support groups or counseling to address emotional and
psychological challenges, such as anxiety or depression.

• Provide education on coping mechanisms and stress reduction techniques (e.g., mindfulness,
meditation).

6. Avoid Risk Factors

• Educate patients about reducing exposure to:

• Tobacco and alcohol use.

• Environmental toxins.

• Emphasize the importance of a healthy lifestyle in preventing further complications.

7. Partnering with Healthcare Providers

• Encourage patients to actively discuss their concerns with their healthcare team.

• Provide education on available treatments for symptom management and maintaining quality of
life.

8. Comorbidities Management
 • Advise on managing other health conditions, such as diabetes or cardiovascular disease, which
may affect prostate cancer outcomes.

• Stress the importance of routine monitoring of blood pressure, cholesterol levels, and glucose
levels.

9. Educating Caregivers
• Provide caregivers with education on how to support the patient physically and emotionally.

• Highlight the importance of caregiver self-care.

Secondary prevention is about empowering patients with knowledge and tools to manage their
condition effectively and maintain the best quality of life possible.

Secondary prevention focuses on early detection and treatment to halt the progression of a disease. For
breast cancer and prostatic cancer patients, secondary prevention involves screening and early
intervention strategies. Here’s a breakdown:

Breast Cancer - Secondary Prevention

1. Screening Tests:

• Mammography:

• Recommended annually or biennially for women aged 40–74 (guidelines may vary).

• Clinical Breast Exam (CBE):

• Performed by a healthcare provider, especially for women in higher-risk groups.

• Breast Self-Examination (BSE):

• Encouraged to promote self-awareness of breast changes.

• MRI:

• For women at high risk (e.g., genetic predisposition or strong family history).

2. Early Diagnosis:

• Evaluating breast lumps, skin changes, or nipple discharge immediately.

• Biopsy of suspicious lesions for definitive diagnosis.

3. Genetic Testing:

• Screening for BRCA1 and BRCA2 mutations in individuals with a family history of breast or
ovarian cancer.

4. Follow-Up and Monitoring:

• Regular imaging and check-ups for those with prior abnormalities or at high risk.

Prostatic Cancer - Secondary Prevention

1. Screening Tests:
 • Prostate-Specific Antigen (PSA) Test:

• Recommended for men aged 50+ (or 40+ for high-risk groups like African-Americans or
those with a family history).

• Helps detect elevated PSA levels, though false positives can occur.

• Digital Rectal Examination (DRE):

• Palpation of the prostate to identify lumps or abnormalities.

2. Early Diagnosis:

• Timely evaluation of urinary symptoms such as frequent urination, difficulty starting urination,
or weak urine flow.

• Biopsy of abnormal prostate findings for definitive diagnosis.

3. Genetic Testing:

• Screening for mutations in genes such as BRCA2 and HOXB13, which can increase prostate
cancer risk.

4. Active Surveillance:

• For patients with low-risk cancer, regular monitoring through PSA and DRE instead of
immediate treatment.

Shared Strategies:
• Patient Education:

• Teaching patients about the importance of routine screenings and recognizing symptoms.

• Lifestyle modifications to reduce risk (e.g., maintaining a healthy weight, regular exercise, and a
balanced diet).

• Community Health Programs:

• Promoting awareness and accessibility to screening services in at-risk populations.

• Psychosocial Support:

• Providing counseling to alleviate anxiety related to screening or diagnosis.

Secondary prevention plays a critical role in improving survival rates and outcomes for both breast and
prostatic cancers. If you need more details on treatment or specific guidelines, let me know!

Certainly! Here are detailed responses to the questions:

1. Nursing Characteristics in Cultural Diversity

• Cultural Awareness: Recognizing and respecting cultural differences in values, beliefs, and
practices.
 • Cultural Competence: The ability to provide care that aligns with a patient’s cultural
preferences and needs.

• Empathy: Understanding and addressing patients’ unique cultural and emotional contexts.

• Communication Skills: Using language and nonverbal cues that resonate with diverse cultural
groups, often employing interpreters when necessary.

• Flexibility: Adapting nursing care plans to honor cultural dietary restrictions, spiritual
practices, or family involvement.

• Advocacy: Supporting culturally diverse patients to access appropriate healthcare resources.

2. Epidemics Affecting Communities or Worldwide

• COVID-19 Pandemic: A global health crisis with widespread implications for healthcare
systems, economies, and societies.

