COMPETENCY APPRAISAL 2

WEEK 1-2 | Community Health Nursing | By: JK - Alene - Maria - Iris - Cheska

Public Health Nursing ●​ Health promotion and disease prevention are

●​ Closely linked to the development of the the core of community health nursing
department of health and include many key practice.
events. ●​ Heinrich & Freeman (1981), “an area of
●​ Focused on disease prevention and health human services directed toward developing &
promotion. enhancing the health capabilities of people
●​ Key Events: either singly as individuals or collectively as
○​ Early Health Beliefs groups and communities.
-​ Bad spirit: sickness
-​ Albularyo, hilot Characteristics of Community and Public Health
-​ “Anito” ancestral spirits that Nursing
guides our health 1.​ CPHN is Developmental (starts from scratch)
○​ Spanish Colonization - people are imbued with human rights and this
-​ Christian beliefs thru prayer includes the right to health.
and divine intervention -​ However, nurses believe that
-​ Intro of hospitals, clinics, etc. individuals, families and population
(by catholic nuns) groups are primarily responsible for
-​ modern medical practices their health.
-​ herbal plants 2.​ CPHN is Multidisciplinary (collaboration) -
○​ Philippine Revolution health needs of clientele varies that ranges
-​ Tending to wounded soldiers from sanitation, food safety, control of non
-​ emotional support, food and communicable disease and infection.
shelter to soldier (Nightingale 3.​ CPHN is Ecology Oriented (environmental) -
Theory) holistic approach; the largest portion of health
-​ Doña Hilaria de Aguinaldo: care delivery system is community based and
founder of the PH Red Cross care is provided in the natural environment of
(1893) humanitarian aid during the people.
revolution 4.​ CPHN uses research data (improve nursing
○​ First Nursing Students practice)
-​ trained by American nurses on 5.​ CPHN promotes social justice - health is a
1907 human right and all people should enjoy
○​ The DOH access to health care.
-​ health education, -​ The nurse allocates resources and
immunization and control, healthcare budget for the benefit of all
community engagement, etc. or at least for the greatest number.
-​ government and 6.​ CPHN values consumer involvement
non-government sectors (partners of health) - patient in community are
(private) not merely consumers or end users of
○​ helps in developing healthcare service but they are considered
programs that taxes partners of health.
can’t handle 7.​ CPHN uses prepayment mechanism -
○​ Pasay city health department services provided by public health system are
-​ organized first training center not given for free.
-​ It is funded by taxes of the people.
Definitions of Community Health and Public Health As the community nurse,
Nursing fundamentally committed to attend to
●​ Specialized field in nursing practice that patients in the communities regardless
renders care to individuals, families, and of their status since all are paying
communities focusing on health promotion and taxes directly or indirectly.
disease prevention (core) through people 8.​ CPHN focuses on preventive service -
empowerment. providing healthcare to a wide range of
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 clientele afflicted by both acute and chronic ○​ Together with the rural health midwife,
conditions. they keep track of illness encountered
-​ The CHN and PHN are constantly rich in their areas and submit reports to
of risk that make people vulnerable to health authorities.
disease. ●​ Client advocate: taking a proactive stance in
9.​ CPHN offers comprehensive care - old ensuring the right to health of the population.
adage that nursing is caring from womb to ○​ Engage with stakeholders, and
tomb is a reality to community and public clamoring and lobbying policies that
health. impact health of communities.
-​ On the field, nurses cannot choose ○​ Also, initiates organizing activities to
who their parents will be and predict form coalitions and linkages to foster
that cases they will deal with. awareness of people to various health
-​ The practice of the nurse in the related issues.
community offers several opportunities
to help individuals, families, and Standards of Public Health Nursing in the
groups to realize their birthright to Philippines
health and longevity. -​ for guidance, minimize errors and injuries,
provides best practice and continuity care
Roles and Responsibilities of Community and 1.​ Data collection/assessment -
Public Health Nursing provides EBP, individualized, assess
●​ Health care provider: caring is the essence of health literacy
nursing and has been widely accepted in all 2.​ Population diagnosis and priorities
settings. - determine risk and prioritization of
○​ The use of the nursing process applied problems then validated to ensure
in the natural environment of the client accurate diagnosis (minimizes error)
pertains to this role. 3.​ Outcome identification - enhance
●​ Health educator: communicating information patient care
to help patients make an informed choice 4.​ Planning - establish clear objectives
regarding their health is a key activity in public (resources allocation)
health work. 5.​ Implementation - turns planning into
○​ It is hoped that awareness will impact action
people’s behavior to achieve health in 6.​ Evaluation - determine effective
their own hands. treatment and management;
●​ Program implementer: nurses working under determine future planning
LGU deliver healthcare to the grassroot. 7.​ Coordination of care - high client
○​ This also requires that program satisfaction
initiated by national government thru 8.​ Health teaching and health
DOH are executed at all levels. promotion - enhance understanding
●​ Community organizer: working with people of health behavior
in communities and providing them 9.​ Regulatory activities - comply in
ownership of their healthcare needs to act protection of patients
collectively on their issues is best 10.​ Ethics - provides moral framework,
captured by this role of the nurse in public define professional conduct and
health. behavior
●​ Manager/Leader: Community and public 11.​ Assumes professional
health work deals with competing claims development/education - maintains
specifically on utilization of limited resources. current knowledge and competence
○​ Budgeting, inventories, scheduling through ongoing education, lifelong
and staffing, conducting training learning, and practical experiences.
sessions are likewise included under 12.​ Evidence based practice/research -
this role. integrates evidence and research
●​ Research/Epidemiologist: nurse is regarded findings into practice by utilizing
as health monitor of the community. current evidence, engaging in

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 research, implementing protocols, and Overview of the Healthcare Delivery System
critically analyzing results. ●​ A nation’s healthcare delivery system has a
13.​ Quality of practice - coordination tremendous impact not only on the health of its
enhances quality. people but also on their development including
14.​ Leadership - exhibits leadership. their socio-economic status
15.​ Interdisciplinary collaboration - ●​ Factors in Shaping 21st Century Health
Collaboration with other professions, (Anderson & MacFarlane, 2011)
populations, organizations, and ○​ Healthcare reforms - Accessibility;
stakeholder groups; is the most Affordability; Elimination of
effective way to promote and protect unnecessary dx procedures; staff
public health. shortages
○​ Demographics - Q-Sex & Gender;
Hierarchy of Nursing Science Influence patient’s care
●​ Highest and lowest needs of people ○​ Globalization - Worldwide Healthcare
●​ A strong knowledge base is essential to Delivery (Increase access to specialize
competently address the myriad needs and care; Provide advanced medical
concerned of the people knowledge and best practices)
○​ Maternal and child health nursing ○​ Poverty and growing disparities -
○​ Adult health nursing Breakdown of society; Limitation of
○​ Mental health and psychiatric nursing financial resources; Expensive
○​ Public health nursing healthcare supplies & services; Poor
●​ Thus, community and PHN focuses on all health outcomes
population groups; a shift from concrete to ○​ Social disintegration - Extreme
abstract concepts. inequality; Worst health outcome.
●​ From care of individuals in specific health care ●​ Characteristics of Healthcare Delivery in
settings of groups in larger settings from Public and private settings
curative and rehabilitative care to preventive ○​ Public health care - consists of the
and promotive care. national and local government
agencies providing health services.
Key Concepts of Community and Public Health ○​ Private health care - is largely market
Nursing oriented and health care is rapid
●​ Community as a client through users fee at the point of
○​ Group of people living in a particular service. (doctors are the most
area with common beliefs, values and important)
tradition and important attributes. ○​ Health insurance - Financial
○​ Bound by location of people which Protection; Medical Coverage;
develop common beliefs and values Encourages regular checkup.
●​ Health as a goal ○​ Healthcare levels
○​ More than a state of well being -​ Level 1: Preventive Care
○​ Multidimensional reality (routine check up, vaccine,
(socio-economic, environmental and health education)
political factors). -​ Level 2: Specialized Care
○​ With health as a goal, healthcare must (internal med, med consult for
be holistic HPN and DM)
●​ Nursing as the vehicle or means to achieve -​ Level 3: Advanced
its aims Specialized Care (ICU,
○​ Body of knowledge grounded on the Hi-Tech DX Test,
works of nursing theorist. Sub-Specialist)
○​ Assertion from nightingale’s theory ●​ The WHO: provides global leadership in health
provides powerful description of what matters
nurses do in the community and public ●​ Health services are provided by government
and private sector for profit and non-profit with
health work.
the latter frequently referred to as non
○​ Ground on the works of nursing government organizations (NGO).
●​ On the national level, direction is set by DOH.
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 ●​ By virtue of the mandate RA 7160, LGU 4.​ Translation to ensure that
employs an operating mechanism to meet their quality evidence is turned into
community needs. products
●​ A health system consist of 6 building 5.​ Organization to strengthen the
blocks research
1.​ Service delivery ○​ Set norms and promoting good
2.​ Health workforce research practice
3.​ Information ○​ Articulate ethical and evidenced-based
4.​ Medical products policies
5.​ Vaccines and technologies ○​ Provide support, catalyze change,
6.​ Financing, Leadership and build sustainable institutional
governance or stewardship capacities
●​ The PHN must possess an understanding of -​ Sustainable Development
dynamic relationships among its concepts and Goals or Agenda 2030 - aims
an adequate information on referral system. to continue the gains achieved
●​ Philippine Setting thru the Millennium
○​ The DOH (national) Development Goals
○​ NGOs (private) implemented from 2000-2015.
○​ LGUs (RA 7160) -​ The SDGs contain 17 goals
●​ The health systems according to WHO and 169 targets that will cover
○​ Service delivery the period 2016-2030.
○​ Health workforce
○​ Health Information System (HIS) Millennium Development Goals
●​ Objective - framework of goals by UN to
○​ Medical products, vaccines, and
improve the lives of the poorest of the poor
technologies 1.​ To eradicate extreme poverty and
○​ Health system financing hunger
○​ Leadership and governance 2.​ To achieve universal primary
(stewardship) education
3.​ To promote gender equality and
World Health Organization empower women
●​ Specialized agency of the UN 4.​ To reduce child mortality
●​ April 1945: Proposal of WHO 5.​ To improve maternal health
●​ July 22, 1946: Draft of WHO constitution 6.​ To combat HIV/AIDS, malaria, and
●​ April 7, 1948: Creation of WHO constitution other diseases
●​ Headquarters at Geneva, Switzerland 7.​ To ensure environmental sustainability
●​ It has 50 country offices and 6 regional 8.​ To develop a global partnership for
offices: development
1.​ Africa
2.​ Europe Sustainable Development Goals
3.​ Western Pacific 1.​ No poverty
4.​ America 2.​ Zero hunger
5.​ Eastern Mediterranean 3.​ Good health and well-being
6.​ Southeast Asia 4.​ Quality education
●​ PH is a member of the western pacific region 5.​ Gender equality
●​ Objective of the WHO - Attainment by all 6.​ Clean water and sanitation
people of the highest possible level of health 7.​ Affordable and clean energy
●​ Core Functions of WHO 8.​ Decent work and economic growth
○​ Private leadership on matters critical to 9.​ Industry, innovation and infrastructure
health care 10.​ Reduced inequalities
○​ Shape the research agenda; 11.​ Sustainable cities and communities
stimulating the generation, translation 12.​ Responsible consumption and production
and disseminate valuable knowledge. 13.​ Climate action
○​ 5 Goals: 14.​ Life below water
1.​ Capacity in reference to 15.​ Life on land
capacity building 16.​ Peace, justice, and strong institutions
2.​ Priorities is focus research on 17.​ Partnership for the goals
priority health needs
3.​ Standards to promote good History of Philippine Healthcare Delivery System
research practice -​ Records of public health services dates back
from spanish regime.

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 ●​ National agency mandated to lead the health
1577 Juan Clemente
sector towards assuring quality healthcare
-​ Opened a medical dispensary in
for all Filipinos
Intramuros
●​ Vision
○​ Filipinos among the healthiest in
1690 Dominican Fr. Juan de Pergero
Southeast Asia by 2022 and in Asia by
-​ Installation of water system in San
2040
Juan City
●​ Mission
-​ Manila smallpox vaccination was
○​ Lead the country in the development
started by Dr. Francisco de
of a productive resilient, equitable, and
Balmis
people-centered health system
●​ Functions
1876 Medicus Titulares (Chief Physician)
○​ Planning and formulating policies
worked as provincial health officers
○​ Monitoring and evaluating
○​ Advocating for health promotion
1888 2 year program of fundamental medical
○​ Serving as a technical authority
and dental course has offered at UST
○​ Providing administrative and technical
leadership
1890 Cirujanos Ministrates (Surgical Minister)
○​ Providing logistic support to LGUs and
served as male nurse and sanitation
public sector
inspectors
○​ Lead agency in health and medical
1901 Creation of board of health by US-PH research
Commission through Act 57 created by ○​ Protecting standards of excellence
the board of health of the philippine islands (training and education) of healthcare
providers
1905 La Gota de Leche (drop of milk) was ●​ Tasks
established by association feminista filipina ○​ Serves as administrator of selected
-​ Reduce mortality in infant health facilities
-​ Promote breastfeeding ○​ Provide specific program components
(TB, Malaria, Schistosomiasis,
1912 The Fajardo Act HIV/AIDS, Micronutrient)
-​ Sanitary divisions compose of 1-4 ○​ Develop strategies for responding to
municipality emerging health needs
○​ Provide leadership in health
1947 DOH was recognized to Bureaus emergency preparedness and
response services (that is why referral
1954 Congress passed RA 1082 (Rural Heact and network system is evident)
Act) creation of rural health units in every ●​ Core Values
municipality ○​ Integrity
○​ Excellence
1957 RA 1891, the PH medical act “Fajardo Act” ○​ Compassion and respect for human
amended the Rural Health Act dignity
-​ Covers medical professions ○​ Commitment
○​ Professionalism
1958 Healthcare Delivery Regional Offices ○​ Teamwork
were created as a result of decentralization ○​ Stewardship
●​ Accessibility to Filipinos
●​ The Organizational Structure of DOH
1970 Restructuring of the PH delivery system

1991 Devolution of basic services thru RA

7160 (Local Government Code 1991) was
restructed

LGU took primary health care

-​ Preventive, curative, rehabilitation

Department of Health (DOH)

●​ Organizes various health events all year round
●​ Assumes leadership role (EO, series of 1999)

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 1 RHU/HC Physician 20,000 Population
Ratio

1 Public Health Nurse 10,000 Population Ratio

1 Public Health Midwife 5,000 Population Ratio

1 Public Health Dentist 50,000 Population Ratio

1 RHU 20,000 Population Ratio

1 BHS 5,000 Population Ratio

(Adapted from 2018 National Objectives for health

Local Health System and Devolution of Services Document)
●​ The Local Government Code (RA 7160) was ●​ The BHS is the first contact health care facility
enacted to bring genuine & meaningful local that offers basic services at the barangay level.
autonomy that enables LGU to attain fullest ●​ It is the satellite station of the RHU manned by
development & self-reliance. volunteer barangay health workers under the
●​ Devolution – refers to the act by which the supervision of Rural Health Midwife
national government confers power & authority ●​ The Municipal Health Officer or Rural Health
upon various LGU’s to perform specific Physician (MHO) or Rural Health Physician
functions & responsibilities heads the health services at the municipal
●​ RA 7160 provided creation of Provincial Health level & carries out the following roles &
Board & City Municipal Health Board or Local functions:
Health Boards 1.​ Administrator of the RHU
●​ The Chairman of the board is the: Local 2.​ Community Physician
executive/ The Provincial Governor/ Mayor; 3.​ Medico-Legal Officer
The Provincial/City/Municipal health Officer
serves as vice chairman. Levels of Healthcare Services
●​ Members of the board are composed of: The ●​ Category A: Primary Care Facility
chairman of a committee on health of the ○​ A first contact health care facility that
Sanggunian, a representative from the private offers basic services including
sector or NGO involved in health services. emergency services & provision for
●​ The functions of local health boards are as normal deliveries.
follows: ●​ Category B: Custodial Care Facility
1.​ Proposing to the Sanggunian annual ○​ A health facility that provides long term
budgetary allocation for operation & care including basic services like food
maintenance & shelter to patients with chronic
2.​ Serving as an advisory committee to conditions requiring ongoing health &
the Sanggunian on health matters nursing care due to impairment.
3.​ Creating committees that shall advise ●​ Category C: Diagnostic/ Therapeutic
local health agencies on various Facility
matters. ○​ Facility for examination of human
body, specimens from human body for
The Rural Health Unit diagnosis. This category is further
●​ Commonly known as a health center is a classified into:
primary level of health facility in the ○​ Laboratory facility – such as but not
municipality. limited to the following: Clinical, HIV
●​ It’s focus is preventive & promotive testing, Blood service, Drug testing,
●​ DOH recommendations for human resource for Newborn screening, Laboratory for
health & health facilities ratio to population are drinking water analysis.
as follows:

