“YEAR OF THE BICENTENARY OF PERU: 200

“YEARS OF INDEPENDENCE”

Faculty of Health Sciences

Professional Nursing School

TEACHER: Mgrt. Ana Cerdan Vargas

COURSE : Nursing care in child health

ISSUE : Comprehensive health care packages for children

STUDENTS: Nole Gutierrez Mirella

Ordoñez Juárez Ericka Yanina Sujey
Palacios Guzmán Luis Miguel
Quino Reyes Jhon Jesús
Santin Gutierrez Rocio
Vargas Nieves Rosa Merly

Sullana - 2021

The comprehensive child health care model seeks to address the health needs of the person,
family and community in a comprehensive manner. Its purpose is to provide quality health
care that responds to the health needs of children and increases their quality of life for the
sustainable development of the country.

The comprehensive health care model is a set of policies, components, systems, dimensions,
processes and instruments. Its objectives are:

• Improve the quality of services

• Increase citizen participation
• Meets health needs.

PRINCIPLES OF MAIS

• Integrity: ability to solve most health problems; for example, vaccination campaigns
against influence.
• Access university: have health systems that serve all citizens without distinction of
social class; for example, having basic services such as water and drainage

• Quality: user satisfaction; for example, that the patient is treated with respect, taking
care of their privacy
• Equity: solidarity and social justice; for example, that everyone is treated in the same
way
• Efficiency: achievement of goals; for example, vaccination coverage - Respect for
the rights of the person: gender equality
• Participation and promotion of citizenship: empowerment of the population; For
example, the community has and can be included to help take health prevention
measures.

In comprehensive child health care, care packages are offered, which are the articulated sets
of essential care that the child requires to satisfy their health needs, within which we have the
comprehensive health care package for the newborn, the child from 29 to 11 months, from
the child from 1 to 4 years, from the child from 5 to 9 years. Where guidelines are indicated,
related to the care that we must take into account in the comprehensive care of the child; thus
guaranteeing good growth and development of the child, a better quality of life. That is why
health professionals, especially nursing staff, provide this care in a holistic and
comprehensive manner; treating the child in all its aspects, giving priority to actions to
promote the child's health and prevent illnesses.

COMPREHENSIVE CHILD CARE PACKAGES

 1. NEWBORN CARE:

The focus on this point of the comprehensive package is important and necessary to
guarantee the good health of the newborn, and thus, promote their quality of life in
the future. For this reason, the responsibility of providing the correct evaluation of
the child in the first hours of life is in our hands, allowing various diseases to be
detected in time, such as congenital malformations, in order to take measures for
correct treatment. with the corresponding specialist. Therefore, what concerns the
care of the newborn is:

Early contact: Also called attachment, which consists of placing the newborn face
down above the mother's womb. This procedure consists of drying the amniotic fluid
from the head and back of the baby, leaving the baby's hands wet, so that the
newborn can follow the smell of the amniotic fluid and be able to crawl over the
mother's body and recognize the breast. , hold on to it and suck correctly. The time of
this procedure in some literature shows us that attachment should last 50 minutes and
in others 30 minutes, and could even last longer. The benefit of this attachment, it has
a beneficial effect on the beginning of breastfeeding, skin-to-skin contact favors
bonding, reduces the baby's crying time and improves blood glucose levels and
cardiorespiratory stability, reducing the risk of anxiety , breast pain and postpartum
hemorrhage.

1.1. ATTENTION TO PREVALENT DAMAGES ACCORDING TO

PROTOCOL

Prematurity: According to the WHO, a child is said to be premature when he or she

is born before 37 weeks of gestation has been completed. Pregnancy normally lasts
about 40 weeks, however, premature children are born all over the world, in high,
middle and low income countries.
That is why the measures that must be taken in this regard are the following:

• Check their good respiratory effort, color and heart rate, compliance with
routine care, providing warmth, early attachment.
• In this case, the compromised neonate: Does not breathe spontaneously, is
cyanotic, flaccid and has a heart rate of 100.
• Start RESUSCITATION according to the table titled “'Resuscitation
Procedure”.
• Warm, wet O2 record the concentration administered
• If it is possible to channel a peripheral or umbilical route, guarantee arterial or
venous vascular access

Premature children are not fully prepared for extrauterine life. They cool down more
easily and may need more help feeding than full-term infants. That is why we must
intervene in a timely manner with appropriate measures to deal with any situation that
may affect the good health and stability of the newborn.

