NCM 104
DOH PROGRAMS
ESSENTIAL PACKAGES FOR ADOLESCENT

Management of illness

Counseling on substance abuse, sexuality, and reproductive tract infections

Nutrition and diet counseling

Mental health

Family planning and responsible sexual behavior

Dental care

First aid and safety
HERBAL MEDICINES

As part of PHC and because of the increasing cost of drugs, the use of locally available
medicinal plants has been advocated by the Department of Health

Many local plants and herbs in the Philippine backyard and field have been found to be
effective in the treatment of common ailments as attested by the National Science
Development Board, other government and private agencies/persons engaged in
research.

The DOH is advocating the use of the following ten (10) herbal plants
o
Sambong (Blumes balsamifera)
o
Akapulko (Cassia, alata L. )
o
Niyug Niyogan (Quisqualis indica L.)
o
Tsaang Gubat (Carmona retusa)
o
Ampalaya (Mamordica charantie)
o
Lagundi (Vitex negundo )
o
Ulasimang Bato (Peperonia pellucida)
o
Bawang
o
Bayabas/Guava (Psidium guajava L.)
o
Yerba ( Hierba) Buena (Mentha cordelia)
SAMBONG (Blumea balsamifera)

Uses: ANTI-EDEMA, DIURETIC, ANTI-UROLITHIASIS
o
Boil chopped leaves in water for 15 minutes
until 1 glass full remans.
o
Cool and strain

Note: Sambong is not a medicine for kidney infection.
7 – 12 yrs
½ tbsp of
adult dose
Adults
4 – 6 tbsp
AKAPULKO (Cassia, alata L.)

Uses: ANTI-FUNGAL
o
Fresh matured leaves are pounded.
o
Apply as soap to the affected part 1 -2 times a day.
NIYUG – NIYOGAN (Quisqualis indica L.)

Uses: ANTI-HELMINTHIC (used to expel round
worms ascariasis)
o
The seeds are taken 2 hours after supper.
o
If no worms are expelled, the dose may be
repeated after one week.

Caution: Not to be given to children below four years
old
4 – 5 yrs.
4 – 5 seeds
6 – 8 yrs.
5 – 6 seeds
9 – 12 yrs
6 – 7 seeds
Adults
8 – 10 seeds
TSAANG GUBAT (Carmona retusa

Uses:
o
DIARRHEA

Boil the following amount of chopped
leaves in 2 glasses of water for 15
minutes or until amount of water goes
down to 1 glass. Cool and strain
o
STOMACHACHE

Wash leaves and chop.

Boil chopped leaves in 1 glass of water
for 15 minutes.

Cool and filter/strain and drink
6 – 7 yrs.
2 ½ – 3 tbsp
7 – 12 yrs
5 – 6 tbsp
Adults
10 – 12tbsp
7 – 12 yrs
½ – 1 tbsp
Adults
2 – 3 tbsp
AMPALAYA (Mamordica charantia)

Uses: LOWER BLOOD SUGAR LEVELS (DIABETES MELLLITUS)
o
Gather and wash young leaves very well.
o
Chop.
o
Boil 6 tablespoons in two glassfuls of water for 15 minutes under low fire.
o
Do not cover pot.
o
Cool & strain.
o
Take one third cup 3 times a day after meals.

Note: Young leaves may be blanched/steamed and eaten½ glassful 2 times a day.
LAGUNDI (Vitex negundo)
AGE
DRIED
FRESH

Uses:
LEAVES LEAVES
o
ASTHMA, COUGH AND FEVER

Boil chopped raw fruits or
2 – 6 yrs.
1 tbsp
1 ½ tbsp
leaves in 2 glasses of water
left for 15 min. until water left
7 – 12 yrs. 2 tbsp
3 tbsp
in 1 glass. Strain.
o
DESENTERY, COLDS, AND PAIN
ADULT
4 tbsp
6 tbsp

decoct a handful of leaves &
flowers in water
o
SKIN DISEASE (scabies, ulcer, dermatitis, eczema)

decoct leaves, wash & clean the skin
o
HEADACHE

crushed leaves may be applied on the forehead
o
RHEUMATISM, SPRAIN, CONTUSIONS, INSECT BITES

Pound the leaves and apply on the affected part
o
AROMATIC BATH FOR SICK PATIENTS

prepare leaf decoction for use in sick and newly delivered patients.
ULASIMANG–BATO (Peperonia pellucida)

Uses: LOWERS URIC ACID (RHEUMATISM AND GOUT)
o
Wash the leaves well.
o
One and a half cup leaves are boiled in two glassfuls of water over low fire.
o
Do not cover pot.
o
Cool and strain.
o
Divide into three parts and drink each part three times a day after meals.
o
May also be eaten as salad.

Wash the leaves.

Prepared 1 and ½ cups of leaves and take it 3x a day.
BAWANG

Uses: HYPERTENSION, TOOTHACHE AND TO LOWER CHOLESTEROL LEVELS IN
BLOOD
o
May be fried, roasted, soaked in vinegar for 30 min. or blanched in boiled water
for 5 minutes. Take 2 pcs 3x a day after meals

Toothache: pound a small pc and apply to affected part

Caution: take on a full stomach to prevent stomach and intestinal ulcers.
BAYABAS /Guava (Psidium guajava L.)

Uses
o
WASHING WOUNDS

wash guava leaves & boil for 15 minutes at low fire, do not cover pot,
cool & strain

may be used twice a day
o
DIARRHEA

wash guava leaves & boil for 15 minutes at low. fire, do not cover pot,
cool & strain
o
TOOTHACHE

warm decoction is used for gargle.
YERBA (Hierba) BUENA (Mentha cordifelia)

Uses:
o
FOR PAIN IN DIFFERENT PARTS OF THE BODY AS HEADACHE,
STOMACHACHE

boil chopped leaves in 2 glasses of water for 15 minutes. Cool and
strain
o
NAUSEA AND FAINTING – crush leaves & apply at nostrils of patient
o
RHEUMATISM, ARTHRITIS AND HEADACHE

crush the fresh leaves and squeeze sap.

Massage sap on painful parts with eucalyptus
o
COUGH AND COLD

Get about 10 fresh leaves and soak in a glass of boiling water for 30
minutes. Use solution to gargle.
o
SWOLLEN GUMS

Steep 6gms of fresh plant in a glass of boiling water for 30 minutes.

Use solution as gargle.
o
TOOTHACHE

Cut fresh plant and squeeze sap.

Soak a piece to cotton in the sap and insert this in aching tooth cavity.

Mouth should be rinsed by gargling salt solution before inserting the
cotton.

To prepare salt solution: add 5gms or 7 table salt to one glass of
water.
o
MENSTRUAL AND GAS PAIN

Soak a handful of leaves in a glass of boiling water.

Drink infusion. It induces menstrual flow and sweating.
o
INSECT BITES

Crush leaves and apply juice on affected part or pound leaves until
paste-like and rub this on affected part.
o
PRURITUS

Boil plant alone or with eucalyptus in water. Use decoction as a wash
on affected area.
REMINDERS ON THE USE OF HERBAL MEDICINES

Avoid the use of insecticides as these may leave poison on plants.

In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low
heat.

Use only the part of the plant being advocated.

Follow accurate dose of suggested preparation.

Use only one kind of herbal plant for each type of symptoms or sickness.

Stop giving the herbal meds in case untoward reaction such as allergy.

Consult a doctor if symptoms are not relieved after 2 or 3 doses.
GUIDLEINES ON THE USE OF MEDICINAL PLANTS

B – boiling: remove cover

O – one kind of plant for each type of symptoms

N – no insecticides

U – use clay pot and plant part advocated

S – stop in case of untoward reactions; seek consultation if S/S are not relieved after 2-3
doses.
DECOCTION : Procedures/Preparations

Gather leaves & wash thoroughly, place in a container the washed leaves

Let it boil without cover to vaporize/steam to release toxic

Substance-add water

Use extracts for washing undesirable taste
POULTICE : Procedures/Preparations for treatment of skin disease

Example
o
Akapulko leaves-when pounded, it releases extracts coming out from the leaves
contains enzyme (serves as anti-inflammatory) then apply on affected skin or
spewed it over skin
o
Done by pounding or chewing leaves used by herbolaryo
INFUSION : Procedures/Preparations

To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water
where a brown solution is collected, pectin which serves as an adsorbent and astringent
JUICE/SYRUP : Procedures/Preparations

To prepare a papaya juice, use ripe papaya &mechanically mashed then put inside a
blender & add water

To produce it into a syrup, add sugar then heat to dissolve sugar & mix it
CREAM/ OINTMENT : Procedures/Preparations

Start with poultice (pound leaves) to turn it semi-solid

Add flour to keep preparation pasty & make it adhere to skin lesions

To make it into an ointment:
o
add oil (mineral, baby or any oil-serves as moisturizer) to the prepared cream to
keep it lubricated while being massage on the affected area
ORESOL (Oral Rehydration Solution)

Glucose 20 grams 1” Significance: For re-absorption of Na Facilitates assimilation of Na 2

Significance: Provides heat & energy

Sodium Chloride/NaCI (3.5 grams) For retention of water/fluid Sodium 2.5 grams Buffer
content of solution Bicarbonate/NaHCO3 Neutralizer content of solution

Potassium Chloride/KCI 1.5 grams Stimulates smooth muscle contractility especially the
heart & GIT 25

PREPARATION OF PROPER HOMEMADE ORESOL
o
250 ml drinking water
o
2 teaspoon salt
o
A pinch of salt-10-12 granules of rock salt, lodized salt-tips of thumb & Index
finger are penetrated with salt
OTHER FORMS OF ALTERNATIVE THERAPY

ACUPRESSURE THERAPY
o
is a method of maintaining health, treating diseases and alleviating pain by
applying pressure or massaging certain points on the body surfaces.
o
Contraindications:

Pregnant women, cardiac patient, patient with full stomach
o
Avoid foods cold or iced food, alcohol, peanut, sour foods, and seafoods

AROMATHERAPY
o
stimulates the senses with essential oils extracted from flowers, plants, and
trees.

AURICOLOTHERAPY – insertion of needles to the ear

HOMEOPATHY
o
a European system of extremely diluted remedies.
o
is a medical system based on the belief that the body can cure itself.
o
Those who practice it use tiny amounts of natural substances, like plants and
minerals.

REFLEXOLOGY
o
Stimulation of the soles of the feet and the posterior-inferior regions of the ankle
joints.

HUMOR AND LAUGHTER / LAUGHTER THERAPY
o
is a noninvasive and non-pharmacological alternative treatment for stress and
depression, representative cases that have a negative influence on mental
health.

MOXIBUSTION (VENTOSA) – application of heat to acupuncture points

TAI CHI (Chinese Shadow Boxing)
o
gentle form of martial art and exercise that involves a formal series of flowing,
graceful, slow

YOGA
o
a Sanskrit word translated as “yoke” or “union.” To yoke means to draw
together, to bind together, or to unite.
o
Its aim is to yoke or create a union of the body, mind, soul, and universal
consciousness.
o
This process of uniting the physical, mental, emotional, and spiritual aspects of
ourselves is what allows yogis to experience deep states of freedom, peace and
self-realization.
NON-COMMUNICABLE DISEASES (NCD)

Commonly referred to as lifestyle diseases as they occur as a result of certain habits and
can be controlled by life style modification.

NCD’s are costly to control and have a major impact on the lives of persons affected, their
families and the country
THE PROBLEM : NCD

The global burden of non-communicable diseases continues to grow.

NCDs kill 41 million people each year, equivalent to 74% of all deaths globally
(World Health Organization, 2023)

According to the data complied by the Philippine Statistics Authority (PSA) from JanuaryJune 2021, the top five causes of deaths in the country are:
o
Ischemic heart disease
o
Cerebrovascular disease including strokes and aneurysms
o
Neoplasm or cancers
o
COVID 19.

A recent report from WHO also shows that an estimated 70% of deaths in the Philippines
are due to NCDs.

One half of all public/private hospital beds are occupied by people suffering from NCDs

Hospital stay for patients with NCD’s average 15-30 days.

80% of the drug costs for the National Prescription Drug Plan are spent on treating
hypertension and diabetes. (Philippine Institute for Development Studies 2012)

7 of the 10 leading causes of death in the Philippines are NCD’s. (DOH)
ISCHEMIC HEART DISEASE / CORONARY ARTERY DISEASE / CORONARY HEART DISEASE

Heart Disease
o
is the general term used refer to problems that affect one or more components
of the heart

The most common cause of heart disease is the narrowing or blockage of the heart’s
arteries which leads to heart attack called ISCHEMIC HEART DISEASE.

From January to February 2022, Ischemic Heart Disease were the leading cause of death
with 9,122 cases or 20.8% of the total deaths 42 in the Philippines.
6 FACTORS OF HEART DISEASE
o
High Blood Pressure
o
High Cholesterol
o
Obesity
o
Diabetes
o
Smoking/ Vaping
o
Stress
STROKE / CEREBROVASCULAR DISEASE

occurs when blood is not supplied to some parts of the brain due to
o
blockage (ischemic stroke-70%)
o
bursting (hemorrhagic stroke) of a blood vessel in the body.
CANCER

World Health Organization (WHO), over 12 million people are diagnosed with cancer
every year.

If no urgent action is taken, the number of cancer deaths may reach 17 million by the year
2030.

50 thousand cancer cases have been recorded in the Philippines and the number is
estimated to increase by 5% every year.

HOW FATAL IS CANCER
o
Liver: 93%
o
Brain: 83%
o
Leukemia: 83%
o
Lungs: 80%
o
Colon/Rectum: 53%
o
Ovary: 47%
o
Cervix: 41%
o
Breast: 37%
Chronic Obstructive Pulmonary Diseases(COPD)

Include chronic bronchitis, chronic asthma, and emphysema.
o
Bronchitis –Increased mucus and inflammation
o
Emphysema – Destruction and enlargement of air spaces

It is estimated that 7% of all deaths worldwide are caused by chronic respiratory diseases

15% of cigarette smokers develop COPD. Second-hand smoker, third hand smoke and
pollution aggravates the problem.
DIABETES

An estimated four million Filipinos suffer from diabetes.

Experts predict the number to increase to 380 million by 2025.

With diabetes comes a number of life-threatening health complications such as heart
disease, stroke, and kidney failure.
HYPERTENSIVE DISEASE

“Silent Killer”; High Blood Pressure; Hypertension

In 2021, according to Philippine Heart Association, the prevalence of hypertension among
Filipinos increased to 37%

January to February 2022, hypertensive disease was among the top causes of death in
Philippines, with 2,565 deaths or 5.9% of total deaths.
KIDNEY FAILURE

Stage 5 kidney failure patients require renal replacement therapy or dialysis.

Of the patients who undergo dialysis, only 50% may be healthy enough to undergo kidney
transplant and of this number, only 20% can afford the costly life-saving operation.

2 million pesos per patient per year (Dialysis fee)
ROAD ACCIDENTS AND INJURIES

1.2 million people worldwide die from road accidents (WHO).

WHO predicts that road accident deaths would beat the death counts of HIV/AIDS deaths
by 2030.
NCD RISK FACTORS

Unhealthy Diet

Physical Inactivity

Tobacco Use

Alcohol Consumption
PREVALENCE OF NCD

47% of persons surveyed were overweight or obese

64% described themselves as sedentary in their leisure time

80% were cigarette smokers

51% did not eat vegetables everyday

47% did not have even 1 serving of fruit each day
IMPACTS OF NCD

Increases the economic burden on The Philippine healthcare system.

Cause poverty

Decreased quality of life for persons afflicted and their families

Derail economic development.

Can be debilitating or even lead to reduced life expectancy
CHALLENGES FACED WHEN DEALING WITH NCD

Non-adherence to therapeutic regimen for persons already afflicted
o
We know what works, We just need to do it

Sedentary lifestyle

Dietary habits (high salt and fat content)

Lack of information/knowledge for clients

Inadequate support systems

Globalization and Urbanization – Migration

Health workers being poor examples of healthy lifestyles.

Environmental change is a key: Regulate harmful products.

Use sin tax funds for promoting health & Preventing NCD’s.

Cultural beliefs (“Thick is it” belief)
CONCLUSION

The Philippines, like many other countries have taken a severe blow from NCDs. The
battle is not over, but realizing the problem is an important step

As a part of the global community, the Philippines is making a valiant effort to combat
NCDs
NUTRITION

Is a state of well-being achieved by eating the right food in every meal and the proper
utilization of the nutrients by the body.
GOALS

To improve the nutritional status, productivity and quality of life of the population thru
adoption of desirable dietary practices and healthy lifestyle
OBJECTIVES

Increase food and dietary energy intake of the average Filipino

Prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases

Promote a healthy well-balanced diet

Promote food safety
PROPER NUTRITION IS IMPORTANT BECAUSE:

It helps in the development of the brain, especially during the first years of the child’s life.

It speeds up the growth and development of the body including the formation of teeth and
bones

It helps fight infection and diseases

It speeds up the recovery of a sick person

It makes people happy and productive

Proper nutrition is eating a balanced diet in every meal

Balanced diet is made up of a combination of the 3 basic groups eaten in correct amounts.
Grouping serves as a guide in selecting and everyday meals for the family.
THE THREE (3) BASIC FOOD GROUPS ARE:

Body-building food – are rich in protein and needed by the body for
o
growth and repair of worn-out body tissues
o
supplying additional energy
o
fighting infections

Examples of protein-rich food are:

Fish; pork; chicken; beef; cheese; butter; kidney beans;
mongo; peanuts; bean curd; shrimp; clams

Energy-giving food – are rich in carbohydrates and fats and needed by the body for:
o
providing enough energy to make the body strong

Examples of energy-giving food are:

rice; corn; bread; cassava; sweet potato; banana; sugar
cane; honey; lard; cooking oil; coconut milk; margarine;
butter

Body-regulating food – are rich in Vitamins and minerals and needed by the body for:
o
normal development of the eyes, skin, hair, bones, and teeth
o
protection against diseases

Examples of body-regulating food are:

tisa; ripe papaya; mango; guava; yellow corn; banana;
orange; squash; carrot
LOW FAT TIPS
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and cereals eg, rice, noodles and potato
3. If you use butter or margarine, pat it on thinly
4. Choose low fat substitute ie. Replace whole milk with skimmed milk, low fat cheese
5. Become a label reader. Look for foods that have less than 5 g/100 g of product
6. Eat less high fat snacks and take away potato chips, sausage rolls or breaded meats
7. Cut all visible fat from meat, remove skin from chicken fat drippings and cream sauces
8. Aim for thin palm-size serving of lean meat, poultry and fish/ meal
9. Grill, bake, steam, stew, stir-fry and microwave, try not to fry
10. Drink lots of water all day- it’s a food quencher
AMBULATE

Start by walking for 10 min.

Build up to 30-40 min/day

Go for 3-4 times / week of any exercise you enjoy
FILIPINO FOOD PYRAMID

Drink a lot – water, clear broth

Eat most – rice, root crops, corn, noodles, bread and cereals

Eat more – vegetables, green salads, fruits or juices

Eat some fish, poultry, dry beans, nuts, eggs, lean meats, low fat dairy

Eat a little fats, oils, sugar, salt
IMPORTANT VITAMINS AND MINERALS
VITAMIN
FUNCTIONS
MINERALS
FUNCTIONS
Calcium
Mineralization of bones and teeth, regulator of many of the body’s biochemical
processes, involve in blood clotting, muscle contraction and relaxation, nerve
functioning, blood pressure and immune defenses.
Chloride
Maintain normal fluid and electrolyte balance.
Chromium
Work with insulin and is required for release of energy from glucose.
Copper
Necessary for absorption and use of iron in the formation of hemoglobin.
Helps release energy from nutrients, support skin health, prevent deficiency
manifested by cracks and redness at corners of mouth; inflammation of the
tongue and dermatitis.
Manganese
Facilitate many cell processes.
Molybdenum
Facilitate many cell processes.
Niacin
Help release energy from nutrients; support skin, nervous and digestive system,
prevents pellagra.
Phosphorus
Mineralization of bones and teeth; part of every Cell; used in energy transfer and
maintenance of acid-base balance.
Pantothenic
Help in energy metabolism.
Selenium
Work with vitamin E to protect body compound from oxidation.
Work with vitamin E to protect body compound from oxidation.
Biotin
Help energy and amino acid metabolism; help in the synthesis of fat glycogen.
Sodium
Maintain normal fluid and electrolyte balance, assists nerve impulse insulin.
Folic Acid
Help in the formation of DNA and new blood cells including red blood cells;
prevent anemia and some amino acids.
Sulfur
Integral part of vitamins, biotin and thiamine as well as the hormone.
Zinc
Essential for normal growth, development reproduction and immunity.
Vitamin A
Maintain normal vision, skin health, bone and tooth growth reproduction and
immune function; prevents xerophthalmia.
Food sources:

Breastmilk,poultry eggs; liver, meat, carrots;squash; papaya,mango tiesa;
malunggay,kangkong; camotetops; ampalaya tops
Thiamine
Riboflavin
Help release energy from nutrients; support normal appetite and nerve function,
prevent beri-beri.
Vitamin
B12
Help in the formation of the new cells; maintain nerve cells, assist in the
metabolism of fatty acids and amino acids.
Vitamin C
Help in the formation of protein, collagen, bone, teeth cartilage, skin and scar
tissue; facilitate in the absorption of iron from the gastrointestinal tract; involve in
amino acid metabolism; increase resistance to infection, prevent scurvy.
Food sources:

Guava pomelo lemon;orange; calamansi; tomato; cashew
VITAMINS
FUNCTIONS
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Strong anti-oxidant, help prevent arteriosclerosis; protect neuro- muscular system;
important for normal immune function.
Involve in the synthesis of blood clotting proteins and a bone protein that regulates
blood calcium level.
MALNUTRITION

An abnormal condition of the body resulting from the lack or excess of or more
nutrients like

Protein

Carbohydrates

Fats

vitamins and minerals
PRIMARY CAUSE: POVERTY

Lack of money to buy food
o
Majority of the victims of malnutrition comes from families of farmers, fisherfolk,
and laborers who cannot afford to buy nutritious foods.

Lack of food supply

Lack of information on proper nutrition and food values
SECONDARY CAUSES

Early weaning of child and improper introduction of supplementary food

Incomplete immunization of babies and children

Bad eating habits

Poor hygiene and environmental sanitation:
o
lack of potable water
o
lack of sanitary toilet
o
poor waste disposal
FORMS OF MALNUTRTION
1.Protein-Energy Malnutrition (PEM)

is a nutritional problem resulting from a prolonged inadequate intake of body-building
and/or energy-giving in the diet.

Kinds:
o
A.) MARASMUS

This child does not get the right amount and kind of energy food.
She/He:

is always hungry

has the face of an old man

is very thin

easily gets sick

looks weak

THIS CHILD IS JUST SKIN AND BONES!
o
B.) KWASHIORKOR

This child does not get enough body-building food, although she/he
may be getting enough energy. She/He:

has swollen face, hands, and feet

easily gets sick

has dry, thin, pale hair

has sores on the skin

has thin upper arms

looks sad

has dry skin

is underweight

THIS CHILD IS SKIN, BONES, AND WATER!
2.VITAMIN A DEFICIENCY (VAD)

A condition in which the level of Vitamin A in the body is low.

