home-based care management

8/6/2019 Home-based Care Management

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HOME-BASED CAREMANAGEMENTCourse description:

Describe and demonstrate theprinciples in homemanagement,housekeeping skills and techniques,the use of common householdgadgets, appliances and equipment,basic household budgeting skills;

beginning principles in home


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COURSE OBJECTIVES:

The students will be able to :

1. Provide transitional and continuing care to thechildren and elderly with

with special needs in the home. 2. Demonstrate housekeeping tasks 3. Promote an adequate and appropriate nutrition 4. Facilitate leisure and entertainment 5. Promote a safe, secure, well-managed and

comfortable environment 6. Apply first-aid measures to common injuries at home 7. Maintain professionalism at the workplace


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Definition of terms: Home Management Organization

Transitional Care Homemaker Hospice care

Scope of Home Based Care Management Traditional homes Hotels and inns Offices Rented houses or chartered houses


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Assisted living homes Skilled nursing facility Temporary shelter Orphanages of asylums

Objectives of Home Based Care management Roles of Health Care Professionals in Home

Based Care Management Importance of Home Management


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FACTORS AFFECTING PERFORMANCE OF TASKS

v CULTURAL BELIEFS AND PRACTICESv

The cultural practices of some countries or regions affect theperformance of some household tasks . Some of these are:

*Sweeping at night is bad luck

*Young ladies are not supposed to sing while cookingbecause they will

marry old men.

* If you cry while cutting onions , you will never bein good terms with

your in-laws.

* You should bite a pin or a matchstick when slicingbitter gourd to remove its bitter taste when cooked

vAVAILABLE RESOURCES. In mostsettin s, not all standard cleanin materials,


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v Weather and Climate Conditions

Shoveling the snow during winter is a major task.Mopping during the rainy season is also a major taskespecially in countries with only two weather conditions,like the wet and dry season in the Philippines.

v Geographical Location Food storage, menu planning and food purchasing will

surely be affected by geographical location. Ice cream, fish,meat and poultry products must be frozen if the grocery orthe market place is too far away from the home based carefacility.

v Frequency of tasks

Monthly chores ---Paying monthly bills, water lights,telephone, cable, ren

tal, etc.


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Recording of expenses and receipts for

payments

vWeekly chores

- Laundry ( sorting dirty clothes, washingand drying, folding and pressing)

- Car washing

- Gardening

- Shopping for grocery supplies

vDaily chores

Cleaning and dusting rooms such asliving, dining, bedroom, kitchen, familyroom, bathroom, laundry room, etc.

Cooking meals and snacks

Menu planning Marketing

Food preparation and cooking

Setting tables and doing after care ofutensils, chinaware, silverwares,etc.


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v Seasonal chores ( winter, spring, summer, and fall ) Chores done during summer

1. Harvesting vegetables and fruits 2. Cleaning and using air conditioning or room coolers 3. Storing and preparing winter clothes and beddings 4. Use of thinner clothes and blankets 5. Assisting and sun bathing 6. Broiling, grilling, or barbecuing outside the house 7. Escorting clients to picnics, hunting and parties 8. Accompanying clients to malls ( eating, strolling,

shopping) 9. Accompanying clients in outdoor games or recreation

Chores during spring

Characterized by a gradual decline in the temperature-snow melts and plants start to grow; birds which migrate towarmer places are now coming back. People will be busyoutside in their yards doing the following:


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1. Collecting dried leaves and branches of trees left on theground before winter and disposing them.

2. Trimming plants and trees affected by winter

3. Preparing the garden for gardening of vegetables and flowers,plants, and fruits 4. Actual planting and tending of the garden 5. Cleaning the garage, disposing of discardable things that

accumulated for the past year. 6. This is the best time to plant fruits and harvest early produce

Chores during fall

1. Raking and disposing of falling leaves 2. Trimming plants 3. Covering some plants to protect them from frost 4. Preparing for winter like shopping for winter clothes, buying

water softener, checking home heaters, chimney and fireplaces 5. Winterizing of tires of cars, vans and trucks.