Asphyxia at birth: To reduce infant mortality, it is essential to create strategies to

prevent asphyxia in the perinatal period, through the identification and timely
treatment of conditions that affect fetal well-being .

Neonatal Sepsis: It is defined as the invasion and proliferation of bacteria in the

bloodstream.

• Early. Multisystem infection that manifests itself in the first four days of life,
the causative bacteria are acquired before or during childbirth .

• Late It occurs after 5 days of life, but is more common after the first week of
age. The bacteria responsible generally come from the postnatal environment,
contaminated equipment, or from carrier or sick human contacts.

An exhaustive clinical history should be performed, looking for risk factors in the
maternal history and signs of sepsis during childbirth, such as meconium amniotic
fluid, sustained intrapartum fetal tachycardia, or Apgar test < 6 at 5 minutes, to act
quickly. and avoid complications that affect the health status of the newborn.
1.2.1 IMMUNIZATIONS WITH BCG/HVB : Vaccination is a fundamental pillar
of the health system of every country, according to the World Health
Organization (WHO) , since it prevents up to three million deaths a year with its
implementation.
BCG vaccine : protects against tuberculosis.
Hepatitis B : prevents the transmission of Hepatitis B

1.3. EDUCATIONAL TOPICS FOR PARENTS

The Integrated Care Strategy for Prevalent Childhood Illnesses (IMCI) practices,
presented on the back, contribute to: Stimulate physical growth and mental
development Prevent illnesses Provide the best home care, and Early identify
when to seek care out of home. Families can incorporate it into everyday care to
ensure children's good growth, development, and quality of life. The key practices
are organized into four groups, according to the intention of each of the practices.

1.3.1. EXCLUSIVE BREASTFEEDING

Breastfeeding is the ideal way to provide young children with the
nutrients they need for healthy growth and development. Virtually all
women can breastfeed, as long as they have good information and support
from their family and the health care system. EBF has multiple
advantages for the baby, the mother, the family and society.
> For him baby :

• It is the best food because it has all the nutrients that the newborn
needs, more important than water
• It is a stimulus for the senses, allowing a better development of the
baby's abilities.
• Helps it grow healthy, strong and safe
• Helps you create antibodies that protect you from diseases such as
diarrhea, colds and infections
• It allows the mother-child binomial to be strengthened
> For the mother

• You save time, money and work

• The uterus returns to its normal size faster
• Emotional satisfaction
 • There is less bleeding after childbirth, reducing the risk of suffering
from anemia
• Helps with weight recovery
• Helps prevent some types of cancer
• Works as a contraceptive method
> For the family:

• Greater family love

• Less expenses
• There is less crying
> For society:

• Less illnesses and deaths

• Protects the environment, there is less waste
• The mother will not interrupt breastfeeding when performing other
tasks
• Greater savings in the country due to less spending on health and
medicines
• Better intellectual development of the child

2. HOME VISIT

Community IMCI : It is one of the three basic components of the IMCI strategy that
mobilizes all the social networks of a locality to improve knowledge and family
practices, systematically promoting in families and the community the application of
practices related to the care and upbringing of children at home.

Observation of the home visit. The home visit is the main action within the functions
of the ACS since through it sick children and pregnant women are evaluated, those who
warrant it are referred, instructions are given and agreements are established on
measures that protect health and the most vulnerable families and communities are
detected. The visit is also the main element of the Community Surveillance System that
the health 24 actor must have in place.

- Children born at home

Basic health care for the newborn must include the promotion and support of
immediate and exclusive breastfeeding; practices to keep the baby warm;
measures to encourage increased hand washing, and hygienic care of the
umbilical cord and skin; methods to detect situations that require additional
care and advice regarding when to take the newborn to a health facility (see
box below). During home visits, the mother and newborn should be examined
for any signs of danger. At the same time, it is necessary to guide families
about what these signs are and the need to immediately go to health services,
if one or more are present.

- Low weight newborns

Treatment will depend on your child's symptoms, age, and general health. It
will also vary depending on the severity of the condition.
Treatment for low birth weight includes:

- Care in a neonatal intensive care unit (NICU).

- Temperature controlled bed.

