Herbal MedicineAKAPULKO

• English name: Acapulco, ringworm bush

• Scientific name: Cassia alata L.• Family:

Leguminosae Akapulko or bayabas-bayabasan contains chrysophanic

acid, a fungicide used to treat fungal infections, like ringworms, scabies and eczema.

Akapulko also contains saponin, a laxative that is useful in expelling intestinal parasites.

The extracts from the plant is commonly used as an ingredient for lotions, soaps and shampoos.

Uses of Akapulko:

Treatment of skin diseases:Tinea infections, insect bites, ringworms, eczema, scabies and itchiness.

Internal: Expectorant for bronchitis and dyspnoea, mouthwash in stomatitis, alleviation of asthma symptoms, used as diuretic and purgative, for cough & fever, as a laxative to expel intestinal parasites and other stomach problems. A strong decoction of the leaves is an abortifacient.

Preparation Pound fresh, mature leaves Apply extracted juice on affected area of the skin 1-2

times a day For people sensitive (allergic) to extracted juice, make

decoction1. Boil 1 glass of chopped leaves with 2 glasses of water

under low fire for 15 minutes without cover2. Wash the affected area of skin 1-2 times aday

AMPALAYA• English name:

Bitter gourd, bitter melon• Scientific name: Momordica charantia • Family

Cucurbitaceae DESCRIPTION

Vine, with flower and fruit bearing Vegetables family, the leaves and fruit can be eaten Contains a mixture of flavanoids and alkaloids make the

Pancreas produce more insulin that controls the blood sugar in diabetics.

Good source of vitamins A, B and C, iron, folic acid, phosphorous and calcium.

Uses of Ampalaya:• Good for rheumatism and gout• And diseases of the spleen and liver• Aids in lowering blood sugar levels• Helps in lowering blood pressure• Relives headaches• Disinfects and heals wounds & burns • Can be used as a cough & fever remedy• Treatment of intestinal worms, diarrhea • Helps prevent some types of cancer

• Enhances immune system to fight infection• Is an antioxidant, parasiticide, antibacterial &

antipyreticPREPARATION

Wash the leaves and cut into small pieces Boil 2 glasses of chopped leaves, add 4 glasses of water,

let it boil for 15 mins. in low fire without cover Set aside to cool then strain Drink 1/3 glass of decoction 30 mins. Before meal 3 x a

day Sprouted leaves can be eaten, steamed or cooked on top

of boiled rice, ½ glass 2x a day

BAWANG• English name:

Garlic• Scientific name: Allium sativum • Family:

Liliaceae DESECRIPTION

Cloves used as spice Elongated leaves with flower Uses of Bawang: • Good for the heart

• Helps lower bad cholesterol levels (LDL)• Aids in lowering blood pressure• Remedy for arteriosclerosis• May help prevent certain types of cancer• Boosts immune system to fight infection• With antioxidant properties• Cough and cold remedy• Relives sore throat, toothache• Aids in the treatment of tuberculosis• With anticoagulant properties

PREPARATION Fry in a small amount or without oil Broil the cloves Soak in vinegar for 30 minutes Blanch in boiling water for 5 minutes Eat 2-3 cloves 3 x a day after meal

BAYABAS• English Name: Guava• Scientific name: Psidium guajava • Family:

Myrtaceae DESCRIPTION

Bayabas or guava is a small tree, 3 – 5 meters tall with greenish-brownish smooth bark.

The round globular bayabas fruit starts as a flower and is usually harvested and eaten while still green. The fruit turns yellowish-green and soft when ripe.

The bark and leaves can be used as astringent. The use of the leaves is for cleaning and disinfecting

wounds by rinsing the afflicted area with a decoction of the leaves. The fruit, aside form being delicious, contains a very high concentration of vitamin C.

DESCRIPTION Bayabas or guava is a small tree, 3 – 5 meters tall with

greenish-brownish smooth bark. The round globular bayabas fruit starts as a flower and is

usually harvested and eaten while still green. The fruit turns yellowish-green and soft when ripe.

The bark and leaves can be used as astringent. The use of the leaves is for cleaning and disinfecting

wounds by rinsing the afflicted area with a decoction of the leaves. The fruit, aside form being delicious, contains a very high concentration of vitamin C.

Uses of Bayabas:

• Antiseptic, astringent & anthelminthic • Kills bacteria and fungi • Treat diarrhea in children• Hypertension, diabetes and Asthma • Promotes menstruation• Toothache

PREPARATION Wash the leaves and chop into pieces Boil 2 glasses of chopped leaves with 4 glasses of water Boil for 15 minutes in low fire without cover Set aside to cool then strain Wound treatment: Wash the wound 2x a day Mouth wash: Luke warm decoction

LAGUNDI• English Name: Chaste tree• Scientific name: Vitex negundo L.• Family:

Verbenaceae DESCRIPTION

Shrub, 5 meters high It is one of the ten herbal medicines endorsed by the

Philippine DOH as an effective herbal medicine with proven therapeutic value.

Uses of Lagundi Relief of asthma & pharyngitis Relief of rheumatism,

dyspepsia, boils, diarrhea Treatment of cough, colds, fever and flu and other

bronchopulmonary disorders Alleviate symptoms of Chicken Pox Removal of worms, and boils

PREPARATION Wash the leaves and chop or cut into pieces Measure 2 glasses of water and 1 glass of chopped fresh

leaves Boil under low fire for 15 minutes without cover Set aside to cool then strain Cough and Asthma: 1/3 glass 3 x a day Fever: 1/3 glass every 4 hours

SAMBONG• English Name: Blumea camphora • Scientific name: Blumea balsamifera

• Family:Compositae

DESCRIPTION Shrub, 3 meters high

Uses of Sambong Diuretic agent Effective in the dissolving kidney stones For hypertension & rheumatism Treatment of colds & fever Anti-diarrheic & Anti-gastralgic properties Helps remove worms, boils Treats dysentery, sore throat

PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain 1/3 glass 3x a day

TSAANG-GUBAT• English Name:

Wild tea• Scientific name: Ehretia microphylla Lam.• Family:

Boraginaceae DESCRIPTION:

Shrub, 5 meters high Has small and shiny leaves

Uses of Tsaang-Gubat Stomach pains Gastroenteritis Intestinal motility Dysentery Diarrhoea or LBM Mouth gargle Body cleanser/wash

PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain 1/2 glass every 4 hours

ULASIMANG BATO• English Name: Peperomia • Scientific name: Peperomia pellucida Linn.• Family:

Piperaceae DESCRIPTION

A variety of grass with heart-shaped leavesUse of Pansit-pansitan

Arthritis Gout Skin boils, abscesses, pimples Headache Abdominal pains kidney problems

PREPARATION Wash 1 ½ glass fresh mature leaves Add pinch of salt and pepper to taste Divide into 3 parts and consume in the morning, at noon

and at nightDECOCTION

Wash the leaves and cut into small pieces Boil 2 glasses of chopped leaves with 4 glasses of water,

let it boil for 15 mins. Under low fire without cover Cool then strain Drink 1/3 glass 3x a day after meal

YERBA BUENA• English Name: Peppermint• Scientific name:

Mentha cordifolia Family:

Labiatae DESCRIPTION

Vine with mint aroma Green four-sided leaves

Uses of Yerba Buena : • Arthritis• Head aches• Tooth aches• Mouth wash• Relief of intestinal gas• Stomach aches• Indigestion• Drink as tea for general good health

PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain Body pain/ache: 1/3 glass 3x a day Pounded fresh leaves can be applied directly on the

location of the pain

NIYUG-NIYOGAN• English Name: Chinese honey suckle, Burma Creeper,

Liane Vermifuge, Rangoon• Scientific name: Quisqualis indica L.• Family:

Combretaceae DESCRIPTION

Vine, up to 8 meters high Has red, rose and white flowers Nuts (fruit) bearing Seeds that taste like coconut

Uses of Niyug-Niyogan • Antihelminthic: Dried seeds preferable for deworming • Diarrhea and fever: Roasted seeds• Skin diseases: Pounded leaves externally • Dysuria: Decoction of boiled leaves

PREPARATION Used only matured seeds, dried and newly cracked nut

Consume seeds 2 hours after meal If the first dose has no effect, repeat the same dose after

one weekNutrition and Diet

Science that deals with the process by which components of food are made available for an organism for meeting energy requirements, building and maintaining and in more general terms, for maintaining the organism in an optimum function state.

Two Groups of FoodsMicronutrients – include vitamins and some elements. These are consumed in small amounts and are absorbed unchanged.

Macronutrients – include carbohydrates, fats and proteins, which on digestion are converted to glucose, fatty acids, glycerol, peptides and amino acids

I. CARBOHYDRATES prime importance in the diet Food sources:

Starches (Plain cooked rice, maize, bihon, puto); root crops (camote, cassava, gabi, potato);fruits; sugar; vegetable (upo, beets, carrots, patani, batao)

providing the major source of energy intake (40-80% of total energy intake in different country and total energy intake for Filipinos) for work and development because of the following reasons.

Reasons1. Carbohydrates are readily available being widely

distributed in a variety of easily grown plants such as grains, vegetables and fruits

2. The cost in the total food budget is relatively small3. Provides quick and sustained body fuel from rapid

oxidation of starches and sugars yielding the needed body heat and energy with CO2 and water as end products

Carbohydrates RDA: 55-70% of TCA Energy yield: 4kcal/g

II. FATSFood Source:

Saturated fatty acids – animal source like meat, eggs, milk fat

Unsaturated fatty acids – plant source like vegetable oil (olive oil, peanuts, almonds, avocado oil)

A. Functions Containing source of fuel for the body to store and burn as

needed for energy Like carbohydrates, fat spares protein from being used for

energy Dietary vehicle for vitamins A, D, E and K Controls body temperature Protections against injury RDA: 20-30% Energy yield: 9 kcal/g

III. PROTEINSD. Food source:

Animal foods : fish, meat, poultry, and other internal organs, seafoods (crabs, shrimps, shellfish)

Plant foods : dried beans, mongo, soybean, garbanzos, peanuts, beans, nuts, rice and bread

From the Greek word “proteius” meaning “of primary importance”

Are large complex molecules that made up 20% of our body weight – muscles, bone, cartilage, skin, and other tissues

TYPES OF PROTEINS1. Antibodies2. Contractile proteins3. Enzymes4. Hormonal proteins5. Structural Proteins6. Storage Proteins and Transport proteins

Functions of Proteins: Contributing to enzymes activity that promotes chemical

reactions in the body Transporting substances around the body Keeping fluids and pH balance in the body Serving as building blocks for hormone production Helping blood clot Promoting antibody activity that controls immune and

allergy functionsIV. VITAMINS

They are classified as fat-soluble (ADEK) and water-soluble (Vitamins B and C)

Needed by the only in small amount Signs and symptoms in adult patients

Sign and Symptoms Possible Nutrient Deficiency

General: Wasted, skinny (especially temporal muscles)

Protein calorie

AbdomenDistension and Hepatomegaly

Protein –calorie

Extremities: Edema

Protein, thiamine

Decubitus ulcer, poor wound healing Protein, Vitamin C, Zinc

Bone tenderness Vitamin D

Bone ache, joint pain Vitamin C

Muscle wasting and weakness Protein , calorie, Vitamin D

Muscle tenderness, muscle pain Thiamine

Sign and Symptoms Possible Nutrient Deficiency

SkinPallor

Folate, iron, vitamin B12

Follicular hyperkeratosis Vitamins A and C

Perifollicular petechiae (especially after raised venous pressure)