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 ○​ Radiologic Facility – providing Leads to people to become closer to
services such as X-Ray, CT scan, health.
Mammography, MRI, Ultrasonography ○​ NEGATIVE: brought segregation
○​ Nuclear Medicine Facility – a facility /division of public health. Municipalities
regulated by the Philippine Nuclear and cities work alone, can’t be
Research Institute utilizing applications delivered efficiently
of radioactive materials in diagnosis, ●​ Referral – is set of activities undertaken by a
treatment or medical research. healthcare provider or facility in response to its
●​ Category D: Specialized Outpatient Facility inability to provide the necessary health
○​ A facility that performs highly interventions to satisfy a patient’s need
specialized procedures on an ○​ It could be external or internal
outpatient basis such as: Dialysis -​ Internal referrals – occur
clinic, Ambulatory, Surgical Clinic, within the health facility from
Cancer chemotherapeutic center/ one health personnel to the
clinic, Cancer radiation facility, other.
Physical medicine, Rehabilitation -​ External referrals – are
center/ clinic. movement of a patient from 1
health facility to another.
Inter local Health Zone ■​ It may be vertical
●​ The ILHZ is defined to be any form of where the patient from
organized arrangement for coordinating the lower to right has a
operations of an array & hierarchy of health higher level of facility
providers & facilities which typically includes or the other way
primary health providers: around.
○​ The ILHZ functionality is defined ■​ It can also be
mainly by observable, improved health horizontal where a
status & coverage of public health patient is referred
intervention of the zone population. between similar
○​ Access by everyone in the zone to facilities in different
qualify the care catchment areas.
○​ Efficiency in the operations of the
inter-local health services Health Sector Reform
●​ It has the following components: ●​ 2005-2010: FOURmula One (Gloria
○​ People – Although WHO has Macapagal Arroyo)
described the ideal population size of ●​ 2011-2015: Kalusugang Pangalahatan or
health district between theAquino Health Agenda
100,000-500,000 ●​ 2016: Duterte Health Agenda or Philippine
○​ Boundaries – RHUs BHUs & other Health Agenda
health facilities that decide to work ●​ 2017-2022: FOURmula One Plus (F1 Plus)
together ○​ Administrative Order 2018-0014
○​ Health workers – to deliver entitled “Strategic Framework &
comprehensive services, the ILHZ Implementing Guidelines for
health workers include personnel of FOURmula One Plus for Health”
the DOH, district or provincial -​ better health outcomes
hospitals. -​ a more responsive healthcare
system
The Health Referral System -​ more equitable healthcare
●​ Implemented since 1992, devolution has financing
brought decision making & accountability on
basic government services Universal Health Care In The Philippines (RA
●​ Devolution 11223)
○​ POSITIVE: make decision making and ●​ All individuals & communities receive the
accountability in health services. health services they need without suffering
financial hardships

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 ●​ Major Milestone - automatic coverage of all family records, family team
Filipinos under the National Health Insurance members, investigation
Program of the Philippines (PhilHealth) reports, reference books.
●​ Primary Health Care ○​ Data Collection Methods &
○​ Levels of Prevention Techniques
1.​ Primary Prevention - Set of -​ Making judgement
measures that aim to prevent -​ Effective communication
disease or injury from -​ Investigation & measurement
occurring before the disease ○​ Methods of Data Collection
process begins such as: -​ Observation
a.​ Immunizations -​ Listening
b.​ Regular exercise -​ Questioning
c.​ Health education -​ Review of family records
d.​ Legislation to ban or -​ Examination & Investigation
control hazardous ○​ Categories of Analyzing Data
measures -​ Health Threats
e.​ Mandating safe -​ Health Deficits
practices -​ Foreseeable disease
2.​ Secondary Prevention - ●​ Family Nursing Diagnosis
Measures that help with early ○​ Several levels
diagnosis & prompt treatment -​ as individual family member
of an illness or injury. This can -​ as a family unit
help limit disability & prevent -​ as the family, in relation to its
more serious problems. environment/community
3.​ Tertiary Prevention - ○​ Family Coping Index
Measures that help with -​ alternative tool for family
chronic care management like nursing diagnosis
symptom management, -​ focuses on identifying coping
rehabilitation, physical therapy patterns of the family
& chemotherapy. ●​ Formulating the Plan of Care
Family Nursing Process ○​ priority setting
●​ Systematic approach to help families to ○​ establishing goals and objectives
develop & strengthen their capacity to meet ○​ determining appropriate interventions
their health needs & solve health problems. ●​ Implementing the Plan of Care
●​ Assessment Phase (Family Identification) ○​ when the nurse or the family execute
○​ Collection & analysis of data to the plan of action
determine useful to family profile & ○​ the nurse should be conscious on the
make family diagnosis possible barriers
○​ Categories of data ●​ Evaluation
-​ Family structure & ○​ determine the value of nursing care
characteristics (Genogram, that has been given to a family
Eco Map, Family Tree) ○​ 2 Ways in Conducting Evaluation
-​ Lifestyle 1.​ Formative Evaluation
-​ Culture and socioeconomic -​ refers to ongoing
factor assessment that
-​ Health, Medical history & happens during the
behavior learning process,
-​ Environmental Factors providing feedback to
○​ Sources of Data Collection identify areas for
-​ Primary – obtained directly improvement and
from the client or family guide further learning
members 2.​ Summative Evaluation
-​ Secondary – obtained from
friend, neighbor, colleagues,
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 -​ is a final assessment
Diagnosis
at the end of a Priorities
learning period
-​ used to determine if a Standard 3: Identifies outcome for a plan
student has achieved Outcome
the required Identification
competencies and
Standard 4: Develops plan that reflects
learning outcomes, Planning best nursing practice
typically with a
pass/fail result Standard 5: Implements the identifies plan
Implementation by partnering with others
CHN AND PHN (coordination,
●​ often used synonymously or interchangeable health education,
●​ similar yet distinctive ideologies, visions or consultation,
regulatory
philosophies
activities)
●​ PHN
-​ synthesis of public health and nursing Standard 6: Evaluates the health status of
practice Evaluation the population
-​ field of professional practice in nursing
and in public health in which technical Standard 7: Systematically enhances
Quality of practice quality and effectiveness of
nursing, interpersonal, analytical and
nursing practice
organizational skills are applied
(Freman, 1963) Standard 8: Attains knowledge &
-​ traditionally, a subspecialty nursing Education competency that reflects
practice delivered within official or current nursing & public
government agencies health practice
●​ CHN
Standard 9: Evaluations one’s nursing
-​ considered to be broader and more Professional practice in relation to
general specialty are (occupational practice professional practice
health nursing, forensic nursing, home evaluation standards & guidelines
health, etc.)
-​ a synthesis of nursing practice and Standard 10: Contribute to the professional
public health practice applied to Collegiality & development of peers,
professional students, colleagues, & others
promoting and preserving the health
relationship
populations (ANA, 1980)
●​ ANA (1996) defined PHN Standard 11: Collaborates with the
-​ as practice of promoting and Collaboration representatives of the
protecting the health of population population, organization
using knowledge from social and
Standard 12: Integrates ethical provision in
public science
Ethics all areas of practice
-​ population focused with goals of
promoting health and preventing Standard 13: Integrates research findings in
disease and disability for all people Research practice
●​ CHN as global or umbrella term and PHN as a
component or subset, and may be used Standard 14: Consider factors related to
interchangeably Resources safety, effectiveness, cost,
utilization impact on practice, planning,
population delivery of nursing, public
Standards of Public Health Nursing Practice health programs, policies and
Standards of Care services.
Standard 1: Collects Comprehensive Data
Assessment Standard 15: Provides leadership in nursing
Leadership & public health
Standard 2: Analyzes assessment data
Population

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Occupational Health Nursing Levels of Prevention
●​ A subspecialty of public health nursing 1.​ Primary
(AAOHN) -​ health promotion and disease
●​ Occupational Health Nurses (OHNs) play a prevention
crucial role -​ weight and cholesterol reduction
●​ Article 23 of the UN Universal Declaration -​ ergonomics training
of Human Rights - everyone has the right to -​ smoking cessation
work, to free choice of employment, to just and -​ breast cancer education and early
favorable conditions of work detection
●​ There is rising demand for highly trained and -​ stress management
experienced occupational health nurses -​ work-home balance
●​ DOLE is the lead government for OSH 2.​ Secondary
○​ through the Occupational Safety and -​ early diagnosis
Health Center (OSHC), this leads to -​ early treatment interventions
the National Profile on Occupational -​ attempts to limit disability
Safety and Health of the Philippines -​ health screenings
○​ defined OSH as a discipline involved 3.​ Tertiary
in the promotion and maintenance of -​ involves rehabilitation and restoration
the highest degree of physical, mental of the worker to an optimal level of
and social well being of workers on all functioning
occupations -​ case management
●​ Derives frameworks from multidisciplinary -​ workplace accommodation
base -​ counselling and support
●​ Elements
1.​ Nursing Science - helps identify and Skills and Competencies
address the unique needs of the ●​ Clinical and Primary Care - applying nursing
individuals, groups, and populations process in the delivery care; providing first aid
which operates within a framework and primary care
that includes prevention, health ●​ Case Management - conducting case
promotion and care management management assessment
2.​ Medical Science - specific to ●​ Workforce, Workplace and Environmental
treatment and management if illness Issues - performing risk assessments ;
and injury identifying and monitoring potential existing
3.​ Occupational Health Sciences - exposures
Toxicology; Determine health effects of ●​ Legal and Ethical Responsibilities -
toxins; Identify workplace hazards; influencing regulatory and legal processes
Safety; Ergonomics ●​ Management and Administration - managing
4.​ Epidemiology - investigates budget, hiring staff and management of
work-related illness and injury performance
5.​ Business and Economic Theories, ●​ Health Promotion and Disease Prevention -
Concepts, and Principles - for integrating all levels of prevention
strategic and operational planning and ●​ Occupational and Environmental Health
management of occupational health and Safety Education - developing and
and safety programs implementing training programs
6.​ Social and Behavioral Sciences - ●​ Research - recognizing trends in health
explore various factors that influences outcomes
the workers health ●​ Professionalism - engaging in a lifelong
7.​ Environmental Health - examine learning plan
interrelationship between the worker
and the extended environment Laws and Standards
8.​ Legal and Ethical Issues - ensure ●​ Presidential Decree 442 (Philippine Labor
compliance with regulatory activities Code)
●​ The Administrative Code on Enforcement of
Safety And Health Standards

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 ●​ The Occupational Safety and Health Standard ○​ Home Health Care
(OSHS) ○​ Hospice Home Care (palliative care is
●​ Executive Order 307: Establishing an important)
Occupational Safety and Health Center within ○​ Faith Community Nursing or Parish
the Employees’ Compensation Commission Nursing
●​ PD 626: Establishing the Employees’ ○​ Correctional Nursing
Compensation Program ○​ Entrepreneurship in Nursing
●​ Hazard-Specific Laws regarding anti-sexual
harassment Theories of Health Promotion
●​ RA 9165: an act instituting the Comprehensive 1.​ Pender's Health Promotion Model
Dangerous Drugs Act of 2002 ●​ “Individual’s Perception”
●​ RA 6969: Toxic Substances and Hazardous ●​ Developed in 1980’s & revised in
and Nuclear Wastes Control Act 1996, it explores the numerous
●​ RA 9231: an act Providing for the Elimination biopsychosocial factors that influence
of the Worst Forms of Child Labor and individuals to pursue health promotion
Affording Stronger Protection for the Working activities.
Child ●​ It depicts the complex
●​ RA No. 11058: Occupational Safety and multidimensional factors with which
Health (OSH) Standard Act people interact as they work to
achieve optimum health.
School Health Nursing ●​ The model contains 7 variables related
●​ Education and health are interrelated to health behaviors as well as
●​ To learn effectively, children need good health individual characteristics that may
(WHO) influence a behavioral outcome.
●​ School-aged children and adolescents face ●​ This does not include threat as a
increasingly difficult challenges related to motivator, as threat may not be a
health in the Philippines motivating factor for clients in all age
○​ Preschool (1.2 Million), Elementary groups.
(13.7 Million), High School (6.8 Million) 2.​ The Health Belief Model
○​ A unique opportunity for the school ●​ “Motivation”
nurse to make a positive impact on the ●​ If a patient is motivated to do
nation’s youth something, they will likely put in more
●​ The school nurse is responsible for planning effort.
and conducting training programs for teachers ○​ This motivation often comes
on health and nutrition from the perceived benefits.
●​ School Health Services ●​ Initially proposed in 1958, this provides
○​ Comprehensive School Health the basis for much of the practice of
Education (Grades K-12) health education & health promotion.
○​ Physical Education and Activity ○​ This was developed by a
○​ Nutrition Services group of social psychologists
○​ School Health Services in the attempt to explain why
○​ School Counseling, Psychological & the public failed to participate
Social Services in screening for tuberculosis.
○​ Health & Safe School Environment ●​ This documented information alone is
○​ Student, Family, and Community rarely enough to motivate one to act.
involvement in schools ○​ Individuals must know what to
○​ Health Promotion for school staff do before they can take
action.
Emerging Fields of Community and Public Health
●​ It has several constructs:
Nursing in the Philippines
○​ Perceived seriousness
●​ Public Health, Occupational Health and
○​ Perceived susceptibility
School Health are established and recognized
○​ Perceived benefits of
fields of practice in nursing
treatment
●​ To provide for the needs of the patients:

11 | PRELIMS CMPA412
 ○​ Perceived barriers for ●​ These intentions are determined by
treatment one’s attitude regarding a behavior &
○​ Cues to action the subjective norms associated with
○​ Self efficacy. the behavior.
3.​ The Transtheoretical Model
●​ “Changing Behavior” Nursing Process in the Care of Community
●​ Behavior – a set of actions or ●​ The community & public health nurse’s aim is
responses that are unique to an to improve the health status of the community.
individual and deemed acceptable by ●​ To the nurse, the community is not just the
them setting or the context for providing community
●​ Combines several theories of health nursing but the focus of nursing care,
interventions giving its name. It understanding the meaning of community is a
includes constructs of self efficiency & requisite.
process of change. ●​ It could be local, national, or international with
○​ This is based on assumptions specific or broad interest.
that behavior change takes ○​ It is composed of a group of people
place over time progressing who have common interests, interact
through a sequence of stages. with one another, and have a sense of
○​ It also assumes that each of unity concerns.
the stages is both stable & ●​ These includes aggregate of people,
open to change – In other location in space & time & social system
words one may stop in one A.​ Aggregate of People – is a
stage, progress to the next community composed of people who
stage or return to the previous have similar demographic
stage. characteristics such as age, sex,
4.​ The Transtheoretical Model & Change ethnic background or common
●​ Change is difficult even for the most activities, concerns & goals (aggregate
motivated of individuals. of senior citizens)
●​ People resist change for many -​ Health related traits or risk
reasons. factors are “people factors”
●​ Change may: that help define a community
○​ Be unpleasant (exercising) -​ An aggregate who have
○​ Require giving up pleasure impaired health or who have
(eating desserts or watching common predispositions. (e.g.
tv) person with disabilities or
○​ Be painful (insulin injections) living with HIV may join
○​ Jeopardize social relationships together as a group or
(gatherings with friends & community to learn from &
family that involves food) support each other)
○​ Not seem important anymore -​ A community may form
(older individuals or those with common problem or issue
the ill effects of lifestyle unites individuals. This type of
choices such as DM & HPN) community is known as a
○​ Require change in self image “community of solution”
(from couch potato to athlete) B.​ Location in Space – the physical
5.​ Theory of Reasoned Action location or geographic boundaries of a
●​ “Intention” group of people may define a
●​ Developed by Fishbein & Ajzen, this community.
attempts to predict a person’s intention -​ Geopolitical communities are
to perform or not to perform a certain highly defined by their
behavior. geographical landmarks such
●​ This is based on the assumption that as barangay or districts,
all behavior is determined by one’s whether urban or rural.
behavioral intentions.
12 | PRELIMS CMPA412
 -​ It strongly influences the type -​ Geography plays an important role in
of health problems that the disasters (earthquakes, landslides,
nurse may identify. floods).
C.​ Social System – the relationship of -​ Limited roads in rural areas, limiting
members that forms one another is a access to health facilities
major dimension of a community. C.​ Social System - patterned series of
-​ The interaction of members to interrelationships existing between individuals,
fulfill their essential functions groups & institutions & forming a coherent
to achieve a goals make them whole.
up as a community that forms -​ The composite part of the social
a complex social system system of the community affects &
constitute a community (a interacts with one another.
school is a functional -​ During these interactions, patterns &
community) communications transpire which form
the basis of organization.
Conditions in the Community Affecting Health -​ A government agency, a bank & a
A.​ People - population variables that affect the school are examples of formal
health of the community include size, density, organization.
composition, rate of growth or decline, cultural
Characteristics of a Healthy Community
characteristics, mobility, social class &
●​ A shared sense of being a community based
educational attainment.
on history & values​
-​ Health needs vary because of the
●​ A general feeling of empowerment & control
differences in population composition
over matters that affect the community
by age, gender, occupation, level of
●​ Existing structures that allow subgroups within
education & other variables.
the community to participate in decision
-​ Rapid growth or decline of a
making in community matters
population affects the health of the
●​ The ability to cope with change, solve
community.
problems & manage conflicts within the
-​ Rapid growth usually results from
community through acceptable means
migration of a large number of people
●​ Open channels of communication &
in the community as evident in
cooperation among the members of the
migration from rural to urban areas
community
that results in increased demand in
●​ Equitable & efficient use of community
services.
resources with the view towards sustaining
-​ On the other hand, a rapid decline in
natural
population may result from
disturbances brought about by Tools for Community Assessment
circumstances like diseases, political 1.​ Collecting Primary Data
instability or economic changes, this ●​ Observation - through ocular or
usually means a decrease in economic windshield survey either on driving,
activity & lower government revenue riding or walking
B.​ Location - the health of community is affected ●​ Survey - necessary when there is no
by both natural & man-made variables related available information about the
to this aspect. community or specific population
-​ Natural factors consist of geographic group.
features, climate, flora & fauna. ○​ Made up of series of questions
-​ Boundaries whether urban or rural, ●​ Informant interview - purposeful talks
presence of open spaces, quality of with either key informants or ordinary
soil, air & water & location of health members of the community.
facilities are influenced by human ○​ Key informants consist of
decisions & behavior. formal & informal community
-​ Features that consist of land & water leaders or persons of positions
forms that influence food sources & & influence
prevalence occupations.
13 | PRELIMS CMPA412
 ●​ Community forum - open meeting of Epidemiology
the members of the community. Vital Statistics
○​ Pulong-pulong sa barangay is Population Indicators:
a good example. 1.​ Crude birth rate - measures how fast people
●​ Focus Group - differs from the are added to the population
community forum in the sense that the 2.​ General fertility rate - number of live births
focus group is made up of a much per 1000 women aged 15-49
smaller group usually 6-12 members
Mortality indicators:
only
1.​ Crude death rate - total or overall death rate
2.​ Secondary data sources
in a given population
●​ Registry of vital events - Act 3753
2.​ Specific death rate - represents a subset of
(Civil Registration Law, Phil.
the population or which particular classes of
Legislature 1930) established the civil
deaths
registry system that requires
3.​ Proportionate mortality ratio - describes the
registration of vital events (birth,
proportion of death in a specified population
marriages, death).
4.​ Maternal mortality rate - death due to
○​ The NSO serves as the
complications from pregnancy or childbirth
central repository of civil
5.​ Infant mortality rate - # of deaths per 1000
registries.
live births of children under 1 year of age
●​ All these functions are now under the
6.​ Neonatal mortality rate - newborn death
PSA by virtue of RA 10625
occurring within 28 days postpartum
"Philippine Statistical Act of 2013"
7.​ Post-neonatal mortality rate - death of
●​ Health records & reports - EO No.
children aged 29 days to one year
352, the Field Health Service
8.​ Early post neonatal mortality rate - may be
Information System is the official
partitioned into those dying within the first
recording & reporting system of the
week of life & remainder that survive the first
DOH & is used by PSA to generate
seven days but die before one month of age
health statistics.
9.​ Perinatal mortality rate - combines death of
○​ This is an essential tool in
fetus of specified gestational age with deaths
monitoring the health status of
of liveborn infants who die in the first two
the population at different
weeks of life
levels.
10.​ Age & sex specific death rate
○​ Records are facility based
11.​ Cause specific death rate
which are kept at the BHS or
at RHU or health center that Morbidity Indicators:
contain the day to day 1.​ Incidence rate - occurrence of new cases
accounts of activities of health 2.​ Prevalence rate - number of all cases of a
care workers. specific disease or condition in a population at
○​ Services delivered to clients a given point in time
are based on the data entered 3.​ Prevalence proportion - measures the total
in the records. number of existing cases of disease at a
○​ Reports are submitted particular point in time
monthly, quarterly & annually
to the Provincial Health Office Latest Trends in Nursing
& finally to regional level of ●​ In the Philippines, the latest trends in
DOH community health nursing include a strong
●​ Disease Registries - listing of focus on digital health integration, utilizing
persons diagnosed with a specific type telehealth services, incorporating data-driven
in a defined population. approaches – to community assessments,
●​ Census data - periodic governmental prioritizing mental health promotion, and
enumeration of the population actively engaging with community stakeholders
to address specific health concerns all while
leveraging emerging technologies like

14 | PRELIMS CMPA412
 electronic health records and wearable devices
to enhance care delivery.
●​ Key aspects of these trends:
○​ Telehealth adoption: Increased use
of virtual consultations and remote
monitoring for chronic conditions,
particularly in geographically isolated
areas
○​ Data-driven decision making:
Utilizing health information systems
and community data to identify
high-risk populations and target
interventions effectively
○​ Community engagement: Fostering
active participation from community
leaders and residents in planning and
implementing health programs
○​ Mental health focus: Prioritizing
mental health promotion and early
intervention services, addressing the
growing need for mental health
support Integration of technology:
Utilizing electronic health records,
mobile apps, and wearable devices to
improve patient education,
self-management, and communication
○​ Focus on preventive care:
Emphasizing health promotion
activities like nutrition education,
exercise programs, and immunization
campaigns to prevent disease.
○​ Capacity building: Training
community health nurses in advanced
skills like health literacy, advocacy, and
community mobilization

15 | PRELIMS CMPA412
COMPETENCY APPRAISAL 2
WEEK 3-4 | Maternal & Child (Abnormal) | By: JK - Brie - Rikki

RA 9262 (Anti-violence against Women and the ●​ Battery: act of inflicting physical harm upon
Children Act of 2004) the woman or her child resulting in physical
Violence against Women and their Children and emotional distress.
●​ Any act or a series of acts committed by any ●​ Battered Woman Syndrome: pattern of
person against a woman who is his wife, psychological and behavioral symptoms found
former wife or against a woman with whom the in women living in battering relationships as a
person has or had a sexual or dating result of cumulative abuse.
relationship. ●​ Stalking: intentional act of a person who,
1.​ Physical violence: bodily physical knowingly and without lawful justification,
harm follows a woman or her child under
2.​ Sexual violence: sexual in nature surveillance directly or indirectly or a
-​ Rape, sexual harassment, combination.
children as sex object, forcing ●​ Dating Relationship: situation wherein the
him/her towards obscene, parties live as husband and wife without the
prostitutioning the benefit of marriage or are romantically
woman/child involved. A casual acquaintance or ordinary
-​ Act causing or attempting to socialization of two individuals.
cause the victim to engage in ●​ Sexual Relations: single sexual act which
any sexual activity by force, may or may not result in the bearing of a
threat of force, physical or common child.
other harm. ●​ Safe place or shelter - any home or situation
-​ Prostituting the woman or maintained by the DSWD or any other agency
child accredited by the DSWD for the purpose of
3.​ Psychological violence: act or this act or any suitable place the resident of
omissions causing or likely to cause which is willing to temporarily receive the
mental or emotional suffering of the victim.
victim (intimidation, mental infidelity) ●​ Children: refers to below 18 y/o who is
4.​ Economic abuse: acts that make or incapable of taking care of themselves (under
attempt to make a woman financially the RA 7610). As used in this act includes
dependent which includes: biological children of the victim and other
-​ Withdrawal of financial children under her care.
support or preventing the
According to DSWD (Section 41)
victim from engaging in any
●​ Counseling and treatment of offenders - the
legitimate profession or
DSWD shall provide rehabilitative counseling
business, except in cases
and treatment to perpetrators towards learning
wherein other spouse/partner
constructive ways of coping with anger and
objects on valid, serious and
emotional outburst and reforming their ways.
moral grounds defined in
●​ When necessary, the offender shall be ordered
Article 73 of family code.
by the court to submit psychiatric treatment or
-​ Threat of deprivation of
confinement.
financial resources and right to
use and enjoyment of Nursing Care of the Client with Problems during
conjugal, community or Labor and Postpartum complication
property owned in common
-​ Destroying household 1.​ Hypotonic Uterine Contraction
property -​ Number of contractions not more than
-​ Controlling victims’ own 2 or 3 occurring in a 10 minute period
money or properties or -​ Resting tone of the uterus remains
solely controlling conjugal less than 10 mmHg
money/properties.
16 | PRELIMS CMPA412
 -​ If the uterus becomes exhausted, it gestation, unwise use of oxytocin,
can cause the uterus not to contract obstructed labor and traumatic
effectively during post-partal. maneuvers of forceps or tractions.
-​ Signs and symptoms: severe pain
2.​ Hypertonic Uterine Contraction during strong labor contraction
-​ Uterine resting tone is more than 15
mmHg 6.​ Uterine Inversion
-​ Lack of relaxation between ●​ Uterus turning inside out which either
contractions may not allow optimal birth of the fetus or delivery of placenta
uterine artery filling, this can lead to
1st Trimester Complications
fetal anoxia early in the latent phase of
labor. Fetal development starts when the egg is fertilized until
the end of the 13th week.
Comparison of Hypotonic and Hypertonic
Contractions 1.​ Hyperemesis gravidarum
Criteria Hypertonic Hypotonic ●​ Excessive or increase vomiting during
pregnancy
Most common Latent Active ●​ Severe form of morning sickness
phase of ●​ Risk Factors: Age below 17 and more
occurrence
than 35, primigravida, multiple
Symptoms Painful Limited pain pregnancy, underweight and obesity,
psychological factors (unwanted
Medication - - pregnancy), trophoblastic disease
used (h-mole).
●​ Possible cause: Emotional,
Oxytocin Unfavorable Favorable
reaction reaction psychological, hormonal fluctuations.

Sedation Helpful Little value 2.​ Gestational Trophoblastic Disease

●​ Nausea and vomiting of moderate
intensity especially common until
3.​ Precipitate Labor
about the 16 weeks
-​ Cervical dilation that occurs at a rate
●​ Risk factors: age below 17 & more
of 5 cm or more per hour in a
than 35; primigravida, multiple
primipara or 10 cm or more per hour in
pregnancies; underweight and obesity;
multipara
psychological factor such as unwanted
-​ It can be predicted in a labor graph if
pregnancy & marital problems;
during the active phase of dilation
trophoblastic disease
4.​ Prolonged Labor
3.​ Ectopic Pregnancy
-​ Latent Phase - when contraction
●​ An ectopic pregnancy occurs when a
becomes ineffective during the 1st
fertilized egg grows outside of the
stage of labor
uterus. Almost all ectopic
-​ Deceleration Phase - when it extends
pregnancies-more than 90%-occur in a
beyond 3 hours in nullipara or 1 hour
fallopian tube.
in multipara, may results in an
●​ As the pregnancy grows, it can cause
abnormal fetal head position
the tube to burst (rupture). A rupture
-​ Descent Phase - occurs if rate of
can cause major internal bleeding.
descent is less than 1.0 cm per hour in
●​ Risk factors:
a nullipara or 2.0 cm per hour in a
1.​ Medical history: previous
multipara.
ectopic pregnancy, pelvic
5.​ Uterine Rupture inflammatory disease (due to
-​ Rupture of uterus during labor adhesion formation), and
-​ Contributing factors: prolonged endometriosis (adhesion
labor, abnormal presentation, multiple formation)

17 | PRELIMS CMPA412
 2.​ Contraception: IUD or ●​ 2 Types of Gestational
intrauterine system, Trophoblastic Disease
progesterone oral 1.​ Partial Molar Pregnancy -
contraceptives or implant (due one ovum with 23
to fallopian tube ciliary chromosomes is fertilized by
dysmotility), tubal ligation or two sperm, each with 23
occlusion. chromosome
3.​ Iatrogenic: pelvic surgery, 2.​ Complete Molar Pregnancy -
especially tubal surgery one ovum without any
(reversal of sterilization), chromosomes is fertilized by
assisted reproduction (embryo one sperm which duplicates,
transfer in IVF) or (less commonly) two
●​ Signs & Symptoms: Pain. Patients different sperm. This leads to
commonly present with lower 46 chromosomes of paternal
abdominal/pelvic pain, with or without origin alone. Note: Invasive
vaginal bleeding; There can be a moles
history of amenorrhea; discharge; ●​ Other Types
shoulder tip pain; abdominal ○​ Choriocarcinoma - A
tenderness; hemodynamically malignancy of the
unstable. trophoblastic cells of the
●​ Diagnostics: Pregnancy test (urine placenta
B-HCG); transabdominal UTZ; ○​ Placental Site Trophoblastic
Transvaginal UTZ. Tumor - A malignancy of the
●​ Management: intermediate trophoblasts,
A.​ Medical - offered to px who which are normally
are stable, with well controlled responsible for anchoring the
pain and B-HCG levels <1500 placenta to the uterus.
iU/ml, The ectopic should be ○​ Epithelioid Trophoblastic
unruptured, and without visible Tumor - A malignancy of the
heartbeat; IM Methotrexate. trophoblastic placental cells,
B.​ Surgical - removal of ectopic which can be very difficult to
pregnancy; offered to px with distinguish from
severe pain, serum B-HCG choriocarcinoma
>5000 mIU/ml, adnexal mass ●​ Risk factors: Maternal age of 35,
>34mm and fetal heartbeat Previous gestational trophoblastic
visible on scan. disease (this risk is not decreased by a
C.​ Laparoscopic change of partner), Previous
Salpingectomy miscarriage, Use of the oral
D.​ Salpingotomy - opening contraceptive pill
E.​ Conservative - Watchful ●​ Signs & symptoms: Vaginal bleeding,
waiting; Serum B-hCG (ensure Hyperemesis, Hyperthyroidism,
it is falling by equal or greater Anemia
50% of the level until it falls to ●​ Diagnostics
approximately, 5mIU/mL). ○​ Urine B-hCG high
●​ Complications: Bleeding leading to ○​ Blood B-hCG levels high
hypovolemic shock ○​ Ultrasound scan (granular and
snowstorm appearance)
4.​ Gestational Trophoblastic Disease ○​ Histological Examination -
●​ Pre malignant conditions (more retained product of
common) conception.
●​ Malignant conditions (rarer ○​ MRI can also be used-
●​ Molar Pregnancies (abnormality in evaluates the uterus can
chromosomal number during detect h. Mole and
fertilization) Choriocarcinoma
18 | PRELIMS CMPA412
 ●​ Management
ned bleeding pregnancy bleeding
○​ D and C- method: suction +/- pain; admit/observe
curettage cervix
○​ Anti-D prophylaxis - RH closed If not,
immunoglobulin for reassure and
prophylaxis if RH negative back to
(RH incompatibility can result GP/Midwife
to hemolysis therefore anti-D
If >12 weeks
prophylaxis is given to prevent and rhesus
RH sensitization) negative:
○​ Chemotherapy - if invasive Anti-D
mole and choriocarcinoma
○​ Surgery - if placental site
trophoblastic tumor and
Type Clinical Transvag Management
epithelioid trophoblastic tumor inal UTZ
5.​ Miscarriages Missed Asymptom No fetal May want to
●​ Defined as loss of a pregnancy at less atic or heart rescan and
than 24 weeks gestation history of pulsation second
●​ Risk factors: Maternal Age >30-35 threatened where person to
(largely due to an increase in miscarriag crown confirm
e, on-going rump
chromosomal abnormalities); Previous
discharge, length is Manage
miscarriages; Obesity; Chromosomal small for >7mm* conservatively
abnormalities (maternal or paternal); dates (lower
Smoking; Uterine anomalies; Previous uterus success
uterine surgery; Antiphospholipid rated),
syndrome; Coagulopathies medically or
surgically
●​ Signs & symptoms: vaginal bleeding
often accompanied by suprapubic, If >12 weeks
cramping pain (similar to primary and rhesus
dysmenorrhea) negative:
●​ Diagnostics: Imaging; blood test Anti-D
serum ß-HCG (Full blood count; blood
group and rhesus status; triple swabs
and CRP if pyrexial) Type Clinical Transvagin Managem
●​ Management: al UTZ ent
1.​ Conservative (expectant) -
allows the product of Incompl POC** Retained expectant ,
conception to pass naturally ete partially POC, with medical or
expelled – A/P surgical
2.​ Medical - use of vaginal
symptoms endometrial manageme
misoprostol (prostaglandin of missed diameter nt
analogue) to stimulate cervical miscarriage >15mm and
ripening and myometrial or bleeding proof that if >12
contractions. there was weeks and
3.​ Surgical - manual vacuum intrauterine rhesus
pregnancy negative:
aspiration with local
previously Anti-D
anesthetic, if <12 weeks, or present
evacuation of retained (USS/clinic
products of conception. ally remove
clots)
Type Clinical Transvagi Management
nal UTZ