CAUSES :
o
Not eating enough foods rich in vitamin A

e.g. yellow vegetables and yellow fruits
o
Lack of fat or oil in the diet which help the body absorb Vitamin A.
o
Poor absorption or rapid utilization of Vitamin A during illness

Eye Signs
o
night blindness (early stage); total blindness (later stage)
o
bitot’s spot (foamy soapsuds-like spots on white part of the eye)
o
dry, hazy and rough appearing cornea
o
Crater-like defect on cornea
o
Softened cornea; sometimes bulging

Other Manifestations
o
increased cases of childhood sickness, and death and decreased resistance to
infection
o
susceptibility to childhood malnutrition and infection (measles, diarrhea and
pneumonia)

Prevention – Vitamin A rich foods
o
liver, eggs, milk, crab meat, cheese, dilis, malunggay, gabi leaves, kamote tops,
kangkong. Alugbati, saluyot, carrots, squash, ripe mango, including fats and oils
o
breastfeeding the child
o
Immunizing the child
o
taking correct dose of Vitamin A capsules as prescribed
o
o
VAD is most common in children suffering from PEM and other infectious
diseases. Bottle-fed infants are also at risk of VAD especially if the milk formula
used is not fortified with Vitamin A.
Common among preschoolers and infants (FNRI)
SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS PRESCHOOLERS AND
MOTHERS
SCHEDULE
Infants
Preschoolers
Post Partum Mother
(6-11 mos)
(12-83 mos)
Give 1 dose
100, 000 IU
200,000 IU
200,000 IU Within
one month
Give after 6 months
High risk Condition
Present
100, 00 IU
200, 000 IU
After delivery of
each child only
SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY
SCHEDULE
Infants
Preschoolers
(6-11 mos)
(12-83 mos)
Give today
100, 000 IU
200,000 IU
Give tomorrow
100, 00 IU
200, 000 IU
3.ANEMIA

a condition characterized by the lack of iron in the body resulting in paleness.

S/S:
o
paleness of the eyelid
o
inner cheeks
o
palms and nailbed
o
frequent dizziness and easy fatigability

Common cause:
o
inadequate intake of food rich in iron can also be caused by blood loss during
menstruation, pregnancy and parasitic infections.

Prevention:
o
Eating iron-rich food such as liver and other internal organs
o
green leafy vegetables
o
foods rich in Vitamin C
PREVENTION OF IRON DEFICIENCY
Recommended Iron Requirements
Dosage
Infants (6-12 months)
0.7 mg. daily
Children (12-59 months)
1 mg daily
TREATMENT OF IRON DEFICIENCY
Recommended Iron Requirements
Children 0-59 month
Dosage
3-6 mg/kg. Body wt./day
4.GOITER

Enlargement of thyroid gland due to lack of iodine in the body.

Common in areas where the iodine content in the soil, water and food are deficient.

Effect of lodine deficiency to fetus:
o
May be born mentally and physically retarded.

Goiter can be prevented by:
o
daily intake of food rich in iodine
o
use of iodized salt
ION SUPPLEMENTATION
Dosage
Children 0-59 month
(in endemic areas)
Iodine capsules (200mg) potassium iodate in oil orally once a year.
CHECKING THE NUTRITIONAL STATUS WEIGHT

Weight is a very important indicator of a person’s nutritional status. It is measured in
relation either AGE or HEIGHT. A well-nourished child gains weight as she/he grows
older.

On the other hand, a malnourished child either decreases in weight or maintains his/her
previous weight.

The nutritional status of a person can also be checked by looking for specific signs and
symptoms of the different forms of nutritional deficiencies.
IMPORTANT

Weigh the child in minimal clothing, with no shoes, clogs or slippers on; and hands and
pockets free of objects.

The same type of scale should be used for subsequent weighing.

Observe the proper maintenance of the weighing scale.

Do not use a bathroom scale avoid inaccurate of weight.

Bring the malnourished child together with the parents to the health center for proper
nutritional advice and treatment.

Visit the malnourished child regularly and monitor his/her weight

Advise parents and the whole community about better nutrition and proper feeding
especially of infants, children and sick.
NUTRITIONAL GUIDELINES
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods
while continuing breastfeeding
3. Maintain children’s normal growth through proper diet and monitor growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other calcium-rich foods such as small fish and dark
green leafy vegetables everyday. Use iodized salt, but avoid excessive intake of salty
foods.
8. Use iodized salt, avoid excessive intake of salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, avoid drinking
alcoholic beverages.
AIMS AND RATIONALE OF EACH OF THE GUIDELINES

Guideline No. I
o
is intended to give the message that no single food provides all the nutrients
the body needs.
o
Choosing different kinds of foods from all food groups is the first step to obtain a
diet.
o
This will help correct the common practice of confining of choice to a few kinds
of foods, resulting in an unbalanced diet.

Guidelines No.2
o
is entitled to promote exclusive breastfeeding from birth to 4-6 months and to
encourage the continuance of breastfeeding for as long as two years or longer.
o
This is to ensure a complete and safe food for the newborn and the growing
infant besides imparting the other benefits of breastfeeding.
o
The guideline also strongly advocates the giving of appropriate complementary
food in addition to breast milk once the infant is ready for at 6 months.
o
Malnutrition most commonly occurs between the age of 6 months to 2 years,
therefore there is a need to pay close attention to feeding the child properly
during this very critical period.

Guideline No. 3
o
Gives advise on proper feeding of children.
o
It also promotes regular weighing to monitor the growth of children, as it is a
simple way to assess nutritional status.

Guidelines No. 4,5,6 and 7
o
are intended to correct the deficiencies in the current dietary pattern of Filipinos.
Including fish, lean meat, poultry and dried beans, which will provide good
quality protein and dietary energy, as well as iron and zinc, key nutrients lacking
in the diet of Filipinos as a whole.
o
Eating more vegetables, fruits and root crops will supply the much needed
vitamins, minerals and dietary fiber that are deficient in our diet.
o
In addition, they provide defense against chronic degenerative diseases.
o
Including foods cooked in edible oils will provide additional dietary energy as a
partial remedy to calorie deficiency of the average Filipino.
o
Including milk and other calcium-rich foods in the diet will serve to supply not to
sup only calcium for healthy bones but to provide high quality protein and other
nutrients for growth.

Guideline No. 8
o
Promotes the use of iodized salt to prevent iodine deficiency, which a major
cause of mental and physical underdevelopment in the country.
o
At the same time, the guideline warns against excessive intake of salty foods as
a hedge against hypertension, particularly among high-risk individuals.

Guideline No. 9
o
Is intended to prevent food-borne diseases.
o
It explains the various sources of contamination of our food and simple ways to
prevent it from occurring.

Guideline No. 10
o
Promotes a healthy lifestyle through regular exercise, abstinence from smoking
and avoiding consumption.
o
If alcohol is consumed, it must be done in moderation. All these lifestyle
practices are directly or indirectly related to good nutrition.
NUTRIENTS IN FOOD

Nutrients are chemical substances present in the foods that keep the body healthy, supply
materials for growth and repair of tissues, and provide energy for work and physical
activities.

The major nutrients include the macronutrients, namely;
o
Proteins
o
Carbohydrates
o
Fat
o
Micronutrients – A, D, E and K, the B complex vitamins and C and
Minerals – calcium, iron, iodine, zinc, fluoride and water.
DOH PROGRAMS : ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH AND SANITATION

Is a branch of public health that deals with the study of preventing illnesses by managing
the environment and changing people’s behavior to reduce exposure to biological and
non-biological agents of disease and injury.
ENVIRONMENTAL FACTORS

Water supply sanitation

Proper excreta disposal

Solid waste management

Insect vector and rodent control

Food sanitation

Air pollution

Proper housing

Noise

Radiological protection

Institutional sanitation

Stream Pollution
LAWS AFFECTING ENVIRONMENTAL HEALTH

RA 6969 Toxic Substances and Nuclear Waste Control Act of 1990 and its IRR
o
regulates the importation, use, movement, treatment and disposal of toxic
chemicals and hazardous and nuclear wastes in the Philippines.

RA 8749 Clean Air Act of 1999
o
provides a comprehensive air pollution management and control program to
achieve and maintain healthy air.

RA 9003 Ecological Solid Waste Management Act of 2000
o
declares the adoption of a systematic, comprehensive and ecological solid
waste management program as a policy of the state using the community based
approach and mandating waste diversion through composting and recycling.

RA 9275 Clean Water Act of 2004
o
aims to establish wastewater treatment facilities that will clean waste water
before it is released into the bodies of waters like rivers and seas.

PD 856
o
supplemental IRR on sewage collection and disposal and excreta disposal and
drainage of sanitation code of the Philippines.
WATER SUPPLY SANITATION PROGRAM – Approved type

Approved type Level 1/Point Source Type
o
is a covered well or a developed spring with an outlet but without distribution
system generally adaptable for rural areas where the houses are thinly
scattered.
o
It serves 15-25 households and its outreach must not be more than 250 meters
from the farthest user.

Level 2 or communal faucet system or stand posts type
o
composed of a source, a reservoir, a piped distribution network; and communal
faucets.
o
Designed to deliver 40-80 L of water per day to an average of 100 households
with 1 faucet per 4-6 households.
o
Located not more than 25 meters from the farthest house.

Level 3 type or the waterworks system or individual house connections type
o
composed of a source, a reservoir, a piped distribution network, and household
taps.
o
This is suited for densely populated urban areas and requires a minimum
treatment and disinfection.

Unapproved types of water supply
o
include water coming from doubtful sources such as

open dug wells

unimproved springs

wells that need priming
WATER SUPPLY SANITATION PROGRAM

Access to safe and potable drinking water
o
a certification of potability of an existing water source is issued by the Secretary
of DOH or his duly authorized representative.

Water quality and monitoring surveillance
o
every municipality through RHU’S must formulate an operational plan for quality
and monitoring surveillance yearly using the area program based approach.
o
The examination of drinking water shall be performed only by duly DOH
accredited government or private laboratories.
Household Water Disinfection / Treatment

Boiling – heating water to boiling point to destroy pathogenic microorganisms.

Chemical coagulation
o
use of aluminum sulfate (tawas) to coagulate suspended materials in water.

Filtration
o
use of sand, piece of cloth or any other material for filter to remove suspended
materials from water.

Chlorination
o
adding chlorine to water to kill pathogenic microorganisms.
o
Chlorine stock solution = 1 tsp to liter of water

Softening
o
boiling or adding certain chemicals to reduce calcium and Mg salts which cause
water to be hard.
Proper Excreta Disposal Program Approved Types of Toilet Facilities

Level 1
o
1st category

non-water carriage toilet facility.

E.g. pit latrines and reed odorless earth closet.
o
2nd category

require a small amount of water. E.g. aqua privies, pour flush toilets.

Level 2
o
include on-site toilet facilities of the water carriage type with water sealed and
flush type with septic vault/tank disposal facilities.

Level 3
o
are connected to septic tanks and/or to sewerage systems connected to
treatment plans
TYPES OF TOILET FACILITIES

Pail system – a pail (arinola) is used

Open pit privy – a pit covered by a platform with an uncovered hole.

Closed pit privy – a pit covered by a platform with a covered hole.

Bored hole latrine – a deep but relatively narrow hole made with a boring equipment.

Overhung latrine – the toilet house is constructed over a body of water.

Antipolo type – elevated toilet house, the shallow pit is extended upwards

Water sealed and flushed type
FOOD SANITATION POLICIES

Inspection/approval of all food sources. containers, & transport vehicles.

Compliance of sanitary permits requirements for all food establishments.

Health certificate for food handlers, cook & cook helpers.

All laboratories to use Formalin Ether Concentration technique in the analysis of stools of
foodhandlers.

Destruction or banning of food unit for human consumption

Training of food handlers & operators on food sanitation.
FOOD CLASSIFICATION

Class A – Excellent

Class B – Very Satisfactory

Class C – Satisfactory
RIGHTS IN FOOD SAFETY

Right source

Right preparation

Right cooking

Right storage
LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING



Acts – are laws passed by the congress of the Philippines.
Decrees – are orders of the President in his capacity to act as legislator.
Orders – are issued by the Executive Department in order to implement a Constitutional or
statutory provision.
R.A. 7160 OR THE LOCAL GOVERNMENT CODE

Involves the devolution of powers, functions and responsibilities to the local government
both rural & urban

The code aims to transform local government units into self-reliant communities and active
partners in the attainment of national goals thru a more responsive and accountable local
government structure instituted thru a system of decentralization.

Hence, each province, city and municipality has a lacal health board (LHB) which is
mandated to propose annual budgetary allocations for the operation and maintenance of
their own health facilities.
o
DETERMINANTS OF SUCCESS:

LGU’s financial capability

A dynamic and responsive political leadership

Community empowerment
R.A. 2382 – Philippine Medical Act.

This act defines the practice of medicine in the country.
R.A. 1082 Rural Health Act. – created the 1st 81 Rural Health Units.

amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary
inspectors will live in the rural areas where they are assigned in order to raise the health
conditions of barrio people, hence help decrease the high incidence of preventable
diseases
RA 2644 Philippine Midwifery Act

Registered nurses may practice midwifery through passing the midwifery exam and
completed 20 actual deliveries.
RA 2382 Practice of Medicine by a Nurse

during epidemics/national emergencies, whenever services of doctor are not available.
R.A. 7305 Magna Carta for Public Health Workers.

This act aims:
o
to promote and improve the social and economic well-being of health workers,
their living and working conditions and terms of employ aims
o
to develop their skills and capabilities in order that they will be more responsive
and better equipped to deliver health projects and programs
o
to encourage those with proper qualifications and excellent abilities to join and
remain in government service.
R.A. 6758

standardizes the salary of government employees including the nursing personnel.
R.A. 8423 – created the Philippine of Traditional and Alternative Health Care (PITAHC).
R.A. 8344

an act penalizing the refusal of hospitals and medical clinics to administer appropriate
initial treatment and support in emergency cases.
R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees.

It is the policy of the state to promote high standards of ethics in public office.

Public officials & employees shall at all times be accountable to the people and shall
discharges their duties with utmost responsibility, integrity, competence &loyalty, act with
patriotism and justice, modest lives uphold public interest over personal interest
PD 626

employee compensation and state insurance fund where injury/death that is work-related
is compensable.
PD 807 – Civil service law

provides for recruitment and selection of employees in government service,
EO 180 – guidelines on the right to organize government employees
Letter of Instruction No. 949 – legal basis of Primary Health Care dated OCT. 19, 1979

Promotes development of health programs on the community level
PD 442 labor code of the Philippines

provides for the rights, benefits/privileges of employees in the private sector –
vacation/sick leave, night shift differentials (10%), overtime pay.
R.A. 7875 –National Health Insurance Act
RA 6675 – Generic Drug Act of 1988

which promotes, requires and ensures the production of an adequate supply, distribution,
use and acceptance of drugs and medicines identified by their generic name.

generic/brand name, drug list
R.A. 9165 Comprehensive Dangerous Drug Act of 2002

prohibited acts: sell, administer, deliver/distribute/transport drugs, importation of prohibited
drugs, maintenance of den/drive, use and possession, & culture of plants.
R.A. 953 Narcotic Drug Act

Registration and imposition of license on all persons who deal in narcotic drugs and the
control of the legal traffic in narcotic drugs.
R.A. 6425 Dangerous Drug Act – Provision of S2

code for selected doctors who can prescribe narcotic drugs.
R.A. 7877 Anti Sexual Harassment Law

Authority, influence or moral ascendancy over another who demands, requests or requires
any sexual favors.
R.A. 9262 Anti Violence against Women and Their children physical, sexual, psychological and
economic abuse
R.A. 7610-anti – child abuse
R.A. 7658 – an act prohibiting the employment of children below 15 yrs. Old
R.A. 6809 – emancipation law lowered majority age from 21 to 18 years old
P.D. No. 965

requires applicants for marriage license to receive instructions on family planning and
responsible parenthood.
P. D. 418 – promote the concept of family responsible parenthood and family planning.
P.D. NO. 79 – defines, objectives, duties and functions of POPCÓM EO 209 Family Code
P.D. No. 651

requires that all health workers shall identify and encourage the registration of all births
within 30 days following delivery.
P. D. 603 – child and youth welfare code

registration of births, child’s health, freedom of expression, right to basic health services.
P.D. No. 996

requires the compulsory immunization of all children below 8 yrs. Of age against the 6
childhood immunizable diseases.
Α. Ο. NO. 2005-0014- ΝΑΤIONAL POLICIES ON INFANT AND YOUNG CHILD FEEDING:

All newborns be breastfeed within 1 hr. after birth

Infants be exclusively breastfeed for 6 mos.

Infants be given timely, adequate and safe complementary foods

Breastfeeding be continued up to 2 years and beyond
E.O. 51 – Phil. Code of Marketing of Breast milk Substitutes
Α.Ο. No. 2006-0012

specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code,
Relevant International Agreements, Penalizing Violations thereof and for other purposes
R.A. 7600 – Rooming In and Breastfeeding Act of 1992
R.A. 8980 of 2000

promulgates a comprehensive policy and a national system for Early Childhood Care
(ECCD)

An act promulgating a comprehensive policy and a national system for early childhood
care and development (ECCD), providing funds therefor and for other purposes

It is hereby declared the policy of the State to promote the rights of children to survival,
development and special protection with full recognition of the nature of childhood and its
special needs; and to support parents in their roles as primary caregivers and as their
children’s first teachers
Α.Ο. No. 2006-0015

defines the Implementing guidelines on Hepatitis B Immunization for Infants
R.A. 7846

mandates Compulsory Hepatitis B Immunization among infants and children less than 8
yrs. Old
R. A. 7719 National Blood Services Act
R.A. 8172 Salt lodization Act (ASIN LAW)
R.A. 8976 Food Fortification Law
R.A. 3573

an act providing for the prevention and suppression of dangerous Communicable
Diseases

requires reporting of all cases of communicable diseases and administration of
prophylaxis
Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease.
R.A. 4073 –advocates home treatment for leprosy
R.A. 2029 – mandates Liver Cancer and Hepatitis B Awareness Month Act (February)
R.A. 8749 Philippine Clean Air Act of 1999

right of people to a balanced and healthful ecology, promote and protect the global
environment.
P.D. No. 856 –Code on Sanitation.

It provides for the control of all factors in man’s environment that affect health including
the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary
and recreation facilities, noise, pollution and control of nuisance.
P.D. No. 825 – Garbage disposal act

Provides penalty for improper disposal of garbage
R.A. 7432 –Senior Citizens Act.
R. A. 7876

an act establishing a senior citizens center in all cities and municipalities of the
Philippines, and appropriating funds thereof.
R.A.7277 – Magna Carta for Persons with Disabilities (PWD’s)

provides their rehabilitation, self-development and self-reliance and integration into the
mainstream of society
NCM 105: NUTRITION AND DIET THERAPY
Nutrition Education and Counseling: Behavioral Change
Edvidence- Base Guidelines (EG) NusPractice
NUTRITION COUNSELING : COUNSELING FOR CHANGE
NUTRITION COUNSELING GOALS

“The necessary function of the dietitian or nutritionist is not only to know nutrition but also
to facilitate behavior change”
Curry& Jaffe in Nutrition Counseling and Communication Skills, 1998, p.4.

Facilitate lifestyle awareness

Healthy lifestyle decision making

Take appropriate action
BEHAVIOUR CHANGE

Behaviour does not occur in a vacuum

Adapting new behaviours entails “costs” and “benefits”

Focus on individual internal change processes

Cannot ignore socio-cultural and physical environmental influences
THEORITICAL APPROACHES

Person Centred Therapy / Client Centered
o
Basic assumptions:

Humans are basically rational, socialized and realistic

Inherent tendency to strive towards growth, self-actualization & self
direction
o
Totally accept clients without passing judgments on thoughts, behaviour, or
physical self
o
Acceptance is cornerstone of TRUST

Behavioural Therapy
o
Behaviours are learned so it is possible to learn new ones
o
Change environment so it will be conducive to learning new behaviours

Classical conditioning

Operant conditioning

Modeling

Gestalt Therapy
o
Emphasizes confronting problems

I.e. have clients take dietary responsibility rather than blame spouse
for not buying appropriate foods
o
Setting realistic goals important to gaining ownership over problems

Cognitive Therapies
o
Negative self-talk and irrational ideas are self defeating learned behaviours
o
Identify harmful self-monologues, eliminate & replace with productive self- talk
o
Change thinking and feelings and actions will be modified

Solution Focused Therapy
o
Work with client to concentrate on solutions that have worked in past
o
Identify strengths to be expanded upon & used as resources

Language (solution-talk) provides a guide -What can I do that would
be helpful to you?

Was there a time when you ate whole grain food?

When was the last time you ate fruit?

Has a family member or friend ever encouraged you to eat
low sodium foods?
BEHAVIOUR CHANGE MODELS

Self-Efficacy
o
Stands alone & incorporated into numerous models
o
“our personal belief of how capable we are of exercising control over events in
our life”
o
Attainment of health behaviour
o
Changes correlate solidly with strong self-efficacy

Health Belief Model
o
Cognitive factors influence individual’s decision to make & maintain a specific
health behaviour
o
Central tenants:

Belief to which individual is susceptible to a health problem

Belief that specific disease can severely impact quality of life

Changing behaviour will reduce risk of disease

Barriers to change are overcome with reasonable effort

Individual is capable of making change

Stages of Change
o
Is a process in which individuals progress through a series of 6 motivational
stages:

Pre-contemplation

Information & awareness; emotional acceptance

Contemplation

confidence in ability to adopt recommended behaviours

Preparation

initiate change by resolving ambivalence, eliciting a firm
commitment, & develop specific action plan

Action

Behavioural skill training & social support

Maintenance

Develop problem solving & encourage social and
environmental support

Termination/ Relapse

Motivational Interviewing
o
Complements stages of change model
o
Focus on strategies to motivate clients to build commitment
o
Motivation considered a state of readiness

Can fluctuate & be influenced by others
o
Patient-centred counseling, resolve ambivalence, reduce resistance &
encourage action
o
Basic principles

Express empathy

acceptance & understanding of a clients perspective

Develop discrepancy between present behaviour & goals

Avoid escalating resistance

defensiveness; denial, arguing, showing reluctance

Roll with resistance

Support self-efficacy
o
Specific Strategies

Listen respectively (mirror)

Elicit self-motivational statements

opportunities for client to make arguments for change


Request clarification, formulate reflective listening statements of
previous statements, reinforce self motivational statements, change
roles

Ask open ended questions (curiosity, concern, & respect)
Health Behaviour Change Method
o
Two main foundations

Importance

Confidence
o
Use in assessing readiness to change and designing intervention
COUNSELING

An internal process for the client:

Client centered

A sequence of events: Involvement in a problem solving process

The elements of the interpersonal relationship between the counselor and the client:
o
focuses on the dynamics of communication
MODELS OF DECISION MAKING

Paternalistic model
o
The patient acquiesces to professional authority

Informed model
o
the provider gives information to enable the patient to make an informed choice

Shared model
o
The provider and patient share all stages of decision-making equally
PROBLEM SOLVING NUTRITION
PROBLEM SOLVING NUTRITION COUNSELING MODEL : GOALS

To help clients become aware of solutions to problems they face

To help control nutrition behavior based on nutrition principles and their own lifestyles

To help them become more assertive In making nutrition decisions
KEY ASSUMPTIONS IN PROBLEM SOLVING MODEL

Every client situation is different

Individuals are constantly changing

Clients are experts on their own problems

Many different approaches and strategies are needed to deal with each individual problem

Effective counseling is a process that is done with the client, not to or for them
SIX STAGES OF COUNSELING

Build the foundation

Define problems

Select alternative solutions

Plan for change

Reach a commitment

Evaluate progress
1.Building the foundation

Establishing rapport
o
if rapport is not established it is unlikely that the problem solving process will
proceed

Gathering data
o
For purposes of both screening and assessmendat
o
Is needed in order to determine the nature and scope of the problem
2. Define problems multidimensionally

Look at the problem from several dimensions
o
physiological, psychosocial, the patient, the counselor
o
May have to address problems that are not direct nutrition issues (smoking and
weight control in teen girl)

As problems are defined they evolve into goals
3. Select alternative solutions

Explore as many options as possible for addressing the problems

Consider changes in food choices, feelings, attitudes, beliefs, or even interpersonal
relationships
4.Plan for Change

Select one or two alternatives

Affirm client’s ability to make desirable changes

Identify coping mechanisms for difficult situations related to the problem
5. Reach a commitment

Bring about genuine commitment to action

Agree on :
o
What are you going to do? (goals)
o
How are you going to go about doing it? (plan)
o
What will be the consequences of the change? (outcome)
o
What are the barriers to change? (barriers)

Offer verbal affirmation and support for client’s commitment

Have clients summarize plan and commitment for actions
6. Evaluate progress

What was accomplished during the session and how does your client feel about the
session?