Vitamin C

Flaking dermatitis, scaling Protein, Calories, Niacin,

Riboflavin, Zinc, Vitamin A

Bruising purpura Vitamin C, K, Fatty acids

Pigmentation changes, desquamation of semi exposed areas

Niacin, protein-calorie

Signs and symptoms in infant patients

Sign and Symptoms Possible Nutrient Deficiency

Stunting, washing, lethargy, poor appetite, weight loss

Energy, protein, folic acid, Vitamin B12, Vitamin C, Vitamin D, Zinc, Calcium, Iron

Poor wound healing, impaired resistance to infection

Vitamin A, Vitamin C, Zinc

Anemia Vitamin A, Folic acid, Vitamin B12, Iron

Hypoglycemia, ketosis Carbohydrates

Xerophthalmia Vitamin A

Rickets Vitamin D, Calcium

Brain damage, mental retardation, hypothyroidism

Iodine

Hyperparathyroidism Calcium

Sensitivity to cold, changes to finger-nails, hair or tongue

Iron

Table of Vitamins

Vitamins Source Function Deficiency, Overdosage and Toxicity level

RDA

Vitamin A(Retinol)

Liver, eggs, milk, crab, fat, cheese, dilis, malunggay, kamote tops, kangkong, saluyot, carrots, squash

Healthy skin, bone and teeth development, healthy hair, good vision and reproduction

Night blindnessHeadache, skin disease10 mg

5000 I.U.

Vitamin D(Calciferol)

Manufactured by the body through direct sunlight or UV rays. Liver fish oils, egg yolk

Bone growth and development; helps in the absorption of calcium and phosphorus

Rickets, muscle spasmLoss of appetite, nausea, vomiting, excessive thirst, increased urination, nervousness and hypertension

400 I.U.

Vitamin E(Tocopherol)

Vegetable oils, egg yolks, whole grain cereals, wheat germ, green vegetables, nuts, and seeds, margarine

An antioxidants. Helps form red blood cells

RBC hemolysis, bleeding problems, eye problems, difficulty in walking, nervous system disorders, double vision, muscles weakness1g

30 I.U.

Vitamin K Leafy vegetables, alfalfa leaves, spinach, carrot tops, tomatoes, pork, liver vegetable oils

Formation of clotting factors

HemorrhageKernicterus 500 mg

Vitamin B1(Thiamine)

Whole grain, cereals and dried beans, lean pork and beef, liver, heart, kidney, fish and shellfish and duck egg’s yolk

Helps in the nervous system function. May also help in the release of energy from absorbed carbohydrates

Pernicious anemia, beriberi

1.5 mg

Vitamin B2(Riboflavin)

Dried mushrooms, malunggay, seaweed, powdered milk, liver, heart, kidney, lean meat, shellfish, quail eggs

For protein metabolism. Helps the body release energy from food

Chapped lips, cracked mucous membranes at the side of the mouth

1.7 mg

Vitamin B3(NIACIN)

Peanuts, peanut butter, rice polishing, whole wheat bread, mushrooms, dried Saffron flowers(kasubha), sesame seeds, powdered coffee and tea

For nervous and digestive system functions; helps release energy from food; controls blood cholesterol

Pellagra characterized by dermatitis, diarrhea and inflammation of the mucous membrane100 mg

20 mg

Vitamin B6(pyridoxine)

Dried yeast, liver, organ meats, whole grain cereals, fish, legumes

Helps in nitrogen metabolism

Convulsion among infants, anemia, skin diseases, nerve problemsNerve problems500 mg

2 mg

Vitamin B12(Cyanocobalamin)

Meats, liver, whole grain cereals, corn, soybeans, peanuts and green leafy vegetables

Helps from red blood cells, metabolized nutrients and function of nervous system

Pernicious anemia

6 ug

Folic acid(folate)

Green leafy vegetables, root vegetables, lean beef, liver, kidney, dairy products and yeast

Helps form red blood cells

Blood disorders

400 ug

Vitamin C(ascorbic acid)

Citrus fruits, tomatoes, potatoes, cabbage, green peppers

Helps promote growth, bone and teeth development. Also help in the repair of tissues and increase resistance to infection

Scurvy 60 mg

Table of Minerals

Vitamins Source Function Deficiency, Overdosage and Toxicity level

RDA

Calcium Dairy products, milk and milk products, fish, meat, eggs, cereal products, beans, fruits, leafy vegetables

Helps in the bone and teeth formation. Helps in muscles contraction and blood clotting

Hypocalcemia, muscle spasmHypercalcemia, kidney problems, difficulty in urination2000 mg

1000 mg

Chromium Yeast, nuts, mushrooms, asparagus, meat, chicken,

Takes part in glucose metabolism and helps in carbohydrate and fat utilization

Impaired action of insulin and low blood glucose level

50-200 ug

Cobalt Meat, kidney, liver, milk, oysters, clams

Essential components of cobalamin that helps treat a certain type of anemia

Poor growth and appetite, listlessness (lack of energy) and progressive emaciation (thinness)

8 ug

Copper Banana, peas, whole

Assists the body in iron utilization;

Anemia, anorexia, edema and

1-2 mg

wheat, prunes, oysters, shellfish

helps built hemoglobin in the blood; takes part in ascorbic acid metabolism and aids use of fatty acid

retarded growth10 mg

Iodine Onions, seafood, meat, eggs

Helps regulate the rate of energy production and body weight and promotes proper growth. It also promotes healthy hair, nails, skin and teeth

Hypothyroidism, goiter, and related growth2000 mcg

120-150 ug

Iron Red meat, liver, kidney, beans, peas and lentils, dried apricots and figs, cocoa, bread and cereal products

Helps form red blood cells and transport of oxygen in the blood and muscles

Anemia, decreased mental alertness

18 mg

Magnesium

Dried figs, dried apricots, lemon, almonds, corn, nuts, seeds, vegetables, fruits

Aids in regulation of body processes like normal heart rhythm and in normal functioning of body enzymes

Irritability, abnormal heart rhythm, emotional tension, depression, and muscular weakness