Threate Mild Viable If heavy

19 | PRELIMS CMPA412
 3.​ Problems with the Umbilical Cord
Type Clinical Transvagin Managem
al UTZ ent ○​ The umbilical cord may get caught on
an arm or leg as the infant travels
Complet Clots and No POC Discharge through this birth canal.
e POC and seen in to GP ○​ Typically, the provider intervenes if the
pain uterus with cord becomes wrapped around the
endometriu If >12
infant’s neck, is compressed, or comes
m that is weeks and
<15mm rhesus out before the infant.
diameter negative:
and Anti-D 4.​ Abnormal Heart Rate of the Baby
previous ○​ Many times, an abnormal heart rate
proof of during labor does not mean that there
intrauterine is a problem.
pregnancy ○​ A health care provider will likely ask
(scan) the woman to switch positions to help
Septic Infected Leukocytosi Medical or the infant get more blood flow.
POC: s, raised surgical ○​ In certain instances, such as when the
fever, CRP can be manageme test results show a larger problem,
uterine features of nt delivery might have to happen right
tenderness complete or away. In this situation, the woman is
, incomplete IV more likely to need an emergency
bleeding/di miscarriage antibiotics
cesarean delivery, or the health care
scharge, and fluids
pain provider may need to do an episiotomy
If > 12 to widen the vaginal opening for
weeks and delivery.
rhesus ○​ Position of mother: Left side lying
negative: ○​ Heartbeat of baby: 120-160
Anti-D
○​ Avoid unnecessary movement to
conserve oxygen
Intrapartal Complications (Bleeding cause placental
delivery and lacerations) 5.​ Water Breaking Early
○​ Labor usually starts on its own within
1.​ Labor that does not progress
24 hours of the woman’s water
○​ Sometimes contractions weaken, the
breaking. If not, and if the pregnancy is
cervix does not dilate enough or in a
at or near term, the provider will likely
timely manner, or the infant’s descent
induce labor.
in the birth canal does not proceed
○​ If a pregnant woman’s water breaks
smoothly.
before 34 weeks of pregnancy, the
○​ If labor is not progressing, a health
woman will be monitored in the
care provider may give the woman
hospital.
medications to increase contractions
○​ Infection can become a major concern
and speed up labor, or the woman
if the woman’s water breaks early and
may need a cesarean delivery.
labor does not begin on its own.
2.​ Perineal Tears
6.​ Perinatal Asphyxia
○​ A woman’s vagina and the
○​ This condition occurs when the fetus
surrounding tissues are likely to tear
does not get enough oxygen in the
during the delivery process.
uterus or the infant does not get
Sometimes these tears heal on their
enough oxygen during labor or
own.
delivery or just after birth.
○​ If a tear is more serious or the woman
has had an episiotomy (a surgical cut 7.​ Shoulder Dystocia
between the vagina and anus), her ○​ In this situation, the infant’s head has
provider will help repair the tear using come out of the vagina, but one of the
stitches. shoulders become stuck
20 | PRELIMS CMPA412
 8.​ Excessive Bleeding ●​ Symptoms may include persistent
○​ If delivery results in tears to the uterus, sadness, loss of interest, anxiety and
or if the uterus does not contract to intrusive thoughts.
deliver the placenta, heavy bleeding ●​ It's crucial to seek professional help in
can result. experiencing these conditions, as they
○​ Worldwide, such bleeding is a leading can be effectively treated with therapy,
cause of maternal death. medication or both.

Post Partal Complications 7.​ Preeclampsia

●​ Characterized by high blood pressure
1st Trimester Complication and damage to organs, primarily liver
1.​ Postpartum Hemorrhage and kidneys.
●​ This is excessive bleeding following ●​ In some, it can persist or develop
childbirth, often caused by the failure postpartum, requiring continued
of the uterus to contract properly after monitoring and management of blood
delivery. pressure.
●​ It can be a life-threatening condition if
not treated promptly. 8.​ Puerperal Mastitis
●​ Inflammation of the breast tissue
2.​ Infection occurs when breastfeeding. Symptoms
●​ Infections can occur at the site of a include breast pain, redness and
cesarean section incision or in the swelling.
reproductive organs. ●​ Which can lead to infection if not
○​ Endometritis is a common addressed, and treatment involves
postpartum infection that antibiotics, and continuing to
affects the uterine lining. breastfeed or express milk.

3.​ Perineal Tears and Episiotomy 9.​ Wound Complication

●​ Tears in the vaginal area can occur ●​ If woman had CS or other surgical
during childbirth. procedures during childbirth,
●​ Sometimes, healthcare providers may complications at the incision site can
perform an episiotomy (deliberate cut occur, including wound infections, poor
to the perineum) to aid delivery. Both healing or keloid scarring.
can lead to complications if not ●​ Proper wound care and in some,
managed. antibiotics may be needed.

4.​ Thromboembolic Disorders 10.​ Anemia

●​ Blood clots in the legs (DVT) or the ●​ Some women may develop anemia
lungs (pulmonary embolism) can after childbirth due to blood loss that
develop after childbirth, especially if occurs during delivery.
the woman is immobile for an ●​ Symptoms include fatigue, weakness
extended period. and pallor. Iron supplements and
dietary change may help.
5.​ Urinary Problems
●​ Issues like incontinence (loss of 2nd Trimester Complication
bladder control) or urinary retention 1.​ Bleeding
(inability to empty bladder) can occur. ●​ Brought about by miscarriages in the
second trimester (before 20 weeks)
6.​ Psychological Complications
may be caused by several different
●​ Postpartum depression and
factors.
postpartum anxiety are mental health
○​ Uterine septum - a wall, or
conditions that can affect some
septum, inside the uterus
women after childbirth.
divides it into two separate
parts.

21 | PRELIMS CMPA412
 ○​ Incompetent cervix - when muscles and stopping
the cervix opens too soon, contractions.
causing early birth. 3.​ Preterm Premature Rupture of the
○​ Autoimmune diseases - Membrane (PPROM)
examples include lupus or ●​ Risk factors: infections, uterine
scleroderma. These diseases abnormalities, and a history of preterm
can occur when your immune birth
system attacks health cells. ●​ Diagnostics: a physical exam,
○​ Chromosomal abnormalities medical history and laboratory tests;
of the fetus - this is when ○​ Speculum exam - visualizes
something is wrong with a fluid leaking from the cervix
baby's chromosomes, which ○​ Fern test - examines dried
are cells that are made up of vaginal fluid under a
DNA. microscope for a fern-like
2.​ Preterm Labor pattern
●​ When labor occurs before the 38th ○​ pH test - measures the acidity
week of pregnancy, it’s considered or alkalinity of vaginal fluid
preterm. Various conditions may cause ●​ Signs & Symptoms: vaginal
preterm labor. discharge, uterine contractions, uterine
●​ Risk factors: a previous preterm birth, tenderness, abdominal pain, pelvic
twin pregnancies, multiple pressure
pregnancies, extra amniotic fluid (the ●​ Treatment: Hospitalization, antibiotics;
fluid surrounding the fetus), infection of steroids, such as betamethasone,
the amniotic fluid or amniotic medications that can stop labor, such
membrane as Terbutaline
●​ Signs and Symptoms: vaginal 4.​ Cervical Incompetence or Cervical
pressure, low back pain, frequent Insufficiency
urination, diarrhea, increased vaginal ●​ The cervix is a tissue that connects the
discharge, tightness in the lower vagina and the uterus. Sometimes, the
abdomen, severe painful contractions, cervix is unable to withstand the
leakage of fluid from vagina, vaginal pressure of the growing uterus during
bleeding. pregnancy.
●​ Treatment: ○​ The increased pressure
○​ Pharmacology weakens the cervix and
1.​ Magnesium Sulfate - causes it to open before the
act in the treatment of ninth month.
hypomagnesemia, ●​ Risk factors: a previous cervical
eclampsia, and trauma, such as a tear during delivery;
inhibition of uterine a cervical cone biopsy; other operation
contraction in preterm on the cervix.
labor. ●​ Signs & Symptoms: (-) pain or
2.​ Corticosteroids - can contractions; (+) vaginal bleeding or
reduce the risk of discharge
serious complications ●​ Treatment; emergency cerclage
in premature babies, ●​ Prevention: if you have a history of it,
such as breathing you can receive a cerclage with future
problems, bleeding in pregnancies at about 14 weeks
the brain, and 5.​ Preeclampsia
developmental delay. ●​ Risk factors: High blood pressure;
3.​ Tocolytics - proteinuria (a large amount of protein
Medication that can in the urine); excessive edema
delay preterm birth by (Swelling)
relaxing the uterine ●​ Signs & Symptoms; rapid swelling of
your legs, hands, or face; headache
22 | PRELIMS CMPA412
 that doesn't go away after taking
Pain Painless Sharp, colic-like
acetaminophen (tylenol); loss of pain, camplike
visions “floaters” in your eye (specks
or spots in your vision); severe pain on Bleeding Bright red Dark red
your right side or in your stomach
area; easy bruising. Uterus Soft, boggy, Board-like, firm,
flaccid rigid, tender
3rd Trimester Complication
Complications Infection, Infection,
1.​ Gestational DM hemorrhage/ hemorrhage/
●​ Occurs because the hormonal shock, fetal shock, fetal
changes of pregnancy make it more anemia, fetal distress,
difficult for your body to effectively use distress couvelaire
insulin. uterus, or
uteroplacental
○​ When insulin cant do its job of
apoplexy
lowering blood sugar to
normal levels, the result is
abnormally high glucose 4.​ Intrauterine Growth Restriction (IUGR)
(blood sugar) levels. ●​ Occasionally a baby won't grow as
●​ Diagnostics: For the oral glucose much as they’re expected to at a
tolerance test, you fast for at least certain stage in a woman’s pregnancy.
eight hours and then have 100 ●​ Risk factors: alcohol abuse, smoking,
milligrams of glucose, after which your drug addiction clotting disorders, high
blood sugar levels are checked. blood pressure or heart disease;
○​ Those levels will be measured diabetes; kidney disease; poor
at one, two, three hours after nutrition
you drink the glucose. ●​ Signs & Symptoms: The baby’s
●​ Treatment; can be treated with diet, measurements are off the growth
lifestyle changes, and medicines. harts; the baby’s movement
2.​ Placenta Previa decreases; the amount of amniotic
●​ Placenta that comes first and blocks fluid decreases; the mother’s uterus is
the opening to the cervix. smaller than expected; the mother’s
●​ Clinical Features: bright red, sudden, weight gain is poor.
profuse, and painless vaginal ●​ Treatment: Nutrition; bed rest delivery;
bleeding, which usually occurs after treatment of medical conditions;
the 28th week of pregnancy. surveillance; smoking cessation.
●​ Treatment: bed rest, medication, and 5.​ Post Term Pregnancy
sometimes a C-section ●​ Any pregnancy lasting longer than 42
3.​ Abruptio Placenta weeks is considered post-term or
●​ Rare condition in which the placenta post-dates
separates from the uterus prior to ●​ Treatment: observation, labor
labor. induction, or C-section
●​ Risk factors: advanced maternal age; 6.​ Meconium Aspiration Syndrome
cocaine use; diabetes; heavy alcohol ●​ First stool that is passed on the baby
use; high blood pressure; pregnancy ●​ Treatment: suction; oxygenation;
with multiples; preterm premature breathing machine; antibiotic;
rupture of the membranes; prior surfactant; inhaled nitric oxide; IV
pregnancies; short umbilical cord; nutrition; radiant warmer
smoking; trauma to the stomach; 7.​ Malpresentation (Transverse, Breech)
uterine distention due to excess ●​ Treatment: external cephalic version
amniotic fluid. (ECV) - procedure that gently turns the
baby into a head-first position); C
Placenta Abruptio section
Previa Placenta

23 | PRELIMS CMPA412
 Blood Transfusion ○​ When rheumatic fever occurs, the
body’s immune system mistakenly
●​ Patient’s history attacks the heart, causing scarring and
●​ Ordered RBC unit standby (Doctor’s order) stiffening of the heart valves
●​ Important: It cannot be hooked to the main (especially the mitral valve)
line; before transfusing, cross matching should ●​ Can result to:
be done first by the medtech then to the nurse. ○​ Mitral stenosis (causes narrowing of
●​ Management: the valve between the left atrium and
○​ Transcribe the doctor’s order left ventricle
○​ Go to the patient, explain the ○​ Mitral regurgitation cause abnormal
procedure and secure consent leakage of blood between the left
○​ Check the chart for blood typing atrium and ventricle (the mitral valve
○​ If there is a result, call the laboratory doesn’t close properly)
(make sure to ask who you’re ●​ During pregnancy, there is an increase in
speaking with in the laboratory, as this blood volume of 30-50% resulting in increased
should be documented in the chart pressure on the valves.
and kardex) ●​ For women with rheumatic heart disease this
○​ Endorse to the next shift. increased pressure presents increased
Cardiovascular Disorders and Pregnancy maternal or fetal risk.
●​ For women with more severe rheumatic
1. A Woman with Left Sided Heart Failure heart disease, it could lead to the
●​ During pregnancy, the heart has to work development of much more serious symptoms
harder to pump extra blood for the baby. such as pulmonary edema, atrial fibrillation, or
○​ If the left side is weak, it struggles, clotting.
leading to complications. ●​ Note: Cardiovascular changes begin in the first
○​ Left = Lungs (mostly lung related trimester but peak at 28-30 weeks and
signs and symptoms) sustained until term.
●​ Occurs in conditions such as mitral stenosis, ○​ This means, women with valvular
mitral insufficiency and aortic coarctation. disease become more symptomatic in
●​ In these instances, left ventricle cannot move the third trimester
the volume of blood towards the systemic
circulation. 4. A Woman with Artificial Valve Prosthesis
○​ If this happens, this will lead to IUGR, ●​ Is a device designed to replace a damaged
preterm birth, fetal distress, neonatal heart valve
complications. ●​ Were advised not to become pregnant for fear
the increased blood volume gained during
2. A Woman with Right Sided Heart Failure pregnancy would overwhelm artificial valve.
●​ Congenital heart defects such as pulmonary ●​ Today, women with a valve prosthetics
valve stenosis and atrial and ventricular septal complete pregnancy safely; one potential
defects can result in right sided heart failure. problem involves the use of oral anticoagulants
●​ Occurs when the output of the blood of right that a woman takes to prevent the formation of
ventricle is less than the blood volume clots at the valve.
received by the right atrium from the vena ●​ Management:
cava. ○​ Close monitoring
●​ The right ventricle cannot move the volume of ○​ Adjustment of anticoagulation therapy
the blood towards the pulmonary circulation. (adjusted during pregnancy to
○​ If this happens, this will lead to IUGR, minimise bleeding and complications)
preterm birth, fetal distress.
5. A Woman with Chronic Hypertensive Vascular
3. A Woman with Rheumatic Heart Disease
Disease
●​ Heart valves are damaged because of
●​ Chronic hypertension means a woman already
rheumatic fever (complication of streptococcal
has high blood pressure (140/90 mmHg or
infection)
higher) before pregnancy or before 20 weeks
●​ Past strep throat infection → rheumatic
of gestation. When combined with vascular
fever → damages the heart valves over time
24 | PRELIMS CMPA412
 disease, it means her blood vessels have ●​ True anemia is present when a woman’s
already been damaged due to long-term high hemoglobin concentration is less than 11 g/dL
blood pressure. (hematocrit 33%) in the 1st or 3rd trimester of
●​ Hypertension of this is associated with pregnancy or hemoglobin concentration is less
arteriosclerosis or renal disease. than 10.5 g/dL
●​ Chronic hypertension places both woman and ●​ Other True Anemias: Iron-Deficiency Anemia;
fetus at high risk due to fetal well being can be Folic Acid-Deficiency Anemia; Sickle Cell
compromised by poor placental perfusion Anemia; Thalassemia; Malaria
during the pregnancy.
Renal and Urinary Disorders & Pregnancy
●​ Management
○​ Regular blood pressure monitoring 1. A Woman with a Urinary Tract Infection
○​ Fetal monitoring thru ultrasound ●​ A serious condition that needs prompt
○​ Lifestyle modification intervention because there will be an increase
chance of:
○​ First line treatment: methyldopa
○​ Risk for preterm
6. A Woman with Venous Thromboembolic Disease ○​ low-birth weight
●​ The incidence of venous thromboembolic ○​ sepsis
disease increases during pregnancy because ●​ UTI in pregnancy when bacteria enter the
of a combination of factors urinary system (bladder, urethra, or kidneys),
○​ Blood stasis in the lower causing an infection.
extremities from uterine pressure ○​ they are more prone to UTI because
(this pressure can slow blood flow and hormonal changes slow urine flow, and
may also contribute to vessel damage, the growing fetus presses on the
particularly in the lower extremities, bladder, making it harder to fully
due to compression from the growing empty.
uterus or fetal head). ●​ S/sx:
○​ Hypercoagulability (due to elevated ○​ Burning sensation while urinating
estrogen). ○​ frequent urination
○​ When this triad effect is in place ○​ pelvic pain/discomfort
■​ Stasis ○​ fever chills
■​ Vessel damage ●​ Management
■​ Hypercoagulation ○​ Drinking plenty of fluids
○​ The stage is set for thrombus ○​ Rest
formation in the lower extremities. The ○​ Good hygiene
likelihood of deep vein thrombosis ○​ Safe antibiotics: nitrofurantoin
(DVT) (macrodantin); cephalexin
■​ Leading to pulmonary
2. A Woman with Chronic Renal Disease
embolism increases for
●​ A severe chronic kidney disease in pregnancy
women 30 years of age or
can be further complicated by hypertension
older because increased age
and proteinuria (triggers inflammatory
is yet another risk factor for
cytokines which are vasoconstrictors
thrombosis formation.
contributing in hypertensive states (increased
Anemia & Pregnancy bp and worsening hypertension)
●​ Risk for: preeclampsia, preterm, low-birth
●​ blood volume expands during pregnancy this weight, maternal death
results in slight decrease of RBC ●​ Management:
●​ Most women have pseudo-anemia of early ○​ BP control
pregnancy. Kaya nag folic acid ang pregnant ○​ Manage presence of protein in the
women due to slight decrease of RBC urine
●​ This condition is normal and should not be ○​ Anemia (due to CKD)
confused with true types of anemia that can ○​ Dialysis (indicated/required in women
occur as complications of pregnancy. with advanced CKD)