- Special feeding. Sometimes this is done through a tube to the stomach if

the baby cannot suck. Or it can also be given intravenously (IV).

If they have no other complications, low birth weight babies often "catch up" in
their physical growth. For these babies, a special medical monitoring program
may be necessary.
 > Newborns with congenital malformations

Children with birth defects often need special care and treatment. Because the
symptoms and problems caused by these defects vary, the treatments also
differ. Possible therapies may include surgery, medications, assistive devices,
physical therapy, and speech therapy.

Children with birth defects may need a variety of services and may need to
see several specialists. The primary health care provider can coordinate any
special care the child needs.

> Newborns of mothers with TB, HIV and Syphilis

If there is no clinical, laboratory, or radiographic evidence of disease,

neonates should receive INH at a dose of 10-15 mg/kg orally once daily for 9
months and should be closely monitored. Newborns fed exclusively with
breast milk should receive pyridoxine 1 to 2 mg/kg once a day. Universal
BCG vaccination of newborns is not routinely indicated in developed
countries, but may limit the incidence of childhood tuberculosis or reduce its
severity in populations at higher risk of infection.

II. COMPREHENSIVE CHILD HEALTH CARE PACKAGE FROM 29 DAYS

TO 11 MONTHS 29 DAYS.

2.1. GROWTH AND DEVELOPMENT CARE

2.1.1. Nutritional surveillance

The evaluation and monitoring of growth is carried out using anthropometric

measurements (weight, length, height and head circumference), which are taken
at each contact of the girl or boy with health services and are compared with
current reference standards. determining the growth trend.

Through growth monitoring we evaluate the progress of weight gain, as well as

length or height.

We classify whether growth is adequate: Condition in the girl or boy that

shows weight gain and increase in length or height according to the normal
ranges expected for their age (± 2 SD).

Inadequate growth: Condition in the girl or boy that shows no gain (± 2 SD).

Weight measurement for the girl or boy from 29 days to 11 months 29 days

Equipment: A scale calibrated in Kilos with graduations every 10 grams. To

carry out weight control of children, two people must participate.

One of them, which is generally the mother, father or adult responsible for the
child's care, is in charge of holding the child and ensuring that the child does not
fall, while the health personnel is in charge of measuring and recording.

Procedure:

1. I fixed the scale on a flat and firm surface, thus avoiding an incorrect
measurement.

2. Cover the weight plate with a diaper (pre-weighed)

3. Calibrate the scale to zero before each weighing.
4. Ask the child's parents to remove shoes and as much clothing as possible.
5. Place the child naked or with the least amount of clothing, on the
saucer, sitting or lying down (according to age) and try to balance him.
5. The health personnel will stand in front of the scale and proceed to read
the marked weight.
6. Write down the weight read and with approximations of 10 to 20 grams
before taking the child off the scale. Repeat the action twice to obtain an
exact weight.
 7. Record the weight on the appropriate documents and forms and compare
the value with the expected weight for the age.
8. Balance the scale until it is at zero

2.2. Early stimulation

The stimulation of development strengthens the emotional bond between parents or

caregivers and their children, which strengthens the security, self-esteem and
confidence of the child.

• Developmental stimulation includes specific activities to improve the child's

abilities and skills in specific areas of development such as: Language, motor,
social, emotional and cognitive.

• The stimulation of development is carried out in the office individually or

collectively through sessions grouping children according to their age.

• The guidelines for stimulating the development and comprehensive care of

the child must be in accordance with the age and level of development of the
child, considering the socioeconomic and cultural context of the family.

• The material used for stimulation can be prepared with the joint participation
of health personnel, parents and the community, considering local and
regional cultural patterns.
 2.3. Micronutrient Administration

• Ferrous sulfate : a bottle of ferrous sulfate drops is given to the mother of

the child from six months of age, this being a supplement to prevent anemia.
The goal of supplementation is to prevent iron deficiency anemia, which is
the result of insufficient intake, excessive loss, limited stores, or increased
iron requirements.
A hemoglobin test is performed on the boy or girl.

In girls and boys from 6 months to 35 months, at term, with adequate weight to the be
❖ Iron supplement scheme born,
administer 35 to 40 mg.
of iron
elementary per week,
from 6 months of age and
for 6 months a year.
In

premature infants, 2 mg is prescribed. of elemental iron/kg of

weight/day from the second month and for 12 months.