How can achievements be incorporated into new nutrition behaviors

Bring about closure:
o
Signal end of session
NUTRITION COUNSELING STRATEGIES
ACTIVE LISTENING

A strategy of communication that involves all of the senses and is the cornerstone for a
problem-solving counselling relationship

Most important counseling strategy

Guides effective problem solving

Includes empathy and concrete responses

Undivided attention to client

Listen for verbal messages

Observe non-verbal behaviour
o
Eye Contact
o
Attentive Body Language
o
Vocal style
o
Verbal Following

Not simply hearing words
o
Hard work requiring focused attention & concentration

Essential Components of Effective Listening:
o
Openness
o
Concentration
o
Comprehension
PARAPHRASING AND SUMMARIZING

Briefly restate the essence of what the person has said concisely using different words

Summarize what has been said over a period of time
REFLECTIVE LISTENING

Listen to not only the words but also the feelings associated with the message

It is a way of communicating your understanding
o
Phrased as a statement rather than a question

Steps:
1. Correctly identify the feeling being expressed
2. Reflect the feeling you have identified to the client
3. Match the intensity of your response to the level of feeling expressed by the
client
4. Respond to the feelings of your client not the feelings of others
QUESTIONING

OPEN and NEUTRAL QUESTIONS
o
“Tell me about yourself”
o
“Tell me about your eating habits”
o
“What have you been doing to lower your blood cholesterol?”
o
Tell me what time do you rise in the morning, and what do you have to eat?”
o
Take me through your day…

CLOSED QUESTIONS
o
“Do you smoke?”
o
“Do you salt your food at the table?”
o
“Do you eat chicken with the skin on?”

LEADING QUESTIONS
o
“Do you eat ice cream every evening?”
o
“You don’t use whole milk, do you?”
CLARIFYING

Probing & Prompting
o
Communicate tell me more through body language
o
Use trailing words
o
Ask clarifying questions
CONFRONTATION / CHALLENGING

To “bring to the front” or to discuss problems, concerns, and issues that may be barriers to
a healthy nutrition lifestyle

Note discrepancies
AFFIRMING

Alignment:
o
The counselor tells the client that s/he understands and is there to support at
this difficult time

Normalization
o
the counselor tells the patient that it is perfectly normal to have these feelings/
reactions
ADVICE

Provide possible solutions for problems

Should be:
o
Given in nonjudgmental manner
o
Identify the problem
o
Explain the need to change
o
Advocate an explicit plan of action
o
End with an open ended question to elicit a response from the client
DIRECTING

Telling a client exactly what needs to be done

Often part of educational component of session

When giving directives:
o
Be clear and concise
o
Determine if instructions were completely understood
o
Have them repeat back instructions
ALLOWING SILENCE

Silence is a valuable tool!

Clients need space for internal reflection & analysis
o
After given response to an evaluation
o
During instructions of complex dietary regimen
o
After emotional outburst due to demands of coping with newly diagnose illness
Divert eyes for moment
o
30-60 seconds
o
Break silence by repeating last sentence or phrase spoken to client
SELF- REFERENT

Self disclosing & self involvement

Increase openness, build trust, provide model to increase client level of disclosure, create
more personal atmosphere

Be careful of amount and stage of introduction
ASSESSING READINESS FOR CHANGE

Readiness to change questions

Provide simple readiness to change statements
o
i.e. In the past 6 months have you tried to eat less fat?
o
Are you seriously thinking about eating less fat over the next 6 months?
o
Do you plan to continue trying to eat less fat over the next 6 months
o
How confident are you that you can change your diet to eat less fat?

Ruler if 1 corresponds to not thinking about a change and 12 corresponds to highly
motivated
o
0-4= not ready (precontemplation)
o
4-8= unsure (contemplation)
o
9-12= ready (preparation)
COUNSELING FOR CHANGE NOT READY

Goals:
o
Raise Doubts
o
Facilitate patients ability to consider change
o
Identify and reduce patient’s resistance and barriers to change
o
Identify behavioural steps toward change that are tailored to each patient’s
needs

Strategies for Success
o
Raise Awareness
o
Personalize benefits
o
Promote change talk
o
Respect decision
o
Summarize
o
Offer professional advice
o
Respectful acknowledgement of decision that not ready to change not
necessarily going to set out behaviour change goals
COUNSELING FOR CHANGE UNSURE

Goals : Build confidence

Strategies
o
Explore ambivalence
o
Explore barriers
o
Imagine the future
o
Explore successes
o
Encourage support
o
Summarize
o
Ask about next steps
COUNSELING FOR CHANGE READY

Goals
o
Collaborate with client to set goals for change including a plan of action

Strategies
o
Praise positive behaviours
o
Explore options
o
Negotiate realistic short-term goal/s
o
Develop action plan
CULTURE COMPETENCE IN COUNSELING
CULTURE

“learned, shared, and transmitted values, beliefs, norms & life practices of a particular
group that guides thinking, decisions, and actions in patterned ways (Coffman, 2004 р.
100)

As professionals need to understand impact of culture on health
CULTURE COMPETENCE

“emphasizes the ability to function effectively with members of different groups through
cultural awareness and sensitivity” (Friedman & Hoffman Goetz. 2006, p. 427)

Conscious & direct effort to acquire this understanding
Cultural competence requires Attitudes, Knowledge & Skills
ATTITUDE

First learn about your own culture & how it influences your behaviour
KNOWLEDGE

Be cautious of generalizations
SKILLS

Involving participants in decision making helps overcome cultural barriers

May need to work with client to be comfortable with client centered approach
REFLECTING ON CULTURE

How would you define your ethnocultural background

Consider family structure, ethnicity, gender, geographic location, ability, religion, class, &
language

How have these beliefs, values etc influenced our interactions with people of other
cultures

How might these reflections might influence future behaviour
STRATEGIES FOR CULTURALLY COMPETENT COUNSELING

Open ended questions

Client-centered framework of communication

Openness and listening to experiences, valuing client expertise & being sensitive to
difference
Last but not least…

Consider what strengths you have to bring to the counseling situation and then

Build on them!
Programs and Services available in GO’s and NGO’s
47th Nutrition Month

MALNUTRISYON PATULOY NA LABANAN, FIRST 1000 DAYS TUTUKAN!
2021 Nutrition Month Campaign Objectives

Educate
o
Increase the understanding of the First 1000 Days of life strategy and the PPAN
as overall framework

Encourage
o
Facilitate collaboration among various stakeholders for scaled up interventions
to fight malnutrition

Engage
o
Generate interactions from stakeholders about nutrition
Presidential Decree 491

mandates that July shall be the month to create greater awareness on nutrition.
OUR NUTRITION SITUATION : National Nutrition Surveys.

Wasting – 5.6% of children under-5 (800,000)

Obesity – 4.0% of children under-5 37.2% among adults

Chronic Energy Deficiency – 8% of adults

Stunting – 30.3% of children under-5 (3.4 Million)

Hunger – 21%

Food Insecurity – 53.9%

Micronutrient Deficiencies – Hidden Hunger


Even before the COVID-19 pandemic, the Philippines is already struggling with various
forms of the triple burden of malnutrition – undernutrition, overnutrition and micronutrient
deficiencies.
While there has been improvement in the situation, this has been and inconsistent with the
economic growth that the country has experienced.
BREASTFEEDING PRACTICES
COVID-19 did not affect drastically the breastfeeding practice.

60.8% of children 0-5.9 months were exclusively breastfed during COVIC-19 pandemic

59.7% of children 0-23 months were currently breastfed during COVIC-19 pandemic
– Nutrition Assessment Survey done by FNRI in November 2020

exclusive breastfeeding rates are still below target.

61.8% – Decided not to breastfeed
o
REASONS

19.0% – of children 0-23 months had stopped breastfeeding during
COVID-19 pandemic

9.1% – Child did not want to be breastfed

15.5% – Returned to work

2.7% – not able to go home
COMPLENTARY FEEDING PRACTICES
COVID-19 did not affect complementary feeding practices.

Meeting Minimum Meal Frequency – 93.3

Meeting Minimum Dietary Diversity – 30.0

Meeting Minimum Acceptable Diet – 20.2

COVID-19 did not affect complementary feeding practices.
o
Minimum meal frequency – proxy indicator of energy adequacy.
o
Dietary Diversity Score – proxy indicator of micronutrient adequacy.
o
Minimum acceptable diet – proxy of both energy and micronutrient adequacy.

However, the figures are way way below than desirable.

Only 20 percent or 1 in 5 babies are eating properly and the figures do not improve even
as family incomes increase.
TOP COMPLEMENTARY FOODS CONSUMED BY CHILDREN 0-23 months

45.6% – Commercial baby food

19.5% – Mashed vegetables

14.4% – Porridge/lugao

7.6% – Rice

3.2% – Fruits
WHAT IS THE IMPACT OF THE PANDEMIC ON NUTRITION ?

Families had limited access to food

“Ayuda” food items were insufficient to meet nutritional needs

Interruptions of nutrition programs and services

Maternal health services were affected

Physical inactivity and unhealth behaviors increased
–
Source 2020 RNAS DOST-ENRI

Due to lockdowns and limited resources, programs such as Operation Timbang Plus
activities, supplementary feeding, micronutrient supplementation, and deworming were
interrupted.

Note that 15.5% of pregnant women were not able to have their prenatal check-ups.
HOW DO WE ADDRESS THE CHALLENGE OF MALNUTRITION

We do have the Philippine Plan of Action for Nutrition 2017-2022.

While we are on the 5th year of the plan, we continue to push for its adoption by partners
and especially by local government units
WHAT ARE NUTRITION SPECIFIC INTERVENTION

Programs that address the immediate causes of malnutrition.
o
Inadequate food intake and intake of food of poor nutrient quality
o
Poor maternal and child caring practices
o
Disease
PPAN 8 SPECIFIC NUTRITION INTERVENTION that addresses the triple burden of malnutrition

Infant and Young Child Feeding

Integrated Management of Acute Malnutrition

National Dietary Supplementation Program

National Nutrition Promotion Program for Behavior Change

Nutrition in Emergencies

Mandatory Food Fortification

Micronutrient Supplementation

Overweight and Obesity Management and Prevention Program
FIRST 1000 DAYS

Starts from conception up to the first two years of a child

“golden window of opportunity” where health, nutrition, and development foundations are
established

Its impact:
o
Optimum growth and development
o
Higher IQ and better performance in school
o
Lower risk of diseases and overall better health
o
Increased productivity and higher income
o
Reduced child deaths

One of the strategic focus of PPAN is the first 1000 days of life
strategy. Evidence show that the most strategic period to prevent
malnutrition and achieve children’s potential for physical growth and
mental development is from conception until the child reaches his or
her second birthday.
CONTINUE AND SCALE UP CRITICAL INTERVENTIONS IN THE FIRST 1000 DAYS OF LIFE

PREGNANCY
o
At least 4 pre-natal visits in 3 trimesters (1-1-2)
o
180 tablets of iron-folic acid supplementation.
o
Balanced protein-energy dietary supplementation

YOUNGER STAGE OF INFANCY (birth to 5 months)
o
Exclusive breastfeeding for the first 6 months

For optimal development and immunity against illness and diseases.

ensure the strict implementation of the Milk Code such as not allowing
milk donations.

provide support and counselling to mothers.

OLDER STAGE OF INFANCY & TODDLERHOOD (6-24 months)
o
Age-appropriate complementary feeding with continued breastfeeding
o
Micronutrient supplementation (Vit. A, Micronutrient Powder)

If we want to reduce stunting by at least 20%, the coverage of these six critical
interventions in the critical First 1000 Days should be continued and scaled to 90%
coverage
MALNUTRITION CAN BE PREVENTED PARTICULARLY DURING THE FIRST 1000 DAYS OF
LIFE
1. Antenatal multiple micronutrient supplementation to reduce risk of
o
Stillbirths
o
low birthweight
o
small-for-gestational age babies
2. Provision of supplementary food in food-insecure settings.
3. Use of locally produced, ready to use supplementary and therapeutic food to manage
acute malnourished children;
4. Preventive small-quantity lipid based nutrient supplementation for children aged 6 to 23
months for positive effects in child growth.
5. Integrated interventions including diet, exercise, and behavior therapy for prevention and
management of childhood obesity;
6. Nutrition-sensitive programs that yield nutritional benefits including
o
malaria prevention
o
preconception care
o
water, sanitation, hygiene (WASH) promotion
7. Improved coverage of interventions to reach the most vulnerable groups.
o
Evidence points to the need to reach also the most vulnerable group which
includes those living in geographically isolated and disadvantaged groups and
those who belong to indigenous peoples.
BASIS FOR LGU FUNDING FOR NUTRITION

DILG Memorandum Circular 2018-42
o
enjoins all LGUs to prioritize in their allocation of local funds the PPAN included
in their local nutrition action plans formulated in accordance with the PPAN
2017-2022

DILG-DOH Joint Memorandum Circular 2019-0001
o
Guidelines for integration of PAPs from the PPAN to the local development
plans, investment programs and budget of LGUs

DBM guidelines on annual LGU budget preparation that requires LGUs to prepare local
nutrition action plans
o
National Budget Memorandum No. 130
o
Local Budget Memoranda No. 77 S. 2018
o
Local Budget Memoranda No. 80. 2020
o
Local Budget Memoranda No. 82. 2021

LGU budget increase with the effectivity of Mandanas ruling
POLICIES AND PROGRAM THAT SUPOORT NUTRITION

RA 11148 Kalusugan at Nutrisyon ng Mag-Nanay Act
o
Scales up interventions in the first 1000 days.

RA 11210 105-Day Expanded Maternity Leave Law

RA 11037 Masustansyang Pagkain para sa Batang Pilipino Act

RA 10410 Early Years Act

RA 10028 Expanded Breastfeeding Promotion Act

RA 8976 Food Fortification Law

RA 8172 ASIN Law

EO 51 Philippine Milk Code
PLATFORMS FOR COLLABORATION

IATF on Zero Hunger
o
Launched the National Food Policy under the leadership of the Office of the
Cabinet Secretary Karlo Nograles
o
Involve all government stakeholders to

eradicate hunger

achieve food security

improve the nation’s nutrition situation

promote sustainable agriculture.

Pilipinas Kontra Gutom (PKG) Movement
o
Organized to tap the private sector to support and complement government
efforts.
o
National and multisectoral anti-hunger movement with support from the private
sector, NGOs and foundations, CSOs, and digital and media partners
 The Duterte Administration has shown support to address hunger with
the issuance of Executive Order 101 creating the Interagency Task
Force in January 2020/.

Scaling Up Nutrition (SUN) Movement
o
Global movement to convene different sectors to implement actions aligning
nutrition targets
o
Philippines became the 51st country to join the Scaling Up Nutrition Movement
in 2014

SUN Philippines
o
Organized sectors including: United Nations, don’t cl society, business,
academe, and government Adopted SUN Strategy 3.0 in June
OPPURTUNITIES TO SUPPORT NUTRITION : LOCAL GOVERNMENT
1. Adopt the PPAN in local nutrition action plan and annual investment plan
2. Increase support to nutrition programs and its implementation, with focus on the first 1000
days with adolescents, pregnant and lactating women, and infants and young children as
primary beneficiaries
3. Ensure delivery of essential health and nutrition programs in the first 1000 days, as
mandated by RA 11148
4. Improve access of health and nutrition programs in far-flung areas, geographically-isolated
and disadvantaged areas, urban poor, resettlement areas and indigenous peoples
5. Coordinate with national government agencies through the regional offices in capacity
building and technical assistance for implementation of programs on health and nutrition
CURRENT SUPPORT FOR NUTRITION
How you or your agency or organization is supporting nutrition?

Personal development?
o
As an individual, you may eat healthy because you believe its good for you. Or
as a parent, you ensure that your family eats well.

Service delivery?
o
If you work for an organization who is working for nutrition, then you may be
helping in delivery nutrition services.

Policies and budgets?
o
As a policy maker, you may make decisions related to funding and approval of
activities.

Advocate?
o
If you are a member of the academia, your focus may be on nutrition education.

Nutrition education?

Don’t care?
o
And some of may be very vocal about nutrition.
o
And probably, there is one among you who doesn’t really care.
OPPURTUNITIES TO SUPPORT NUTRITION : MEDIA

Develop materials for information, education, and communication of nutrition messages to
the public

Disseminate factual information on good nutrition through print, television, radio, digital
media, and other media

Promote good and healthy nutrition practices in commonly consumed media like film and
television, as well as digital media

Encourage the public to participate in national and local health and nutrition.coocase
o
Media are also discouraged from soliciting donations of milk and products
covered under the Milk Code especially during emergencies.
HOW CAN STAKEHOLDERS SUPPORTS NUTRITION
OPPURTUNITIES TO SUPPORT NUTRITION : NATIONAL GOVERNMENT
1. Strengthen policies and programs on scaling up nutrition interventions
2. Invest in nutrition through inclusion of nutrition programs in the national annual budget,
operational plans, and human resources
3. Establish more nutrition-sensitive programs to address basic and underlying causes of
malnutrition
o
Prioritize nutritionally vulnerable groups as beneficiaries in nutrition-specific and
nutrition- sensitive government programs
OPPURTUNITIES TO SUPPORT NUTRITION : PRIVATE SECTOR
1. Create an enabling work environment for women and chil
2. Ensure protection of women in the labor industry by establishing lactation stations and
provision of breastfeeding breaks (RA 10028)
3. Provide and allow expanded maternity leave to encourage proper postpartum care and
exclusive breastfeeding
4. Tweak budget and plans for nutrition-related activities and services to employees and
clientele
5. Comply with EO 51 for manufacturers of breastmilk substitute
o
There are many ways for the private sector to participate and as mentioned
earlier, there are now platforms that are available such as

Pilipinas Kontra Gutom

Scaling Up Nutrition Movement business
OPPURTUNITIES TO SUPPORT NUTRITION : CIVIL SOCIETY
1. Advocate for increased attention to nutrition in the first 1000 days, and more investment
on it
2. Empower communities to support programs for prevention of malnutrition in the first 1000
days
3. Work with the government in strengthening efforts to address malnutrition
4. Widen reach of nutrition programs to areas with less access to health and nutrition
programs
5. Join the Scaling Up Nutrition Civil Society Alliance.
o
SUN networks

it is the civil society alliance that was first to be organized.

Civil society groups can help advocate for nutrition aside from
implementers of nutrition programs.

they align nutrition efforts along the PPAN and complement
government efforts by sharing their knowledge technologies such as
in community organizing, research and project modelling.
OPPURTUNITIES TO SUPPORT NUTRITION : ACADEME
1. Ensure that nutrition is part of the curricula.
2. Conduct webinars, online for a, and other activities on nutrition
3. Have its extension programs promote good nutrition and encourage the school and
university constituents’ participation
4. Conduct research on nutrition aligned with the PPAN Research Agenda
5. Join the Scaling Up Nutrition Academe Network
o
A strength of academic institutions is its expertise in research and development
– develop nutritious food products., technologies to improve nutrition and lend
your technical expertise to policy formulation and program implementation.
OPPURTUNITIES TO SUPPORT NUTRITION : FAMILIES/ INDIVIDUALS

Practice good nutrition in your family

Participate in nutrition programs

Help others achieve proper nutrition by doing voluntary work in communities

Innovate and think out of the box.
o
Beneficiaries of programs should not just be passive recipients. They too can
also contribute something.
o
Let us be inspired by Patricia Non who started a community pantry to help
others and with her example, she encouraged others to also help.
ACTIVITIES TO SUPPORT NUTRITION MOΝΤΗ CAMPAIGN

Disseminate Nutrition Month through streamers, websites, and social media

Conduct nutrition webinars and online fora

Review and tweak organization plans and budgets to include nutrition-related activities
and services.

Participate in Nutrition Month activities in your community and that of the NNC and other
agencies with observance of minimum health standards

Do volunteer work in nutrition
Call to action for nutrition!

Let us all work together to eliminate all forms of malnutrition, raise a new #Laking 1000
generation of Filipinos achieving their full potential.

Be one of the spoons to advocate for good nutrition among Filipinos beginning in the first
1000 days of life!

Sa PPAN, Panalo ang Bayan!
BUILDING EVIDENCE – BASED PRACTICE INTO ALL AREAS OF DIETETICS
EVIDENCE – BASED PRACTICE

The use of systematically reviewed scientific evidence in making food and nutrition
practice decisions

Achieved by integrating best available evidence with professional expertise and client
values to improve outcomes
–ADA Scope of Dietetics Framework Definition of Terms 2007
KEY CONSIDERATION : EBP

based on the best available evidence including research, national guidelines, policies,
consensus statements, expert opinion and quality improvement data.

involves continuing evaluation of outcomes.

involves complex and conscientious decision-making based not only on the available
evidence but also on client/customer/community characteristics, situations, and
preferences.
EBP IMPORTANCE

Evidence-based practice will position the profession for improved reimbursement,
recognition, and quality services.
WHY USE EBP?

Explosion of Literature
o
Over 10,000 new research articles added to MedLine annually
o
Estimated that clinicians must read ~20 articles a day to keep up!

Unmet Information Needs
o
Questions from clients and other stakeholders are continuously being
generated.