Chores during winter

1 .Checking insulation of homes 2. Use of thermal blankets, warm sheets and pillow cases


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3. Protecting plants from frost by using blankets, hay,

bark of trees, or foam cover. 4. Some plants need to be kept inside the house 5. Use boots and winter jackets when going out 6. Maintaining faucets and pipelines to avoid frost 7. Operating room and water heaters

COMMON TASKS OR CHORES DONE BY THE CAREGIVEROR HOMEMAKER IN

THE HOME

Demonstrate procedures in the classroom or skills labwhen necessary

Cleaning Appliances - Blender/osterizer - Range or stove - Washing machine

- Microwave/oven - Dryer -


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Cleaning and Dusting Rooms including walls, floors,windows ,furnitures

bedroom, living room, dining room, kitchen, laundryroom, carpet cleaning, vacuuming, mopping, care od blindsand curtains

Laundry. operating the w)ashingmachine and dryer,use of detergents, sorting clothes, handwashing clothes

Bed making open bed, closed bed, occupied bed

Gardening. Tools used to prepare soil, garden soil,potting mixed soil, fertilizer

Cooking.. Menu planning ( breakfast, lunch, dinner,

and snacks)


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Setting tablesplacemats, plates, silverwares, tablenapkins

COMMON TASKS OF A HOMEMAKERA familys human resources are its members. Managing human

resources involves the productive and satisfying use of themembers of achieving the familys dreams, goals andobjectives.

* Financial Management Career professional homemakers maintain the

household budget, pay bills ,handle banking responsibilities,tax fillings and other financial matters.

They shop/purchase food and other household needs.

Planning and organizing

Career professional homemakers effectively plan thethings to be achieved

in the home. They anticipate important or critical events,identify resource requirements, and assign responsibility forspecific work, including deadlines and performanceexpectations.


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v SCOPE OF HOUSEKEEPING MAINTENANCE

v * Client room maintenance covers tasks like : - Maintaining cleanliness and orderliness - Furnishing the room wuth the necessary amenities and supplies - Attending to service requests of clients / guests - Keeping the area free of safety hazards

* Maintenance of public areas include the following; - Maintaining cleanliness and orderliness in all public areas - Maintaining the upkeep of the surroundings of the building by

keeping it clean and free of liters - Keeping the public areas free of safety hazards - Undertaking minor repair like busted bulbs, broken furnitures, etc

* Providing linen laundry service: - Collecting and delivering laundry items - Washing, drying, ironing guest laundry, as well as linens used in

banquet functions, food service, and guestrooms - Mending services


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v Installation, cleaning, and maintenance of facilities likefurniture and appliances.

v Provision of special services like providing turn-down service( preparing the bed for use of the client), adding of water

pitcher and drinking glass near the bed of the client, butterservice for the guests, etc

STANDARDS OF IDEAL HOUSEKEEPING

Cleanliness All areas are immaculately clean- corner to corner, from

top to bottom, including surfaces, Closets, cabinets andstorage areas are also kept clean. Furniture and fixtures areproperly dusted ; doorknobs and metal fixtures are polishedwith the right polishing chemical. Windows and glass panelsare dusted and polished. Floors are vacuumed, polished. Orshampooed when necessary .Grounds are free of liters and dirt.

Orderliness Facilities and fixtures are properly arranged and

installed in appropriate location. Room amenities are properlyinstalled in appropriate location. Beds are made up properly;Lines are neatly folded, mitered, and wrinkle free.


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Sanitation The whole area is free from all sources of bacterial

contamination such as undisposed garbage and left over-food, stagnant water, etc.

Guests room Rooms are well ventilated and lighted. Guests are

not disturbed by noise and other forms of distractions .There are sufficient amenities for the comfort of guests likelinen, toiletries, drinking glass, etc.

Eye Appeal Ambience is soothing to the eyes , not dim or

dull . There is suitable Interior design and proper blending of colors. No

eyesore can be Found in guest- contact areas.