• Vitamin A: Supplementation with Vit. “A” is carried out on girls and boys in
prioritized areas according to criteria of high prevalence of morbidity due to
frequent infectious diseases and levels of poverty and extreme poverty.

2.4. Immunizations: It is an important way to protect a child's health. Vaccines

 can prevent more than a dozen serious diseases. Not vaccinating a child
can put them at risk for serious and sometimes fatal diseases. The
importance of vaccines is explained to the mother of the child, she is
informed which vaccines will be applied in which place and the effects
they may have.

2.5. Educational topic for parents

Breastfeeding: the mother is reiterated about the importance of exclusive
breastfeeding during her six months, its benefits and properties.
At six months the mother is informed about complementary feeding along with
breast milk. They are taught what their boy or girl can eat at that age and how
they can prepare it and how they can give ferrous sulfate and how many drops it
corresponds to.

2.6. Home visities

Mothers of boys and girls who have not gone to a health center are visited for
their respective vaccinations and for their well-child check-ups.

Damage control (pneumonia, EDAS w/DH, malnutrition) Others according to

each Region
 2.7. Attention to health priorities and prevalent damages:
Damage considered in the Comprehensive Care of Prevalent Childhood Illnesses
(IMCI)
Others according to area or region

III. COMPREHENSIVE HEALTH CARE PACKAGE FOR CHILDREN FROM 1

YEAR TO
4 YEARS

3.1 Growth and development care. nutritional surveillance, early stimulation

Health personnel will provide nutritional counseling to the parents and/or

guardians of any boy or girl with feeding problems identified when the service is
delivered.

3.2 Administration of micronutrients: ferrous sulfate, vitamin A according to

risk criteria, protocols and programming

Supplementation with multimicronutrients and iron is an intervention that aims

to ensure its supply in girls and boys under 36 months of age to ensure adequate
levels of iron in their body, prevent anemia and promote their growth and
development.

3.3 Tracking and monitoring of multimicronutrient and iron supplementation

• The health personnel who provide health care to girls and boys (doctor,
nurse, nutritionist, nursing technician) are responsible for monitoring
supplementation, at the intramural and extramural level.

• In the Health Establishment The health personnel who care for the girl or boy
in the health establishment (doctor, nurse, nutritionist, technician) must take
advantage of any reason for contact or consultation in the health
establishment to monitor acceptance and adherence to the consumption of
iron and multimicronutrient supplements, strengthen the messages of the
benefit of this supplementation and record them in the medical history and
card.

• Monitoring at home is carried out through a home visit, using the “Home
supplementation monitoring sheet”.

• The first home visit is carried out within the second week (7–15 days) of
starting multimicronutrient or iron supplementation.

• The second visit is recommended to be carried out 2 months after starting the
supplementation or when the mothers do not come in a timely manner to pick
up the supplements.
 • The third visit is recommended 9 months after starting supplementation .

• In every home visit, regardless of the reason, health personnel (doctor, nurse,
nutritionist or other health personnel) must monitor the consumption of
supplements with multimicronutrients and iron, and reinforce the messages of
the benefit of this supplementation and verify the next:

} Consumption of multimicronutrient supplements with solid/semi-solid

preparations and frequency of consumption of foods of animal origin
rich in iron.
} Appropriate storage and preservation practices for the
multimicronutrient supplement (well closed and protected from
sunlight and humidity).
} Explore the occurrence of unwanted effects related to the
consumption of supplements and the practice adopted by parents or
caregivers in such case.
} Hand washing practices, sanitary conditions at home (consumption of
safe water and proper disposal of solid waste) and hygiene conditions
of the mother and/or caregiver.
} Depending on the situation found in the family, guidance, counseling,
consultation and/or demonstration will be provided, strengthening the
messages of the benefit of multimicronutrient supplementation.
} Compliance with the vaccination schedule according to the age of the
girl and boy; and practice exclusive and prolonged breastfeeding as
appropriate.
} In Other Spaces In spaces for the care and care of children under 36
months such as Cuna Más, shelters, centers for the promotion and
community surveillance of maternal and child care (CPVC) and
others, the staff of the establishment providing services in the field of
jurisdiction (doctor, nurse).
3.4 Immunizations: Measles, rubella and mumps (MMR). Anti-yellow
according to area or region

• Measles, rubella and mumps (MMR).