25 | PRELIMS CMPA412
 Respiratory Disorders & Pregnancy ●​ It can range from mild to severe and may get
better, worse, or stay the same during
1. A Woman with Acute Nasopharyngitis (Common pregnancy.
Cold) ●​ Uncontrolled asthma can increase the risk of
●​ It can increase the risk of preterm labor maternal mortality
particularly if the mother has a fever
●​ Also, risk for low birth weight, particularly if the 6. A Woman with Tuberculosis
mother has a severe cold ●​ Is a bacterial infection caused by
●​ Acute nasopharyngitis is just a fancy term for Mycobacterium tuberculosis.
the common cold. ●​ It primarily affects the lungs but can also
●​ It’s caused by viruses and affects the nose and spread to other organs.
throat, leading to symptoms like sneezing, ●​ It spreads through airborne droplets when an
runny nose, sore throat, and mild cough. infected person coughs or sneezes.
●​ Risk for: increase the risk of maternal
2. A Woman with Influenza mortality and fetal distress leading to birth
●​ Is a viral infection that affects the respiratory asphyxia
system (nose, throat, and lungs). ●​ Can be transmitted to fetus resulting in
●​ It causes fever, chills, cough, body aches, congenital tuberculosis
fatigue, and sore throat.
●​ Unlike the common cold, the flu can lead to 7. A Woman with Chronic Obstructive Pulmonary
serious complications, especially during Disease
pregnancy. ●​ A chronic lung disease that makes it hard to
●​ There will be an increase risk of severe illness breathe due to airway inflammation, mucus
from influenza buildup, and lung damage.
●​ This may be caused by pneumonia and ards ○​ It includes chronic bronchitis and
emphysema and is often caused by
3. A Woman with Pneumonia smoking, air pollution, or long-term
●​ It can cause right sided heart failure also, resp lung irritation.
failure, ●​ Note: COPD can cause right sided heart
●​ A life threatening for both the mother and the failure
fetus
●​ Is a lung infection caused by bacteria, viruses, 8. A Woman with Cystic Fibrosis
or fungi. ●​ A genetic disorder that causes thick, sticky
●​ It leads to fever, cough with phlegm, difficulty mucus to build up in the lungs, digestive
breathing, chest pain, and fatigue. system, and other organs.
●​ In pregnancy, it can be serious if not treated ○​ This leads to breathing difficulties, lung
quickly. infections, and poor nutrient
absorption.
4. A Woman with Severe Acute Respiratory ●​ Pregnant woman w/cystic fibrosis at increased
Syndrome (SARS) risk of pulmonary exacerbation during
●​ Is a severe viral respiratory illness caused by a pregnancy
coronavirus. ●​ They may also experience malnutrition due to
●​ It leads to high fever, cough, breathing increase nutrient/energy demand during
difficulties, and body aches. pregnancy
●​ It spreads through droplets from coughs and
sneezes and can be life-threatening, especially Rheumatic Disorders & Pregnancy
during pregnancy.
1. A Woman with Rheumatoid Arthritis
●​ Can cause severe illness to the mother
●​ Is an autoimmune disease where the body's
●​ Risk for: increase maternal morbidity and
immune system attacks the joints, causing
mortality and as well as fetal distress
pain, swelling, and stiffness.
5. A Woman with Asthma ●​ It can also affect other organs over time.
●​ A chronic condition where the airways become
2. A Woman with Systemic Lupus Erythematosus
inflamed and narrow, causing wheezing,
●​ Also known as lupus, is a chronic autoimmune
shortness of breath, chest tightness, and
disease where the immune system attacks
coughing.
26 | PRELIMS CMPA412
 healthy tissues, causing inflammation and replacement to prevent
damage to the joints, skin, kidneys, heart, and dehydration,
other organs. -​ Surgical management for
●​ No. 1 & 2: both autoimmune disorders that can severe cases or don't respond
affect the results of pregnancy to conservative
●​ Risk for: low birth weight, fetal anomalies, -​ Laparoscopic cholecystectomy
preterm labor, preeclampsia (increase risk), or open chole
fetal loss
●​ Management: 4. A Woman with Pancreatitis
○​ Lifestyle changes ●​ Inflammation of the pancreas, monitor the
○​ Corticosteroids blood sugar of the patient. Risk for increased
○​ NSAID blood sugar.
○​ Salicylates/Heparin ●​ Monitor the blood sugar of the patient due to
risk for increased blood sugar.
Gastrointestinal Disorders & Pregnancy ●​ Risk for: preterm labor, fetal loss, maternal
mortality, and pancreatic necrosis.
1. A Woman with Appendicitis ●​ Management: conservative management for
●​ A medical emergency that requires prompt mild cases (pain management, fluid
surgical intervention replacement, nutritional support) or surgery
●​ During pregnancy, appendicitis, it can be (for severe cases, involves pancreatic
challenging to diagnose and manage that is debridement, or removal of dead tissue)
because of the anatomical and physiological 5. A Woman with Inflammatory Bowel Disease
that may occur. ●​ Inflammation in the intestine
●​ Also the delay of diagnosis and prompt ●​ Risk for: preterm birth, low birth weight,
treatment can cause pregnancy complications cesarean delivery, and fetal growth restriction.
such as: preterm distress, preterm labor, fetal ●​ Management: Sulfasalazine (drug of choice)
loss, maternal mortality
●​ Management Neurologic Disorders & Pregnancy
○​ Surgery
1. A Woman with Seizure Disorder
○​ Accepted antibiotics
●​ Increases the risk for seizure due to hormonal
○​ Based on the necessity of the patient
changes, can cause fetal anoxia.
with regards to anesthesia
●​ Anti-epileptic drugs increase birth defects
2. A Woman with Gastroesophageal Reflux Disease particularly to development of the neural tube
●​ Common condition during pregnancy d/t defects.
○​ Hormonal fluctuations
○​ Pressure of the stomach d/t growing 2. A Woman with Stroke
uterus ●​ It can affect maternal mortality and increase
●​ Management: complications during pregnancy such as
○​ Lifestyle modification preterm labor, fetal growth restrictions and
○​ Proton pump inhibitors are considered placental abruption.
safe in 2nd & 3rd trimester
3. A Woman with Sleep Disorders
3. A Woman with Cholecystitis and Cholelithiasis ●​ Fatigue, mood disturbances, decreased quality
●​ Cholecystitis - Inflammation of the gallbladder of life due to inadequate sleep and can lead to
●​ Cholelithiasis - Presence of stones in preeclampsia, gestational diabetes, fetal
gallbladder growth restriction and increased risk of
●​ Risk for: preterm labor, fetal loss, maternal postpartum depression.
mortality, gallbladder rupture
●​ Management Musculoskeletal Disorders & Pregnancy
○​ Conservative mgmt particularly for mid
1. A Woman with Scoliosis
cases:
●​ Is a condition characterized by abnormal
-​ Pain management w/accepted
structure of curvature of the spine.
pain relievers fluid

27 | PRELIMS CMPA412
 ●​ It can increase the risk of cesarean delivery Bleeding Disorders & Pregnancy
due to difficulty of the patient with regards to
vaginal delivery. ●​ Abortion/Miscarriage
●​ There will be an increased risk of fetal growth ●​ Ectopic Pregnancy
restrictions due to severe scoliosis and can ●​ H-Mole
reduce lung capacity which impairs the growth ●​ Incompetent Cervix
of the fetus and increase risk of preterm labor ●​ Abruptio Placenta
due to back pain and discomfort. ●​ Premature Labor
●​ Management: regular prenatal care or ●​ Premature Rupture of Membranes
consultation and back pain management ●​ Management:
○​ Pharmacology - Tranexamic Acid and
Endocrine Disorders & Pregnancy Blood Transfusion