Implementation Delays
o
Research findings are often delayed in implementation.
o
It can take 10 to 20 years for original research to be put into clinical practice
IMPORTANCE OF COLLECTING OUTCOMES/ DATA

Ensure progress of profession

Reimbursement

No data no research

No research no evidence

No evidence no basis for practice standards

Align our profession with other medical fields basing their practice on evidence

There is limited nutrition research.
STANDARDIZATION OF PRACTICE

There is a significant gap between best research evidence and application of evidence to
practice.

Nutrition support is not always applied effectively or consistently, despite available
scientific evidence that could be used to enhance a given treatment protocol.
BENEFITS OF EBP

Provides RDs and DTRs with an overarching foundation for patient care and customer
service – a disciplined approach for how we practice

Supports the relationship we have with our clients they trust us & expect us to provide the
“best care”

Facilitates use of the rapidly expanding body of nutrition knowledge

Reduces the gap between research and day-to day practice
PERSONAL BENEFITS OF EBP

Enhances our status on the health care team

Enhances our confidence the EAL is a great resource to support our recommendations to
team members & payers

Provides a sense of satisfaction – Measuring outcomes allows us to see that we make a
difference

Promotes effective time management

Promotes compliance with regulations for MNT, e.g. Medicare part B

Limits the basis for litigation
BOTTOM LINE BENEFITS

EBP leads to:

Improved quality of care

Increased patient safety

Decreased variation in practice

Efficient use of resources

Increased likelihood of achieving desired patient outcome

Improved client, provider & payer satisfaction Increased likelihood of coverage for MNT
DEVELOPMENT OF EBP includes…. Five Fundamental Steps.
EVIDENCE – ANALYSIS PROCESS STEPS
1. Select topic & appoint expert work group
2. Define questions and determine inclusion/ exclusion criteria
3. Conduct literature review for each question
4. Analyze Articles/ Critical Appraisal
5. Overview Table & Evidence summary
6. Develop conclusion statement & assign grade
7. Publish to online EAL
GUIDELINE METHODOLOGIES USED

Center of Evidence Based Medicine

National Heart Lunga and Blood Institute

ICSC Sytems Improvement
o
Whenever possible we don’t “reinvent the wheel.”
EXPERT WORKGROUP

Experts in field

Appointed by Evidence- based Practice Committee (oversight group)

Balance of researchers and practitioners Assists in question

Development Review work of analysts and provide final approval
EVIDENCE ANALYST

Experts in critically analyzing articles.

Must have at least Master’s degree; many have PhD’s

Trained at ADA’s EA workshop

Mentored by ADA Staff and Lead Analysts

Read and analyze articles
Step 4—Critical Appraisal of Each Article

Completes worksheet

Completes quality criteria

Checklist

Completes overview tables

Completes evidence summaries

Most detailed information on EAL
o
Responsibility of Analyst
o
Reviewed by lead analyst
o
Approved by workgroup
Step 5—Evidence Summary

Summarize articles into Overview Table

Information synthesized from articles in to narrative evidence summary
o
Responsibility of Evidence Analyst
o
Reviewed by Lead Evidence Analyst
o
Reviewed and Approved by Work Group
Step 6—Conclusion and Grade

Bottom Line – Answer to question based on the science

Determined after research analyzed

Graded based on quality of supporting evidence
o
Drafted by Analyst Reviewed
o
Approved and Graded by Work Group
GUIDELINE DEVELOPMENT
8. Develop algorithms based on Nutrition Care Process
9. Formulate guideline recommendations
10. Internal/external review and revise
11. Publish guideline on EAL
Step 9—Recommendation

Translation of the evidence into a course of action for the RD

State “what to do” and “why” for the RD

Links to supporting analyzed evidence

Provides “transparency”

Conditional rating for a specific population

Imperative rating for a broad range

Drafted by Lead Analyst Reviewed, Approved and Rated by Work Group

Recommendation Examples
o
Dietary sodium intake should be limited to no more than 2300 mg sodium (100
mmol) per day. Reduction of dietary sodium to recommended levels lowers lov
systolic tolic blood pressure by approximately 2-8 mmHg.

Rating: Strong Imperative
o
If the critically ill ICU patient is hemodynamically stable with a functional GI
tract, then EN is recommended over PN. Patients who received EN experienced
less septic morbidity and fewer infectious complications than patients who
received PN. In the critically ill patient, EN is associated with significant cost
savings when compared to PN

Rating: Strong Conditional
TOOLKIT DEVELOPMENT
12. Develop toolkits to apply guidelines
13. Conduct 60-day usability test of toolkit and revise
14. Make toolkits available for purchase
FEATURES OF EVIDENCE – BADED TOOLKIT

Set of companion documents for application of the practice guideline

Disease/condition specific

Include:
o
Documentation forms
o
Outcomes monitoring sheets
o
Client education resources case studies
o
MNT protocol for treatment of disease/condition

Incorporate Nutrition Care Process/SL as the standard for care

Electronic downloadable purchase item
HOW DO I IMPLEMENT EVIDENCE –BASED PRACTICE?
ACCESS OTHER EBP RESOURCES

Society for Critical Care Medicine Clinical Guidelines

Canadian Clinical Guidelines

UpToDate.com Clinical Reference

Cochrane.org Database of Systematic Reviews

Zynxhealth.com Evidence

NHLBI Clinical Guidelines
INFANCY GROWTH & DEVELOPMENT
INFANCY (AGE 1 MONTH TO 1 YEAR) – most important period in a person’s life
I.PHYSICAL GROWTH AND DEVELOPMENT

A. General Characteristics:
o
The best indication of good overall health in an infant is steadily increasing
height, weight, and head and chest circumference
o
Growth and development is monitored by plotting measurements on a
standardized growth chart from birth to age 2 years




EXTRUSION REFLEX
o
present until age 3 -4 months (food replaced, on an infant’s tongue is thrust
forward and out of the mouth)
The stomach capacity of infants increases from 20-30 ml at birth to 200 ml by 1 yr of age
Drinking from a cup can be possible as early as 4 months with parental control of the fluid
flow
by 8 to 10 months, the infant may be able to independently drink from a cup
NORMAL HEIGHT CHANGES

1½ inch to 4 inch (1.3-1.9 cm per month)

Grows from the average birth length of 20 inches to 30 inches

increases by 50% during the first year
IMMUNE SYSTEM

Becomes functional at least 2 months of age

Able to produce Ig G and M antibodies by 1 year of age

Ig A, E, and D are not plentiful until preschool age

ability to adjust to cold is mature by 6 months
NORMAL WEIGHT CHANGES:

Gain of 2 lb. per month during the first 6 mos. – doubling of birth by age 6 mos.

Gain 1 lb. per month during the 2nd 6 mos. – •
tripling of birth weight by age 12 mos.
RENAL SYSTEM

The kidneys remain immature and not as efficient at eliminating body wastes as in the
adult
HEAD AND CHEST CIRCUMFERENCE

Increase of 4 inch (0.64 cm) per month between 6 -12 mos.

Increases rapidly during the infant period, reflecting rapid brain growth

By end of first year, the brain has already reached 2/3 of its adult size

Head and chest circumference equalize by age 1 year

After age 2 years, chest circumference increases substantially more than head
circumference increase of ½ inch (1.3 cm) per month between 1 – 6 months
ENDOCRINE SYSTEM

Remains particularly immature in response to pituitary stimulation such as
o
Adrenocorticotrophic hormone (ADH) – cortisol production
o
insulin production for the pancreas which unable the infants to react to stress
efficiently

75% of an infant’s body wt. is fluid which increase the susceptibility of the infant to
dehydration from illnesses such as Ibm and vomiting
CRANIAL SUTURE CHANGES

POSTERIOR FONTANEL – measures 1x1cm at birth and normally closes by age 2 mos

ANTERIOR FONTANEL – measures 3.5 x 3.5 cm at birth and normally closes by age 18
mos.
TEETH



BODY SYSTEMS
CARDIOVASCULAR SYSTEM

HR – 100 to 120 bpm

PR – may begin to slow with inhalation (sinus Arrythmia), but this does not become
marked until preschool age

BP – 100/60 mmHg

RR – 20 to 30 breaths/min
o
because the lumen or the tubal cavity of the respiratory tract remains small and
mucous production by the tract is still inefficient, upper respiratory infections
occur readily and tend to be more severe than in adults
DIGESTIVE SYSTE

Functions mature more gradually during the infant year

Although the ability to digest protein is present and effective at birth
o
the amount of Amylase, necessary for the digestion of complex CHO, is
deficient until approx. the 3rd month
o
Lipase, necessary for digestion of saturated fats, is decreased in amount during
the entire first year

Liver of an infant remains immature,
o
possibly causing inadequate conjugation of drugs and inefficient formation of
CHO, CHON and vitamins for storage


6 MOS – the first baby tooth erupt, followed by a new one monthly
Some newborns (about 1 in 2000), may be born with teeth(called natal teeth) or have
teeth erupt in the first four weeks of life (called neonatal teeth)
Deciduous teeth (temporary or baby teeth) are also essential for protecting the growth of
the dental arch.
Milk teeth.
Permanent teeth erupt at age 6 or 7 years old
MOTOR DEVELOPMENT

GROSS MOTOR DEVELOPMENT
o
Ability to accomplish large body movements

FINE MOTOR DEVELOPMENT
o
Measured by observing or testing prehensile ability

ability to coordinate hand movement
GROSS MOTOR DEVELOPMENT
1.VENTRAL SUSPENSION POSITION

refers to the infant’s appearance when held in midair on a horizontal plane, supported by a
hand under the abdomen

the newborn allows the head to hang down with little effort at control
o
1 month old child

lifts the head momentarily, then drops it again

he or she may flex the elbows, extend the hips, and flex the knees
o
2 month old

hold their heads in the same plane as the rest of their body
o
3 month old

lifts and maintains the head well above

The plane of the rest of the body in ventral suspensio

LANDAU REFLEX – develops at 3 mos
o
when held in ventral suspension, the infant’s head, legs and spine extend when
the head is depressed, the hips, knees, and elbows flex
o
continues to be present until 6 minths of life a child with motor weakness,
cerebral palsy, or other neuromuscular defect will not be able to demonstrate
the reflex

PARACHUTE REACTION
o
when infants are suddenly lowered toward an examining table from ventral
suspension, the arms extend as if to protect themselves from falling
2. PRONE POSITION

1 month
o
when lying on their stomach, infants lift their head and turn easily to the side

2 months old
o
can raise their head and maintain the position, but they cannot raise their chest
high enough to look around yet, their head is still held facing down ward

3 months old
o
lifts the head and shoulder well off the table and looks around when prone

4 months old
o
lift the chest off he bed and look around actively, turning the head from side to
side. They can turn from front to back
o
NECK – RIGHTING REFLEX

begins at this age

when the infant turns the head to the side, the shoulders, trunk, and
pelvis turn in that direction, too

5 months old – rests his or her weight on the forearms when prone

6 months old – rest their weight on their hands with extended arms

9 months old – the child can creep from the prone
3. SITTING POSITION – When placed on his or her back, and then pulled to a sitting position

1 month old – has gross head lag as in the first days of life

2 months old
o
can hold his or her head fairly steady when sitting up, although it does tend to
bob forward

3 months old – has only slight head lag when pulled to a sitting position

4 months old
o
reaches an important milestone by no longer demonstrating head lag when
pulled to a sitting position





5 months old
o
can be seen to straighten his r her back when held or propped in a sitting
position
6 months infant
o
sit momentarily without support
o
often sit with their legs spread and their arms stiffened between them, hands on
the floor, as a prop
7 months
o
sits alone, but only when the hands are held forward
8 months
o
can sit securely without support
9 months
o
sit steadily that they can lean forward and regain their balance
4. STANDING POSITION

1 month – newborn stepping reflex can still be demonstrated

2 month
o
when held in a standing position, holds his or her head up with the same show
of support as in a sitting position

3 months – begins to try to support part of their weight stepping reflex begins to fade

4 months – make an attempt to sustain their weight actively on their legs

5 months – continues the ability to sustain a portion of his or her weight

6 months – support nearly their full weight when in a standing position

7 months – bounces with enjoyment in a standing position

9 months – can stand holding onto a table if he or she is placed in that position

10 months
o
can pull themselves to a standing position by holding onto the side of a playpen
or a low table, but they cannot let themselves down again

11 months
o
learns to “cruise” or move about the crib or room by holding onto objects such
as the crib rails, chairs, walls and low tables

12 months
o
a child stands alone at least momentarily
o
Can draw a semistraight line with a crayon
o
enjoy putting objects such as small blocks in containers and taking them out
again
o
can hold a cup and feed themselves fairly well (if they have been allowed to
practice)
DEVELOPMENTAL THEORIES
A. PSYCHOSOCIAL DEVELOPMENT (Erikson)

Trust vs mistrust
o
Infants significant other in this stage is the “maternal person”
o
The psychosocial theme is “To get; to give in return”
o
Developing a sense of trust in caregivers and the environment is a central focus
for an infant
o
The sense of trust forms the foundation for all future psychosocial tasks
o
The quality of the caregiver-child relationship is crucial factor in the infant’s
development of trust
o
The development of mutual reciprocity between a caregiver and an infant is the
desired outcome to enhance the infant’s sense of trust
o
An infant who receive attentive care learns that life is predictable and that her
needs will be met promptly; this foster trust
o
In contrast, an infant experiencing consistently delayed needs gratification will
develop a sense of uncertainty, leading to mistrust of caregivers and the
environment
o
An infant commonly seeks comfort from a security object (e.g. a blanket or
favorite toy) during times of stress
B. PSYCHOSEXUAL DEVELOPMENT (FREUD)

Oral stage (birth to 18 months of age)
o
Erogenous zone is the mouth, lips, tongue, and teeth
o
Sexual activity is from sucking, swallowing, chewing and biting
o
The infant meets the world by:

Crying, tasting, sucking, eating, and early vocalization

Biting to gain a sense of having a hold on and having greater control
of the environment

Grasping and touching, to explore tactile variations in the environment
C. COGNITIVE DEVELOPMENT (PIAGET)

The sensorimotor stage (birth to 18 mos)
o
involves the development of intellect and knowledge of the environment gained
through the senses
o
from reflexive activity to purposeful acts

5 SUBSTAGES:
o
Substage 1 (birth-1 month)

characterized by innate and predictable survival reflexes
o
Substage 2 (1 – 4 mos)

marked by stereotyped repitition and the infant’s focus on his or her
own body as the center of interest
o
Substage 3 (4 –8 mos)

characterized by acquired adaptation and a shifting of attention to
objects and the environment
o
Substage 4 (8 –12 mos)

marked by intentionally and consolidation and coordination of
schemes
o
Substage 5 (12 –18 mos)

characterized by an interest in novelty and creativity and discovery of
new means through active experimentation
EMOTIONAL DEVELOPMENT

His emotions are instable, where it is rapidly changes from crying to laughter.

His affection for or love family members appears.
o
By 10 months

expresses several beginning recognizable emotions, such as anger,
sadness, pleasure, jealousy, anxiety and affection.
o
By 12 months of age, these emotions are clearly distinguishable
SOCIAL DEVELOPMENT

He learns that crying brings attention.

The infant smiles in response to smile of others.

The infant shows fear of stranger (stranger anxiety).

He responds socially to his name.

According to Erikson, the infant develops sense of trust through the infant’s interaction
with caregiver (mainly the mother), especially during feeding, he learns to trust others
through the relief of basic needs.

Attachment to the so begins at birth and becomes increasingly evident after 6 mos.

4 – 8 months
o
infant progresses through the first stage of

Separation

individuation

gaining a sense of self and his or her so as separate persons

begins to acquire a sense of object permanence

recognizing that the so can be absent

The infant makes major strides in personal-social behavior during the first year learning to
shape his or her environment and elicit specific responses from others (e.g. by smiling in
response to pleasurable stimuli)
SPEECH MILESTONES – Crying represents the infant’s means of verbal communication

5-6 weeks – vocalizes with short throaty sounds

2 months – Typically makes single vowel sounds

1-2 months – coos

3-4 months – Consonant sounds

2-6 months – laughs and squeals

8 months
o
More consonants and combined syllables such as “mama” and “dada”
(although without comprehension of meaning)

8-9 months babbles – mama/dada as sounds

10-12 months – “mama/dada specific

1 yr – several short words with meaning
PLAY




The infant’s work, facilitates learning
Learns about the environment through the senses of touch , taste, hearing, smell and
sight
The infant develop motor skills through manipulating toys and other objects
SOLITARY PLAY
AGE APPROPRIATE TOYS
Birth – 2
Mobiles, mirror, music box, stuffed toys with no detachable parts
months
2 – 4 months
Rattles, cradle gym
4 – 6 months
Brightly colored toys (small enough to grasp, large enough for safety), squeeze
toys, busy box
6 – 9 months
Toys with bright colors, movable parts, and noisemakers, blocks, balls
9 – 11 months
Books with large pictures, push-pull toys, teddy bears, large puzzles, building
blocks
RED FLAGS IN INFANT DEVELOPMENT

Unable to sit alone by age 9 months

Unable to transfer objects from hand to hand by age 1 year

Abnormal pincer grip or grasp by age 15 months

Unable to walk alone by 18 months

Failure to speak recognizable words by 2 years.
HEALTH PROMOTION
A. Fears
o
Infants exhibit a reflexive startle response to loud noises, falling, and sudden
movements in the environment
o
Stranger anxiety typically begins around 6 mos
o
caregiver’s cuddling and warmth can help ease fears
B. Temperament
o
Temperament theory

attempts to account for individual differences among infants in
behavior, reactions, and manner of thinking
o
The better the fit between parental expectations and infant responses, the more
mutual reciprocity the parent-infant relationship has
C. Communication
D. Discipline
E. Nutrition and Feedings
F. Sleeping Patterns
G. Dental Health
H. Immunization
I.
Injury Prevention
NUTRITION IN INFANCY
NUTRITION ALLOWANCES
FACTORS THAT DETERMINE INDIVIDUAL NEEDS FOR NUTRIENTS:

Age

Gender

Body size

Rate of growth

Physical activity

Basal energy expenditure
ENERGY

Higher basal metabolic demand in infancy= larger loss of heat

Energy needs of children of the same size, age, and gender vary

The best evaluation of sufficiency of an infant’s energy is the adequacy of their growth
rates in length and weight.
o
If upward or downward changes in weight percentile occurs without changes in
length, under nutrition or over nutrition is suspected.
PROTEIN

Necessary for the formation of new cells

Needed 2.2 per kilogram of BW

Histidine, found in both milk forms
FATS



Supplies 40-50% of the energy during infancy
Linoleic acid, essential fatty acid necessary for growth and skin integrity in infants
Linoleic deficiency – result of prolong use of fat free milk for
CARBOHYDRATES

Supply 30-60% of energy

Lactose
o
the disaccharide found in human milk and added to commercial formulas,
appears to be the most easily digested of the carbohydrates
o
also improves calcium absorption and decreases the possibility of GI illness
WATER

Recommended intake of 1.5 ml/kcal/day

Higher percentage of body weight is water, as a result they can dehydrate very rapidly

Intoxication: restlessness, nausea and vomiting, diarrhea, hyponatremia
o
This may occur when

water is fed replacement for milk

formula is excessively diluted

bottled water instead of an electrolytes solution is given for diarrhea
VITAMINS

Lactating mothers supplies all the vitamins that the full term baby needs except for vitamin
D.

Human milk contains 40-50 IU/L

Commercially prepared formula milk are fortified with all necessary vitamins so there is no
need for supplements among infants using formulas.
CALCIUM

Important mineral in infant

Tetany seldom occurs in infant
IRON


Needed to maintain hgb and increase the iron mass
Iron in milk is bioavailable
NUTRITION ASSESSMENT
ANTHROPOMETRY

Wasting or thinness – low weight for height, reflects failure to gain weight or loss of weight
o
i.e stunting, short stature, or linear growth deficiency
WEIGHT

can be measured thru the use of table beam scale

Infants are weighed nude
LENGTH

measured in recumbent position

recorded as the distance between headboard and the front board when the infant has
been positioned properly
INFANT: BEFORE 6 MONTHS

Able to coordinate sucking, breathing and swallowing and are prepared to suck liquids but
not foods with texture.

At 4-6 months of age, the mature sucks is refined and munching movements or up and
down chopping motions starts to manifest
BREASTFEEDING BENEFITS FOR INFANTS

Optimal nutrition

Strong bonding with infant

Strong bonding with mother

Safe, fresh milk

Enhanced immune system

Reduced risk for
o
acute otitis media
o
AGE
o
Severe LRTI

Protection against allergies

Association with higher IQ

Reduced risk for
o
Sudden Infant Death Syndrome
o
morbidity
o
mortality

Reduced risk for chronic diseases, such as obesity, DM, HPN, & heart diseases










Best for babies
Reduce incidence of allergies
Economical
Antibodies present
Stool inoffensive (golden yellow)
Temperature always ideal
Fresh milk never goes off
Emotional bonding
Easy once established Digested easily
Immediately available Nutritionally optimal Gastroenteritis greatly reduce
BREASTFEEDING BENEFITS FOR MOTHERS

Strong bonding with infant

Increase energy expenditure that will lead to faster return to pregnancy weight

Faster shrinking of the uterus

Reduced postpartum hemorrhage

Decreased postpartum depression

Decreased risk for chronic disease as such as type II DM, breast and ovarian cancer

Money and time saved from formula preparation
THE FORMULA-FED INFANT

Should fed with formula based on
o
cow’s milk
o
Soy products

Soy based formulas are available for those that do not tolerate cow’s
milk-based formulas.

This is recommended for

Children of vegetarian families

Children with galactosemia or primary lactase deficiency

Infants who are potentially allergic to cow’s milk.
UNMODIFIED COW’S MILK

Not recommended for infants because its

Tough, hard curd is difficult for the infant to

Digest and lesser amount of fats is

Absorbed compared with human milk.

May also cause
o
small Gl blood loss
o
Iron deficiency anemia
o
chronic constipation
o
anal fissure

are some problem if unmodified cow’s milk is introduced to < 12
months of age
INFANT:




AFTER 6 MONTHS
Interest in food changes
Reduce their milk intake and become finicky on what and how much to eat
Learn to eat foods with different texture and flavors
Should not be allowed to continue on diet with one or two of their fav foods
INTRODUCING SOLID FOODS
HOME PREPARATION OF INFANT FOOD

Choose fresh fruits, vegetables, or meat

Be sure all utensils to be used are thoroughly clean

Wash your hands before preparing

Clean, wash and trim the food

Cook the food until tender. DO NOT OVER COOK.

DO NOT ADD SALT, HONEY OR CORN SYRUP.

Add enough water to easily puree the food

Strain or puree the food using food mill baby food grinder, kitchen strainer, or electric
blender

When ready to serve, place in serving container the amount of food that will be consumed
in one feeding
TECHNIQUES FOR FEEDING SOLID FOOD

Introduce one food at a time

Introduce the food before formula or bf when an infant is happy

Introduce small amount of a new food (1 or 2 tsp.) at a time

Respect infants preferences ja child cannot be expected to like all new taste equally well

Use only minimal to no salt and sugar on solid foods to minimize the number of additives

Remember that the extrusion reflex is present for the first 4-6 mos. So any foods placed
on an infants tongue will be pushed forward

Introduce foods with a positive “you’ll like this” attitude
SUGGESTED SCHEDULE FOR INTRODUCTION OF SOLID FOODS
AGE (MONTHS)
FOODS TO INTRODUCE
5–6
with iron fortified infant cereal mixed with bf
7
Vegetables
8
Fruits
9
Meat
10
Egg yolk
OBESITY

weight above the 95th percentile in relation to height and body build.