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Guests Relations

Requests and concerns of guests are given prompt andproper attention. Staff exhibits warm and pleasantdisposition in dealing with guests, Customer feedback issolicited to determine customer satisfaction and thesefeedbacks are evaluated for corrective action. There isaccurate and appropriate response to guest inquiries..

Guests with special problems, like those who are ill aregiven necessary assistance and support


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Safety The rooms and public areas are free from any safety

hazards like open electrical outlet, dangling wires, damaged

tiles, slippery floors, etc.. Building is provided with allrequired safety facilities. Safety instructions in all roomsare available. The institution is prepared for any emergencythat may arise. The staff are trained on emergencyprocedures. Trained roving guards are available to checkmovements in guestrooms and to ensure protection ofguests.

Material control and Preventive Maintenance There is designated budget for supplies and materials.

Consumptions of supplies is always monitored. Regularrequisitions and par stock is maintained and monitored.Supplies and materials consumed are within the budget.Losses, damages and breakdowns are reported,documented and accounted for. There is regular inventorysupplies and materials. Staff are trained on the proper use

and maintenance of equipment.


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CLEANING EQUIPMENT AND

PROCEDURES


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CLEANING EQUIPMENT ANDPROCEDURES

EQUIPMENT PROPER USE ANDMAINTENANCEVacuum cleaner It is used to eliminate loose soiland dust particles from carpetsurfaces, upholstered furniture,

and even hard surfaces.Dust bags must be emptied dailyAfter using, roll back the wireneatly on the back of the vacuumcleaner. Place it on one end of

the trolley.

Floor polisher To be used in scrubbing,stripping and polishing hard floor

surfaces and also vinyl, wood,parquet, etc.Use the appropriate pad forscrubbing, stripping, and

polishing

Give the wax on the floor enoughtime to dry before polishing.

Carpet sweeper Used to pick up dirt and particles

from the carpet.Press the handles and pushtowards the dirt to vacuumsweep the carpet


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HOUSEKEEPING TASKS AND CLEANINGSTANDARDS

According to Bill Saunders and Rick Mazzoli of Glit Inc.,floor care is a 4 step process. The process begins with

foundation and stripping . Floor finishes are not permanentfixtures. Floors must be stripped of their old finish for thefollowing reasons:

1. There is a breakdown in the floor surface indicatedby a worn away finish and the bare floor is exposed.

2. Show presence of a wet look or shadowy areas,usually blamed on burnishing without mopping it first, which

results in a shiny dirt appearance. 3. There is staining from spills or from cleaning

solutions. 4. A noticeable flaking or chipping of the surface of the

floors

Floor Cleaning Process * Stripping


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*Sealing Smoothens rough surfaces , scratches and other

types of floor abuse , thus enhancing the floorsappearance. Floor abuse is the presence ofspots and stains on floors due to floor spills,

excessive burnishing without mopping, andimproper movement of furniture leading toscratches or sharp wheels of carts and trolleys,and other equipments.

*Finishing Prolongs the life of floors. Coat is applied on

the floor to make it appear glossy andappealing to the eyes.

*Maintaining The floor must be retouched and rebuffed to

remove embedded dirt and heel marks. Use of


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Floor Care, Cleaning and Maintenance

Floor in good condition should be well keptand well maintained .Proper maintenance is doneaccording to the type of floor and these arefollows:

TYPES OF FLOORS DAILYMAINTENANCE

Hard Floors

. Marble and cemented Sweeping daily Damp mopping-as needed

Plain polishing daily Stripping and finishing-periodical . Mixed:Pebbles,crazy cut Brushing with a push

brush Wet mo in


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*FLOOR CLEANING AND MAINTENANCE

KINDS OF FLOOR CLEANING EQUIPMENT NEEDED

Sweeping-removing dirt and Soft broom for finesurfaces trash from floors using like cemented floors, vinyl. Sweepers and dust pan Stick broom for hard

surfaces

like grounds Carpet sweepers

for carpets


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*Dust mopping dusting away dirt on floors using mops ( drymop with handle)

*Damp mopping mopping the floor with lightly wet mop toclean the floor of dirt and soil. Mop must be squeezed tightlyon the wringer to prevent dripping ( mop with handle andwringer)