1. A Woman with Hypothyroidism Mental Illness & Pregnancy

●​ This can have a significant effect on both
●​ Postpartum Depression and Postpartum
mother and fetus.
Anxiety - can affect any woman regardless of
●​ It can cause impaired cognitive function and
age, socioeconomic status and background.
motor development of the fetus, and increase
●​ Management: psychotherapy (counselling or
the risk of congenital anomalies as well as
talk therapy), medications (antidepressants or
thyroid dysfunction.
mood stabilizers), support groups, lifestyle
2. A Woman with Hyperthyroidism changes and stress management.
●​ It increases the risk miscarriage, preterm
Pediatric Nursing
labor, low birth weight and fetal growth
restriction as well as fetal thyrotoxicosis, and Newborn Screening
congenital abnormalities.
●​ Management: anti-thyroid medications ●​ Checks for rare but serious health conditions
(propylthiouracil) in babies
●​ Goals: to detect conditions before they cause
3. A Woman with Diabetes Mellitus symptoms
●​ Significant health concerns during pregnancy Congenital Hypothyroidism
which affects both the mother and the fetus. ●​ Function of thyroid gland: help regulate your
●​ Most common types of DM in pregnancy are metabolism (growth, metabolism, T3 & T4)
gestational DM and pre-existing diabetes. ●​ Reduced or absent function of the thyroid
●​ Mother: causes maternal hypertension, gland in a newborn
preeclampsia, cesarean delivery, miscarriage. ●​ A condition where a baby is born with an
underactive thyroid gland or no thyroid at all.
●​ Baby: cause macrosomia or excessive birth
This leads to low thyroid hormone levels,
weight and hypoglycemia which are essential for brain development and
●​ Management: lifestyle modification and growth.
monitoring and insulin. ●​ Symptoms are apparent during the first 3
months of life (formula fed) and apparent in 6
Cancer Disorders & Pregnancy months (breastfed)
●​ Early Diagnosis is crucial
●​ The malignancies most commonly seen with ●​ Assessment findings
pregnancy are those that occur most ○​ Sleeps a lot, Large tongue
frequently in women during childbearing years. ○​ Respiratory difficulty, Noisy respiration
○​ Fatigue during waking hours, Poor
○​ Cervical, Breast, Ovarian, Thyroid,
suck, choking (due to large tongue)
Leukemia, Melanoma, Lymphomas ○​ Cold, dry, scaly skin, Skin (-) of
●​ Treatment: perspiration, Prolonged jaundice, (+)
○​ Chemotherapy Anemia (lethargy & fatigability)
○​ Radiation (avoided in the first ○​ Brittle and dry hair, Short and thick
trimester); or targeted therapy (most neck, Dull facial expression
safety and efficient depending on the (Decreased muscle tone)
○​ Open mouth: Attempt to breathe (due
specific agent and type of cancer) to large tongue)
○​ Surgery ○​ Floppy (due to muscle tone), ragdoll
28 | PRELIMS CMPA412
 appearance, Obesity ●​ Assessment findings: Poor suck, Atopic
○​ Delayed dentition (normal: first teeth dermatitis, Seizure disorder
appear 6 months of age in upper ●​ Management
teeth) ○​ Dietary restriction of large neutral
○​ Chronic constipation, Umbilical hernia amino acids (LNAA)
●​ Laboratory Test ○​ Sapropterin - reduces phenylalanine
○​ Low radioactive iodine: (important production and help proper functioning
for production of Thyroid hormone) ng phenylalanine hydroxylase
○​ Elevated thyroid stimulating ●​ Nursing Management
hormone (anterior pituitary gland) due ○​ A lifetime diet with very limited intake
to low production of thyroid hormone of foods with phenylalanine
●​ Risk factors ○​ Taking a PKU formula
○​ Low iodine level of the mother ●​ Why is it dangerous?
○​ Presence of autoimmune ABS ○​ If untreated, high phenylalanine levels
○​ Genetic predisposition (common in can cause severe intellectual disability,
white people due to their genes) developmental delays, and
○​ Low-birth weight (4,500g) neurological problems.
●​ Diagnostics: Xray and UTZ
●​ Management Galactosemia
○​ Sodium Levothyroxine ●​ A disorder of carbohydrate metabolism where
○​ Supplemental Vitamin D (rickets: weak the body can’t properly break down galactose,
bones in children) leading to high levels in the blood
●​ Goal (galactosemia) and urine (galactosuria).
○​ Correct hypothyroidism, ensure normal ●​ Inherited as an autosomal recessive trait,
growth meaning both parents must carry the defective
○​ Hashimoto thyroid gene for the child to develop the condition.
●​ Nursing Management ●​ Cause:
○​ Monitor for signs and symptoms ○​ There is deficiency in the liver enzyme
○​ Review Newborn Screening results Galactose-1-phosphate
(determining t4 and t3 level) uridyltransferase (GALT), which is
○​ Assess developmental milestones essential for converting galactose into
●​ Why is it dangerous? glucose.
○​ If left untreated, it can cause ○​ Without GALT, galactose builds up in
intellectual disability and stunted the blood, leading to toxic effects on
growth. organs, tissues, and the brain.
○​ Early treatment is critical to prevent ○​ The excess galactose is excreted in
long-term complications. the urine (galactosuria).
●​ Diagnosis
Phenylketonuria (PKU) ○​ Beutler test (screening test) - a
●​ Inherited metabolic disorder caused by a fluorescence-based test that checks
deficiency of the enzyme phenylalanine for the activity of the enzyme GALT in
hydroxylase (PAH) red blood cells
●​ It follows an autosomal recessive inheritance ○​ If the enzyme is low or absent, it
pattern (meaning both parents must carry the suggests classic galactosemia
defective gene for the child to develop PKU ●​ Assessment findings
○​ If only one parent is a carrier, the child ○​ Lethargy
won’t have PKU but can still pass the ○​ Hypotonia (increase galactose lead to
gene to future generations. decrease muscle tone)
●​ How it Happens: ○​ Diarrhea & vomiting (impaired
○​ The missing enzyme (PAH) prevents absorption)
phenylalanine from converting into ○​ Jaundice
tyrosine, an important amino acid for ○​ Bilateral cataracts develops -
making catecholamines (dopamine, (accumulation of galactitol: it’s a sugar
norepinephrine, epinephrine). alcohol, leads to swelling of lens and
○​ As a result, phenylalanine builds up in results of bilateral cataracts)
the blood and is converted into ●​ Management: Diet free galactose
phenylpyruvic acid, which is toxic to
the brain. Glucose-6-phosphate dehydrogenase deficiency
○​ The excess phenylalanine is excreted (G6PD)
in the urine, leading to its detection in ●​ Is an enzyme essential for maintaining red
newborn screening tests. blood cell (RBC) stability and protecting them
●​ Risk factors: Genetics (African/Jewish) from damage.
29 | PRELIMS CMPA412
 ●​ Deficiency in G6PD leads to premature RBC Alterations in Oxygenations Responses to Altered
destruction (hemolysis), especially when Cardiac & Tissue Perfusion
triggered by certain foods, infections, or
medications. Atrial Septal Defect (ASD)
●​ It is inherited as an X-linked recessive trait, ●​ A congenital heart defect characterized by a
meaning it primarily affects males, while hole in the septum between the RA and LA
females can be carriers. ○​ This allows oxygen-rich blood to mix
●​ There are two main forms: with oxygen-poor blood, causing
1.​ Chronic hemolytic anemia (rare, extra blood to flow into the lungs.
continuous RBC breakdown). ●​ Can result in pulmonary HPN & RSHF (tataas
2.​ Acute hemolytic anemia (more ang workload ng heart)
common, triggered by external ●​ 4 types (kung nasaan ang butas ng asd)
factors).
●​ Risk Factors: Hereditary (African,
Mediterranean, Asian)
●​ Diagnosis
○​ Electrophoretic analysis of RBC
○​ Blood smear (+ Heinz bodies)
○​ Enzyme screening test
●​ Assessment Findings (2 forms)
1.​ Children with congenital
nonspherocytic type develop
hemolysis (1ST FORM)
-​ Jaundice
-​ Splenomegaly
-​ Aplastic crisis
2.​ Children with drug induced form -​ Secundum ASDs (in the middle of the
(2ND FORM) septum and most common)
-​ Low grade fever -​ Primum ASDs (opening is atrial part
-​ Back pain of septum less common)
●​ Management -​ Sinus venosus ASDs (atrial septum
○​ Restriction from drugs that can induce defect upper or lower back part of the
hemolysis (Anti malaria, sulfonamide, atrial septum and rarely type)
sulfocysteine (reduce taking this -​ Unroofed coronary sinus (between
meds) coronary sinus sa left and right atrial
○​ Blood transfusion in severe cases sinus) missing or incomplete wall b/w
coronary sinus and left atrium)
Congenital Adrenal Hyperplasia coronary sinus veins collect
●​ The adrenal glands are unable to produce deoxygenated blood that empty
enough cortisol, leading to an overproduction ●​ Assessment Findings: Rales, congestion,
of androgens (male hormones). easy fatigability, frequent respiratory tract
●​ This hormonal imbalance affects both males infections, poor weight gain, systolic murmurs
and females, but the effects are more ●​ Diagnostics: Echocardiogram
noticeable in females due to excess androgen ●​ Management
exposure in utero. -​ Cardiac catheterization (affected part
●​ Assessment Findings of defect)
○​ Male: Enlarged genitalia due to excess -​ Median sternotomy incision
androgens -​ Cardiopulmonary bypass (to correct
○​ Female: fusion of the labia and ASD)
enlarged clitoris (may resemble a
small penis) Ventricular Septal Defect (VSD
●​ Note: Hypospadias is a separate congenital ●​ Opening/hole in the septum between left and
condition where the urethral opening is on the right ventricle
underside of the penis instead of the tip. ●​ Occurs when a portion of ventricular septum
●​ Management does not completely close
○​ Goal is to replace cortisol (missing ●​ Assessment Findings
cortisol) ○​ Left heart dilation - left ventricle
○​ Corticosteroid (oral hydrocortisone) pumps blood into → right ventricle →
●​ Nursing Management then goes back to the lungs leading to
○​ Physical care, education and dilatation (enlargement of the heart)
emotional support) and pulmonary congestion.
-​ The initial volume overload
30 | PRELIMS CMPA412
 happens in the right ventricle harder for the heart to pump blood).
and lungs, but because the ●​ Assessment Findings
lungs send more blood back to ○​ Elevated BP in the right arm - more
the left side, the heart blood flow in the upper body, including
eventually dilates as well. the right arm (or both upper limbs)
○​ (+) murmur at left lower sternal border -​ Causing: strong pulses in the
○​ Tachypnea upper extremities
○​ Poor feeding -​ Wear/absent naman sa lower
○​ Failure to thrive (child does not grow extremities
or gain weight in normal) ○​ Systolic murmur - Heard left sternal
●​ Diagnostics: Echocardiogram border and midscapular area (back)
●​ Management ○​ Unequal blood pressure b/w upper
○​ Diuretics (due to high blood volume in & lower body
the lungs it remains in the left side of ●​ Management
the heart) ○​ Balloon - a balloon is inserted into the
○​ Dietary modification (rich in caloric narrowed artery and inflated to widen
intake) due to less weight of the child the area
○​ Surgical closure (median sternotomy) ○​ Stent Angioplasty - a stent (small
mesh tube) may be placed to keep it
Patent Ductus Arteriosus (PDA) open
●​ Is a normal fetal blood vessel that connects the ○​ End-to-End Anastomosis (Surgical
pulmonary artery (which carries blood to the Correction) - the narrowed segment
lungs) to the aorta (which carries blood to the of the aorta is removed, while the
body). remaining ends are sewn together to
○​ It’s supposed to close after birth restore normal blood flow.
○​ But in PDA, it stays open, allowing
oxygenated blood from the aorta to Aortic Stenosis
flow back into the pulmonary artery ●​ Narrowing of the aortic valve opening
instead of going to the body. makes it difficult for blood to flow from the left
●​ Shunting of blood, pulmonary congestion and ventricle to the aorta and the rest of the body.
pulmonary hypertension ○​ This leads to increased cardiac
●​ “Shunting” is the abnormal blood flow b/w the workload and can eventually cause left
heart chambers or vessels due to a defect ventricular hypertrophy and heart
●​ Risk factors: Premature infants failure
●​ Assessment findings: ●​ Assessment findings
○​ Systolic murmur - (2ND ICS left upper 1.​ systolic murmur - right 2nd of the
sternal border/left clavicular area) intercostal space
○​ Rales, congestion, tachypnea 2.​ Thrill/palpable purring sensation -
○​ Difficulty feeding felt in the suprasternal notch
○​ Failure to thrive 3.​ Chest pain (angina)
○​ Dilated left heart ●​ Diagnostic
●​ Management ○​ ECG
○​ Diuretics (manages pulmonary -​ Cardiac abnormalities
overload) -​ Shows left ventricular
○​ Pharmacological closure hypertrophy (LVH) → large
-​ Indomethacin (nsaid): Inhibits QRS complex due to
prostaglandin this hormone thickened heart muscle.
keeps ductus arteriosus open -​ May show left atrial
-​ Prostaglandin inhibitors hypertrophy (due to
○​ Other NSAIDS increased blood volume) →
-​ Aspirin prolonged P wave.
-​ Ibuprofen ○​ Echocardiography - visualizes the
●​ Surgical closure of the defect narrowed valve and measures blood
flow
Coarctation of Aorta ○​ Cardiac catheterization -
●​ Narrowing of the aorta assess/evaluates the severity stenosis
●​ Due to narrowing of the aorta, the left ventricle and aortic valve pressure
works harder due to increased resistance in ●​ Management
the left ventricle ○​ Beta blocker (propranolol and
○​ That may lead to elevated systemic metoprolol)
vascular resistance (blood vessels in -​ reduces cardiac workload (by
the body are more narrowed, making it slowing the heart rate and
31 | PRELIMS CMPA412
 lowering blood pressure)
-​ prevents further ventricular Tricuspid Atresia
hypertrophy ●​ A congenital heart defect that prevents blood
from flowing properly from the right atrium to
Pulmonic Stenosis the right ventricle
●​ Narrowing of the pulmonary valve ●​ Assessment findings
●​ Assessment findings ○​ Cyanosis, tachypnea, fatigue, poor
○​ Fatigue, SOB, chest pain, fainting, growth, SOB
bluish skin color ●​ Management
○​ Poor appetite, poor weight gain ○​ Prostaglandin (Pharmacologic)
○​ RV hypertrophy, increased RV ○​ Cardiac catheterization - To open
pressure, edema yung tricuspid valve
●​ Management ○​ Open heart surgery/minimally invasive
○​ Balloon valvuloplasty heart surgery
○​ Percutaneous valve replacement
-​ Replacement of valve Transposition of the Great Vessels
-​ Indications: option for younger ●​ A congenital heart defect that occurs when the
ones two main arteries leaving the heart are in the
-​ For those who have had wrong position
multiple pregnancies ●​ The pulmonary artery is attached to the LV
○​ Deoxygenated blood from the body
Tetralogy of Fallot (4 Major Defects) returns to the body instead of the
1.​ Pulmonary Stenosis lungs
●​ There is stenosis/narrowing on the ●​ The aorta is attached to the RV
pulmonary valve and pulmonary artery. ○​ Oxygenated blood from the lungs
○​ The blood flow going to the returns to the lungs instead of the
lungs is ineffective. body
2.​ Right Ventricular Hypertrophy ●​ Assessment finding: Cyanosis
●​ There is enlargement on the right ●​ Diagnostic: Echocardiogram
ventricle ●​ Management: cardiac surgery
○​ The right ventricle is working
hard because the blood is Hypoplastic Left Heart Syndrome
building up in the right ●​ A rare congenital heart defect that occurs
ventricle, which leads to right when the left side of the heart doesn’t develop
ventricular hypertrophy. properly
3.​ Overriding Aorta ○​ Immature development on the left side
●​ The aorta is not only open to the left of the heart. Difficult to pump the heart
ventricle but also to the right ventricle. because it does not develop properly.
○​ It receives oxygenated blood ●​ Assessment findings
from the left ventricle and also ○​ Cool, clammy, pale skin
deoxygenated blood from the ○​ Cyanosis
right ventricle. ○​ Weak or rapid pulse
4.​ Ventricular Septal Defect ○​ Slow or shallow or rapid breathing
●​ There is a hole in the septum, causing ●​ Management: Surgery
the blood from the right and left
ventricles to mix. Alterations in Respiratory System
●​ Assessment Findings
○​ Cyanosis (hallmark), fatigue, Pharyngitis
restlessness ●​ Common illness in children wherein the
○​ Limp body: result of hypoxia pharynx is inflamed
○​ Decreased cardiac output ●​ “Sore throat”
○​ Losing consciousness: due to hypoxia ●​ Cause: Viral or bacterial
○​ Hard time breathing: due to
●​ Assessment findings:
accumulation of the right side of the
○​ Sore throat, difficulty in swallowing,
heart
●​ Diagnostic ○​ In assessing the patient’s throat you
○​ CXR or CT scan will notice a white or yellow patches
○​ Echocardiogram - confirm the dx and ○​ Swollen and tenderness of lymph
evaluate the severity of the defects nodes upon palpation in the neck
●​ Management: Cardiac surgery ●​ Diagnostic: To determine if it is viral or
bacterial, throat culture is done
●​ Management
32 | PRELIMS CMPA412
 ○​ Antibiotics ○​ Myoclonic seizure - characterized by
○​ Pain relievers - if pain is present sudden, brief, massive muscle jerks
(paracetamol or ibuprofen) that involve parts or all of the body.
○​ Rest is encouraged and avoid ○​ Absence seizure (petit-mal) -
strenuous activity Commonly mistaken as daydreaming,
○​ Increase fluid intake for hydration inattention, and ignoring adults.
Characterized by blank stares lasts
Tonsillitis only a few seconds.
●​ Inflammation of tonsils (masses of lymphoid
tissue that protect the respiratory and Neural Tube Defects
alimentary tract) ●​ Neural tubes form the brain and spinal cord fail
●​ Common infection in children, it can be viral or to close properly during fetal development.
bacterial ●​ Examples of neural tube defects
●​ Cause: streptococcus pyogenes (group a ○​ Spina bifida (defect in the spinal cord
strep) and vertebrae)
●​ Complications: if not managed ○​ Anencephaly (the skull does not form
○​ Rheumatic heart disease - as a properly)
result of streptococcus infection ○​ Encephalocele (there is abnormalities
○​ Acute glomerulonephritis - wherein or defects in the covering membranes
the kidney is affected of the brain)
●​ Management
○​ Antibiotics Hydrocephalus
○​ Tonsillectomy - doctors suggests the ●​ Accumulation of cerebrospinal fluid in the brain
removal of tonsils (CSF)
●​ 3 Main reason:
Croup Syndrome 1.​ Overproduction
●​ Also known as laryngotracheobronchitis 2.​ Obstruction
●​ Common respiratory illness in children that 3.​ Interference with absorption
affects the larynx, trachea and bronchial ●​ Management: Common management for
airways. hydrocephalus: Ventriculoperitoneal shunt-
●​ Manifestations: the other end of the shunt is in the peritoneum
○​ Hoarseness of abdomen to drain the excess CSF, while the
○​ Stridor and wheezing other end is in the ventricles of the brain to
relieve pressure.
Pneumonia
●​ Inflammation of the lungs Soft Tissue Injuries
●​ Causes: Bacterial, Viral or Fungal ●​ Damage to the muscles, tendons, ligaments
and other soft tissue.
Alterations in Neuroskeletal System ●​ This is common in children caused by
accidental trauma, infections or biomechanics
Seizure Disorder (poor posture)
●​ Also known as Epilepsy
●​ A common neurological condition in children Fractures
●​ Different types of seizure: ●​ Children are more prone to fracture since their
○​ Generalized seizure - involve bones are softer and more flexible compared
electrical discharges in the whole brain to adult bones.
○​ Partial seizure - begin in one part of ●​ Possible causes:
the brain ○​ Trauma
○​ Tonic- clonic seizure (grand mal) - a ○​ Osteogenesis imperfecta - an
convulsive seizure that is inherited (genetic) bone disorder that
characterized by alternating muscle affects bone strength that leads to
rigidity and jerking temporarily, brittle bones.
suspended breathing and altered ○​ Rickets - softening and weakening of
consciousness. bones due to vitamin D deficiency.

33 | PRELIMS CMPA412
Dysplasia of the Hip ○​ Affectation of ear structure - there is
●​ Abnormal development of the hip joints a problem on hearing
●​ When assessing the hip: ●​ Assessment findings
○​ There is asymmetrical skin folds on ○​ Visible separation of lips and palate
the thighs (kasi hindi pantay) ○​ Difficulty in feeding and swallowing
○​ Limited range of motion on the
affected hip Hirschsprung
○​ Asymmetrical leg length ●​ This is a rare congenital disorder that affects
○​ Abnormal gait the colon – it affects the large intestine which
●​ Management causes problems in passage of the stool.
○​ Pavlik harness - soft harness that is ●​ There is missing nerve muscle of the intestine
worn by the baby to help stabilize and which leads to functional obstruction.
align the hip joints. ●​ Assessment findings
○​ Casting or bracing ○​ Severe constipation - inability to pass
stool
○​ Abdominal distention due to swelling
○​ Vomiting