Occurs when there is an increase in the number of fat cells because of excessive calorie
intak

Mostly occurs in bottle fed infant

Extra fats likely to remain throughout childhood
Add a source of fiber, such as whole grain cereal and raw fruits to an infants diet.
BABY BOTTLE SYNDROME

Putting infant to bed with bottle of formula, breast milk, orange juice or glucose water can
results in aspiration

It also leads to decay of all upper and lower tooth.

Because the CHO in solutions such as formula or glucose water ferments to organic acids
that demineralize the tooth enamel until it decays

Therefore, infants should be fed, burped, and put to bed without milk, juice or food
COLIC




LOW BIRTH WEIGHT
Low Birth Weight : < 2500g
Very Low Birth Weight : 1500g
Extremely Low Birth Weight : 100 g

LBW and premature infant did not have a chance to fully develop in the utero so they have
a variety of medical problems in neonatal period.

At high risk nutritionally because of poor nutrient stores, physiological immaturity, illness
that may interfere with nutritional mgt. and the nutrient demands for growth

Will survive if cared and given optimal nutrition
OTHER NUTRITION PROBLEMS

Obesity

Baby bottle syndrome

Colic

Paroxysmal abdominal pain that generally occurs infants under 3 months.
Mark by
o
loud, intense crying
o
face may becomes red and flushed
o
fist clenched
o
abdomen becomes tense.
Formula fed infants are more likely to have
May occur in susceptible infants from
o
overfeeding
o
swallowing too much air while drinking.
Some parents try placing hot water bottle on their infant’s stomach. This should be
DISCOURAGED
IMPORTANCE OF COMMUNICATION WITH PATIENTS REGARDING DRUG ADMINISTRATION
WHY COMMUNICATE?

Major Purpose
o
To send, receive, interpret, respond appropriately and clearly to a message
(e.g. pre-operative)
o
An interchange of information

Supportive Purposes:
o
To correct the information a person has about himself and others
o
To provide the satisfaction or pleasure of expressing oneself
DEFINITION OF COMMUNICATION

Imparting or interchange of thoughts, opinions or information by speech, writing or signs

Effective communication is the medium through which each of us makes our work
successful

Good communication is thus basic to providing quality patient care
IMPORTANCE OF COMMUNICATION IN NURSING

Generate trust between the nurse and client

Provides job satisfaction

Brings about change that promotes client’s wellbeing

Foundation of relationship between nurse and other team members

Basis for leadership

Provides means of co-ordination
METHOD OF COMMUNICATION

Verbal Communication
o
Face to Face

Nonverbal Communication
o
Rapport: harmonious feeling experienced
o
Empathy
o
Body language
o
Silence
o
Listening

Essential Relationship Verbal communication
o
is always accompanied by nonverbal expression.
o
Even no expression tells the other person something.
Techniques for Communicating with patients

Establishing the setting

Verbal Communication skills

Interviewing techniques
Barriers of effective communication

HCP
o
Language
o
Frequent interruptions
o
Use of medical terms
o
Preoccupation with personal matters Prejudice based on diagnosis e.g. Attitude
changes when diagnosed with AIDS, TB etc


Patient
o
Low literacy level
o
Superstitious, religious and cultural beliefs
o
Pre-conceived notions
Environment
o
Physical
o
Long waiting periods
o
Lengthy admission and discharge procedure
o
Poor signages
o
Lack of clear delegation of duties
DEFINITION

Medication errors
o
“any preventable event that may cause or lead to an inappropriate medication
use or patient harm while in the control of the health care professional, patient
or consumer”.
o
may result in…

An adverse event if a patient is harmed

A near miss if a patient is nearly harmed or

Neither harm nor potential for harm

Medication errors are preventable

Side-effect
o
known effect, other than that primarily intended, relating to the pharmacological
properties of a medication
o
E.g. oplate analgesia often causes nausea

adverse reaction
o
unexpected harm arising from a justified action where the correct process was
followed for the context in which the event occurred
o
E.g. an unexpected allergic reaction in a patient taking a medication for the first
time

Error
o
failure to carry out a planned action as intended or application of an incorrect
plan

adverse event – an incident that results in harm to a patient

adverse drug event:
o
May be preventable (usually the result of an error) or
o
Not preventable (usually the result of an adverse drug reaction or side-effect)
COMMON MEDICATION ERRORS

Calculation errors

Administration of wrong drug
o
E.g. cyclopam and cyclophosphamide

Health illiteracy

Improper documentation

Heavy workload

Unfamiliarity with medication

Lack of adequate staffing

New staff

Physical environment (lighting bedside)

Organization communication channels

Pharmaceutical related issues
PERSONNEL ISSUES

Personal neglect

Understanding of how errors occurs

Failure to adhere to policy procedure and documents

Number of hours on shift Distraction
FACTORS THAT CONTRIBUTE TO THIS MEDICATION ERROR

two drugs of the same class prescribed unknowingly with potentiation of side-effects

patient not well informed about his medications

patient did not bring medication list with him when consulting the doctor

doctor did not do a thorough enough medication history

two doctors prescribing for one patient

patient may not have been warned of potential side- effects and of what to do if sideeffects occur






Lack of knowledge about medication
Dosage calculation
Work load
Care delivery method
Insufficient training
Insufficient hospital training
ERROR CAUSED BY MEDICATION ORDER

Poor hand writing

Incomplete orders

Misplacement of decimal point

Complicated doctor- initiated order
STRATEGIES TO PREVENT MEDICATION ERRORS INCLUDE:

Check Three Times

The 8 Rights Of Medication Administration

Transcribing Medication Order

Check three times for safe medication administration
o
FIRST CHECK

Read the medication administration record (case paper) & remove the
medications from the client drawer verify that the clients name and
room number match the record (case paper)

Compare the label of the medication against the medication
administration record

If the dose does not match with the record, determine if you need to
do a math calculation

Check the expiration date of the medication

SECOND CHECK
o
While preparing the medication look at the medication label and check against
the record

THIRD CHECK
o
Recheck the label on the container before returning to its storage place or
before opening the package at the bed side
THE 8 RIGHTS OF MEDICATION ADMINISTRATION

Right Patient

Right Drug

Right Time

Right Dose

Right Documentation

Right Route

Right Reason

Right To Refuse.







Minimize distractions when preparing and administering medications.
Avoid established do not use abbreviations.
Develop specific protocols for high-risk drugs, including independent verification and
double check procedures.
Standardize drug packaging and labeling.
Encourage healthcare providers to document indication for drug use on prescriptions.
Avoid dependence on memory by standardizing processes and equipment.
Provide patient-centered car an encourage active participation.
TRANSCRIBING MEDICATION ORDER

Date of the order

Full name of the drug

Dose form and amount

Administration route

Time schedule

Date to start the drug

Date to stop the drug
EXAMPLE.CASE

a 74-year-old man sees a community doctor for treatment of new onset stable angina
o
the doctor has not met this patient before and takes a full past history and
medication history
o
he discovers the patient has been healthy and only takes medication for
headaches
o
the patient cannot recall the name of the headache medication
o
the doctor assumes it is an analgesic that the patient takes whenever he
develops a headache
o
but the medication is actually a beta-blocker that he takes every day for
migraine; this medication was prescribed by a different doctor
o
the doctor commences the patient on aspirin and another beta-blocker for the
angina
o
after commencing the new medication, the patient develops bradycardia and
postural hypotension
o
unfortunately the patient has a fall three days later due to dizziness on standing;
he fractures his hip in the fall

How could this situation have been prevented?
o
patient education regarding:

Regular medication

Potential side-effects

The importance of being actively involved in their own care- e.g.
having a medication list

more thorough medication history

a 38-year-old woman comes to the hospital with 20 minutes of itchy red rash and facial
swelling; she has a history of serious allergic reactions
o
a nurse draws up 10 mls of 1:10,000 adrenaline (epinephrine) into a 10 ml
syringe and leaves it at the bedside ready to use (1 mg in total) just in case the
doctor requests it
o
meanwhile the doctor inserts an intravenous cannula
o
the doctor sees the 10 ml syringe of clear fluid that the nurse has drawn up and
assumes it is normal saline
STEPS IN USING MEDICATION

Prescribing

Administering

Monitoring

Note: these steps may be carried out by health-care workers or the patient; e.g. selfprescribing over-the counter medication and self-administering medication at home
PRESCRIBING INVOLVES

choosing an appropriate medication for a given clinical situation taking individual patient
factors into account such as allergies

selecting the administration route, dose, time and regimen

communicating details of the plan with:
o
Whoever will administer the medication (written-transcribing and/or verbal)
o
And the patient

documentation
HOW CAN PRESCRIBING GO WRONG?

inadequate knowledge about drug indications and contraindications

not considering individual patient factors such as allergies, pregnancy, co-morbidities,
other medications

Wrong patient, wrong dose, wrong time, wrong drug, wrong route

Inadequate communication (written, verbal)

Documentation – illegible, incomplete, ambiguous

Mathematical error when calculating dosage

Incorrect data entry when using computerized prescribing e.g.

Duplication, omission, wrong number
Look-a-like and sound-a-like medications

Celebrex (an anti-inflammatory)

Cerebryx (an anticonvulsant)

Celexa (an antidepressant)
AMBIGOUS NOMENCLATURE

Tegretol 100mg 
Tegreto 1100 mg

S/C

S/L

mg

10 mg

.1 mg

1 mg
Avoiding ambiguous nomenclature

avoid trailing zeros – write 1 not 1.0

use leading zeros – write 0.1 not.1

know accepted local terminology

write neatly, print if necessary
Administration involves…

obtaining the medication in a ready-to-use form; may involve counting, calculating, mixing,
labeling or preparing in some way

checking for allergies

giving the right medication to the right patient, in the right dose, via the right route at the
right time

documentation
How can drug administration go wrong?

wrong patient

wrong route

wrong time

wrong dose

wrong drug

omission, failure to administer

inadequate documentation
Monitoring involves…

Observing the patient to determine if the medication is working, being used appropriately
and not harming the patient

Documentation
How can monitoring go wrong?

lack of monitoring for side-effects

drug not ceased if not working or course complete

drug ceased before course completed

drug levels not measured, or not followed up on

communication failures
Do you know which drugs need blood tests to monitor levels?
Which patients are most at risk of medication error?

patients on multiple medications

patients with another condition, e.g. renal impairment, pregnancy

patients who cannot communicate well

patients who have more than one doctor

patients who do not take an active role in their own medication use

children and babies (dose calculations required)
In what situations are staff most likely to contribute to a medication error?

inexperience

rushing

doing two things at once

interruptions

fatigue, boredom, being on “automatic pilot” leading to failure to check and double-check

lack of checking and double checking habits

poor teamwork and/or communication between colleagues

reluctance to use memory aids
How can workplace design contribute to medication errors?

absence of a safety culture in the workplace
o
Eg. Poor reporting systems and failure to learn from past near misses and
adverse events

absence of memory aids for staff

inadequate staff numbers

How can medication presentation contribute to medication errors?

Look-alike, sound-a-like medications

ambiguous labeling
Performance requirements
What you can do to make medication use safer:

Use generic names rather than trade names

Tailor your prescribing for each individual patient
o
Consider:

Allergies

Co-morbidities (especially liver and renal impairment)

Other medication

Pregnancy and breastfeeding

Size of patient

Learn and practise thorough medication history taking
o
Include name, dose, route, frequency, duration of every drug
o
Enquire about recently ceased medications
o
Ask about over-the-counter medications, dietary supplements and alternative
medicines
o
Make sure what patient actually takes matches your list:

be particularly careful across transitions of care

Practise medication reconciliation at admission to and discharge from
hospital
o
Look up any medications you are unfamiliar with
o
Consider drug interactions, medications that can be ceased and medications
that may be causing side-effects always include allergy history

Know which medications are high risk and take precautions
o
Narrow therapeutic window
o
Multiple interactions with other medications
o
Potent medications
o
Complex dosage and monitoring schedules
o
Examples:

Oral anticoagulants

Insulin

Chemotherapeutic agents

Neuromusculat blocking agents

Atminoglycoside antibiotics

Intravenous potasium

Emergency medications (potent and used in high pressure situations)

Know the medication you prescribe well
o
do some homework on every medication you prescribe
o
suggested framework

Pharmacology

Indications

Contraindications

Side-effects







Special precautions

Dose and administration

Regimen
Use memory aids
o
textbooks
o
personal digital assistant
o
computer programmes, computerized prescribing
o
protocols
o
free up your brain for problem solving rather than remembering facts and figures
that can be stored elsewhere
o
looking things up if unsure is a marker of safe practice, not incompetence!
Remember the 5 Rs when prescribing and administering
o
Can you remember what they are?

right drug

right dose

right route

right time

right patient
Communicate clearly
o
The 5 Rs
o
state the obvious
o
close the loop
Develop checking habits
o
when prescribing a medication
o
when administering medication:

Check for allergies

Check the 5 Rs
o
remember computerized systems still require checking
o
always check and it will become a habit!
Develop checking habits
o
some useful maxims…
o
unlabelled medications belong in the bin
o
never administer a medication unless you are 100% sure you know what it is
o
practise makes permanent, perfect practice makes perfect

So start your checking habits now
Encourage patients to be actively involved in the process
o
when prescribing a new medication provide patients with the following
information:

Name, purpose and action of the medication.

Dose, route and administration schedule

Special instructions, directions and precautions

Common side-effects and interactions

How the medication will be monitored
o
encourage patients to keep a written record of their medications and allergies
o
Encourage patients to present this information whenever they consult a doctor
Report and learn from medication errors
SAFE PRACTIVE SKILLS

whenever learning and practising skills that involve medication use, consider the potential
hazards to the patient and what you can do to enhance patient safety

knowledge of medication safety will impact the way you:
o
Prescribe, document and administer medication
o
Use memory aids and perform drug calculations
o
Perform medication and allergy histories
o
Communicate with colleagues
o
Involve and educate patients about their medication.
o
Learn from medication errors and near misses
SUMMARY

medications can greatly improve health when used wisely and correctly

yet, medication error is common and is causing preventable human suffering and financial
cost

remember that using medications to help patients is not a risk-free activity

know your responsibilities and work hard to make medication use safe for your patients
RIGHTS/ RULES IN MEDICATION ADMINISTRATION

Right patient

Right drug

Right route

Right time

Right dose

Right documentation

Right reason

Right assessment data

Right education

Right response





Nurses must administer numerous drugs daily in a safe and efficient manner.
The nurse should administer drugs in accord with nursing standards of practice and
agency policy.
The safe storage and maintenance of an adequate supply of drugs are other
responsibilities of the nurse.
The nurse documents the actual administration of medications on the medication
administration record.
The MAR is a medical record form that contains the drug’s name, dose, route, and
frequency of administration
RIGHT PATIENT

The medication must be administered to the patient for whom it is prescribed.

Administering a medication to the wrong patient is a common error.

Verify the identity of the patient using at least two identifiers.
o
Check the medication card/record against the patient’s name, bed and other
patient’s identification.
o
Ask the patient to tell you his/her name.

For unconscious patients or children, use an identification tag and ask patient relatives.
RIGHT DRUG

When administering a medication, the nurse should check the label written on the
container against the MAR at least three times before giving the drug

The nurse should:
1. Check the label when removing the drug container from the client’s
medication drawer.
2. Check the drug when removing the amount of medication ordered from the
container. (expiry date, color, consistency, name)
3. Check the drug at the bed side before administering the medication to the
patient.

The nurse should give only medications that the nurse has prepared and checked.

The nurse who administers the medication is the responsible party should an error occur.

If a client questions a medication to be administered, the nurse should never ignore the
question.

Clients are active participants in their care and usually know when a medication is
different from that usually taken.
RIGHT ROUTE

Numerous errors have been reported involving the correct medication being administered
to the correct patient but by the incorrect route.
o
For example enteral and parenteral medication are confusion in pediatric
population because liquid medication are frequently given in orally.
o
Syringe for enteral and parenteral should be leveled clearly.

The nurse’s responsibilities in maintaining the right route are:
o
Read the physician’s order carefully to ensure the route of administration
o
Know abbreviation for methods e.g. I/V, I/M, P/O
o
If any error occurs, it should be immediately reported to the ward sister and the
physician
RIGHT TIME

Medications must be administered at the correct time to ensure therapeutic serum levels.
Administering the medication at the wrong time is therefore one type of error.

Nurse should give a medication ordered pc (after meals) within 30 minutes after a meal
when the patient has a full stomach. You give a STAT medication immediately.

Some medications must be given at a certain time for proper therapeutic effect; e.g.
Insulin is normally given hour before meal.
o
Lasix is given in morning and afternoon only.
o
A drug should not be given more than a half-hour before or after the scheduled
time (according to organizational policy).

Administering medications at the right time also involves preparing the medication at the
appropriate time.
o
Medications should not be prepared many hours (or even one hour) before they
are administered, unless the manufacturer recommends this.

Intravenous infusion of Phenytoin, for example, must begin within one
hour after preparation.
RIGHT DOSE

Nurses must be cautious when reading the patient's medication chart. A decimal point in
the wrong place could result in either one tenth or ten times the correct dose being
administered
o
In one case, a nurse administered 5mls of morphine 20mg/ml, instead of 5mg.
The patient was given 100mg of morphine and consequently died.

The nurse must know how to reduce the risk of error by correctly calculating doses and
having them double checked before administration.



After calculating dosages, prepare the medication using standard measurement devices.
Use graduated cups, syringes, and scaled droppers to measure medications accurately
we cannot crush all medications.
o
Some medications, such as time-released or extended-release capsules, have
special coatings to keep the medication from being absorbed too quickly.





RIGHT DOCUMENTATION

When a nurse administers a medication, he or she must sign the medication chart. This
provides evidence that the medication has been administered to the patient.

Signing the medication chart before the medication has been administered is a risk, as the
patient may refuse their medication or, in some cases, forget to take them.
o
Similarly, failing to sign when a medication has been administered creates the
risk that another nurse may assume that it has not been administered, and
repeat that dose.

Documentation should include the medication's generic name, dose, time, route, reason
for administration and the effect achieved.

Document the patient's responses to medications, either positive or negative, in the
nursing notes.
o
Notify the patient's health care provider of any negative responses to
medications, and document the time, date, and name of the health care provider
you notified in the patient's chart.
RIGHT REASON

When a nurse is administering a medication, he or she must ensure it is prescribed for the
appropriate reason.
o
For example, it is not appropriate to administer an antibiotic for a viral infection,
nor an antiviral for a bacterial infection.
o
Similarly, administering a sedative to a patient

Who already appears sedated may be harmful. When a nurse is administering a
medication, he or she should state to the patient the action of the medication and the
reason for which it is prescribed.
RIGHT ASSESSMENT DATA

collect appropriate assessment data related to mechanism of action and therapeutic data
is necessary.
RIGHT EDUCATION

assessment of the patient prior knowledge is important before giving education.

Provide right education regarding purpose, dosing, administration information, costing
information to patient and visitors.
RIGHT RESPONSE

Once a medication is administered, the nurse should monitor the patient to it medication
has the desired effect or response.

This right of medication administration involves an evaluation of the effectiveness of the
medication’s intended purpose which is crucial for some high-risk medications such as
anti- arrhythmic and insulin.

Monitoring for the right response for example could involve assessment of the patient’s
blood glucose level, vital signs or other physiologic parameters such as urine output.











WAYS OF PREVENTING MEDICATION ERROR
Identification of the cause of medication error.
Check the label of each medication 3 times before giving the medicine
Read medication labels carefully
o
because most products come in similar container, colors and shape
Question administration of multiple tablets or vial for single dose
o
because most doses are 1 or 2 tablets or capsules or single dose vial, incorrect
interpretation of order may result in excessively high dose
Be aware of medications with similar name.
Ways of preventing medication errors
Check decimal point
o
because some medications come in quantities that are multiples of one another;
for e.g., caumadin in 2.5 mg and 25 mg tablets
Question sudden and excessive increase in doses
When new or unfamiliar medication is ordered consult resource
Do not administer medication ordered by nick name or unofficial abbreviation.
Do not attempt to decipher illegible handwriting
o
because there is chance of misinterpretation
Identifying the patient
o
complete patient name, date of birth, medical record number) (at least two
identifier
Do not confuse equivalents
o
because when in hurry the nurse may misread equivalents; e.g., milligram
instead of milliliter
The nurse who prepares the medication also administer the drug and records the drug
administration.
Ensure that the right medications given to the right patient in the right dose through
the right route at the right time for the right reason based on the right (appropriate)
assessment data using the right documentation and monitoring for the right
responses by the patient with right education, ensuring that patient receive accurate
and through information about the mediation and considering the right to refuse,
acknowledging that patients can and do refuse to take medication
ROLE AND RESPONSIBLITIES OF NURSES DURING MEDICATION ADMINISTRATION

The administration of medications to patients requires knowledge and a set of skills that
are unique to nursing.
o
Responsibilities of medication administration include assessing the client’s
ability to self administer medications, determining whether a client should
receive a medication at a given time, administering medications correctly, and
monitoring the effects of the prescribed medication.
o
Safe and accurate medication administration is an important and potentially
challenging nursing responsibility.
o
Medication administration requires good decision-making skills and clinical
judgment, and the nurse is responsible for ensuring full understanding of
medication administration and its implications for patient safety.

Be vigilant when preparing medications.

Check for allergies

Use two patient identifiers at all times. Always follow agency policy for patient
identification.

Assessment comes before medication administration.

Be diligent in all medication calculations.
















Avoid reliance on memory; use checklists and memory aids.
Communicate with your patient before and after administration.
Avoid workarounds.
Ensure medication has not expired.
Always clarify an order or procedure that is unclear.
Report all near misses, errors, and adverse reactions.
Be alert to error-prone situations and high-alert medications.
If a patient questions or expresses concern about a medication, stop and do not
administer it.
Plan medication administration to avoid disruption:
o
Dispense medication in a quiet area.
o
Avoid conversation with others.
o
Follow agency’s no-interruption zone policy.
Prepare medications for ONE patient at a time.
Follow the Nine RIGHTS of medication preparation.
Perform hand hygiene.
Check room for additional precautions.
Introduce yourself to patient.
Complete necessary focused assessments, lab values, and/or vital signs, and document
on MAR.
Patient and family education about proper medication administration.
TODDLER DEVELOPMENT
TOODLERHOOD – I to 3 years of age.

Dramatic advances occur in
o
Language
o
interpersonal skills
o
affective
o
motor
o
cognitive
o
physical growth.
FINE MOTOR SKILLS

Fine motor development during toddlerhood consists of refinements in:
o
Reaching
o
Grasping
o
Manipulating

18-month-old
o
can make a tower of four blocks.
o
Will hold the crayon in a fist and scribble spontaneously.