* Spray buffing Spraying the floor with a buff finish to retouchit and to keep the gloss. (sprayer, buff finish, steel wool, nylonpads)

* Plain polishing retouching the shine of floors by polishingwith a polisher. The floor does not need to undergo strippingand sealing ( floor polisher, for manual polishing use abaca

foot pad or coconut husk)*Floor stripping requires application of stripping solution(Finishing solution, mop with handle, mop with wringer)

* Finishing floors- performed on floors that are stripped of oldwax and dirt and sealed for protection. The finishing isaccomplished through the application of wax or floor shine andpolishing thereafter using a floor polisher (paste/liquid wax,

floor polisher


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KINDS OF FLOOR CLEANING AND EQUIPMENTNEEDED

Extraction - is the process of extracting deeply embedded

dirt and soil in carpets especially those in inner layers thatcould be removed by shampooing ( carpet extractor)

Shampooing removal of embedded dirt and stains usingcarpet shampoo either manually or by the use of amachine. The process applies to carpets ( push brush,

carpet shampoo, pail of water)Vacuuming elimination of embedded dirt on floors using a

vacuum cleaner ( ordinary vacuum cleaner or Hydro-vac ( wet and

dry vacuum for wet and dry surfaces


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*CLEANING AND MAINTENANCE OF RESILIENT FLOORS * Types of resilient floors and their maintenance . Linoleum . Vinyl . Asphalt tile . Rubber tileNew resilient floor should not be waxed immediately after

installation. It should be thoroughly scrubbed first before theinitial polishing.

For the care or resilient floors, an emulsion wax is recommended.

Steps: . Sweep the floor to remove dust . Pour small quantity of emulsion wax on the floor and

spread evenly with a clean cloth. . Let it dry depending upon recommendation of the

emulsion wax used . Use coconut husk, abaca footpad or floor polisher to

make the floor shine


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To prevent damage while removing chewing gum, candle wax,etc. from resilient floors , use an ice cube in a plastic bag andplace it on the spot /area to harden the gum and then scrapethe dirt with a hard edge tool. Clean by rubbing with fine steelwool or nylon dipped in detergent solution. Rinse, let dry, andapply emulsion polish.

To remove black heel marks , rub the marks with fine steel woolor nylon dipped in an emulsion wax. Rub the area gently thenbuff. Spread the new wax over the cleaned area, blendingedges and let dry.

Excessive use of water or harsh cleaners causes tile to loosen.Replace loose tiles immediately. To prevent recurrence. Use amild cleaner and avoid flooding the floor with water whencleaning.

Care and maintenance of hard floors Hard Floors a type of floor that could easily be broken,

scratched, or dulled

Types of Hard floors * Marble comes from quarries in Rizal, Mindoro,

bulacan, and Romblom


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*Mixes comes in granolithic, terrazzo, ceramic, and tile, terracotta brick, and concrete and pebble wash out

1. Terrazzo and granolithic have basically the same

composition. Made out of white marble chips and white cementthat is compressed and thick slab ground that is polished to avery smooth finish.

2. Ceramic tile baked clay, unglazed or high glazed. 3. Terra cotta hard baked clay reddish or red -yello in

color

4. Concrete mixture of sand and cement with gravel,broken stone 5. Pebble washout mixture of river stones and cementCare of Hard Floors 1. Protect from scratches, water-borne stains, dirt and

discoloration 2. Spillage should be avoided 3. Sealer or a thick liquid wax should be used to prevent

discoloration Wooden and Parquet FloorsInitial Care * Have the floor properly sanded

* Clean using vacuum cleaner * Fill or steal it three coats of sealer then buff between


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Daily

.Buff with heavy powered machine to bring out its gloss

.Apply second coat of wax and then buff again

.Use wax treated dust mop which should be changed often

.Damp mop ( only if necessary ) with just a little amount ofmoisture

Periodically

.Buff floor with a steel wool or nylon pads

. Spot clean with damp mop and diluted solution of detergent

. Rebuff. Apply light coat of wax if needed .When spill occurs on wooden floors wipe them immediately

with a damp cloth or sponge.