Intussusception
●​ A rare medical condition where part of the
intestine presses against one another
●​ The part of the intestine is called the
intussusceptum.
Scoliosis ○​ The intussusceptum telescopes into
●​ Condition that is characterized by abnormal another part of the intestine, which we
curvature of the spine. call the intussuscipiens, causing a
●​ Types of scoliosis: blockage.
○​ Idiopathic scoliosis - cause is ●​ Management
unknown and most common ○​ Air enema to relieve intussusception
○​ Congenital scoliosis - wherein the and relieve blockage
scoliosis is already present at birth ○​ Surgical procedure
●​ Risk factors
○​ Genetics Appendicitis
●​ Inflammation of the appendix
○​ Sex - girls are more likely to have
●​ Why is appendicitis common in children?
scoliosis due to hormonal imbalances/
○​ Children's appendices are longer and
differences and body composition narrower, making them more prone to
muscle attributes. blockages and, consequently,
appendicitis
Congenital Clubfoot ○​ Also dietary factors, kids have a diet of
●​ It is a birth defect that is also known as talipes low in fiber and high in processed
equinovarus (TEV). foods. So it can contribute to the
●​ It affects the foot and ankle development of appendicitis in
children.
Alteration in Nutrition and Gastrointestinal, ●​ Management: Appendectomy - removal of
Metabolism and Endocrine the appendix
Cleft Lip Palate Pyloric Stenosis
●​ Birth defect that occurs when tissues of the lip ●​ Narrowing in the pylorus - food may not pass
and palate dont come together properly during through easily or flow properly into the
fetal development intestines.
●​ Risk for aspiration! ●​ Cause of stenosis:
●​ Manifestations: ○​ Vomiting
○​ Nasal regurgitation ○​ Dehydration
○​ Difficulty of speaking and articulating ○​ Weight loss in infants
words in kids
34 | PRELIMS CMPA412
 ●​ Management: Surgical pyloromyotomy - ●​ Diagnostics - sickle turbidity test (screening);
involves making a small incision in the pylorus hemoglobin electrophoresis (confirmatory)
to relieve the stenosis/ narrowing and blockage
Aplastic Anemia
Celiac Disease ●​ A rare and serious blood disorder in the bone
●​ An autoimmune disorder that occurs in marrow fails to produce enough blood cells.
genetically predisposed individuals causing the ●​ Blood cells: WBC, RBC and platelets
immune system to react to gluten. ●​ Pancitopenia- is where there is a decrease in
WBC, RBC and platelets
Alterations in Hematologic Dysfunction
Thalassemia
Iron Deficiency Anemia ●​ It is a genetic disorder that affects the
●​ It is characterized by decrease in number and production of hemoglobin - so this
size of RBCs due to insufficient iron. thalassemia can cause bone deformities due
●​ Risk factors to bone marrow expansion.
○​ Age - infants and toddlers are at high ●​ Note:
risks for iron deficiency anemia, ○​ Thalassemia requires lifelong
because of rapid growth and treatment, including regular blood
development. transfusions.
○​ Diet - lacking in intake of iron rich ○​ This means that as long as the patient
foods is alive, continuous management is
○​ Premature birth necessary.
○​ Low birth weight ○​ Due to regular or frequent blood
●​ Treatment transfusions, the patient often
○​ Ferrous sulfate - oral with ascorbic experiences iron overload (can lead to
acid to help with absorption organ damage.
○​ Dietary iron - re/organ meats,
legumes, green leafy, raisins, dried Hemophilia
apricots, iron-fortified cereals and ●​ Is a rare genetic disorder characterized by the
formula. inability of the blood to clot properly.
○​ Iron Dextran - IM (Z track method) ●​ Assessment findings
●​ Considerations ○​ Prolonged bleeding
○​ Liquid iron given through straw to ○​ Joint pain and swelling - since
avoid teeth staining repeated bleeding involves the joints it
○​ Milk, pancreatic enzyme, Vit. E are can cause joint pain, swelling and
avoided limited mobility.
○​ Iron supplements causes dark green ○​ Muscle weakness - bleeding into
or black stool or constipation muscles causes weakness and pain.
●​ Types
Sickle Cell Anemia ○​ Hemophilia A (classic) - factor VIII
●​ It is a genetic disorder that affects the deficiency
production of hemoglobin ○​ Hemophilia B (christmas) - factor IX
●​ Occlude small vessels causing pain deficiency
●​ Manifestations ○​ Hemophilia C - factor XI deficiency,
○​ Sickle cell crisis - period of recessive in both sex
exacerbations ○​ Von Willebrand’s Disease - factor VII
○​ Vaso-occlusive crisis - painful deficiency
episodes with spasm
○​ Sequestration crisis - pooling of blood Idiopathic Thrombocytopenic Purpura
to the liver and spleen ●​ A rare autoimmune disease characterized by
○​ Aplastic crisis - diminished RBC prod low platelet count - Due to a low platelet count,
○​ Hyperhemolytic crisis - accelerated it may lead to manifestations of bleeding.
RBC destruction ●​ Manifestations of bleeding:
○​ Petechiae
35 | PRELIMS CMPA412
 ○​ Bruising Eczema
○​ Fatigue ●​ Atopic dermatitis is a common skin condition
in children that causes dry, itchiness and
Cellular Aberrations Basic Concepts on Oncology inflamed skin.
Leukemia (ALL & AML) Asthma
●​ Overproduction by stem cells in bone marrow ●​ Is a chronic respiratory disease that affects the
●​ Nonfunctional immature cells infiltrate the children of all ages causing recurring episodes
tissues and replace normal cells of wheezing, coughing, chest tightness and
●​ Signs & symptoms - anemia, bruising, shortness of breath.
bleeding, nose bleeds, high fever, sepsis
●​ Diagnostic - bone marrow aspiration and Alterations in Fluids, Electrolytes and Acid Based
biopsy (confirm); lymph node biopsy; lumbar Balance
puncture (detect meningeal involvement);
WBC count Dehydration
●​ 2 types: ●​ If there is a problem with fluid and electrolytes,
1.​ ALL (Acute lymphoblastic leukemia) - it can result in dehydration
affects the lymphocytes or lymphoblast
Diarrhea
cells.
●​ If you have abnormal absorption of fluids and
2.​ AML (Acute myeloid leukemia) -
electrolytes, you may develop diarrhea.
affects the myeloblast.
●​ Treatment - intrathecal chemotherapy and low Vomiting
dose radiation of spine and head; antibiotic
●​ If you have hormonal or fluid imbalances, you
antifungal, antiviral drugs; colony
may experience vomiting.
Lymphoma
Burns
●​ Lymphoma affects the lymphatic system
●​ Burns can also lead to electrolyte losses
●​ 2 types:
1.​ Hodgkin's lymphoma Renal Disorders
2.​ Non-hodgkin's lymphoma ●​ Affect kidney function, leading to fluid
imbalance, high blood pressure, and
Wilms Tumor electrolyte issues.
●​ Cancer of the kidneys also known as
nephroblastoma Acute Glomerulonephritis

●​ Glomeruli are the filtering units of the kidneys.

Brain Tumors
This is a common kidney disease in children
●​ Cancer of the brain
and could also lead to acute kidney injury if left
untreated.
Alterations with Infectious, Inflammatory and
●​ Risk factors:
Immunologic Response
○​ Infection - streptococcus (most
Juvenile Rheumatoid Arthritis common cause)
●​ It is a chronic disease that affects children ○​ Tonsillitis - may cause acute
under the age of 16 years old. glomerulonephritis
●​ Characterized by: Inflammation and stiffness
of the joint which can lead to pain, swelling and Nephrotic Syndrome
limited mobility. ●​ This is a kidney disorder characterized by
excessive loss of protein in the urine, leading
Allergic Rhinitis to low levels of protein in the blood.
●​ It affects the nasal passages , sinuses and ●​ Common kidney disease in children.
eyes ●​ Treatment - prednisone, albumin IV followed
●​ This occurs where the immune system by IV furosemide; antihypertensive, analgesic,
overreacts to airborne allergens. antibiotic and immunosuppressive medications
●​ Common allergens: Pollens, pollution and
dust

36 | PRELIMS CMPA412
Renal Failure
●​ Causes sepsis, infection, trauma, injury,
medication toxicity such as antibiotics and
particularly NSAIDs that are nephrotoxic.
●​ Chronic kidney damage resulting to diabetes
or hypertension
●​ Management
○​ Dialysis - There are 2 types of
dialysis: hemodialysis (access is in
the circulation) and peritoneal
dialysis (removal of waste through
peritoneum)
○​ Manage fluid and electrolyte
○​ Note:
-​ If there is fluid overload,
diuretics are used.
-​ To control elevated blood
pressure, antihypertensive
medications are given.
-​ In end-stage disease, kidney
transplantation is required.

37 | PRELIMS CMPA412
COMPETENCY APPRAISAL 2
WEEK 5 | Nursing Research | By: AE

Research ○​ Experimental - manipulation of one or

●​ Organized inquiry carried out to provide more independent variable
information for solving problems. ○​ Quasi qualitative - establish cause and
●​ It is the cornerstone of every science. effect relationship

What is Research? According to Outcome:

●​ RE: Again ●​ Applied - used to answer specific questions
●​ SEARCH: Find and problem to gain knowledge about
●​ Process: Step by step or phases ●​ Basic or pure - concerned with generalization
and formulation of theory
Purpose of Research
●​ Actions - addressing certain problem through
●​ Explore
●​ Describe active participation and self reflection
●​ Explain
Nursing Research
Steps in Qualitative Research
●​ Definition: Nursing research is a systematic
1.​ Acknowledge Social Self
process that uses evidence to improve patient
2.​ Actual Perspective
care, nursing practices, and health outcomes.
3.​ Design Study
It's based on the idea that nursing is an
4.​ Collect Data
evidence-based practice.
5.​ Analyze Data
●​ Purpose:
6.​ Interpret Data
○​ To develop knowledge about health
7.​ Inform Others
and well-being
Types of Research ○​ To improve care for people with
disabilities or health problems
According to Purpose: ○​ To help people respond to health
●​ Exploratory problems
●​ Descriptive ○​ To shape health policy
○​ Descriptive psychological - behavior ○​ To impact the health of people in all
of individuals in different situations countries
○​ Social - used to dx the root cause of ●​ Research Methods:
the topic ○​ Uses big data, technology, and
●​ Analytical carry out analysis of the innovation
phenomenon ○​ Involves a biobehavioral,
●​ Predictive interdisciplinary, and translational
approach to science
According to Process: ○​ Involves studying individuals, families,
●​ Qualitative and communities
○​ Phenomenological - lived experience ●​ Research Areas:
○​ Grounded - key social psychological ○​ Caregiving science
process ○​ Symptom science
○​ Ethnographic - patterns meanings in a ○​ Self-management science
holistic pattern ○​ Non-communicable disease
○​ Historical prevention and control
●​ Quantitative ○​ Care of older persons nd those with
○​ Descriptive - summarizing using mean, chronic illness
median and mode ○​ Women’s health and care of children
○​ Correlational - examine two or more ○​ Nursing education
variables ○​ Community health nursing
○​ Human resources for health
●​ Nursing Research Resources
38 | PRELIMS CMPA412
 ○​ Nursing Research Journal, which was 4.​ Journal clubs - Participating in discussion
founded in 1952 about research articles with colleagues to
○​ Health news sites critically analyze findings and share knowledge
○​ Websites: Google Scholar 5.​ Patient education - Communicating
○​ Research Gate research-based information to patients to
○​ PubMed promote informed decision-making
○​ Science Direct
Building Blocks of Nursing Research
Roles of Nurses in Nursing Research
1.​ Concepts - refers to research abstract (Ex:
●​ As producers in nursing research, nurses terms of pain, quality of life, particular aspects
actively design, conduct, and analyze research of human behavior, and characteristics). In
studies, often acting as principal investigators. qualitative study this is known as Phenomena.
●​ As consumers, they critically appraise and 2.​ Constructs – refers to an abstract or mental
apply findings from research literature to representation inferred from a situation or
inform their daily practices, staying updated on behavior, it is more complex compared to
relevant knowledge to improve patient care. concepts. (Ex: self care in Orem’s model)
●​ Producers actively create new research, while 3.​ Theory - systematic, abstract explanation of
consumers utilize existing research to guide some aspect of reality.
either clinical decisions. 4.​ Conceptual Model - interrelated concept or
abstract assembled together in a rational
Key roles of nurses as Research Producers
scheme by virtue of their relevance to a
1.​ Identifying research questions - Drawing common theme; sometimes called conceptual
from clinical experience to identify problems or framework.
gaps in nursing practice that require further 5.​ Variables - something that varies or differs; in
investigation. quantitative studies, concepts are usually
2.​ Developing research protocols - Designing called variables.
study methodologies, including sampling ○​ Heterogenous - the degree by which
strategies. Data collection methods, and objects are dissimilar on some
analysis plans. attributes
3.​ Recruiting study participants - Identifying ○​ Homogenous - the degree by which
and enrolling eligible patients to participate in objects are similar on some attributes
research studies. ○​ Continuous - have values along
4.​ Data collection - Gathering data through continuous and in theory can assume
interviews, surveys, observation, or an infinite number of values between 2
physiological measurements. points (Ex: weight)
5.​ Data analysis - Interpreting and analyzing ○​ Discrete - has finite number of values
collected data to draw meaningful conclusions. between any two points (Ex: number
6.​ Disseminating findings - publishing research of children)
results in peer-reviewed journals and ○​ Categorical - variable that take on a
presenting at conferences. handful discrete non quantitative
values (Ex: blood type)
Key roles of nurses as Research Consumers ○​ Dichotomous - those that take only
1.​ Literature review - actively searching for and two values (Ex: gender)
critically evaluating relevant research articles ○​ Independent - the presumed cause
to stay updated on current evidence. ○​ Dependent - the presumed effect
2.​ Appraising research quality - Assessing the 6.​ Research Methodology
validity, reliability, and applicability of research ○​ Conceptual definition - a description
findings to their clinical practice. of a concept’s meaning and abstract
3.​ Implementing evidence-based practice nature. It’s the foundation of a
(EBP) - Integrating research findings into research question and helps ensure
clinical decisions-making to optimize patient consistency across studies.
care. ○​ Operational definition - a clear
description of how to measure a
variable or concept. It’s a way to turn
39 | PRELIMS CMPA412
 abstract ideas into practical and ●​ Current diagnostic
testable elements. procedure and
7.​ Data - information that has been gathered to relevant health care
support research findings. It can be in many delivery models
formats, including digital and physical. ●​ Better understand
affected client and
Phases of Nursing Research Process
setting in which the
1.​ Conceptual Phase - the initial stage of a care is provided
project or research, when ideas are developed ■​ Field work strengthen the
and evaluated. It's a crucial step that sets the study
foundation for the research’s success. ○​ Step 4: Defining Framework and
○​ Step 1: Formulating and Delimiting developing Conceptual Definitions
(state clearly the problem) ■​ Quantitative research
■​ Researcher identifies an performed within the context
interesting, significant problem of a theoretical framework
and good research question ■​ Findings may have broader
■​ Good research depends to a significance of the study
great degree of good ■​ If research questions not
questions embedded in a theory
■​ While developing a research ●​ Have a conceptual
questions, researchers must variable
pay close attention to ●​ Clear sense of
●​ Substantive issues concepts under study
●​ Theoretical issues ■​ Development of conceptual
●​ Clinical issues framework is an important task
●​ Methodologic issues ○​ Step 5: Formulating Hypotheses
●​ Ethical issues ■​ Hypothesis is a statement of
○​ Step 2: reviewing the Related researcher’s expectations
Literature about relationships between
■​ Quantitative research study variables
conducted within the context ■​ It is predictions of expected
of previous knowledge outcomes
■​ What is already known about ■​ The research question ask
a research problem how the concepts under
■​ Through literature review investigation might be related
■​ For clinical problems, learn ■​ But the hypothesis predicts
about “status quo” of current the answer
procedures relating to topic 2.​ Design and Planning Phase - the initial stage
■​ Review existing practice of a research where the overall concept,
guidelines or protocols strategy, and detailed blueprint are developed,
○​ Step 3: Undertaking Clinical Fieldwork including defining objectives, considering
■​ To refresh or updating clinical constraints, exploring different design options,
knowledge and creating a comprehensive plan for
●​ Spend time in clinical execution, essentially laying the groundwork
settings for the research’s successful implementation.
●​ Discussing the topic ○​ Step 6: Selecting a Research Design
with clinicians, health ■​ It is the overall plan for
care administrators obtaining answers
and observing current ■​ Helps in handling some
practices difficulties encountered during
■​ Clinical field work provides research process
perspectives ■​ Research designs in
●​ Recent clinical trends quantitative study-non
experimental, experimental
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 ■​ Researcher specify the design ●​ Population undergoing
will be adopted, procedure to chemotherapy in
minimize the bias and belgaum
enhance the interpretability of ●​ Menopausal women in
results belgaum
■​ In quantitative study, research ●​ Neonates in belgaum
designs are highly structured ○​ Step 9: Designing the Sampling Plan
and controlled ○​ Step 10: Specifying Methods to
■​ Research designs indicates Measure the Research Variables
other aspects of study ○​ Step 11: Developing Methods for
■​ Eg: how often data will be Safeguarding human / Animal Rights
collected, what type of ○​ Step 12: Finalizing and Reviewing the
comparisons will be made, Research Plan
where the study will take place 3.​ Empirical Phase - a stage in the research
■​ Research design is the process where data is collected and prepared
architectural back bone of the for analysis. It’s part of the empirical research
study. cycle, which also includes observation,
○​ Step 7: Developing Protocols for the induction, deduction, testing, and evaluation.
Intervention ○​ Step 13: Collecting Data
■​ In experimental research, the ○​ Step 14: Preparing the Data for
researcher creates the Analysis
independent variable - means 4.​ Analytic Phase - the stage of laboratory
participants exposed to testing where a specimen is tested and the
different treatments (Ex: results are interpreted. It’s one of the three
relaxation therapy) phases in the laboratory testing process, along
■​ Development of intervention with the pre-analytical and post-analytical
protocol - who would phase.
administer it, how frequently, ○​ Step 15: Analyzing the Data
over how long a period the ○​ Step 16: Interpreting the Results
treatment would lost, and so 5.​ Dissemination Phase - the process of sharing
on and what alternative research findings and other information with a
condition would be specific audience. It’s an important step for the
■​ The goal of well articulated success of a research network.
protocol is treating the ○​ Step 17: Communicating the Findings
subjects in each group the ■​ Final task - preparation of a
same way research report to share with
■​ In non-experimental research, others
this step is unnecessary ■​ Various forms of research
○​ Step 8: Identifying the Population to reports - are term
be Studies presentation, dissertation,
■​ Quantitative researchers need journal articles, presentation at
to know conferences
●​ Characteristics of ■​ Journal articles - reports
study participants appearing in professional
●​ To which group the journals as nursing research
study results can be ○​ Step 18: Utilizing the Finding in
generalized ie Practice
identification of the ■​ High quality study is to plan for
population to be its use in practice settings
studies ■​ Recommending the evidence
■​ Population is all the individuals of the study to be incorporated
or objects with common, into practice of nursing
defining, characteristic