One year later – he can stack eight blocks.
AFFECTIVE DEVELOPMENT is highlighted by the toddler’s:

Striving for autonomy and independence

Attachment to family

Development of impulse control.

APPEARANCE
o
are usually chubby, face appears small in comparison to the skull
o
Loose the baby look by 2 years old.
o
Posture – have pronounced lumbar lordosis & a protruding abdomen.
FINE MOTOR ABILITIES

18 Months / 1 yr and 6 months
o
Making a tower of four cubes
o
Releasing 10 cubes into a cup
o
Scribbling spontaneously
o
Imitating a vertically drawn line

24 Months / 2 yrs.
o
Building a seven cube tower
o
Aligning two or more cubes to form a train
o
Imitating a horizontally drawn line
o
Beginning circular strokes
o
Inserting a square block into a square hole

36 Months / 3 yrs.
o
Copying a circle
o
Copying bridges with cubes
o
Building a tower of 9 to 10 blocks
o
Drawing a person’s head
PHYSICAL DEVELOPMENT
GROWTH RATE AND PHYSICAL APPEARANCE

After the rapid growth of infancy, the rate of growth slows in the toddler years.

After age 2, toddlers gain about
o
5 lb in weight
o
2.5 inches in height each year.

Head circumference: increase 1 inch – 2 to 12 years.

Growth of the lower extremities
o
often is accompanied by tibia torsion and physiologic bowing of the legs, (bow
legs) which usually corrects by age 3 years.

Senses –visual acuity is comparable to that of an adult by a years old.

Percentage of body fat – decreases from 22% at age 1.
GROSS MOTOR SKILLS

Complex gross motor patterns rapidly develop, and balance and coordination improve.

Most children walk without assistance by 18 months.
GROSS MOTOR ABILITIES

18 Months / 1 yr and 6 months
o
Walking fast, seldom falling
o
Running stiffly
o
Walking up stairs with one hand held
o
Seating self in a small chair
o
Climbing into an adult chair

24 Months / 2 yrs.
o
Running well without falling
o
Walking up and down stairs alone
o
Kicking a large ball

36 Months / 3 yrs.
o
Walking up stairs by alternating feet
o
Walking well on toes
o
Pedaling a tricycle
o
Jumping from a step
o
Hopping two or three times
SOCIAL DEVELOPMENT

Autonomy
o
Parents feel out of control of child & loss of baby

They are learning who they are

Exerting independence finding what they can do

Self control
o
two year olds don’t have it
o
Remove breakables because of aggressiveness
o
inner feelings can’t be expressed in words
o
Jealous of baby – give substitute object to hit

Blaming Other
o
1st step toward a conscience because they realize it was wrong.
o
Parents must show disapproval – child has no inner incentives to do right they
will do what parents like.

Power Struggles
o
conflict between parent and child
o
Avoid them, child will outgrow them by 3.

Give them choices – stay away from yes or no questions

Divert attention to something else

Remove yourself from conflict or put them in timeout

it is okay to give in sometimes

Autonomy and Independence
o
Because of improved motor skills, the transition from infancy to toddlerhood is
marked increased autonomy and independence.
o
The child can move easily away from the parent and begins to test boundaries
and limits.
o
The toddler may

refuse to eat unless allowed to feed himself

may no longer may be willing to try new foods.
SOCIAL DEVELOPMENT

Copies others

Plays close to and sometimes with other children.

Shows interest in pretend play (example… playing with a doll)

Points to show others things

Notices emotions of other people

Usually does not like to share

Excited to see familiar people

Begins to make friends or favor people
ABNORMAL DEVELOPMENT

Doesn’t point to show someone something

Doesn’t make eye contact with others

Doesn’t play pretend

Doesn’t copy others actions

Doesn’t show interest in playing with others
ACTIVITIES AND STRATEGIES TO SUPORT SOCIAL DEVELOPMENT

Dramatic Play Area
o
Children learn about themselves and what they like by trying new activities.
o
For example, children can try on new roles and perspective of other people in
their lives or in their community.

Turn taking activities
o
Pushing cars back & forth
o
Putting shapes into a shape sorter
o
Blowing bubbles.

Eating/Pretend to eat

Classroom Chores
o
Teaches team work
o
Encourage and model conversation to help them accomplish their task
TEACHERS AND ADULTS ROLES IN SUPPORTING SOCIAL DEVELOPMENT

Teachers help children explore how we are alike and different and honor all families.

Encourage child to play pretend and be creative.

Give child props and dress-up clothes.

Help your child resolve conflicts or problems in a healthy way

Provide guidance and initiate sharing and turn taking.

Be understanding that toddlers are less willing to be complaint when they are tired or not
feeling well.

Model positive social and sharing behaviors in your everyday interactions with children
and parents
EMOTIONAL DEVELOPMENT

Normal Emotional Development

Has temper tantrums or shows defiant behavior.

Shows fear or is nervous around strangers

Shows affection towards others

Shows concern for others

Understands the idea of “mine” and “no”

Begins to show signs of guilt or remorse
SOCIAL AND EMOTIONAL DEVELOPMENT

18 Months / 1 yr and 6 months
o
Removing a garment
o
Feeding self and spilling food
o
Hugging a doll
o
Pulling a toy
o
Using a spoon; spilling little food

24 Months / 2 yrs.
o
Verbalizing toileting needs
o
Pulling on a simple garment
o
Verbalizing immediate experiences
o
Referring to self by name

36 Months / 3 yrs.
o
Showing concern about the actions of others
o
Playing cooperatively in small groups
o
Developing the beginnings of true friendships
o
Playing with imaginary friends
ABNORMAL DEVELOPMENT

Shows little to no emotion (example… happy. Sad, excited or anger)

Does not realize when unknown people are present

Fails to make eye contact or frequently look at the primary caregiver

Does not show any signs of affection toward others (example… another child crying)

Lacks emotion when a toys is taken by another child
ACTIVITIES AND STRATEGIES TO SUPPORT EMOTIONAL DEVELOPMENT

Looking at pictures of emotions

Read/look books about feelings and emotions

Have pictures of different emotions and what they are around the classroom where the
children can see.

Have a quite place in your room where a child can go to if they are feeling angry, sad, or
upset and just need a moment to calm down.
TEACHERS AND ADULTS ROLES IN SUPPORTING EMOTIONAL DEVELOPMENT

Teacher and Adult Roles in Supporting Emotional Development

Help your child understand and name feelings.

Just being there and listening to them.

Show interest, empathy and understanding of how they are feeling.

Respond to child’s emotional and physical needs.

Express feelings and emotions in a safe and appropriate ways.

Allow them to show their anger in a way that is okay and what is not okay.
COGNITIVE DEVELOPMENT
Sensorimotor : 0 – 2 yrs
Pre- conceptual : 2 – 4 yrs

Characterized by egocentricity

Very little concept of time & space

No social awareness can’t sympathize, does not

Know how to share, is selfish & possessive Has animism

Has magical thinking

Can understand preposition (under, over, below, top)

Knows relationship between cause & effect if the Interval between the 2 is short.

Death as a concept – thought of someone as leaving.

Concept of weight –perceive small object as light object

Concept of self –developed physical concept by looking at the mirror

Concept of beauty – responds to colors, light music & objects
NORMAL COGNITIVE DEVELOPMENT

Uses common items appropriately – spoon, phone, toy hammer

Line up and stack blocks

Shows eye-hand coordination

Grasps items with pointer finger and thumb

Asks for help when needed

Begins counting and Identifying shapes

Begins solving problems – blows on hot food
INTELLECTUAL ABILITIES

18 Months
o
Pointing to named body parts
o
Understanding of object permanence
o
Beginning to understand cause and effects

24 Months
o
Forming mental images of objects
o
Solving problems by trial and error
o
Understanding simple time concepts

36 Months
o
Asking “why” questions
o
Understanding daily routine
o
Appreciating special events, such as birthdays
o
Remembering and reciting nursery rhymes
o
Repeating three digits
ABNORMAL COGNITIVE DEVELOPMENT

Doesn’t know how to use or is unable to name common items

Does not frequently gain new words

Lacks eye-hand coordination

Loses skills he or she once had

Is unable to follow simple instructions

Does not gain knowledge of body parts, shapes or numbers
ACTIVITIES AND STRATEGIES TO SUPPORT COGNITIVE DEVELOPMENT

Reading books
o
Encourage vocabulary building and verbal development.

Playing with blocks
o
Learn balancing concepts

Puzzles & shape sorters
o
Allows them to

problem-solve

increases memorization

understand the relationship between objects as they match shapes
and figure out how things fit.

Sensory table
o
Sense of touch to learn

Identify noise

Give them choices to choose from

Sing/practice the ABC’s

Counting everything/anything

Point out shapes & colors
TEACHERS AND ADULTS ROLES IN SUPPORTING COGNITIVE DEVELOPMENT

Allow them to try & figure out problems and suggest possible solutions to them.

Provide different shapes, colors or sizes, of blocks.

Help them sort from smallest to largest, or longest to shortest, or by color

Describe what your child is doing during this process.

Explore outdoors with your child, and look for patterns, size, number and shapes in nature
and in the community.

Use numerical concepts in everyday routines.
LANGUAGE DEVELOPMENT
NORMAL DEVELOPMENT

Incorporate plurals on simple words

Recognizes things or pictures when they are named

Repeats words

Can say first name and age

Follows instructions

Shows interest in reading and writing

Creates sounds while playing with toys – animal noises
LANGUAGE SKILLS

18 Months
o
Looking selectively at a book
o
Using 10 to 20 words.
o
Naming and pointing to one picture card
o
Naming an object (ball)
o
Following two-directional commands

24 Months
o
Using two to three word sentences
o
Using “I” “me.” “you”
o
Naming three picture cards
o
Naming two objects
o
Knowing four-directional commands

36 Months
o
Using four to five word sentences
o
Telling stories
o
Using plurals
o
Recognizing and naming most common objects
ABNORMAL DEVELOPMENT

Doesn’t copy others words

Does not speak in sentences

Produces an unusual amount of drool

Speech is unclear

Doesn’t understand simple instructions

Does not communicate feelings
ACTIVITIES AND STRATEGIES TO SUPPORT LANGUAGE DEVELOPMENT

Listening to music, doing things with music, singing songs, playing with instruments

Learning about rhymes

Going to the grocery store/library/field trip…

Talking about food/outside/what you are doing

Learning how to use a book

Discovery print

Learning my name
TEACHERS AND ADULTS ROLES IN SUPPORTING LANGUAGE DEVELOPMENT

Encourage your child to use sounds and actions to communicate with you.

Talk together

Pay attention when your child talks

Make stories & books part of your everyday routine

Adapt schedules and activities to meet needs of a certain child

Labels & objects with print and pictures

Speak in complete sentences

Respond with the correct pronunciation when your child mispronounces something.

Use props, such as puppets or dolls, with the stories.

Give your child the chance to communicate with other children.
PSYCHOSEXUAL DEVELOPMENT (Freud)
Anal Stage – 1 to 3 yrs.old

Erogenous zone in focus – anus

Gratifying Activities
o
Bowel movements
o
Withholding such bowel movements

Interaction with the environment – toilet training
SYMPTOMS OF ANAL FIXATION

Anal – Expulsive Personality
o
Sloppy, disorganized, reckless, careless, defiantdefian

Anal – Retentive Personality
o
Clean, orderly, Meticulous, intolerant to cleanliness
TOILET TRAINING : PREREQUISITES

PHYSICAL READINESS
o
Should begin & be completed according to the child’s ability & not according to
a set schedule.
o
Must have control of urethral & rectal sphincter.
o
Wait until the child is able to walk independently

COGNITIVE UNDERSTANDING
o
Be able to understand

what it means to hold urine & stool until they can release them at
certain place & time
o
at about 2-3 years old
TOILET TRAINING SCHEDULE

Start of toilet training – 18 to 24 months

Bowel Training – 2 to 25 years

Daytime Bladder Training – 2 to 3 years

Night Time Bladder Training – 3 to 4 years
TECHNIQUES OF TOILET TRAINING

Allow the child to see that older children uses the toilet.

It is best not to suggest that urine & feces are dirty, simply make it clear that bigger people
customarily have these materials in the toilet.

Parents should be cautioned not to introduce morality into toilet training or to equate good
with being dry or bad with being wet.

Be sure not to flush the toilet while the child is sitting on it, because of their poor space
concepts they are unable to realize that they will not be flushed away.

Put the child in the potty chair at regular intervals: when the child wakes up in the
o
Morning
o
after breakfast
o
mid-morning
o
before & after lunch
o
after nap
o
before & after dinner
o
before bedtime.

Give praises if the child satisfactorily urinate or defecate

The child should not remain in the potty chair for more than 10 minutes.

He should not be taught not to sit on the chair while eating or playing for he will be
confused for its purpose.

Parents should not put on pressure on the child to try to accomplish night time dryness.

It is generally ineffective to wake the child during the night & carry them to the bathroom to
void.

It prolongs night time wetness because it conditions the child to void every 4 hours instead
of retaining the urine for 12 hours while they sleep.
PSYCHOSOCIAL DEVELOPMENT : ERIKSON
STAGE 2: TODDLER

CRISIS – Autonomy vs. Shame & doubt

DESCRIPTION – toddlers learn to walk, talk, use toilets themselves.

POSITIVE OUTCOME
o
if parents encourage, child develops confidence to cope with future situations.

NEGATIVE OUTCOME
o
if parents disapprove or are overprotective – child feels ashamed & doubts his
abilities.

MORAL & RELIGIOUS DEVELOPMENT

By the 2nd year of life children begin to know that some activities elicit affection & approval.

They also recognize that certain rituals such repeating some phrases from prayers also
elicit approval

This provides children with feelings of security
DISCIPLINE & PUNISHMENT

DISCIPLINE
o
means setting rules or road signs so that the child knows what is expected to
do.

PUNISHMENT
o
usually results from a breakdown in discipline, from disregarding the rules.
FORMS OF DISCIPLINE

Ignoring

Withdrawal from social privileges

Can be corporal, but safe

Needs explanation & reasoning

Diversion
PRINCIPLES OF DISCIPLINE

CONSISTENCY – brings security

FIRM – but should be coupled with loving attitude

TIMING – discipline right away

REASON – give reasons for disciplining

PHYSICAL CARE
o
should be provided afterwards – this will prevent doubt about parental love
BEHAVIORAL TRAITS OF TODDLER

NEGATIVIS “NO”
o
does not mean that the child does not want
o
But it is used to show autonomy & independence.
o
Means children see themselves as separate individuals with separate needs.
o
It is important that they do this if they are to grow up to be persons who are
independent & able to take care of their own needs & desires.
o
The more the parents attempt to make the child obey them, the more the child is
likely to resist
o
MANAGEMENT:

Limit the number of questions asked of the child.

Offer choices-make sure they are good

Parents should be helped to realize that negativism is not only a
normal phenomenon but a positive stage of development




TEMPER TANTRUMS
o
are natural consequences of toddler’s development.
o
are independent enough to know what they want, but they don’t have enough
vocabulary or wisdom to express their feelings in a more socially acceptable
way.
o
it occurs when the child can’t integrate his internal impulse with the demands of
reality.

He is frustrated & reacts in the only way he knows; unrealistic request
by a parent, if parents are saying “no” too frequently; as a response to
difficulty making decisions
o
MANAGEMENT:

Best approach is for parents to tell the child that they disapprove the
tantrums.

Ignore the tantrum.

Allow the child to cry until tired, but provide physical care afterwards

Ignore the behavior, but not the child’s safety.

Do not punish the child it will trigger more tantrums.
DAWDLING – too slowly in doing things.
o
Reasons

The task the child has been asked to do is difficult for him.

He is avoiding decision making

His attention span is too short for him to remain interested in the task.
o
MANAGEMENT:

See to it that any task the child is asked to perform is one that he has
the motor development coordination, & cognitive development to
accomplish
RITUALISTIC BEHAVIOR – repetitive ways of doing things
o
REASONS

They enjoy ritualistic patterns

The child who seems to need an

excessive number of objects to cling to

excessive number of routines may be trying to speak out
that the child needs more guidelines, more rules.
o
MANAGEMENT

Adhere to the child’s routine as long as they are safe.

Allow rituals for they provide mastery of skills.
EGOCENTRICITY
CURIOSITY – may lead to danger because children use senses to test reality.
o
falls
o
poisoning
o
burns
o
drowning
o
vehicular accidents
o
suffocation
SPECIAL NEEDS & GENERAL CARE

Nutritional needs

Sleep

Play

Bathing

Care of teeth

Clothing

Shoes

Fresh air, sunshine, exercise

Health protection/ Safety measures
CULTURE AND ETHNICS FACTORS

Language

Diet

Parents Approach

Education

Values

Beliefs

Spirit

Personality

Religion

Clothing

Traditions
SOCIOECONOMIC AND ENVIRONMENTAL FACTORS

Family Stability

Nutrition

Mental and Health

Physical

Quality of Schools

Living Conditions

Parenting Style

Parental Involvement

Opportunity to Succeed

Child’s Readiness for School
THE PRESCHOOLER
PRESCHOOLER – 3-6 years old

PSYCHOSEXUAL STAGE – Phallic

PSYCHOSOCIAL STAGE – Initiative vs. Guilt
PHYSICAL DEVELOPMENT

Slow growth

Change – chubby to sturdy

Tripled body weight – 1 year

Doubled height – 1 year & increase 2 – 2.5 inches /year

Grows proportionately

Lordosis disappeared

Appears tall & thin by the end of preschool years
MOTOR DEVELOPMENT 3 YEARS OLD

Walks backwards

Walks downstairs alone

Jump from low step

Rides tricycle using pedals

Try to dance

Pours fluid from pitcher well

Begins to use scissors

Copies circle

Builds tower 9-10 blocks

Tries to draw a picture

Can go to toilet

May be able to brush teeth

Feeds self well

Can help to dry dishes & dust

Undress himself
MOTOR DEVELOPMENT 4 YEARS OLD

Climb/ jump well

Go up & downstairs without holding

Throws ball overhead

Cut out pictures with scissors

Copies a square

Lace shoes
MOTOR DEVELOPMENT 5 YEARS OLD

Run skillfully

Hop well

Jump rope

Can roller skate

Balance with one foot

Put toys neatly in a box

Can form some letters

Fold paper diagonally

Print first name
PSYCHOSEXUAL DEVELOPMENT (Freud)
PHALLIC STAGE

EROGENOUS ZONE IN FOCUS – genitalia

GRATIFYING ACTIVITIES – genital fondling

INTERACTION WITH ENVIRONMENT
o
feeling of greater attachment with parent of opposite sex.

SYMPTOMS OF PHALLIC FIXATION
o
anxiety and guilty feeling about opposite sex & narcissism
o
OEDIPUS COMPLEX

tendency of young boy to be attached more to mother than father.
o
ELECTRA COMPLEX

tendency of girl child developing more affection for father than
mother.
PSYCHOSOCIAL DEVELOPMENT
EARLY CHILDHOOD – 2 to 6 years.

CRISIS – Initiative vs. Guilt

DESCRIPTION – children develop motor skills & interact with people around them.

POSITIVE OUTCOME:
o
If parents encourage with discipline, children accept without guilt that certain
things are not allowed, & will use imagination in make believe roles

NEGATIVE OUTCOME:
o
If not, they develop guilt & feel wrong to be independent
COGNITIVE DEVELOPMENT (Piaget)
STAGE II PERCEPTUAL INTUITIVE
STAGE OF PREOPERATIONAL THOUGHT PERIOD

Reasons can be given for beliefs & actions but pre-logical and intuitive.

Use symbols & mental images to represent objects

Animism, realism, artificialism is present

No concept of reversibility, seriation & conservation


Stow away preschooler
o
Can’t find her way home.
o
Can’t understand rules – changed to suit own needs
o
Learns moral realism

considers that a child who breaks one dish on purpose is not as bad
as the child who breaks six dishes accidentally.
o
Concerned that death is inevitable
o
Likes classic books
Preschooler at play
o
This is the rule for this moment……. No further question
EMOTIONAL DEVELOPMENT

Become increasingly aware of themselves.

Play with own body out of curiosity
o
need to where their bodies begin & end
o
as well as the correct names for different parts

Learn about their own feelings
o
know the words cry, sad, laugh & the related feelings to them.

Learn how to control their feelings & behavior.
SOCIALIZATION & VOCALIZATION 3 YEARS OLD

Vocabulary of 900 words

Uses plurals

Sing simple songs

Knows gender differences

Little understanding of the past, present, & future

Talks sentences about things. Don’t care whether others listen or not
SOCIALIZATION VOCALIZATION 4 YEARS OLD

Vocabulary of 1,500 words

Exaggerates, boasts & tattles on others

Talk with imaginary companion

Can go on errands outside home

Physically & verbally aggressive

Can count to 3

Know how old is

Can name one or more colors
SOCIALIZATION VOCALIZATION 5 YEARS OLD

Vocabulary of approx. 2,100 words

Repeats a sentence of 10 syllables or more

Talks constantly

Name 4 colors – red, green, yellow, & blue

Interested in meanings of relatives

Asks meanings of words

Asks searching questions

Knows names of days of the week

Imitates household chores & activities
LEARNING MENTAL MECHANISM

IDENTIFICATION
o
perceives oneself as similar to another person, behave like that person

INTROJECTION
o
assimilating the characteristics and personality of another person into oneself

IMAGINATION – daydreaming

REPRESSION
o
pushing out from one’s awareness , the experiences, thoughts, & impulses.



Preschoolers
o
Identification, introjections, imagination

Find the:

Priest, the nun, the teacher,

the model, the congressman and the “jejemon”
Imagining as a Christmas Princess
Identification : FATHER with sunglasses, MOTHER carrying a baby
MORAL & RELIGIOUS DEVELOPMENT

Preschoolers hear others discuss moral & religious topics,

But learn best from the example set by their parents rather from what they hear.

Preschooler – Adult plays a significant role in the development of concepts among
preschoolers
SPECIAL NEEDS OF PRESCHOOLERS

NUTRITION
o
increase demand due to increase in physical activities & less interest in eating
o
MANAGEMENT:

Serve food in a quite environment

Provide rest period before meals

Provide pretty dishes & comfortable table & chair

Give small feedings

Avoid coaxing, bribery, & force

Limit nibbling food in between meals

Provide good models, for preschoolers are good imitators.

PHYSICAL CARE
o
naturally slow and clumsy in movement.
o
gaining competency in self care.
o
MANAGEMENT:

Needs supervision & guidance in his bath

Provide feeling of security in the environment to help the child
become independent in self care
o
Preschoolers

Guarded independence is the KEY for the preschoolers to become
responsible grown – ups

SLEEP
o
the preschooler is normally so interested in whatever he’s doing that he does
not when he needs sleep/ rest.
o
resist going to bed
o
MANAGEMENT

Avoid using force

Allow daytime naps

Follow usual bedtime rituals

SAFETY MEASURE
o
since preschoolers have more freedom than the toddler has, plays outdoor
alone, away from the safe environment of the backyard = more accidents are
likely to occur.
o
MANAGEMENT

Preschooler should be taught how to protect themselves.