270-320 mg

Manganese

Nuts, leafy vegetables, beets, peas,

Essential constituent of bone structure; vital in

Skeletal abnormality

2.5-7 mg

whole grain cereals, egg yolks, tea

reproduction and normal functioning of the nervous system

Molybdenum

Green leafy vegetables, lentils, milk, whole grains, potatoes, peas, liver

Active role in enzymatic actions of the body

Poor growth and slowing down of body activities

150-500 mg

Phosphorus

Milk, cheese, meat, poultry, fish, cereals, nut, legumes

Helps in the proper development of bones and teeth. Facilitates quick release of energy for muscle contraction. Transports fatty acids. Prevents rickets

Stunted growth and defective structure of teeth and bones in young childrenImpaired of iron and calcium utilization and bone erosion

800 mg

Potassium Abundant in all foods, fresh fruits and vegetables, including potatoes, meat, whole-meal flour, cereals, milk, coffee, tea

Vital for muscle contraction, nerve impulses and proper functioning of heart and kidneys. Helps regulate blood pressure and water balance in cells

Muscular weakness, increase in nervous irritability, mental disorientation, and cardiac irregularitiesHeart block18g

950-2660 mg

Selenium Wheat germ, tomatoes, onions, broccoli, garlic,

Pert of certain enzymes that act as antioxidants which help

Selenium deficiency is rare in human

7-85 ug

eggs, seafood, liver, kidney

fight cell damage; helps prevent particular type of protein calories malnutrition; enhances proper immune response; and aids proper functioning of heart muscle

Sodium Shellfish, meats, eggs, table salt

Necessary for maintaining fluid balance. Transports nutrients across cell membranes

14 g 950-2660 mg

Zinc Wheat germ, yeast, pumpkin seeds, lentils, corn, eggs, dry milk, nuts, oysters, steak, lamb chops

Helps the body use protein and carbohydrates; vital for growth and development; synthesis of cell protein (DNA and RNA formation); and proper functioning of the immune system

Growth failure, impaired wound healing, impaired sense of taste and smell, and sexual infantilism in teenagers150 mg

12-16 mg

V. Minerals Needed by the body to function properly Some minerals are needed in large doses ( calcium, iron,

etc.) while others may be taken in small amounts (copper, magnesium, manganese, phosphorus, selenium, iodine, sodium, potassium, zinc, etc.)

VI. WATER

Makes up about 60% of an adult’s body weight. Requirements for water are met in many ways. Most fruits are more than 90% water

Takes an active part in many chemical reactions and is needed to carry other nutrients, to regulate body temperature, and to help eliminates wastes

Factors affecting BMR Body size Sex Body temperature Growth Age Pregnancy and lactation Specific Dynamic Action or thermal effect of food Body composition State of Nutrition Climate Hormone secretions Sleep Physical or muscular activity

ADULTSBody Mass Index (BMI)

It is the number that shows body weight adjusted for height.

BMI can be calculated with simple math using inches and pounds, or meters and kilograms.

For adults aged 20 years or older, BMI fall into one of these categories: underweight, normal, overweight, or obese

For adults aged 20 years or older, BMI fall into one of these categories:

Underweight Normal Overweight obese

BMI

Interpretation

BMI Weight statusBelow 15 Emaciated15 - 18.5 Underweight18.5 - 24.9 Normal25.0 - 29.9 Overweight30.0 - 39.9 Obese40 or more Morbidly Obese

DESIRABLE BODY WEIGHT (DBW)DETERMINATION

The DBW, and not the actual weight of the individual is used as the basis in the calculation of TER or TCA.

It can be determined by:

a. Height-weight tables of FNRI

b. Modified Tannhausers method in the absence of height-weight tables

DBW(kg) = (height in cm - 100) - (10%[ht in cm – 100])

c. NADP Formula Males 5ft 112 lbs ±4 lbs for every

inches above (below) 5ft

Female 5ft 106 lbs ±4 lbs for every inches above (below) 5ftInterpretation

Obese if body weight is more than 20% above the desirable weight

Overweight if the weight is >10%-20% above the desirable weight

Normal if the weight is ±10% of the desirable body weight Underweight if the weight is >10% below the desirable

weight An underweight

Physical Signsa. adipose tissue lackingb. muscles are flabbyc. “skin and bones”

Possible complicationsa. Kwashiorkorb. Marasmus

Overweight Hazards/Concerns Changes in normal body functions Risk of developing diseases Increases risk during surgeries Lowers general fitness of a person Physical, Social and Economical implications

DETERMINATION OF TOTAL ENERGY REQUIRMENT (TER) OR TOTAL CALORIC ALLOWANCE (TCA)

Factorial MethodTCA or TER = BMR + PA + SDA

Basal Metabolic Rate (BMR) Minimum amount of energy needed to maintain

the vital process of life under basal condition

wt (lbs)h2 (in)x703= __

______

BMI=

BMI

BMI=wt (Kg)

wt (Kg)

________

________

h2 (m)

h2

(cm)

x10,000

1 kcal/kg of body weight/hour Correction for sleep: deduct 0.5 kcal/kg BW/hr

BMR = 1 kcal/kg x DBW x 24 hrs

Physical Activity (PA) Hospital patient - 10% Sedentary - 30% Light - clerks, typist (50%) Moderate - housewives,shoemaker,jeepney

drivers,students, fishermen (75%) Heavy – construction workers (100%)

PA = BMR x % physical activity classification

Thermogenic effect of blood (Specific Dynamic Action or SDA) The energy required for digestion, absorption, transport,

and utilization of food SDA = (BMR + PA) x 0.6 adult (≥12 y/o)

0.15 child (<12 y/o)

NADP method (National Asso. Of Developmental Pediatrics)

TCA = DBW x 40 To lose in 1-2 (lbs)/week, subtract 500 kcal daily from the

calculated TCA respectively and conversely add same amount of kcal to gain 1-2 lb/week

NADP Recommendation NADP Recommendation for overweight/obese adult

1. Compute allowance base on DBW and subtract 500kcal/day2. If only moderately overweight, recommend exercise and avoidance of fats and sugarExampleEXAMPLE COMPUTATION FOR DBW, TCA AND DISTRIBUTION of the TCA into CARBOHYDRATES, PROTEINS AND FATS

Filipino female, moderately active adult, 5 ft 1 inch (155cm) weighing 130 lbs (59kg) classify the nutritional status of your patient.