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 Literature Reviews 1.​ Null hypothesis - states that there is no
connection between two variables or groups.
Types of Research Reports
The statement that researchers aim to
1.​ Primary Studies - study where the researcher disprove.
collects and analyzes their own original data 2.​ Alternative hypothesis - states that there is a
directly, rather than relying on data gathered relationship between two variables the main
by others; essentially, it’s a study where the driving force for hypothesis testing.
author conducts the research themselves and 3.​ Simple hypothesis - evaluates the basic
reports on the findings firsthand, making it the relationship between an independent and
first source of information on a particular topic. dependent variable.
2.​ Secondary Studies - research method where 4.​ Complex hypothesis - used when there is a
researchers analyze data that was collected by relationship between more than two variables.
someone else, essentially using existing 5.​ Non-directional hypothesis - allows
information rather than conducting their own researchers to explore the relationship
data collection (primary research); this between variables without making any specific
includes utilizing sources like published predictions.
articles, government reports, company 6.​ Statistical hypothesis - a testable hypothesis
records, or historical archives to answer that can be verified based on observation of a
research questions. process that includes random variables.
7.​ Associative hypothesis - suggests that there
Research Questions and Hypothesis is a relationship between two variables, but it
Research Questions in Quantitative Research does not imply causation.
8.​ Directional hypothesis - aims to predict the
1.​ Descriptive research question direction of the relationship or difference
○​ Measures responses of subjects to between two variables.
variables
○​ Presents variables to measure, Data Collection and Sampling
analyze, or assess ●​ The process of gathering information to
2.​ Comparative research question answer research questions, test hypotheses,
○​ Clarifies difference between one group and evaluate outcomes. It’s a fundamental
with outcome variable and another step in research that’s used in many fields,
group without outcome variable including business healthcare, and the social
○​ Compares the effects of variables sciences.
3.​ Relationship research question ●​ Process of collecting and analyzing information
○​ Defines trends, association, on relevant variables in a predetermined,
relationships, or interactions between organized way so that one can respond to
dependent and independent variables specific research questions, test hypotheses,
Research Questions in Qualitative Research and assess results. Data collection can be
either qualitative or quantitative.
1.​ Exploratory - to investigate little understood ●​ Steps in data collection:
phenomena. To identify/discover important ○​ Define research questions and
variables. To generate hypotheses for further objectives
research. ○​ Identify data sources and
2.​ Explanatory - to explain the forces causing requirements
the phenomenon in question. To identify ○​ Choose data collection methods
plausible causal networks shaping the ○​ Decide how to measure and analyze
phenomenon. data
3.​ Descriptive - to document the phenomenon of ○​ Determine how to present data
interest. ●​ Data collection methods:
4.​ Predictive - to predict the outcomes of the ○​ Surveys - common method that can
phenomenon. To forecast the events and be used to collect numerical data
behaviours resulting from the phenomenon. ○​ Interviews - common method that can
Types of Hypothesis be used to gather information directly
from people
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 ○​ Focus groups - common method that of medical research, this is often called
can be used to gather information a “patient-reported outcome” (PRO)
directly from groups of people and is collected through
○​ Observation - common method that questionnaires or interviews where the
can be used to gather information by patient describes their symptoms,
observing people or situations quality of life, and other relevant
○​ Case studies - method that can be aspects of their health.
used to gather descriptive information ○​ Examples of PRO measures - Pain
about specific cases scales, functional ability of
●​ Data collection types: questionnaires, depression and
○​ Primary data - data that is collected anxiety scales, quality of life
directly from sources questionnaires
○​ Secondary data - data that has 2.​ Summated rating scales - step by step guide
already been collected by someone to creating multiple item scales that can be
else used to assess people;s attitudes, behavior,
●​ Difference between population and beliefs,motives, perceptions, values, and many
sampling more things
○​ Population - refers to the entire group ○​ Likert scale
of individuals or items that a study is 3.​ Observational methods - techniques used to
interested in learning about collect data by observing people, events, or
○​ Sampling - is a smaller subset of that activities. They are often used to study human
population selected to collect data behavior, attitudes, and beliefs.
from, which is then used to draw ○​ Naturalistic observation - observing
conclusions about the larger behaviors in their natural environment
populations as a whole. without interference.
○​ The population is the whole group, ○​ Participant observation - similar to
and the sample is a smaller naturalistic observation, but the
representative part of that group you researcher is part of the environment
study to gather information. being studied.
○​ Key points to remember: ○​ Case studies - in depth observation of
■​ Population represents the an individual, group, or event.
entire group of interest in a ○​ Structured observation - researchers
study define categories of behaviors to
■​ Sample is a smaller selection observe in advance and develop a
taken from the population to coding system to record them.
collect data and make ○​ Cross sectional observational study
inferences about the larger - looks at prevalence by observing a
group group at a specific time.
■​ Example 4.​ Biomarkers - study of biological markers,
●​ Population - all which are measurable indicators of biological
students enrolled in a process. Biomarkers are used in research to
university diagnose disease, monitor disease
●​ Sample - group of 100 progression, and develop new treatments.
students randomly
Qualitative Data Collection
selected from that
university to 1.​ Unstructured self report techniques
participate in a survey. ○​ Key informant interview - a
qualitative interview with people who
Quantitative Data Collection
have first-hand knowledge about a
1.​ Self reports / patient reported outcomes community issue. The goal is to collect
○​ Information about a person’s health or information and insights from a variety
experience that they directly provide of people.
themselves, without interpretation by a ○​ Focus-Group Discussion - a
healthcare professional; in the context qualitative research method that
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 involves a group of people discussing Qualitative Research
a topic in depth. It’s a way to gather
1.​ Lincoln and Guba’s Framework
insights into the perspectives of a
○​ Credibility - confidence in the ‘truth’ of
group of people with similar
the findings.
backgrounds or experiences.
○​ Transferability - showing that the
○​ Photo Elicitation - research method
findings have applicability in other
that uses photographs to help guide
contexts.
interviews. It’s a qualitative research
○​ Dependability - showing that the
technique that’s used in many fields,
findings are consistent and could be
including sociology, marketing, and
repeated.
public health.
○​ Confirmability - degree of neutrality
○​ Photovoice - visual research method
or the extent to which the findings of a
that uses photography to document
study are shaped by the respondents
and reflect on experiences. It’s a
and not researcher bias, motivation, or
participatory method that involves
interest.
community members taking pictures
2.​ Quality Enhancement Strategies -
and sharing their stories.
continuous improvement, quality assurance,
○​ Diary - log or journal that participants
data analysis, customer focus, and quality
keep to record their experiences and
culture.
thoughts over time. This method is
called a diary study or diary research. Data Sampling & Participant Selection Techniques
It’s a qualitative research method that
●​ Statistical technique that involves selecting a
can be used in many fields, including
representative subset of a population to study.
health, management, and product
It’s used to identify patterns and trends in the
design.
larger population.
Quality and Trustworthiness in Nursing Research ●​ Data sampling is used to determine the validity
of an outcome in statistical analysis. It’s also a
Quantitative Research
critical component of qualitative research.
1.​ Reliability - the consistency and dependability ●​ When writing about data sampling in research,
of a study’s methods and results. It’s a you can describe the sampling strategy you
measure of how likely a study is to produce the used, justify your choice, and explain the types
same results if repeated. of sampling techniques available.
2.​ Validity - the degree to which a study
Types of data sampling: Quantitative
measures what it intends to measure.
○​ Content validity - whether a 1.​ Simple random sampling (probability) -
measurement includes all the essential every member of the population has an equal
elements it needs to cover. chance of being selected.
○​ Construct validity - whether a test or 2.​ Systematic sampling (probability) - random
measure accurately assesses what it’s starting point is selected, and then sample
supposed to members are chosen at regular intervals.
○​ Internal validity - whether the 3.​ Stratified sampling (probability) - population
observed results represent the truth in is divided into subpopulation (strata) based on
population being studied relevant characteristics. Then, a sample is
○​ External validity - whether the selected from each subgroup.
findings of a study can be generalized 4.​ Cluster sampling (probability) - population is
to other situations, people, settings, divided into smaller groups, and then
and measures. individuals are randomly selected from those
○​ Face validity - whether a test appears groups.
to measure what is supposed to 5.​ Convenience sampling (non-probability) -
measure. samples are selected based on convenience,
such as being the most easily accessible.
6.​ Quota sampling​ (non-probability) -
non-probability sampling technique that

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 involves selecting a predetermined number of Statistical Treatment
participants from a specific population.
1.​ Descriptive Statistics - used to describe the
7.​ Purposive sampling (non-probability) -
overall characteristics of a dataset. This
research technique that involves selecting
includes measures of central tendency (mean,
participants based on specific characteristics
median, mode) and dispersion (range,
or criteria. It’s also known as judgemental
variance, standard deviation)
sampling or selective sampling.
2.​ Inferential Statistics - used to make
8.​ Consecutive sampling (non-probability) -
predictions or inferences about a population
non-probability sampling method that involves
based on a sample. This is done by using
selecting a research subject based on
estimation methods (point estimates and
availability and inclusion criteria. It’s similar to
confidence intervals) and testing methods
convenience sampling, but it aims to include all
(hypothesis testing)
accessible subjects.
3.​ Regression Analysis - method used to
Types of data sampling: Qualitative identify the relationship between different
variables.
1.​ Purposive sampling - researchers select
4.​ Correlation Analysis - method used to
participants who can provide in-depth
understand how two variables relate.
information.
5.​ Factor Analysis - method used to identify
2.​ Convenience sampling - common
which variables impact a particular outcome
non-probability sampling strategy.
most.
3.​ Snowball sampling - researchers use
networks to identify participants who are hard Formulas
to reach.
1.​ Frequency and Percentage Distribution -
Data Analysis used to determine the percentage for data on
profile (Ex: level, age, gender, etc.)
●​ Process of examining data to draw conclusions
2.​ Mean - used to get average or central value
about a research topic or questions. It’s a
(Ex: level, extent, status, etc.)
crucial part of research that involves collecting,
3.​ Standard Deviation
organizing, and interpreting data.
4.​ T-test - determine two variable means which
●​ Data analysis is often included in the
differ significantly or to test the significant
methodology section of a research paper.
difference between 2 variable means
●​ Data sources
5.​ Analysis of Variance (ANOVA) - used to find
●​ Data that can come from many different
out if the frequency of two or more variables in
sources, including surveys, interviews, case
the study differ significantly or test the
files, and databases.
significant difference among several groups.
Data analysis techniques 6.​ Pearson Product - Moment Correlation
Coefficient - used to find the degree of the
●​ Qualitative data analysis - analyzes association of two sets of variables, X and Y or
non-numerical data, such as text from surveys to test the significant relationships between
or interviews, to identify themes and patterns. two variables.
●​ Thematic analysis - analyzes data to identify 7.​ Multiple Correlation - used to test if the
and report patterns or themes. independent variables have influence on the
●​ Inferential statistics - analyzes hypotheses dependent variables.
and makes inferences. 8.​ OMultiple Regression - used to predict, singly
Steps in data analysis or in combination, from among the
independent variables the dependent
1.​ Plan the research design and hypothesis variables.
2.​ Collect data from a representative sample
3.​ Prepare the data by checking for accuracy and Dissemination of Research Findings
entering it into a computer ●​ Refers to the process of sharing and
4.​ Analyze the data to identify patterns, trends, distributing the results of a research study with
and relationships a wider audience, typically through
5.​ Interpret the results publications in academic journals,

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 presentations at conferences, reports, or other 2.​ Poster presentation - visual method of
communication channels, to ensure the communicating research findings by displaying
research has a practical impact and is a concise summary of the study on a poster,
accessible to relevant stakeholders. typically at a conference or academic event,
●​ Process of sharing research findings with where the researcher stands beside it to
stakeholders and wider audiences. answer questions from attendees about their
Dissemination is essential for uptake, and work; it allows for quick, engaging interaction
uptake and used of research findings is crucial and discussion around key research points.
for the success and sustainability of 3.​ Research manuscript - written in the IMRAD
practice-based research networks (PBRNs) in format is a structured scientific paper that
the long term. outlines the research study ny presenting the
“Introduction”, “Methods”, “Results”, and
Key points about dissemination:
“Discussion” sections, which are the core
●​ Purpose: The goal is to make research components of the paper, providing a clear and
findings known and usable by practitioners, concise overview of the research questions,
policymakers, the public, or other researchers methodology used, findings, and interpretation
in the field. of those findings, it’s a widely used format
across various scientific fields.
Important considerations for effective
dissemination: Research Ethics
●​ Target audience - identify the primary ●​ Guidelines that govern how research is
audience for your research and tailor the conducted, including how participants are
communication style and format accordingly. treated and how data is handled. These
●​ Clarity and accessibility - present findings in guidelines help ensure that research is
a clear, concise, and understandable manner, conducted with integrity and respect for human
avoiding technical jargon where possible. rights.
●​ Visual aids - utilize graphs, charts, and
infographics to enhance understanding. Importance of research ethics:
●​ Feedback loop - engage with stakeholders to ●​ Research ethics help ensure that research is
gather feedback and ensure the research is authentic, accurate, and serves the interest of
relevant and applicable to real-world situations. society and individuals. They also help build
trust between researchers and participants.
Methods:
●​ Publication - writing articles for peer-reviewed Principles of research ethics:
journals, research reports, or policy briefs. 1.​ Respect - recognizing the autonomy of
●​ Presentations - giving talks at conferences, participants and protecting those with
workshops, or webinars. diminished autonomy.
●​ Websites and social media - sharing 2.​ Beneficence - minimizing harm and
summaries of findings on research group maximizing benefits for participants and the
websites or social media platforms. community.
●​ Media outreach - engaging with journalists or 3.​ Justice - ensuring that the benefits of research
producing press releases to reach a broader are distributed fairly
public. 4.​ Confidentiality - treating information collected
●​ Community engagement - presenting from participants confidentially and not sharing
findings directly to community groups or it in ways that violate agreements.
relevant stakeholders. 5.​ Integrity - not concealing, misrepresenting, or
falsifying research results.
Types of Presentation
1.​ Oral presentation - research oral presentation Other considerations:
is a speech that showcases the results of 1.​ Responsible use of resources
research. It should communicate the 2.​ Social responsibility
importance of the research, clearly state the 3.​ Honesty
findings, and encourage discussion. 4.​ Respect for human rights

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 5.​ Treatment for human and animal subjects
6.​ Dissemination of research findings

Latest Trends in Nursing Research

●​ Include technological advancements, holistic
care, and community health nursing.

Technological advancements:
●​ Technology has become a key part of nursing,
allowing nurses to improve patient outcomes
and take on new roles.
●​ Nursing informatics uses data-driven systems
to help nurses identity patient risk and
measure care effectiveness.

Holistic care:
●​ Holistic care treats the patient as a whole,
rather than just their disease
●​ This approach is becoming more popular as
patients become more educated and take
more control of their health.

Community health nursing:

●​ Community health nursing focuses on patient
advocacy, remote health monitoring, and
community-based initiatives.
●​ The COVID-19 pandemic has increased the
emphasis on these approaches.

Other trends:
1.​ Bilingual nurses - bilingual nurses are
becoming more valued.
2.​ Burnout awareness - awareness of
compassion fatigue, or burnout, is increasing.
3.​ Family nurse practitioners - the demand for
family nurse practitioners is increasing due to a
shortage of primary care physicians.
4.​ Preventive care - nurses are increasingly
delivering preventive care.
5.​ Evolving workplaces - nurses are working in
a variety of settings, including hospitals,
research institutes, and cruise ships.

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