• Ebola Outbreaks: Regional epidemics affecting communities in West and Central Africa.

• HIV/AIDS Epidemic: A long-standing global health concern, especially in sub-Saharan Africa.

• Cholera Epidemics: Common in areas with inadequate sanitation, such as refugee camps.

• Influenza Pandemics: Including the H1N1 pandemic of 2009.

• Malaria and Tuberculosis: Endemic in specific regions but with global efforts for control and
prevention.

3. Case Study on a Veteran Soldier with Chronic Disease and PTSD

• Primary Prevention:

• Encourage regular health check-ups and screenings.

• Provide education on stress management and coping mechanisms.

• Promote a healthy lifestyle (diet, exercise, and sleep hygiene).

• Secondary Prevention:

• Early detection and management of PTSD symptoms through screening tools.

• Monitor and treat coexisting chronic diseases (e.g., hypertension, diabetes).

• Provide counseling and therapy (e.g., cognitive-behavioral therapy).

• Tertiary Prevention:

• Support long-term mental health therapy and rehabilitation programs.

• Assist with reintegration into society and employment opportunities.

• Ensure ongoing management of chronic diseases to prevent complications.

4. Home Visit Assessment by a Public Health Nurse

• Key Steps During Home Visit:
 • Introduction: Build rapport with the client and family.

• Observation: Assess the home environment for safety, hygiene, and risk factors (e.g., fall
hazards, food security).

• Health Assessment: Evaluate physical and mental health status, monitor vitals, and review
medical history.

• Education: Provide information on managing health conditions, medication adherence, and

lifestyle changes.

• Documentation: Record findings and create a care plan tailored to the client’s needs.

• Follow-Up Plan: Schedule future visits or refer the client to other healthcare services.

5. Objectives
• Ozone Layer and Ultraviolet Light:

• Educate on the importance of protecting the ozone layer to reduce UV radiation exposure, which
can lead to skin cancer and cataracts.

• Global Warming and Greenhouse Effect:

• Advocate for public health initiatives addressing climate change impacts, such as increased
heatwaves and vector-borne diseases.

• Occupational Health Nursing (OHN):

• Aim to prevent workplace illnesses and injuries, promote a healthy work environment, and
provide health education to workers.

• Geriatric Health (Vitamin/Iron Deficiency):

• Address nutritional gaps in older adults to prevent anemia and related conditions.

• Role Play (Demonstrated Refusal):

• Train nurses to handle patient refusal scenarios effectively while respecting autonomy.

• Sexual Education Program (HIV/AIDS):

• Provide age-appropriate education on HIV prevention, safe sex practices, and reducing stigma.

• Decision-Making for Children:

• Support children in learning critical thinking and problem-solving skills, particularly in health-
related choices.

• 36 Questions (Policy Not Included):

• Clarify the scope and objectives of the questions as per the specific context provided (possibly a
structured assessment or guideline).

Let me know if you need further elaboration or additional resources!

For Question 5, here’s how you can address and defend the topics while including skin cancer:
Defending the Objectives:

Ozone Layer and Ultraviolet Light

• The ozone layer acts as a protective shield, absorbing harmful ultraviolet (UV) radiation from
the sun.

• Depletion of the ozone layer increases UV exposure, which leads to:

• Skin Cancer: Prolonged UV exposure, particularly UV-B rays, is a major cause of skin cancers
such as melanoma, basal cell carcinoma, and squamous cell carcinoma.

• Eye Damage: UV rays can also lead to cataracts and other eye diseases.

• Immune Suppression: Excessive UV radiation can weaken the immune system.

• Advocacy for reducing ozone-depleting substances (CFCs) and promoting sunscreen use is
essential.

Global Warming and Greenhouse Effect

• Global warming accelerates climate changes that directly and indirectly affect public health:

• Skin Cancer: Increased global temperatures encourage more outdoor activities, leading to
prolonged UV exposure.

• Heat-Related Illnesses: Heatwaves cause dehydration, heatstroke, and cardiovascular issues.

• Vector-Borne Diseases: Warming climates expand the habitats of disease-carrying mosquitoes

(e.g., malaria, dengue).

Scope and Aim of Occupational Health Nursing (OHN)

• Scope: OHN focuses on promoting health and preventing illnesses in the workplace.

• Aim:

• Identify hazards such as chemical exposure, which could cause skin cancers.

• Provide education on personal protective equipment (PPE) to minimize exposure to UV rays or

carcinogens at work.