Should emphasize safety measures to them in terms that they can
understand.

HEALTH SUPERVISION
o
Regular visit to a physician is important at regular intervals twice/ once a year
o
Dental care is also important

GUIDANCE
o
Limit set by parents give him a feeling of security which he does not have when
he is allowed to decide for himself in matters beyond his ability to decide wisely.
o
Suggestions not commands help the child in achieving what he wants at the
time, or in forming good relations with the people.

PLAY
o
o
o
PURPOSES

Personality development

Foster ability to deal with reality

Provide avenue to control feelings
TYPE OF PLAY – Cooperative Play

the child begins to exchange ideas with other children & gradually
interact with them in play activities.
Preschoolers at play

Exposure to real playmates of “all walks of life” – an essential avenue
for personality development.
PLAY ACTIVITIES SUITED FOR 3 YEARS OLD

Enjoy active games

Listen to nursery rhymes which they may dramatize

Play activities with the sand & water, play with toys built for dumping & hauling

Enjoy quite activities like cutting, pasting, and building blocks

Preschooler
o
Book worm in action
o
“ as if reading”
o
Almost all preschoolers love the beach where they can be as creative and
energetic as they can be.
PLAY ACTIVITIES SUITED FOR 4 YEARS OLD

CHARACTERISTICS
o
often bossy in directing others although may practice taking turns.

Silly in play – does things wrongly by intention

Fond of dramatic play

Plays house

Does household chores as play activity

Enjoys simple puzzle pictures

Preschooler
o
“copies household chores” as play activity
o
Toys make the play among preschoolers to be creative, imaginative, and
develop an attitude of sharing as well the character traits and virtues.
PLAY ACTIVITIES SUITED FOR 5 YEARS OLD

CHARACTERISTICS – is interested in the outside world, immediate environment.

Dress up in adult’s clothing to make game more realistic

Cuts pictures; work with colored papers

Likes to go on excursions

Listen to stories of things he has never seen

Preschooler
o
“An angel from heaven”
o
Loves visiting places
o
loves family outing to different places
o
Try different experience
o
Childhood experience s last lifetime memories
o
To go places is an invaluable opportunity for preschoolers to be exposed to
explore all the experiences they need to understand the environment outside of
home.
DEVELOPMENTAL CONCERN

FEAR OF THE DARK
o
Heightened by the child’s vivid imagination
o
Children wake up terrified and screaming.
o
MANAGEMENT

Assure the child that they are safe, they are just dreaming

Clear the room of potentially frightening objects

Leave on a night light

Protect the child from scary stories

Investigate sources of stress – if disturbance occur nightly.
o
Preschooler

Vivid imagination turns things real

TALL TALES
o
stretching or lying stories to make them more interesting.
o
arises from the child’s overactive imagination
o
MANAGEMENT

Don’t get angry

Avoid calling it lying

Avoid punishment

Don’t encourage story telling

Help the child calmly to separate fact from fiction

IMAGINARY FRIENDS
o
common to many preschoolers
o
usual to children who are not exposed to real playmates
o
MANAGEMENT

Expose to real playmates

Aid to the preschooler to separate fact from fantasy

Help the child to understand what is real and what is made up

Convey the feeling that imaginary friends are silly

SIBLING RIVALRY
o
jealousy of a brother or sister
o
this is the first time that children have enough vocabulary to express what they
feel
o
for the first time they know a name to call someone they don’t like
o
PREPARING FOR A NEW SIBLING

If the preschooler has been sleeping in a crib that is to be used for the
new baby, moved the child to a bed 3 months in advance of birth, with
the announcement that he is sleeping in a new bed because he’s
already a big kid.

If the child is to start a preschool, do so either before or 2-3 months
the birth of the baby, so the child will perceive he is starting school as
result of his maturity & will not think being pushed out of the house
because of the baby

A preschooler should be prepared in advance for being separated
from mother by the birth of the baby.

It is best if the father carries the new baby into the house, leaving the
mother’s arms free to greet the preschooler.

It is helpful if friends & relatives visit the new baby if they spend some
special time with the preschooler.

Urge the parents to be sure that they provide special time for the
preschooler during the day.

Urge the preschooler to help in the care of the new baby
o




Preschooler

Encourage display of affection to a newborn sibling.

“I’m a big kid now, I am responsible to look after my baby sister” says
a proud preschooler.

Develop a positive attitude by exposing the preschooler simple task in
the care of a sibling so that the preschooler will develop a sense of
responsibility and concern for others.
SHARING
o
around 3 years of age, children begin to understand that something are mine,
some are yours, & some can be ours.
o
MANAGEMENT

Define limits

Expose the child to different categories ( mine, yours, ours) to teach
him separate out which objects belong to which category.
SEX EDUCATION
o
children during preschool age become increasingly aware of gender differences.
o
preschoolers question about genitalia are simple & fact finding.
o
sex education is done best:

before the child start school

when they first ask questions.

responses to questions should be simple enough to clarify
issues.

WHERE DO BABIES CAME FROM?
–
“Babies grow in a special place in mother’s
tummy.”

HOW THE BABY GETS OUT?
–
“The woman goes to the hospital & the doctor
helps the baby get out from a special place
between the woman’s legs.”
LANGUAGE PROBLEMS
o
The child is unaware that he is not being fluent unless it is called to his
attention.
o
It is a part of normal development, it will pass.
o
Suggestions that will help or limit stuttering in the Preschool child

Do not discuss in the child’s presence, the difficulty he is having with
speech. Don’t label him as stutterer. It will make him conscious & will
compound the problem.

Listen to what the child is saying with patience. Don’t interrupt or fill in
the word for him.

Talk to the child in a calm & simple way. It is difficult for the child to
cope with adult’s speech.

Protect space for him to talk if there are other children in the family.

Don’t force him to speak if he does not want to. Don’t ask him to
recite or sing for strangers.

Don’t reward him for fluent speech or punish him for non-fluent
speech. Broken fluency is a developmental stage in language
formation& not an indication of regression
THUMBSUCKING
o
can be a sign that the child feels unloved, that he is in danger, or is not good
enough.
o
it may be an expression of dissatisfaction in life
o
Parents & other adults responsible for the care must observe the child & try to
provide a happier childhood experience.



ENURESIS
o
Children who have achieved control of urine & stool may revert to wetting when
they meet problems that they can’t solve.
o
the problem is more psychological than physical.
o
it may be due to physical cause.

The child may have an irritable bladder which can’t hold large
quantities of urine, like in cases of UTI.
ENCOPRESIS
o
may be due to rigid toilet training
o
may be due to a lack of good mother child relationship
SELFISHNESS
o
no child is born with the ability to share with others what is his.
o
he can slowly learn the joy of giving or sharing with others, what he wants to
keep for himself.
o
he can’t be forced to share.
o
he must first develop the sense of ownership before he can learn to be
generous.
o
MANAGEMENT

Expose to a group play to encourage the habit of sharing.

he will learn first that using things together is fun and then to share
and take turns with his toys and with other children.
o


Preschooler

Provide opportunities to experience the fun of sharing
BAD LANGUAGE
o
the child may use bad language on purpose to annoy adults & enjoy the
sensation he creates
o
MANAGEMENT

Try the method of nonparticipation with the group

Suggest other words

Use distraction by playing with other words or sounds

Don’t embarrass or punish the child. Punishment will emphasize the
importance of the word.
HURTING OTHERS
o
The child who repeatedly wants to hurt others by biting, scratching, pulling hair
or hitting is a troubled child

He may be jealous or frustrated.
o
he needs to know that someone who loves him deeply will control him & so
prevent the unpleasant consequences of his behavior.
o
MANAGEMENT

Should be helped to identify what his problem is.

Group therapy may be an avenue for him to identify his problems, to
accept others & be accepted by others.

May be given physical outlet in his play through which to work off
some excess energy and relieve feelings of frustration.

Praise for his achievement in group & solitary play & for his kindness
he does for others.

PREPARATION FOR SCHOOL
o
Preparation for school generally begins with the mother’s own confidence.
o
MANAGEMENT

Take the child to the school building so the child may become familiar
with the environment before he is left with strange adults and children

Meet with the teacher on his visit in order to trust the teacher.
o
Preschooler

first day for school

Achievement Day – I pray myself for this
MGA PANGANGAILANGAN AT IBA'T IBANG URI NG PAGSULAT
MGA PANGANGAILANGAN SA PAGSULAT

Paksa
o
pangkalahatang kaisipang iniikutan ng mga ideya ng teksto
o
mahalaga ang kawastuhan, katumpakan at kasapatan ng kaalaman ng may
akda ukol sa tinatalakay na paksa.
o
Sa ganitong paraan ay mapapanagumpayan ang pagsulat.

Layunin (aim)
o
binibigyang tugon nito ang tanong na “bakit tayo nagsusulat?”
o
makapag lilbigay ng direksyon sa anyo o paraan ng paggamit nya sa wika
upang makapag pahayag

Wika
o
nakapaloob dio ang uri ng wikang gagamitin at ang paraan ng pag gamit nito.

Kombensyon
o
tinutukoy nito ang estilo ng pagsulat na karaniwan sa manunulat at
mambabasa.

Kasanayang Pampag-iisip
o
Kabilang rito ang mga sumusunod.

Analisis – pagtukoy sa mahahalaga at hindi

Lohika – kakayahan na mabisang pangangatwiran

Imahinasyon – paglalangkap ng malikhain at kawili wiling kaisipan

Kasanayan Sa Pag-Buo
o
ito ay tumutukoy sa kakayahan ng maayos na manunulat na maisulat ang
buong piyesa na taglay ang kasiningan at maayos na sikwens ng mga kaisipan.

Kabatiran Sa Prosidyur Ng Pagsulat
o
mahalagang pagtuunan ng pansin sa paglikha ng magandang piyesa

tamang spelling

pagbabantas

wastong pagkakasunod sunod ng mga kaisipan
MGA URI NG PAGSULAT

Teknikal Na Pagsulat
o
Isang uri ng tekstong ekspositori na
o
nagbibigay ng impormasyon para sa teknikal o komersyonal na layunin.
o
Ayon kay B.P. Pineda (KWF), ang teknikal na Filipino ay isang linggwistikong
phenomenon na sumibol sa puso ng baryedad ng wikang Filipino na lalong
kilala sa tawag na Taglish.

Referensyal Na Pagsulat
o
Uri na pagsulat na naglalayong magrekomenda ng iba pang sanggunian hinggil
sa isang paksa.
o
Sa pag-aaral at / o pagsasaliksik ay mahalagang makangalap ng mga datos sa
iba’t ibang sanggunian upang maging balido, masaklaw at efektiho ang isinulat
maging ito’y tesis o mapanahong papel
o
Bukod sa pagbabasa sa nilalaman ng babasahing aklat, polyeto, brochure,
magasin, dyaryo, atb., mahalagang makapagtala muna ng listaha ng mga
sangguniang gagamitin.
o
Maraming mag-aaral at mananaliksik ang tumutunghay mula sa Talaan ng
Nilalaman o Indeks ng aklat para hanapin ang mahahalagang datos na kanilang
hinahanap para sa kanilang pag-aaral.
o
Ang pagtunghay sa Bibliograpi ng aklat at ang mahahalagang pagtatala ng
impormasyon mula rito ay isa sa mga pinaka efektibong gawain sa
pangangalap ng mga datos at informasyon

Halimbawa: bibliography, index, notecards at iba pa.

Tandaan na sa paghahanda/pagsulat ng Bibliograpi ay dapat masunod ang ilang mga
tagubilin

Tukuyin ang paksang susulatin bago humanap ng mga aklat at mga bahasahin.

Sa paghanap ng mga sanggunian, sikaping maitala ang

pamagat ng aklat at mga bahasahin

awtor/mga awtor.

Pagsunod-sunurin ang pagtatala ng sanggunian sa pamamagitan ng pagsulat
muna ng

apelyido, pangalan, at inisyai panggitna ng awtor

taon ng pagpapalimbag ng aklat babasahin

pamagat ng aklat

lugar ng publikasyon

publisidad.

Tiyaking nakalimbag nang pahilis ang pamagat ng aklat.

Ipasok ang karugtong ng impormasyon na nasa pangalawang linya.

Sikaping mapaghambing at matutuhan ang format ng paghahanda/pagsulat ng
bibliograpi na
o
Isa ang awtor
o
dalawa ang awtor
o
maraming awtor
o
Lit ng aklat
o
artikulo sa dyaryo, jornal, at halaw sa internet o elektronikong
babasahin.
Jornalistik na Pagsulat
o
Saklaw nito ang pagsulat ng balita, editorial,kolum anunsyo at iba pang akda ng
karaniwang makikita sa mga pahgayagan o magasin.
o
Ang dyaryo o pahayagan, maging broad sheet o tabloid ay nagtataglay ng mga
sulating iba sa nilalaman at paraan ng pagsulat ng mga sulating malikhain.
o
Hindi mabubuo ang dyaryo o kung walang balita, editoryal, lathain, at iba pang
sulating pampahayagan. Narito ang ilang halimbawa,

Balita

ayon kay Metienzo (2002): Ang anumang pangyayaring
naganap na, nagaganap pa lamang o magaganap pa sa
isang tiyak na hinaharap ngunit hindi pa alam ng marami,
na may kaugnayan sa kapayapaan ng bansa, ng
kabuhayan, edukasyon, politika, isports, kalusugan/ o
religion ay isang balita.

Editoyal

anumang artikulong nagbibigay-pakahulugan sa balita ay
tinatawag na editoyal.

Lathalain

itinuturing na “may laman at dugo”

ang lathalain ay may ganap sa katauhan ito’y
nakapaghahatid ng kaalaman sa mga mambabasa bukod
pa sa kasiyahan at kawilimg hatid nito.
–
Isinasaalang alang ang mga sumusunod:
•
Kunin agad ang punto ng storya
•
Huminga
•
Sumulat ng malinaw




Balitang Pang-Isports

Ang mga laro, paligsahan o anumang pangyayaring
nagaganap sa loob at labas ng gymnasium ay mababasa
sa balitang pangisports.
Profesyonal na Pagsulat
o
Uri ng pagsulat na nakatuon o eksklusib sa isang tiyak na propesyon
o
Halimbawa: Police Report, Invetigative Report, Legal Form, Medical Report
Malikhain na Pagsulat
o
Masining ang uri ng pagsulat na ito.
o
Ang pokus dito ay ang imahinasyon ng manunulat bagamat maaaring pikyon o
di-piksyon ang akdang isinusulat.
o
Halimbawa: tula, nobela, mailkling katha athp.
Akademikong Pagsulat
o
Ito ay isang intelektwal na pagsusulat dahil layunin nitong pataasin ang antas at
kalidad at kaalaman ng mag aaral.
o
Isang awtor ang nagsabing ang akademikong pagsulat ay yaong ginagamit sa
mga kursong komposisyon a malikhaing pagsulat na kalimita’y sariling opinyon
ideya o karanasan ang isinusulat ditto
o
Maituturing ding akademiko ang pagsusulat ng reaksyon sa sinulat ng iba gaya
ng pagsulat ng takdang aralin.
o
Halimbawa: kritikal na sanaysay, laboratory report eksperimento o term paper
IBA’T IBANG GENRE NG NAKASULAT NA TEKSTO
PAGLALARAWAN / DESKRIPSYON

Kasangkapan nito ang isang malikhaing isipan at mayamang bokabularyo.

Ang kakayahan sa paggamit at pagtukoy ng mga idyoma o talinghagang naglalarawan ng
hindi hayag ay isang karagdagang kasanayan.

Ipinalalabas ng mga ito ang isang biswal na konsepto ukol sa isang bagay, tao, pook,
pangyayari at iba pa.
URI NG PAGLALARAWAN

Objektib o Konkreto
o
Layunin nito ang makapaghatid. Itinatala ang mga hayag na katangian gamit
ang mga payak at direktang salita.
o
Halimbawa: Si Tomas ay matanda na.

Sabjektib o Masining
o
ninanais nitong makapukaw ng damdamin at paganahin ang hiraya ng
bumabasa o nakikinig.
o
Ito ang nagbibigay kulay sa isang paglalarawan.

Halimbawa:

Si Tomas ay lipas na sa kalendaryo. Hindi na niya
matandaan ang taon kung kalian siya nakakita ng itim na
buhok sa kanyang ulo. Mabilis pa ngayong lumakad sa
kanya ang apong bahae.

Teknikal
o
madalas na gamitin sa ganitong paglalarawan ang mga ilustrasyon o grap na
ispesipikong matutukoy ang katangian nan als ipaliwanag.
o
Ang ganitong uri ang ginagamit sa mga panahong mahalaga ang akyurasi at
presisyon.
o
Halimbawa: Anatomika ng katawan ng tao.
MGA SALIK SA PAGLALARAWAN

Wika
o
tinutumbasan nito ang biswal na katangian gamit ang salita.

Organisasyon ng Detalye
o
ang wastong pagkakasunod-sunod ng mga pangyayari at ang kaugnay ng
bawat isa.

Pananaw
o
ang damdamin ng naglalarawan ukol sa inilalarawan.

Kung positibo ang impresyon, ayon din ang damdamin.

Ang negatibong damdamin ay lumilikha ng negatibong larawan.

Kakintalan
o
ang pangkalahatan o pangkabuuang impresyon. Dito nasusukat ang kabisaan
ng paglalarawan.
MGA PAMAMARAAN

Progresibong Paglalarawan
o
sumusunod sa isang tiyak na balangkas n amula sa isang pangicalahatang
impresyon papunta sa mga ispesipikong detalye.

Piktoryal o Grapiko
o
ang larawan o ilustrasyon ay nakahayag at nakatalata ang mga tiyak na salitang
naglalarawan o tumutukoy dito.

Hambingan at Kontras
o
ang isang bagay na kabilang sa isang pangkat o uri ay ilalarawan batay sa mga
katangian nito na katulad sa grupo subalit tutukuyin din ang ikinatangi nito sa
mga kauri.

Masining o Inderekta
o
ang ganitong pamamaraan ang tinatawag na “Impressions” o “between the
liner”, ginagamit dito ang patalinghagang pahayag at idyoma

Sayentipik o TTeknikal
o
inilalapat ang kaukulang sayentipiko o teknikal na katawagan upang mapalawak
ang kakintalang mabubuo sa isipan.
PROSESO NG PAGLALARAWAN
1. Mangalap ng kaukulang tala o datos.
2. Bumuo ng isang pangkalahatang impresyon o kabuuang larawan.
3. Piliin ang pananaw na gagamitin. Maaaring kronolohikal. Hengrapikal, ayon sa
kahalagahan o sa posisyon ng naglalarawan.
4. Isulat ang burador.
5. I-edit ang isinulat
PAGSASALAYSAY

Ito ang genreng naratib.

Ito ay palasak at madalas gamitin ang salitang ugat nito ay Salaysay o Kwento.

Layunin ng ganitong pamamaraan ang ipabatid ang mga pangyayari may kaugnayan
mula sa pananaw ng nagsasalaysay.
MGA URI NG SALAYSAY

Salaysay na Batay sa Katotohanan
o
kabilang dito ang mga akdang pangkasaysayan kung saan ang mga datos at
tala ay hango sa mga totoong pangayari.
o
Itinuturing na objektib ang ganitong uri.

Salaysay na Likhang-isip
o
bagama’t taglay nito ang isang paniniwalang unibersal, ang mga pangyayari at
sikwens ay piksyunal o bunga lamang ng isang malikhain at mayamang hiraya.
ELEMENTO NG MABISANG SALAYSAY
1. Panahon

may tiyak na panahon ng pinagkaganapan ng mga pangyayari.

nagpapatibay ng daloy ng mga pangyayari.
2. Kahulugan
o
diwa ng salaysay.
o
Dito nagmumula ang mga motibasyon at aksyon ng mga kasangkot.
3. Kaayusan
o
ang bumubuo sa kasiningan at pagkaepektibo ng salaysay.
o
Ang hindi paikot- ikot at patalun-talong pagkakaayos ng mga pangyayari ang
nagpapadali sa kabatiran.
4. Pananaw
o
ito ang bahaging sumasagot sa tanong na “Sino ang nagsasalaysay?” at “Ano
ang kaugnay niya rito?”
o
Tatlo ang punto de vista ng tagapagsalaysay:
o
Unang Panauhan

ang nagsasalaysay ang gumaganap sa kilos ng pagsasalaysay.
Kadalasang ginagamit ang salitang “AKO”.
o
Ikalawang Panauhan

tagamasid na may limitadong akses ang nagsasalaysay.

Tinutukoy niya ang mga pangyayari batay sa nasaksihan.
o
Ikatlong Panauhan / Omniscient Point of View

taglay ng nito ang kapangyarihang matukoy ang damdamin at iniisip
ng mga tauhan ng kanyang isinasalaysay.

Dayalogo
o
ang tuloy tuloy na pagsisiwalat ng mga pangyayari ay nagiging kabagut- bagot
kaya’t isisingit ang mga salitain o usapan upang magkabuhay ang pasalaysay.
KATANGIAN NG MABUTING SALAYSAY

May kaakit-akit na panagat.

Mahalaga ang paksang tinatalakay.

Kawili-wili ang panimula.

May angkop na utilisasyon ng mga salita.

Maayos ang ugnayan at pamamaraan ng pagkakabun ng teksto.
PAGLALAHAD

Pasalaysay
o
ay pagkukwento batay sa isang pananaw
o
naglalayong umaliw o magpabatid ng kaisipan

Paglalahad o ekspositori
o
Ay pamamaraan ng pagpapaliwanag
o
Binibigyang katwiran nito ang mga kaisipang sinasaklaw ng karunungan ng tao.
o
Mahalaga ang pagkakaroon ng sapat na detalye upang epektibo ang
pagpapahatid ng mensahe.
DAPAT TAGLAYIN NG PAGLALAHAD

Kalinawan
o
natatamo ito sa pamamagitan ng pagkakaroon ng kaisahan ng diwa at mahusay
na pagkakasunod-sunod ng mga pangyayari.

Bisa/Kabisaan
o
kung sapat ang pagbibigay-diin o emphasis sa mga bahagi na nangangailangan
nito.

Gilas
o
ang paraan ng pagkatanggap sa mensahe ay nakabatay sa maganda at
masining na pananalita.

Estilo at Hinis
o
Ang kaanyuan ng pamamaraan ng paglalahad at batay sa estilo na ginamit ng
awtor.
o
Dapat anyong nakikipag-usap lamang at hindi gaanong mahigpit o istrikto.
MGA ANYO NG PAGLALAHAD
1. Pagbibigay-Katuturan o Depinisyon
o
paraan ito ng pagtukoy ng kahulugan ng salita.
o
Dalawang pamamaraan ang magagamit sa kasanayang ito:

Maanyo o Simpleng Depinisyon

sa pamamagitan ng isang pangungusap ay ibibigay ang
pakuhulugan sa salita

Pagsasanay

higit na mahaba kaysa isa o dalawang pangungusap ang
kinakailangan upang matukoy ang kahulugan

Masinsinan ang pamamaraan ng pagtukoy sa katangian at
kaibahan nito sa mga kauri.
2.
Ulat
o
ang paghahatid ng impormasyon ukol sa nabasa, narinig, napapanood, napag
aralan o sinaliksik.
o
Maaari itong pasulat o pasalita.
o
Ang ibang anyo nito ay gumagamit ng grap, o ilustrasyon upang lubos na
maipaunawa ang mga konsepto
o
3.
4.
5.
TATLONG URI NG ULAT

Ulat Pananaliksik

ang ganitong uri ay kinapapalooban ng mga natuklasan sa
tulong ng riserts at eksperimentasyon.