Compute for the dietary intake needed to loose or gain 2 lbs/week if adjusted intake for carbohydrates is 60%, proteins is 10% and fats is 30%.

1. DBW a. Modified Tannhauser Method

DBW (kg) = (height in cm -100) – (10%[height in cm-100]) = (155-100) – (55 x 0.1) = 50 kgNADP Methodb. NADP method

Female 5 ft 106 lbs 1 inch 4 lbs 110 lbs (50 kg)Actual weight – DBW x 100 Actual weight59kg – 50kg x 100 = 15% 59 kg ***59 kg is between 10-20% above the DBW of kg = overweight

TCA/TER = BMR +PA+SDAa. Factorial method

BMR = 1 kcal/kg x DBW x 24 hrs = 1 x 50 x 24 = 1200 kcalPA = BMR x % activity = 1200 x 0.75 = 900 kcalSDA = (BMR + PA) x 0.06 = 2100 x 0.06 =126 kcal

2226 kcal

NADPb. NADP method TCA/TER= DBW x 40= 50 x 40= 2226

Special Considerations

PEDIATRICS1. Waterlow Classification for Wasting

Computation: Actual weightIdeal weight for actual length or height x 100 =___%

Classification: Normal >90% Mild 80-90% Moderate 70-80% Severe <70%

2. Waterlow Classification for StuntingComputation: Actual height or length Ideal height or length for age x 100 =___% Classification:

Normal >95% Mild 90-95% Moderate 80-90 Severe <80%

To lose 2 lbs, deduct 1000 kcal from TCA = 2226 – 1000 = 1226 kcal Carbohydrates = TCA x 0.60 = 736 kcal/4kcal/g = 184 gm Proteins = TCA x 0.10 = 1226x0.10= 123 kcal/4g = 31 gm Fats = TCA x 0.30= 1226 x 0.30= 368 kcal/9g = 41 gm

256 gm_________

PROTEIN-ENERGY MALNUTRITION

MARASMUS *Balanced starvation *Very low in both protein and calories *Caused by insufficient intake of milk

KWASHIORKOR *Very low in protein, but one in which contains calories in the form of carbohydrates

A. Usual age 0-2 y/o 1-3 y/o

B. Essential features

1. Edema None Lower legs, sometimes face or generalized

2. Wasting Gross loss ”all skin and bones”

Sometimes hidden; sometimes fat

3. Muscle wasting

Obvious Sometimes hidden

4. Growth retardation

Obvious Sometimes hidden

5. Mental changes

Usually apathetic, quiet

Usually irritable, moaning, also apathetic

C. Variable features

1. Appetite Usually good Usually poor

2. Diarrhea Often (past or present)

Often (past or present)

3. Skin changes

Seldom Occasional – flaky paint or enamel dermatosis

4. Hair changes

Seldom Often – sparse, straight, silky, dyspigmentation; gray or reddish

5. Moonface Seldom Often

6. Hepatic enlargement

Seldom Always

PHARMACOTHERAPY

application of drugs in the prevention, treatment or diagnosis of disease and their use in purposeful alteration of normal functions

division of Pharmacy which correlates pharmacodynamics with the pathologic physiology or microbiologic or biochemical aspect of disease

Pharmacokinetics- The study of the absorption, distribution, metabolism, and excretion of drugs by living organisms.

Pharmacodynamics- The study of the biochemical and physiologic mechanisms of drug action.

Drugs chemical substances that have an effect on living

organisms. Therapeutic drugs often called medicines, are those drugs

used in the prevention or treatment of diseases. Up until a few decades ago, dried plants were the greatest source of medicines; thus the word drug was applied to the

Drug vs Medicine Drug

• any substance that alters physiologic function w/potential for affecting health

Medicine• drug administered for therapeutic

effects– All medications are drugs– Not all drugs are medications

Sources of Drugs Drugs are obtained from many sources. Many inorganic materials, such as metals, are

chemotherapeutic; hormones, alkaloids, vaccines, and antibiotics come from living organisms;

Other drugs are synthetic or semisynthetic. Synthetics are often more effective and less toxic than the

naturally obtained substances and are easier to prepare in standardized units.

Plants - digitalis and opium Animals - insulin and thyroid Minerals or mineral products - potassium, chloride, and

lithium carbonate Synthetic chemical compounds - barbiturates,

sulfonamides, and aspirin. Biotechnology - genetically engineered pharmaceutical

productsDrug Nomenclature

Drugs used as therapeutic agents may be conveniently divided into two main groups: (1) nonprescription drugs

(2) prescription drugsDrug Names: Chemical Name

exactly the chemical constitution of the drug and the exact placing of its atoms or molecular groupings.

chemical name composition of the drug by its molecular structure

Example: acetylsalicylic acid Generic Name (Nonproprietary Name)

Gomez ClassificationComputation:

Actual weight Ideal weight x

100 = __%Classification:

Normal 91-100

First degree malnutrition 76-90

Second degree malnutrition

61-75Third degree

malnutrition <60

______________________

provided by the United States Adopted Names (USAN) Council

Is equivalent to the same drug with a brand name, but is less expensive

Example: Aspirin Drug Name: Official Name

name under which the drug is listed by the U.S. Food and Drug Administration (FDA).

FDA- empowered by Federal Law to name drugs for human use in the U.S.

Trademark (Brand Name) followed by the symbol ®. This indicates that the name is

registered and that its use is restricted to the owner of the drug, who is usually the manufacturer of the product.

Consistent bioavailability, more easily recognized by appearance.