• Monitor and support workers’ overall health and wellbeing.

Geriatric Health (Vitamin/Iron Deficiency)

• Geriatric populations are more susceptible to nutritional deficiencies:

• Iron Deficiency Anemia: Leads to fatigue and reduced immunity.

• Vitamin Deficiency: Lack of vitamin D (produced with sun exposure) can weaken bones and
immunity.

• While promoting adequate sun exposure for vitamin D, education about avoiding excessive UV
radiation to prevent skin cancer is crucial.
Demonstrated Refusal (Role Play)

• Training nurses to respect patient autonomy while emphasizing the risks of UV exposure, global
warming, and the need for protective measures:

• For instance, role-playing scenarios to educate patients on using sunscreen or wearing

protective clothing to prevent skin damage and reduce cancer risk.

Sexual Education Program (HIV/AIDS)

• Defend the inclusion of sexual education by addressing its role in:

• Reducing risky behaviors linked to sexually transmitted infections.

• Promoting overall health awareness, including knowledge about how some HIV medications
may increase skin sensitivity to UV radiation.

Decision-Making for Children

• Helping children understand and make decisions about protecting themselves:

• Teaching them about the dangers of sun exposure and how to prevent skin cancer from an
early age through sunscreen use, hats, and protective clothing.

By defending these objectives, you align the discussion with both broader public health concerns and the
specific risks of skin cancer. Let me know if you need further expansion!

Questions
Here’s a more detailed response to Question 5 with definitions and information about sunscreen use:

Definitions

Ozone Layer

• The ozone layer is a region of the Earth’s stratosphere that absorbs most of the Sun’s harmful
ultraviolet (UV) radiation. It protects living organisms from UV-induced damage, such as skin cancer.

Ultraviolet (UV) Light

• UV light is a type of electromagnetic radiation emitted by the Sun. It is classified into:

• UVA: Penetrates deeply into the skin, causing premature aging.

• UVB: Causes sunburn and plays a significant role in skin cancer.

• UVC: Absorbed by the ozone layer and doesn’t reach Earth.

Global Warming

• Global warming refers to the long-term rise in Earth’s average temperature due to increased
greenhouse gases like CO2. It contributes to climate change, which affects health by increasing UV
exposure and heat-related illnesses.

Greenhouse Effect
 • The greenhouse effect is the warming of the Earth’s surface caused by greenhouse gases
trapping heat in the atmosphere. While it is a natural process, human activities have amplified it,
contributing to global warming.

Scope and Aim of Occupational Health Nursing (OHN)

• Scope: Promoting health and preventing illnesses in workplace settings.

• Aim: Protect workers from hazards, including UV exposure, which can cause skin cancer in
outdoor workers.

Geriatric Lack of Vitamin/Iron

• Older adults often face deficiencies in:

• Vitamin D: Essential for bone health and immune function. Sun exposure helps produce vitamin
D, but excessive exposure can cause skin damage.

• Iron: Vital for preventing anemia and maintaining energy levels.

Demonstrated Refusal (Role Play)

• In healthcare, demonstrated refusal refers to scenarios where patients or clients decline

recommended treatments or practices. Nurses should educate patients on risks (e.g., not using
sunscreen) and respect their decisions.

Sexual Education Program (HIV/AIDS)

• These programs aim to reduce the spread of HIV/AIDS by promoting safe practices like using
protection, regular testing, and education on reducing risky behaviors.

Decision-Making for Children

• Teaching children critical thinking skills helps them make informed decisions, such as applying
sunscreen during outdoor activities to prevent skin damage.

How to Use Sunscreen

Importance of Sunscreen

• Sunscreen protects the skin by absorbing or reflecting harmful UV rays, reducing the risk of:

• Skin cancer

• Sunburn

• Premature aging

How to Apply Sunscreen

1. Choose the Right Sunscreen:

• Use a broad-spectrum sunscreen with SPF 30 or higher to protect against UVA and UVB rays.

• Water-resistant sunscreens are best for swimming or sweating.

 2. Apply Generously:

• Use about 1 ounce (a shot glass) of sunscreen to cover the entire body.

• Apply to all exposed skin, including often-missed areas like ears, neck, and tops of feet.

3. Timing:

• Apply sunscreen at least 15–30 minutes before sun exposure to allow it to bind to the skin.

4. Reapply Regularly:

• Reapply every 2 hours, or more often if swimming or sweating.