This vaccine contains attenuated viruses, it is administered in two doses to

children under 5 years of age, the first at 12 months and the second at 18
months of age respectively. The vaccine is a single-dose and/or multi-dose
presentation and is administered 0.5cc subcutaneously in the middle third of
the deltoid region, with a disposable syringe and a 1cc retractable needle and
a 25 G * 5/8” needle.
 • Anti-yellow according to area or region

The vaccine contains attenuated virus and is applied universally at 15 months

of age throughout the country. A 0.5cc dose is administered subcutaneously
in the middle third of the deltoid region with a disposable syringe and a 1cc
retractable needle and a 25 G * 5/8” needle. The vaccine is a multidose
presentation.

IV. COMPREHENSIVE HEALTH CARE PACKAGE FOR CHILDREN AGES 5 TO

9
YEARS

1. Growth and development care, nutritional surveillance

2. Educational theme
V Healthy food and nutrition
• Accident prevention

• Protective factors: hygiene, self-esteem, social skills, residence

V Prevention of prevalent childhood diseases

• Prevention of child abuse or communication with children
• Oral health
• Environmental care
3. Home visit
 V To children with health problems
V Children who do not attend growth and development check-ups
4. Preventive, detection, removal of bacterial plaque and fluoridation
5. Attention to health priorities and prevalent damages according to protocol
{ GONNA
{ EDAS
• Malnutrition
{ SOBA-Asthma
V Dental caries
V Others according to each region

INTERVENTIONS IN CHILDREN AGED 5 TO 9

{ CRED: 1 time a year

V Immunizations: according to the vaccination schedule
V Odontostomatological consultation: when they go to the service
V General care with pathologies: as a methodological basis IMCI
V Urgent and emergency care: reference is made if appropriate to the situation
V Follow-up consultation: 48 hours after the first attention
V Counseling: road and cultural traffic safety, sexual and reproductive health, and
mental health
V Nutritional counseling: with food and nutrition problems
V Demonstration session
V Comprehensive family visit
PRIMARY PREVENTION (PP): is defined as the set of activities that are applied in
the management of the health-disease process before the individual becomes ill, that is,
in the Pre-pathogenic period of HNE. Its objective is to limit the incidence of the disease
by controlling its causes and risk factors. It includes immunoprophylaxis,
Chemoprophylaxis and health education activities aimed at controlling risk factors or
risk behaviors.

SECONDARY PREVENTION (PS): includes that set of actions aimed at the early
detection of the disease before the symptoms, that is, they are applied in the Subclinical
stage of the Pre-pathogenic period of HNE. Its purpose is to reduce the prevalence of the
disease. Includes screening activities.

TERTIARY PREVENTION (PT): is defined as the set of rehabilitation and social

reintegration actions, aimed at promoting the recovery of the abilities of sick individuals,
that is, they are applied in the Clinical stage of the Pathogenic period of HNE. Its goal is
to reduce the progress or complications of an already established disease. It includes
timely treatment, rehabilitation and social reintegration measures.
 CONCLUSIONS

• The comprehensive child health care model aims to provide quality care and
also has the ability to solve most problems that may arise in a child and also
prevent many diseases. Within this we find essential interventions such as:
Control of growth and development (CRED), immunizations, nutritional
counseling, all of these interventions are intended to improve the health of the
child and also prevent many diseases that can be found in a child and also
help children grow. healthy and strong.

• The MAIS addresses the complexity of the child, family, community and
health services to help the child throughout their entire stage of development
and face all the challenges with any pathology or illness during their growth.
In this way, as health professionals, by intervening early we counteract the
presence of some pathology or combat it, so that children can enjoy their
stage of life and development in the best way.
 BIBLIOGRAPHIC REFERENCES

1. MINSA. Technical standard for comprehensive health care [Internet series] [cited
March 18, 2021]. Available at: http://bvs.minsa.gob.pe/local/MINSA/1880.pdf
2. MINSA. Comprehensive health technical standard. (internet), (Cited March 17,
2021). Available at: http://bvs.minsa.gob.pe/local/minsa/2089.pdf
3. Uladech. Comprehensive health care model in Peru. (Internet), (cited 17
March 2021). Available in:
https://campus.uladech.edu.pe/pluginfile.php/3312336/mod_resource/content/2/
Sesi on_2/MAIS_NINO_2010-II.pdf