Example: Bayer Drug Classifications

Drugs may be classified according to the body system they affect

• May be classified by their therapeutic use or clinical indications

Ex. Antacids, Antibiotics, Antihypertensive, Diuretics, Laxatives

• May be classified using the physiologic or chemical action

• May be classified as prescription or non-prescription drugs

Drug Classification Indicates Effect on a body system Symptoms relieved Desired effect

Classification of Drugs Antineoplastic Agents Cardiac Muscle Drugs Diuretics Antihistamines Anti-Infective Agents Antifungal Antibiotics Anti-Inflammatory Agents

-Steroids -Non-steroidal Agents

Joint Drugs Blood Coagulants

Anticoagulants Hemorrheologic Agents

Dental Agents Ears, Eyes and Nose Vasoconstrictors GI Enzyme and Acid Agents Gastrointestinal Muscle Movement Agents Genitourinary Muscle Relaxants Glaucoma Agents Adrenal agents

Glucocorticoids Mineralocorticoids

Pituitary Agents Reproductive Agents Thyroid Agents

Nervous System Adrenergic Agents (Sympathomimetic)

Nervous System Anticonvulsants, Sedatives & Hypnotics Tranquilizers Nervous System Cholinergic and Anticholinergic Agents Nervous System Skeletal

Muscle Relaxants Nervous System

Stimulants Pain Agents -also known

as Analgesics Respiratory Antitussives,

Expectorants, and Mucolytics

Respiratory Smooth Muscle Relaxants Serums, Toxoids, & Vaccines Skin & Mucous Membrane Agents and Enzymes Vitamins and Caloric Agents

Non-Prescription Drugs over the counter medications (OTC) which can be

purchased by anyone. No Rx needed Examples: Tylenol, Maalox, Tums

Illegal Drugs Illegal drugs- recreational drugs Drugs and chemical substances used for non-therapeutic

purposes Obtained illegally or have not received approval for use by

the FDASources of Drug Standards

United States PharmacopoeiaUSP verifies the identity, strength, purity, and

quality of dietary supplement finished products, dietary supplement ingredients, and pharmaceutical ingredients.

A National Formulary a manual containing a list of medicines that are approved

for prescription throughout the country, indicating which products are interchangeable.

USP Dictionary of USAN and International Drug Names database contains more established drug name listings

than any other comparable resource. Drug Standards Ensure

Strength or potency Purity Efficacy Safety Bio-availability

Standards of Practice Information for Administering Medications

– Generic Name/Trade Name/Classification– Clinical Uses/Safe Dosage– Mechanism of Action– Side Effects/Adverse Effects– Contraindications/Precautions– Significant Drug Interactions– Monitoring Needs/Patient Education

– Evaluation of EffectivenessPharmaceutical Dosage Forms

Drug substances are seldom administered alone, but rather as a part of a formulation in combination with one or more no medical agents that serve varied and specialized pharmaceutical functions.

Types of Dosage Forms Syrups Elixirs Suspensions Emulsions Capsules Tablets Creams Ointments Suppositories Aerosols Parenteral

Introduction to Drug DosagePrescription

comes from the Latin "praescriptus" compounded from "prae", before + scribere, to write = to write before.

Historically, a prescription was written before the drug was prepared and administered.

Parts of a prescription The superscription (or heading) with the symbol R or Rx

which stands for the word Recipe, meaning (in Latin) to take;

The Rx The inscription which contains the names and quantities of

the ingredients; The subscription or directions for compounding the drug

The signature which is often preceded by the sign s. standing for signa, mark, giving the directions to be marked on the container.

Administration of MedicationsRoute of administration

the path by which a drug, fluid, poison or other substance is brought into contact with the body.

Mode of drug administration affects the rate at which onset of action occurs and may affect the therapeutic response that results

crucial in determining the suitability of a drug Enteral - drug administered along any portion of GI tract

Sublingual, Oral, Buccal, Rectal, Nasogastric Parenteral - any med route other than alimentary canal

IV, IM, ID, SQ, Instillation, Inhalation, Topical, Transdermal,

Drug Action biochemical physiological mechanisms by which the

chemical produces a response in living organisms Three Phases of Action

First Pass Effect Drugs given orally and absorbed from GI tract Carried to the liver Extensively metabolized Only part of the dose reaches systemic circulation for

distribution Bioavailability -%of drug that reaches systemic circulation First pass/hepatic first pass

Enter liver first Coumadin Morphine Lidocaine Some NTGs

Drug Effects Therapeutic effects (primary) Side effects (secondary) Adverse effects (secondary) Toxic effects (secondary) Desired effect

Therapeutic effect-example Adverse effect / Side effect

Harmful, undesirable response Mild reactions to debilitating disease that can

become chronic Dose related or patient sensitivity Drug allergy - patient’s immune system identifies a drug as

dangerous to the body….must be destroyed or neutralized-mild itching to life threatening

Adverse drug reactions

any noxious unintended and undesired effects of a drug that occur at doses used for prevention, diagnosis or treatment.

ADR Type “A” reactions AUGMENTED Predictable, common and related to pharmacological

action of the drug ex. Side effects, secondary effects, drug interaction

Type “B” reactions BIZAARE Unpredictable, uncommon, usually not related to the

pharmacological actions of the drug. ex. Idiosyncratic reaction, pseudoallergenic, hypersensitivity

Type “C” reactions CONTINUOUS associated with long-term drug therapy e.g.

Benzodiazepine dependence and Analgesic nephropathy. are well known and can be anticipated.

Type “D” reactions DELAYED refer to carcinogenic and teratogenic effects. are delayed in onset and are very rare since extensive

mutagenicity and carcinogenicity studies are done before drug is licensed.