Additional Tips for Sun Protection

• Wear protective clothing like hats and sunglasses.

• Avoid the sun between 10 a.m. and 4 p.m., when UV rays are strongest.

• Stay in the shade whenever possible.

Let me know if you need further clarification!

BROWSE OR CHECK THESE TOPIC OUT.

Here’s an analysis of the content in the image and responses to the topics mentioned:

Key Topics from the Image:

1. Nursing Profession

2. Milia (cheese-like substance on newborns)

3. Lochia (postpartum vaginal discharge)

4. Health Beliefs

5. PH Priority (Family)

6. Genital Fistula

7. Calculations (e.g., drip/min)

8. STD Infections

9. Public Health Topics

10. Medications to Avoid Postpartum Hemorrhage

11. APGAR Score

12. Reflexes

13. Head Circumference

14. Pelvic Prolapse

15. Urinary Incontinence

 16. Postpartum Care

17. Newborn Assignments

18. Global Health (Graphs and Rates)

Detailed Responses:

1. Nursing Profession

Nurses play a vital role in promoting health, preventing illness, and caring for individuals and
communities. Key characteristics include professionalism, critical thinking, cultural competence, and
empathy.

2. Milia (Newborn Skin Condition)

Milia are small, white, cyst-like bumps commonly found on a newborn’s face. These occur due to trapped
keratin and resolve on their own without treatment.

3. Lochia

Lochia is the vaginal discharge after childbirth that contains blood, mucus, and uterine tissue. It occurs
in three stages:

• Lochia Rubra: Bright red (1–4 days postpartum).

• Lochia Serosa: Pinkish-brown (4–10 days postpartum).

• Lochia Alba: Yellowish-white (10–28 days postpartum).

4. Health Beliefs

Health beliefs vary based on cultural backgrounds and influence healthcare-seeking behavior. Nurses
must assess and respect patients’ beliefs while providing evidence-based care.

5. PH Priority: Family

In public health, family-centered care focuses on:

• Ensuring the health and well-being of family members.

• Addressing familial factors that impact individual health.

6. Genital Fistula

A genital fistula is an abnormal opening between the vagina and bladder/rectum, often caused by
prolonged labor. Management includes surgical repair and prevention through access to obstetric care.

7. Calculations (Drip/min)

Formula:

Example:
For 1000 mL over 8 hours with a drop factor of 15:
8. STD Infections

Sexually Transmitted Diseases (STDs) are a major public health concern. Prevention includes education,
regular screening, and promoting safe sex practices.

9. Public Health Topics

Public health focuses on preventing disease and improving population health through education, policy,
and accessible healthcare services.

10. Medications to Avoid Postpartum Hemorrhage

• Avoid NSAIDs (e.g., ibuprofen) that may increase bleeding.

• Administer oxytocin or other uterotonic drugs to control bleeding.

11. APGAR Score

A rapid assessment of a newborn’s health at 1 and 5 minutes after birth. Scored out of 10 based on:

• Appearance (skin color)

• Pulse (heart rate)

• Grimace (reflex irritability)

• Activity (muscle tone)

• Respiration (breathing effort)

12. Reflexes in Newborns

Key newborn reflexes include:

• Rooting Reflex: Turning head toward a touch near the mouth.

• Moro Reflex: Startle response to a loud sound or movement.

• Grasp Reflex: Closing fingers around an object.

13. Head Circumference

Measured at birth and during regular checkups to monitor brain growth. Normal range:

• Newborns: 32–38 cm.

14. Pelvic Prolapse

Occurs when pelvic organs drop due to weak muscles. Symptoms include pressure and urinary issues.
Management includes pelvic floor exercises, pessaries, or surgery.

15. Urinary Incontinence

A common postpartum issue caused by weakened pelvic muscles. Treatment includes:

 • Pelvic floor exercises (Kegels).

• Bladder training.

• Surgery in severe cases.

16. Postpartum Care

Focus areas include:

• Monitoring for infection or complications.

• Supporting breastfeeding.

• Providing emotional support (e.g., for postpartum depression).

17. Newborn Assignments

Key aspects include:

• Monitoring growth and development.

• Educating parents about feeding, hygiene, and vaccinations.

18. Global Health (Graphs and Rates)

Understanding trends in health data (e.g., infant mortality, vaccination coverage) is crucial for
addressing global health disparities. Focus on interpreting graphs and identifying key statistics.

Let me know if you need deeper insights on any of these!