. Sometimes while spots may appear on wooden floors afterwaxing, remove them by pouring a little amount of wax on them thenrub gently with fine steel when wax have hardened.

.


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. Work with the grain whenever possible whenapplying liquid/pastel wax

. Buffing waxes need not be applied everyday asthese waxes give floors long lasting protection

. Apply waxes in areas located near entrances andexits since these are the areas that are often subjected

to wearing out and becoming dull . Stubborn spots on wooden floors maybe removed

during waxing . Alkaline stains on wooden floors appear when

sudsy cleaning solutions are spilled and allowed to dry. To

eliminate these dark spots the following steps maybedone: 1. Remove all wax with naphtha or kerosene 2. Thoroughly wash area with vinegar 3. Wipe dry with a clean cloth


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REMOVING SPOTS ON CARPETS SOURCE OF SPOTS OR STAINS SOLUTION

Sugar and starch Wipe spot with a cloth or sponge.Rinse with clean water. Use dry cleaning fluid orpowder cleaner. Use dry cleaning fluid or absorbent powdercleaner.

Milk Sponge with solution of water and detergent,then with clean water.

Ink If spot is caused by washable ink, usedamp absorbent cloth. It it comes from a ballpoint mark,

use dry cleaning fluid.


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Pet spots Sponge urine spots thoroughly with clean water then dry quickly. Repeat until discoloration

disappears.Wax If the wax has dried ,use stiff bristle brush to

remove soiled matter. Spots from self polishing floor waxshould be cleaned with warm water

and detergent.

Cigarette burns If burns appear on the surface ofthe rug, use a sharp scissor to snip away the blackenedends of tuft. Sponge with a solution of wax, detergent, andsponge again with clean water.or consult a professional

carpet service


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Cleaning Standards for Floors. Floor Finishing

Floor finishes are not allowed to build up in corners,baseboards or underneath furniture. Stripping and removing ofold floor finish is done to avoid yellowing and build up incorners, baseboards, or underneath furniture.

.Mopping Water is used sparingly. Cleaning solutions are rinsed

quickly and the floor is dried at once. Sweeping All swept floor do not have dust streaks nor does show

mark where dirt was picked up . Vacuuming All carpeted areas or upholsteries are kept clean, free

of dust and spots which are immediately removed upondiscovery.

Floor Cleaning Swept or vacuumed carpet is shampooed as necessary.

Floor should be free from obstructions. All floors after athorough stripping and scrubbing are applied with a thin andsmooth wax to have an even finish


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BED MAKING, LAUNDRY, AND SETTING TABLES

Bedmaking is defined as the process of applying or changing bed

linens. The main objective for this is for the students to learnhow to make apprppriate beds for clients.

A wrinkle free bed that remains intact when the client movesaround does a great deal for physical and psychologicalcomfort.

* Principles Observed during bed making . Asepsis - clean to clean, sterile to sterile . Hand washing before bedmaking Proper handwashing removes many of the

microorganisms that would be transferred by the hands

from one item to another. .Handle line carefully Microorganism move through space via air

currents. Because of this movement , avoid shaking or tossing the linen,

thus creating air currents on which microorganisms may be

transferred.


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.Both dirty and clean linen should be held awayfrom the uniform

Microorganism are transferred from one surfaceto another whenever one object touches another

* Application of Good Body Mechanics in Bed Making . When you must bend , bend with your knees not your

back . Point your toes and face in the direction that you are

moving. Avoid twisting . Make as few trips around the bed as possible. . Raise the bed to an appropriate height level (waist level)

for your maximum working comfort.

* Types of Bed . Open Bed the bed making process when the occupant

or when the client is up and is able to leave the bed while the bed

is being made.Also the type of bed made for admitting a client


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* Occupied bed the bed making process in which the bed is

made while the cllient is occupying it.