Type “E” reactions ENDING OF USE Withdrawal syndromes

Alcohol (delirium tremens) Barbiturates (restlessness, mental

confusion, convulsions Opioids (narcotic withdrawal)

Type “F” reactions FAILURE OF EFFICACY Result of imperfect or counterfeit manufacture of the

product. Examples of failed efficacy:

Failure to control infection Uncontrolled HPN Intractable pain

Idiosyncratic responseSomething out of the ordinary

– Sensitivity related adverse reactions….– Specific to the individual patient– Sometimes has genetic cause– They don’ t know

Idiosyncratic Reactions vs. Allergic Reactions

idiosyncratic reaction--an uncharacteristic, non-immunological response to a drug that is not related to its pharmacological actions

“allergic” or “hypersensitivity reaction”--immunologically mediated

Toxic Reactions

--Occur in response to high dose or long-term use but may occur with normal doses if drug elimination is impaired. --May cause organ dysfunction, blood disorders (physiological toxicity) or behavioral changes (behavioral toxicity).Toxicity vs. Carcinogenicity

Toxicity--something that will make you sick, either right away or later.

Carcinogencity--will cause cancer, which maybe the results of being exposed to something toxic.

Allergic Reactions vs. Non-allergic drug reactions In a drug allergy, your immune system mistakes a

medication for a disease-causing agent. Nonallergic drug reactions have a wide variety of causes,

including the drug's intended mechanism of action. Allergic Reactions

Indicated by skin reactions ranging from mild rashes to flaming red patches of hives.

More severe reactions cause facial swelling, shortness of breath or dizziness.

Anaphylaxis (rare)--an extremely severe allergic reaction in which blood pressure may fall rapidly and the throat may rapidly swell shut, cutting off the airway.

Hypersensitivity allergic response to a drug after it has been used more

than once May cause rash, swelling, fever, or, in the worst cases,

anaphylactic shock (hypotension, bronchospasm, blocking or airways).

Carcinogencity study to determine the propensity of a drug to produce or

exacerbate tumors or cancer cells in humans or animals Teratogenicity

study to determine whether a drug can cause physical defects in a developing embryo.

Common or Serious Side Effects CNS effects Gastrointestinal effects Hematological effects Hepatotoxicity Nephrotoxicity Allergic or hypersensitivity reaction Drug fever Idiosyncratic reaction Carcinogenicity Teratogenicity Drug dependence Drug tolerance

Sources of Drug Information Pharmacology textbook Pharmacists Internet sources Journal articles Drug reference books

TRADITIONAL AND ALTERNATIVE MEDICINETraditional medicine/TM

refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.

• The term describes medical knowledge systems, which developed over centuries within various societies before the era of modern medicine

Traditional medicines: Herbal medicine Ayurvedic medicine Unani medicine Acupuncture Traditional Chinese medicine

Herbal Medicine folk and traditional medicinal practice based on the use of

plants and plant extracts. Traditional Medicine

A SHAMAN decorates himself and performs a special dance to cast out the evil spirits that make people ill

General Overview of Herbal Medicine History

The practice has existed since prehistoric times and flourishes today as the primary form of medicine for perhaps as much as 80% of the world's population.

Types Herbal teas Herbal tinctures Fluid extracts Solid extracts Powdered herbs and tablets Herbal ointments Essential oils Herbal supplements

Filipino Practice of Herbal Medicine The curative effects of the herbs were tested by

traditional healers on their patient on try-and-error basis.

The rural folks and the poor continued to rely on herbal medicines available in abundance, locally.

Ayurveda Ayurvedic medicine is a practice in use primarily in the

Indian subcontinent, which advocates argue assists with health and healing. A person is seen as a unique individual made up of 5 primary elements

Air, fire, water, ether, and earth Ether and air = Vata dosha Fire and water = Pitta dosha Water and earth = Kapha

dosha The word "Ayurveda" is a tatpurusha compound of āyus

"long life" and veda "knowledge", and roughly translates as the "Science of a long life"

Unani They considered something to be fire, water, earth and air

in the human body

Unani medicine is very close to Ayurveda. The base used in Unani medicine is often honey.

Background of Unani Medicine According to followers of Unani medicine, these elements

(fire, water, earth, air) are present in different fluids and their balance leads to health and their imbalance leads to illness.

Acupuncture is a technique of inserting and manipulating needles into

"acupuncture points" on the body. Background Of Acupuncture

(from Lat. acus, "needle" (noun), and pungere, "prick" (verb)

According to acupunctural teachings this will restore health and well-being, and is particularly good at treating pain.

Chinese Medicine a form of Oriental medicine, which includes other

traditional East Asian medical systems such as traditional Japanese and Korean medicine.

These practices include herbal medicine, acupuncture, and massage

Advantage of traditional medicine• it’s affordable• it’s abundant• easier to prepare• recovery process beyond the management of emotional

and cognitive impairment by also enhancing social interaction, spirituality, and self-functioning

• easy access or handyDisadvantage of traditional medicine

the amount of medication is not accurate there are other substance present in the

medication which you don’t needthere is more adverse/side effectthey work more slowly than the more

aggressive pharmaceutical and surgical medicine

there is undesirable taste can cause allergies some can cause infection can be the cause of instant death

WHO efforts in promoting safe, effective and affordable traditional medicineWorld Health Organization

WHO defines Traditional Medicine as "the medicine that refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being".

World Health Organization launched its first ever comprehensive traditional medicine strategy in 2002The strategy is designed to assist countries to:

Develop national policies on the evaluation and regulation of TM/CAM practices.

Create a stronger evidence base on the safety, efficacy and quality of the TAM/CAM products and practices;

Ensure availability and affordability of TM/CAM including essential herbal medicines;

Promote therapeutically sound use of TM/CAM by providers and consumers.

Document traditional medicines and remedies. Standards and quality control

The legal status of herbal ingredients varies by country. For example, Ayurvedic herbal products may contain levels of heavy metals that are considered unsafe in the U.S.,but heavy metals are considered therapeutic in Ayurvedic medicine.

What is Alternative Medicine? Alternative medicine is a broad term that refers to any

type of treatment that is not yet accepted as customary. Alternative medicine practices are used instead of

standard medical treatments. Alternative medicine broadly describes methods and

practices used in place of conventional medical treatments.