Procedure: . Gather linen to be used and place in order of use . Explain procedure to the client . Place a chair at the foot of the bed. Remove one pillow from

the bed and remove the pillowcase and place it over the back of thechair ( the pillow case will serve as the laundry hamper for the

soiled/dirty linens ) Place pillow on the chair. .Raise one side rail . Move client to the far side of the bed ,making sure that

pillow is moved with him. If possible the client should be on his side ,facing away from you.

. Loosen all tucked linens from the mattress cover to the top

sheet, this includes the underpad or rubber sheet. . Fanfold the linens toward the center of the bed , with the last

fold toward the back of the client and tucked under the clients back orbottom.

. Place the bottom sheet on the bed. . Tuck the sheet under the top, miter the corner, and tuck it

along the far side of the mattress to the foot of the bed.


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.Fanfold the other half of the sheet toward the center ofthe bed.

. Place the new rubber draw sheet and cotton draw sheet.Tuck them under the mattress. Fanfold the other half towardcenter of the bed, tucking it under the clients back and buttocks.

. Assist client to turn to the side of the bed that is alreadymade.Loosen all tucked linens on this side of the bed. Remove thesoiled linens.

. Place it in the pillow case, which serves as laundryhamper.

. Straighten, pull, and tuck the bottom sheet. . Pull and tuck the rubber and cotton draw sheet snugly

and smoothly.

. Help the client to move in the center of the bed in acomfortable position.

. Place the new top sheet over the soiled one . Remove thesoiled sheet,

instructing the client to hold the new one as you pull thesoiled sheet from the top to bottom. Place soiled linen in a laundry

bag.


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* Unoccupied Bed/Close Bed a bed prepared for the receptionof a newly admitted client.

Procedure . Gather the linen to be used and place it in order of use. . Place bottom sheet on the bed centerfold ( right side

uppermost


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CARE OF CHILDREN WITH SPECIAL NEEDS

Newborn Screening (NBS): A procedure to determine a newborn infant has a heritable

congenital metabolic disorder that may lead to serious physicalhealth complications, mental retardation and even , and even deathif left undetected and untreated. Under the NBS, the newborn is achild from the time of complete delivery to 30 days old.

Objectives of NBS

1. To ensure that every newborn has access to newbornscreening for certain heritable conditions that can result in mentalretardation, serious health complications or death if left undetectedand untreated.

2.To establish and integrate a sustainable newbornscreening system within the public health delivery system.


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3. To ensure that all health practitioners are aware ofthe advantages of newborn screening and of their respectiveresponsibilities in offering newborns the opportunity to undergo

newborn screening

4. To ensure that parents recognize their responsibilityin promoting their childs right to health and full development ,within the context of responsible parenthood, by protecting theirchild from preventable causes of disability and death through

newborn screening.

LEGAL BASIS: Newborn Screening Act of 2004 ( R.A. 9288)enacted in order to:

1. protect rights of children and full and healthy developmentas normal individuals


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2. provide for a comprehensive, integrative and sustainable

newborn screening system to ensure that every baby born in thePhilippines is offered the opportunity to undergo newborn screeningand be spared from heritable conditions.

PERFORMANCE OF NEWBORN SCREENING ( R.A. 9288) 1. Performed after 24 hours of life but not later than three days

from complete delivery of the newborn; ideally done on the 48thhour

2. If done earlier than 24 hours, the baby must be screenedagain after two weeks for more accurate results

3.High-risk newborn in NICU maybe exempted from the 3 dayrequirement but must be tested by 7 days.

SCREENING PROCEDURE

1. Explanation of the procedure

2. Collection of blood s ecimen.


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. Done by the physician, medical technologist , or after

training by the nurse or midwife . Heel prick method to obtain few drops of capillary blood

from the babys heel and blot on a special absorbent filter paper . Drying time of blood: 4 hours . NBS fee: P550.; maximum allowable fee for specimen

collection: P50.

3. Send specimen to the Newborn Screening Laboratory( hospitals, lying-ins. RHU and health centers). For homedeliveries, babies maybe brought to the nearest institutionoffering newborn screening.

4. Follow up results. Results are available within seven tofourteen working days after the NBS screening samples aresubmitted to laboratory.

5. Follow institution policy on communication of results. . Negative screen: extremely low riskof having any of the

disorders being screened


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. Positive Screen : increased riskof having one of the

disorders being screened; refer immediately to the nearesthospital or specialist for confirmatory testing and management.

HERITABLE CONDITIONS:

1. Heritable Condition: any condition that can result in mentalretardation, physical deformity or death if left undetected anduntreated and is usually inherited from the genes of either

both or biological parents. Disorders tested in NBS: . Congenital Hypothyroidism: endocrine disorder also

referred to as cretinism or dwarfism; results from the absence orlack of development of thyroid gland causing absence or lack ofTHYROXINE, needed for metabolism and growth of the body andthe brain; is not detected and if hormone replacement is notinitiated within 4 weeks , the babys physical growth will bestunted he may suffer from irreversible mental retardation;treatment: oral hormone (SYNTHROID, PROLOID ) replacementtaken as a single morning dose for life.

.


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. Congenital Adrenal Hyperplasia (CAH): An endocrine disorder caused by an inborn defect in the

biosynthesis of adrenalCORTISOL that causes severe salt orsodium losses, dehydration and abnormally high levels of male sexhormones in both boys and girls; symptoms

begin shortly after birth: anorexia, progressive weight loss,vomiting, dehydration, disturbances in cardiac rate and rhythm,cyanosis and dyspnea; if not treated early babies may die within a

few weeks.; treatment : continued hormonal replacement ofHYDROCORTISONE.

. Phynelketonuria (PKU): Inborn error of metabolismcharacterized by lack of

enzyme PHENYLALANINE HYDROXYLASE needed to

breakdown phenylalanine > elevated serum phynelalanine >braindamage and mental retardation; later physical signs reflect theabsence of adequate melanin pigment: blond hair , fair skin andblue eyes; dietary treatment ---milk-free, phynelalanine-freeformula taken usually for 6-8 years, or until the brain is fullydeveloped.


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. Galactosemia (GAL)

Inborn error of metabolism: . Type 1: deficient GALACTOKINASE > inability to

convert galactose to glucose > galactosemia> galactosuria;complications: mental deficiency, cataract and death; dietarytreatment: galactose-free diet ( galactose: high in milk and milkproducts).

. Type 2: Classic galactosemia: serious deficiency of

URIDYL TRANSFERASE > early symptoms: jaundice, vomiting ,enlarged liver and spleen and hypoglycemia, convulsions andfeeding difficulties > complications: liver cirrhosis andirreversible mental retardation; dietary treatment: exclusion ofgalactose from the diet to prevent severe liver cirrhosis, mentalretardation, cataracts and recurrent hypoglycemia.

. Glucose-6-phosphate-dehydrogenase deficiency( G6PD ): deficiency in G6PD > red blood cells lack protectionfrom the harmful effects of oxidative substances found in drugs ,foods, beverage > severe anemia and hyperbilirubinemia >kernicterus ( jaundice of the brain ) and mental

retardation, convulsion, coma and even death.


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BREASTFEEDING Breastfeeding is the healthiest way to feed most newborn

babies buring the first 6 months , and along with other food ,

breast milk can be a major part of the childs for 2 years or more.

MATERNAL CONTRAINDICATIONS TO BREASTFEEDING 1. Life threatening conditions, such as severe cardiac disease,

cancer. Breastfeeding is incompatible with chemotherapeuticagents.

2. Severely debilitating disease/ condition as extensivesurgery

3. Acute, contagious diseases like hepatitis C virus in themother is a contraindication, but not Hepatitis B virus

4. Drug abuse, such as narcotic addiction . There is possibility

of the infant receiving substantial amount of the drug throughbreast milk.