It may also be described as "diagnosis, treatment, or therapy which can be provided legally by persons who are not licensed to diagnose and treat illness"

Contemporary uses of alternative medicines. acupuncture, aromatherapy, Ayurveda (Ayurvedic medicine), biofeedback, chiropractic medicine, herbalism holistic nursing, homeopathy, hypnosis, massage therapy, meditation, naturopathy, osteopathic manipulative therapy (OMT), reflexology, Reiki, spiritual healing, Tai Chi, traditional Chinese Medicine (TCM), and yoga.

Aromatherapy Essential oils form the basis of aromatherapy Extracted by means of steam distillation, cold expression,

or fixed oil or alcohol extraction Oils can be inhaled, massaged onto the body, added to the

bath or shower, or sprayed in the room. Most of the oils have antiseptic, antiviral, anti-

inflammatory, pain relieving, anti-depressant and expectorant property

Chiropractic The word chiropractic came from the Greek word Cheiro

(hand) and prakrikos (done by hand).

The chiropractor manipulates the backbone with his hands to bring back into alignment the vertebrae that are misaligned or misplaced

Homeopathy Is based on the principle that substances that are

poisonous in large doses can be very beneficial in small doses

The name homeopathy comes from the Greek word “homios” which means “like” and the word “pathos” meaning “suffering”

Examples: bee sting, snake venoms, arsenic, gold and silicaMessage Therapy

Is one of the oldest, simplest forms of therapy and is a system of stroking, pressing and kneading different areas of the body to relieve pain, relax, stimulate, and tone the body.

Osteopathy An osteopath treats a patient’s head and neck using gentle

twisting and turning movementsNaturopathy

Is based on the belief that the body is self-healing. The body will repair itself and recover from illness spontaneously if it is a healthy environment.

Naturopaths treat illnesses and ailments with special diets, fasting, hydrotherapy, and vitamins and herbs.

They advocate the “ounce of prevention” way of life.Reflexology

Is based on the principle that there are reflexes in the feet and hands which correspond to every part of the body.

By stimulating or applying pressure to the feet or hands, circulation is increased and specific bodily and muscular function are promoted.

Shiatsu Is a Japanese word made up of two written characters

meaning finger (shi) and pressure (atsu). The application of pressure is the underlying principle of

shiatsu. The practitioners use fingers and thumb for applying

pressure precisely at localized points Shiatsu also involves gentle stretch and manipulation

techniques Is a Japanese word for “finger pressure,” although shiatsu

therapist also use their feet, elbows, and knees to apply pressure

Yoga Is a set of physical practices that include stretches,

breathing practices, and progressive deep relaxation The main concern is the interaction of body and mind. Yoga therapy employs asanas (posture), pranayama

(breathing exercise) and meditation and /or visualization Herbal Medicines

Is a complementary therapy that uses plants or plant extracts to treat illness.

Herbal practitioners believe that delicate chemicals balance of the whole herb is needed for greater effect and to reduce potential side effects.

Different parts of plants can have very different actions.

Healing works by positive energy instead of positive thinking This is called the “laying on of hands” or touching, to

channel energy into the patientHypnotherapy

Works on the level of the subconscious, where humans hold many thoughts of which they are not aware

Is widely used to treat people with emotional problems

10 Medicinal Plants – DOH SAMBONGScientific name : Blumea balsamifera (L.) DCFamily: Compositae Indication:

Edema, DiureticAnti-urolithiasis

AKAPULKOScientific name:

Cassia alata L.Family: Leguminosae Indication:

Ringworm and other fungal infections of the skin NIYUG-NIYOGANScientific name : Quisqualis indica L.Family: Combretaceae Indication:

Intestinal worms (Ascaris and Trichina) TSAANG-GUBATScientific name:

Ehretia microphylla Lam.Family: Boraginaceae Indication:

Intestinal motility AMPALAYAScientific name : Momordica charantia Family: Cucurbitaceae Indication:

Diabetes mellitus (mild non-insulin dependent) LAGUNDIScientific name:

Vitex negundo L.Family: Verbenaceae Indication:

Anti-coughAnti-asthma

ULASIMANG BATOScientific name :

Peperomia pellucida Family: Piperaceae Indication:

Anti-hyperuricemia (Arthritis and Gout) BAYABASScientific name:

Psidium guajava L.Family: Myrtaceae Indication:

Antiseptic for wounds

Mouthwash (for infection due to swollen gums and tooth decay) BAWANGScientific name :

Allium sativum Family: Liliaceae Indication:

Reduces blood cholesterol YERBA BUENAScientific name:

Mentha x cordifolia Family:

Labiatae Indication:

Body pain/ache

Complementary medicine describes practices used in conjunction and cooperation

with conventional medicine, to assist the existing process.

Complementary and alternative medicine (CAM) umbrella term for both branches. CAM includes practices

that incorporate spiritual, metaphysical, or religious underpinnings; non-European medical traditions, or newly developed approaches to healing.

Support for alternative medicine Advocates of alternative medicine hold that alternative

therapies often provide the public with services not available from conventional medicine.

This argument covers a range of areas: Patient Empowerment Methods of Pain Management Tretment that supports the Biopsychosocial Model of

health, Stress reduction services Palliative CareDIFFERENCES BETWEEN TRADITIONALAND ALTERNATIVE MEDICINE TO WESTERN MEDICINETRADITIONAL MEDICINE• plant, animal, and mineral based medicine• spiritual therapy, manual techniques and exercises• has scientific evidence• safer and more effective• patient- healer relationship• allopathic or Western MedicineALTERNATVE MEDICINE• Temporary aids• mind, body, and spirit of the human being as

composing one single system• physiological and psychological• lack of proper testing• less research• less safe and less effective• dangerous side effectsDIFFERENCES BETWEEN TRADITIONAL & ALTERNATIVE MEDICINE TO WESTERN MEDICINEWESTERN MEDICINE

• Modern medicine• Symptom-based medicine• Technology-based (drug and surgery oriented)• usually used when someone is in life threatening accident• formal system to deliver its services• patient-doctor relationship