5. Positive test for the HIV antibody to avoid postnataltransmission. HIV maternal infection to prevent prenataltransmission


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BREASTFEEDING BENEFITS TO THE MOTHER

1. Promotes maternal infant bonding, protective behaviors,psychosocial advantages as emotional satisfaction and increased

feeling of maternal well-being resulting from the increased serumlevel of oxytocin that coincides with more even mood responses

2. Promotes uterine contraction, thus prevents postpartumhemorrhage and speeds up involution.

3. Reduces rate of ovarian cancer and premenopausal breastcancer.

4. Decreases maternal morbidity and mortality.

5. Provides social and economic benefit


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6. Saves time, money and effort

7. Delays fertility

BREASTFEEDING BENEFITS TO THE INFANT

1. Promotes attachment 2. Provides the perfect food that contains all necessary

nutrients.

3. Causes fewer incidence of allergies, vomiting, diarrhea,constipation, and aspiration

4. Enhances brain development because of taurine content 5. Decreases infant morbidity and mortality


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PRIMARY NURSING CARE RELATED TO BREASTFEEDING

1. HEALTH EDUCATION: Teaching mother feeding techniques and care of the

breasts 2. DEMAND FEEDING 3. POSITION 4. ROOTING REFLEX STIMULATION BEFORE STARTING

5. ESTABLISH EYE TO EYE CONTACT IN FEEDING 6. BUBBLE OR BURP FREQUENTLY 7. KEEPING INFANT UPRIGHT FOR 30 MIN. MORE AFTER

FEEDING BEFORE PUTTING HIM DOWN IN RIGHT SIDE-LYINGPOSITION

8. CONTINUE ABSOLUTE BREASTFEEDING FEEING FOR4 TO 6 MONTHS; MAY EXTEND BREASTFEEDING UP TO 2TTO 2 YEARS

9. THE QUANTITY OF BREASTMILK INTAKE IS SIMILARTO THAT OF BOTTLE FEEDING INTAKE.


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FEEDING

1. Breastfeeding is the best infant feeding. Maintain rooming-in to promote breastfeeding.

2. Demand feeding is the best feeding schedule. This is fee


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COMMON AGING CHANGES AND ADAPTATION

CHANGES

SENSORY

Decreased pupil size

Narrowing of visual fields

Yellowing, opacity, rigidity of lens

Presbyopia ( farsightedness )

High-frequency hearing loss

Tone discrimination loss

Increased production of cerumen

Decreased elasticity of tympanicmembrane

INTEGUMENTARY

Epidermis thins and atrophies

Increased vascular fragility

Loss of subcutaneous fat

Decreased perception to touch, painetc.

Lower wound healing

ADAPTATION

Provide direct, adequate lightning

Avoid monochromatic color schemes

Provide educational materials in largeprint

Address safety concerns in theenvironment

Correct use of glasses and hearingaids

Lower the pitch of your voice

Face the patient at eye level

Check for and remove cerumen

impaction

Assess risk of pressure ulcers

Use appropriate pressure reductiondevices

Avoid the use of tape on fragile skin

Avoid frequent bathing; use emollients


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CARDIOVASCULAR

Decreased stroke volume and cardiacoutput

Decreased ability to increase heartrate in response to stress

Increased amount of collagen and fat

Thickening and rigidity of heart valves

RESPIRATORY Decreased elasticity and number of

alveoli

Decreased vital capacity

Decreased mobility of bony thorax

Weakening of respiratory muscles

Decreased ciliary action

GASTROINTESTINAL

Poor dentition

Decreased taste sensation andappetite

Decreased emptying time

Decreased gastric acid and hepaticenzyme

Increased incidence of malnutrition

Frequent small meals Avoid extremes and sudden changes

in temperatures

Provide frequent rest periods

Be aware of effect of fever, stress onlimited cardiac reserve

Schedule rest periods with activities Careful assessment of respiratory

status

Aggressive pulmonary toiletpostoperatively

Monitoring of pulse oximetry

Careful assessment of nutritionalstatus

Minimize dietary restrictions

Encouraged upright position formeals

Appropriate texture and consistencyof meals


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NEUROLOGIC

Decreased number of neurons Decreased size and weight of brain,

but dementia is not normal aging

Change in sleep pattern

Slower response to stimuli

Decreased sensation

Assess baseline cognitive function Teach in multiple, short sessions

Adjust care to avoid disturbing sleep

Use schedules and memory aids asneeded

Change positions frequently

home-based care management

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