Madalas itong gamitin sa mga larangan ng syensya at
edukasyon.

Ulat Tekniko

maliban sa mga pangkaraniwang pinag-aarjan o sinusuri,
ang mga bahaging teknikal ay kailangan ding mabigyang
linaw at maipaliwanag.

Kabilang dito ang teknikalidad sa larangan ng brodkasting,
pelikula, radyo, at information technology.

Ulat sa Panayam o Pagbasa / Reaction Paper

Dito Ipinapahayag ang mga puna, komento at mungkahi
ukol sa narinig o nabasa
Sanaysay
o
lumulutang ang katauhan ng manunulat sa paraan ng kanyang pagsulat.
o
Malawak ang maaaring maging tema nito sapagkat ang pinakapaksa ay buhay.
o
Ang mga nakapaloob na kaisipan dito ay mula sa manunulat kaya’t
makatutulong ito sa

pagpapayaman ng kaisipan

madagdagan ang ang karanasan

mapalalim ang pagunawa
URI O ESTILO NG SANAYSAY
o
Pormal

lohikal ang paraan ng paglalahad ng mga kaisipan

ang pagbuo ay sumusunod sa isang balangkas

himig seryoso at tila may awtoridad kung saan mababanaag ang
panahong iniukol sap ag-aaral ng mga detalyeng ipinhayag
o
Di-pormal

mas malaya at maluwang ang tuno at himig, halos nakikipagbiro at
animo’y nakikipagpalitan lamang ng kuro-kuro.

Kawili- wili itong basahin bagama’t nakatanim pa rin ang kaisipang
nais ipahatid
Panuto
o
ang mga anyo nito ay ang resipi, handbook sa pagbuo ng isang kasangkapan,
plakard, ng direksyon, ang mga paalala sa panimula ng isang pagsusulit o
pagsasanay.
MGA SANGKAP NG PANUTO

Panimula o Paksa

Mga kagamitan o materyales

Mga hakbang sa paggawa

Wakas
Panunuri o Kritisismo
o
Isa itong pamamaraan upang sa pamamagitan ng panghihikayat ay mahago
ang paniniwala ng kaharap o kausap
PANGANGATWIRAN

isa itong pamamaraan upang sa pamamagitan ng panghihikayat ay mabago ang
paniniwala ng kaharap o kausap
MGA ANYO NG PANGANGATWIRAN

Pormal na Pangangatwiran
o
seryoso ang tono at malalim ang tema ng palesa.

Di-pormal na Pangangatwiran
o
personal, madaling unawain at naangkop sa karaniwang buhay.
URI NG PANGANGATWIRAM

Pagbuod o Induktibo
o
ang daloy ng pangangatwiran sa aring ito’y nagsisimula sa mga maliit na
detalye patungo sa isang pangkalahatang kaisipan.
o
Maaaring isagawa ito sa pamamagitan ng

Pagtutulad

paguugnay sa sanhi ng pangyayari

paggamit ng katibayan at patunay.

Pasaklaw o Deduktibo
o
pamamaraang kinasasangkutan ng silohisma.
o
Silohismo

nagsisimula sa isang pahayag na susundan ng simulaing panlahat at
kongldusyon.
FOOD AND DRUG ADMINISTRATION (FDA)

It’s FDA’s job to see that medicines and medical devices are safe and effective

is a federal science-based law enforcement agency mandated to protect public health.

The agency has approximately 9.000 employees, most of whom are scientists, inspectors,
medical doctors, and other professionals.

FDA’s budged is $ 1.2 billion, or about $ 4 a year peer taxpayer
Food, Drug and Cosmetic Act (FD&C)

This Act, passed in 1938, remains FDA’s main legal basis.

It greatly enlarged the agency’s mission and authority by:
o
requiring that new drugs be shown to be safe before marketing.
o
Extending FDA’s control to cosmetics and therapeutic devices.
o
Authorizing factory inspections and standards of identity for food staples.
o
Eliminating a requirement to prove intent to defraud in drug misbranding cases.
o
Adding court injunctions to the previous penalties of seizures and prosecutions.
FDA Modernization Act of 1997 (FDAMA)

In FDAMA, Congress recognized that the protection of public health is a responsibility
shared by the entire health care community.

It directs the agency to carry out its mission in consultations and cooperation with all FDA
stakeholders, including
o
consumer and patient groups
o
the regulated industry
o
health care professionals
o
FDA’s regulatory counterparts abroad.
Labeling

In addition to setting product standards, FDA regulates the labeling of products under its
jurisdiction – drugs and medical devices
o
Gives pre-scribers and patients reliable guidance about the safety and
effectiveness of health care products.

This information, which must be rigorously truthful, well documented, and not misleading,
plays a major role in protecting consumers and the public health.
HIPAA : Health Insurance Portability and Accountability Act of 1996

PRIMARY GOAL: make it easier for people
o
to keep health Insurance
o
protect the confidentiality and security of healthcare information
o
help the healthcare Industry control administrative costs

Enacted to:
o
Protect the privacy of a patient’s personal and health. Information.
o
Provide for electronic, and physical security of personal and health information.
o
Reduce health care fraud and abuse.

Examples
o
Computer disk containing public health worker sent tw ing the names of 4.000
people who tested positive for HIV.
o
In 2008, thirteen years were fired and six hadical records of Britney Spears.
o
In 2013, six employees (3 physicians) were fired at Kardashian Medical Ce
medical when she tries to access Kim Cardigans medical record when she give
birth.

All healthcare organizations and providers including: hospitals, physician offices, health
plans, employers, public health authorities, life insurers, clearing houses, billing agencies,
information system vendors, service organizations and universities.
o
These are known as covered entities for HIPAA s privacy and security
regulations and they must compy with its regulations.
o
Covered entities must implement standards to protect and guard against the
misuse of individually identifiable health information.
o
Failure to comply may cause the imposition of civil or criminal penalties.
HIPAA Privacy Rule

Gives patients more control over their health information.

Sets boundaries on the use and release of health records.

Establishes safeguards that persons with access to health records must uphold to protect
the privacy of health information.

Holds violators accountable with penalties under certain circumstances.
PROTECTED HEALTH INFORMATION

is the medical record including the
o
demographic (face) sheet
o
photographs
o
footprint sheet
o
finger or voice prints
o
any identifiable health information,
o
census reports.
WHO IS AUTHORIZED TO SEE PHI

Only healthcare providers who are directly involved in providing treatment, payment, or
involved with healthcare operations are authorized to have access to patient information.
RELEASE OF INFORMATION (ROI)

Students need to be very careful in sharing PHI

Patients must be present, with the chance to object when sharing PHI with family and
friends.

If the patient does not object then you may share information that is directly relevant to
that persona involvement

ROI is always done by trained employees.
SAFE DATA PRACTICES

Treat all communication with privacy. Be MINDFUL of technology!!!

Locations- be mindful of privacy when discussing patient information. (BEWARE OF
ELEVATORS, CAFETERIA, GIFT SHOP)

Students as well as employees, volunteers and contract personnel need to adhere to
privacy practice rules and regulations.
REQUIREMENTS OF PROVIDERS : To ensure privacy of patients the provider must:

Provide information to patients about their privacy rights including how their information
will be used.

Enforce privacy procedures.

Train employees regarding privacy procedures.

Designate a Privacy Officer who will be responsible for ensuring that privacy procedures
are adhered to.

Secure patient records so they are not readily available to those who do not need them.





Comply with the minimum necessary information requirements.
Allow patients access to their records.
Notify patients of anyone who has seen their records.
Provide a formal complaint process for patients.
Documentation of training is required from the various entities.
FINES AND PENALTIES FOR VIOLATING HIPAA STANDARD

Civil
o
$100 for each violation up to $25,000/person/year for multiple violations.
o
Will not impose fines under certain circumstances, if violation did not involve
willful neglect and the violator corrects violation within 30 days of when violation
was known.

Fines…

Criminal Penalties
o
A person who knowingly obtains or discloses individually identifiable information
in violation of HIPAA will face a fine of $50,000 and up to one-year
imprisonment.
o
Can increase to $100,000 and up to five years imprisonment if the wrongful
conduct includes false pretenses.
o
$250,000 and up to ten years in prison if involves intent to sell, transfer or use
identifiable health information for commercial advantage, personal gain or
malicious harm.
National Nutrition Council of the Philippines (NNCP)
Policies and programs that support nutrition

RA 11148 Kalusugan at Nutrisyon ng Mag-Nanay Act

RA 11210 105-Day Expanded Maternity Leave Law

RA 11037 Masustansyang Pagkain para sa Batang Pilipino Act

RA 10410 Early Years Act

RA 10028 Expanded Breastfeeding Promotion Act

RA 8976 Food Fortification Law

RA 8172 ASIN Law

EO 51 Philippine Milk Code
RA 11148 Kalusugan at Nutrisyon ng Mag-Nanay Act

Enacted into law last 29 November 2018 as “An Act Scaling Up the National and Local
Health and Nutrition Programs Through A Strengthened Integrated Strategy for Maternal,
Neonatal, Child Health and Nutrition in the First One Thousand (1000) Days of Life,
Appropriating Funds Therefore, and for Other Purposes”

The policy aims to
o
scale up nutrition intervention programs in the first one thousand (1000) days of
a child’s life
o
allocate resources in the sustainable manner to improve the nutritional status
o
address the malnutrition of infants and young children from zero (0) to two (2)
years old, adolescent females, pregnant, and lactating women to ensure growth
and development of infants and young children.
RA 11210 105-Day Expanded Maternity Leave Law

covers female workers in the public and private sectors, including those in the informal
economy, and entitles them to 105 days of maternity leave paid at 100 percent of their
average daily salary credit.

also provides for an additional 15 days of paid leave if the female worker qualifies as a
solo parent under the Solo Parent Welfare Act of 2000, with an option to extend for an
additional 30 days without pay.

President Rodrigo Duterte signed into law in
o
2019 Republic Act No. 11210, or the “105-Day Expanded Maternity Leave Law,”
which extends paid maternity leave from 60 days to 105 days.

Daily maternity leave benefit from the initial 60 days for normal delivery, or 72 days for
caesarian delivery, to 105 days, regardless of the type of delivery.
o
In case of a miscarriage or an emergency termination of pregnancy,, the
entitlement is 60 days of paid maternity leave.

The law further expands maternity leave to every instance of pregnancy, miscarriage, or
emergency termination, regardless of frequency, from the previous limit of the first four
deliveries or miscarriages.

The entitled to the above maternity leave benefits, a pregnant.

Female worker in the private sector must have
o
paid at least 3 months’ contributions in the 12-month period immediately
preceding the semester of her childbirth, miscarriage, or emergency termination
of pregnancy
o
notified her employer of her pregnancy and the probable date of her childbirth.
Employers that fail to comply with the provisions of the law are subject to a fine
of not less than 20,000 pesos (PHP) nor more than PHP 200,000 and/or
imprisonment for not less than 6 years and 1 day nor more than 12 years, as
well as the non-renewal of business permits.
Goal of 11210

The expansion of paid maternity leave granted women. Significantly more time to care for
themselves and their children during a critical period of infancy.

This ensures their health and well-being, including that of any spouses or partners, without
any loss in income.

Kung saan dapat magkaroon ng feeding program ang bawat pampublikong paaralan para
sa mga undernourished na bata sa Pilipinas.
RA 11037 Masustansiyang Pagkain Para sa mga Batang Pilipino.

kung saan dapat magkaroon ng feeding program ang bawat pampublikong paaralan para
sa mga undernourished na bata sa Pilipinas.

Programs under RA 11037
o
Supplemental Feeding Program for Day Care Children.
o
School-Based Feeding Program.
o
Milk Feeding Program.
o
Micronutrient Supplements.
o
Health Examination,
o
Vaccination and Deworming.
o
Gulayan sa Paaralan.
o
Water, Sanitation, and Hygiene (WASH)
o
Integrated Nutrition Education, Behavioral Transformation, and Social
Mobilization
Early Years Act of 2013 (RA 10410)

"An act recognizing the age from zero (0) to eight (8) years as the first crucial stage of
educational development and strengthening the early childhood care and development
system, appropriating funds therefor and for other purposes"
o
by the President last March 26, 2013

Mandate aww! A¹111
o
Implement the National Early Childhood Care and Development (ECCD)
System

ECCD System
o
Refers to the full range of health, nutrition, early education and social services
development programs that provide for the basic holistic needs of young
children from age zero (0) to four (4) years; aMasustansiyang Pagkain Para sa
mga Batang Pilipino

A Program Presentation of the ECCD Council
Salient Features of EYA 2013

Recognition of age 0-8 as the first crucial stage of educational development

Strengthening of ECCD Council to ensure the State’s focus on building a strong
foundation for the development and learning of 0-4 year old years old.

Ensuring sustained inter-agency and multi-sectoral collaboration for the full range of
health, nutrition, early education and social development programs for holistic
development of children

ECCD PROGRAMS AND SERVICES

Infants and Toddlers Program – 0-2 years old

Pre K1 – 3 years old

Pre K2 – 4 years old
NCDC Features

Promotes inclusion of children with special needs, provides reasonable accommodation
and accessible environment

Child-friendly with welcoming and nurturing environment that attracts interest of young
children 0-4 years old and develops in them the love for learning

Big books and story books are available to inculcate love for reading at an early age

Major implementing partners of NCDCs are the local government units where they operate
RA 10028 Expanded Breastfeeding Promotion Ac

Breastfeeding workers/employees shall granted break intervals in addition to the regular
time-off for meals to breastfeed or express milk.
o
These intervals, shall include the time it takes the worker/employee to get to
and from the workplace lactation station, shall be counted as compensable
hours worked.

The Department of Labor and Employment may adjust the same: Provided, That such
intervals shall not be less than a total of forty minutes of every eight-hour working period.

Lactation management the monitoring of breastfeeding mothers to ensure compliance with
the DOH, WHO, UNICEF in the
o
implementation of breastfeeding policies
o
Physiology of lactation
o
establishment and maintenance of lactation stations, at the workplaces in the
private sector as mandated by DOLE.


Per DOLE Department Order No. 143, provides that an application for exemption from
setting up lactation station by a private establishment may be granted for a renewable
period of two years by the DOLE
The DOLE cited provisions in the law that require lactation stations to have adequate
equipment and facilities, such as:
o
lavatory
o
refrigeration or cooling station for storing breastmilk;
o
electrical outlets for breast pumps, and
o
table and comfortable seats
Legal Provisions
o
RA 10028 Expanded Breastfeeding Promotion Act. Amending to the purpose
REPUBLIC Act No. 7600, otherwise known as “ An act providing incentives to
all government and private health institutions with rooming- in and breastfeeding
practices and for other purposes
Program Components
o
Follow-up visits to health facilities where they gave birth and home visits for
women in difficult-to-reach communities;
o
lactation support and counselling from birth up to two years and beyond,
including those women who will return to work and for women in the informal
economies who breastfeed
o
identification of malnutrition and nutritionally-at-risk postpartum and lactating
women, including adolescent mothers, and in addition to dietary
supplementation, as appropriate:
o
Nutrition assessment and counselling to meet the demands of breastfeeding in
health facilities and workplaces in the private sector
o
Community-based support groups and peer counsellors for breastfeeding in
cooperation with other nutrition and health workers;
o
Lactation breaks for women in the workplaces in the private sector including
micro, small and medium enterprises;
o
Availability of breastfeeding/lactation stations in the workplaces, informal
economy workplaces, and in public places and public means of transportation
as stipulated in

Republic Act No. 10028, otherwise known as the “Expanded
Breastfeeding Promotion Act of 2009” and its Implementing Rules and
Regulations:
o
promotion of the consumption of iodized salt and foods fortified with
micronutrients deemed necessary:
o
access to health and nutrition facilities/services, such as, but not limited to,
dietary supplementation, healthy food products and commodities for
nutritionally-at-risk postpartum and/or breastfeeding women,
o
women-friendly and child- friendly spaces where mothers and their infants will
be able breastfeeding to continue during calamities, disasters, or other
emergencies
RA 8976 Food Fortification Law

mandatory the fortification of staples to address micronutrient deficiencies of the Filipino
diet

Voluntary fortification of other processed food products

Covers all imported and locally processed foods or food products for sale or distribution in
the Philippines

All manufacturers/producers, Importers, traders, tollees, retailers, repackers of food
products





RA 8976: Mandatory fortification of staples
o
Rice + iron
o
Oil + Vitamin A
o
Flour + Vitamin A
o
Flour + Vitamin A & Iron
Diamond Seal
o
Staples that pass fortification guidelines of the DOH
o
Status of Food Fortification Program : Mandatory fortification

119 brands of food staples with Diamond Seals

55 flour products/brands44 oil products/brands

55 flour products/brands

9 rice products/brands

9 salt products/brands

2 sugar products/brands
Voluntary Fortification
o
Through the Sangkap Pinoy Seal Program
o
Approved products are awarded the seal by DOH
o
Status of Food Fortification Program : Voluntary fortification

139 food products with Sangkap Pinoy Seal
Rule VIII: Implementation, Monitoring and Review Agencies assisting FDA in monitoring
compliance:
o
Sugar Regulatory Administration for sugar
o
National Food Authority for rice
o
Philippine Coconut Authority for oil
o
Bureau of Customs for imported products
o
LGUs for markets and food service establishments
Advantages of food fortification
o
To food manufacturers

Fortification adds value to the product thereby, increasing demand

Helps promote good nutrition among its consumers

Improves image of company
o
To the consumer

Value for money

Improved nutrient intake from consuming fortified foods

Food fortification seal provides assurance of fortification
RA 8172 ASIN Law / “An Act for Salt lodization Nationwide”

became a law in 1995

seeks to eliminate iodine deficiency disorders by mandating all salt producers and
manufacturers to iodize their product.

However, the law had the unintended effect of killing the local salt industry, as small and
medium salt farmers were unable to comply with the iodization requirements.
EO 51 Philippine Milk Code

also known as the “National Code of Marketing of Breastmilk Substitutes, Breastmilk
Supplements and Other Related Products”

aims to protect and promote breastfeeding and to ensure that breast milk substitutes and
supplements are properly used with adequate information, marketing and distribution.

Signed into law by former Pres, Cory Aquino on 20 October 1986

Important to understand scope:
o
breastmilk substitutes, Infant formula, other milk products, foods and
beverages, feeding bottles and teats




Regulated acts:
o
Advertising needs prior permission from Inter-Agency Committee
Prohibited acts:
o
Giving of samples and supplies of products, gifts of any sort Point of sale
advertising, promotion device (displays, discount, coupons, premiums, special
sales, bonus )
o
Giving of gifts/articles/utensils which promote use of breastmilk substitutes or
bottlefeeding
International Code of Marketing Breastmilk Substitutes
o
Aim protect and promote breastfeeding by ensuring appropriate marketing and
distribution of breastmilk substitutes
o
Covers infant formula, other milk products, cereals for infants, vegetable mixes,
baby teas and juices, follow-up milks when marketed or otherwise represented
as partial or total replacement for breastmilk also applies to feeding bottles and
teats
Prohibited acts:
o
No advertising to the public
o
No free samples to mothers, families or health workers
o
No promotion (product displays, posters, free gifts/samples or free or low-cost
supplies to any part of health care system)
NUTRITION AND HYDRATION IN PALLIATIVE CARE
What happens during Terminal Illness?

Terminal illness can alter the nutritional status of the patient in many ways:
o
Gastrointestinal absorption
o
Nutrient requirements

malabsorption,

Cachexia and increasing tumour mass
o
The dying process gastric emptying

Increased satiety

decreased hunger

food intolerances
o
Nausea, vomiting, diarrhoea and constipation. – Side-effects of Medication
o
Depression causes anorexia (Holland et al, 1977)
o
Anger and guilt when present have a negative impact on dietary intake
ANOREXIA AND CACHEXIA

Anorexia
o
The absence or loss of appetite for food is common in patients with advanced
cancer and other chronic illnesses.

Cachexia
o
Weight loss, anorexia, weakness and asthenia causing reduced performance
status, fatigue, metabolic alterations and reduced quality of life.
o
is an inflammatory process associated with cytokine excess.
o
Weight loss secondary to cachexia is often refractory to therapeutic intervention
and nutritional support.
The metabolic consequences of cancer are listed below (Stratton et al 2003):

Altered glucose metabolism the tumour is inefficient in the use of glucose

Increased rate of glucose oxidation

Increased rate of protein metabolism

Decreased protein synthesis

Increased protein breakdown

Altered lipid metabolism.
WHO states that Palliative Care:

Affirms life and regards dying as a normal process;

Neither hastens nor postpones death;

Provides relief from pain and other distressing symptoms.

Maintain/improve QOL

Control symptoms
HOW SOCIAL FACTORS AND MODERN DIET INFLUENCE FOOD CHOICES
THE ECONOMICS OF FOOD CHOICE

The relationship between low socio- economic status and poor health is complicated and
is influenced by gender, age, culture, environment, social and community networks,
individual lifestyle factors and health behaviours.

Population studies show there are clear differences in social classes with regard to food
and nutrient intakes.

Low-income groups in particular, have a greater tendency to consume unbalanced diets
and have low intakes of fruit and vegetables.

This leads to both under-nutrition (micronutrients deficiency) and over-nutrition (energy
overconsumption resulting in overweight and obesity) within the members of a community,
depending on the age group, gender and level of deprivation.

The disadvantaged also develop chronic diseases at an earlier age compared with higher
socio-economic groups; usually identified by educational and occupational levels
LOW-INCOME GROUPS

find it difficult to achieve a balanced healthy diet, are often referred to as experiencing
food poverty or food insecurity

There are many aspects to food poverty but three of the main barriers to eating a
balanced healthy diet include cost, accessibility and knowledge

Low-income groups, who find it difficult to achieve a balanced healthy diet, are often
referred to as experiencing food poverty or food insecurity.

There are many aspects to food poverty but three of the main barriers to eating a
balanced healthy diet include
o
Cost

Reliance on energy-rich, nutrient-poor foods is a consequence of lack
of money to buy wholesome foods.

The price premium on healthy foods also appears to be greater in
low-income areas.
o
Accessibility

Lack of proper cooking facilities in the home increases the need to eat
convenience or take-away foods that have a potentially higher energy
density.

Living on a low income can also present logistical obstacles to eating
well such a lack of transportation.

Public transport is not a viable solution for many, particularly those
with young children or mobility difficulties.
o
Knowledge

A lack of knowledge or too much conflicting information on diet and
health, lack of motivation and the loss of cooking skills can inhibit
buying and preparing meals from basic ingredients.

Experimenting with cooking is a luxury that low- income groups can
ill-afford.

These factors have led to the development of areas known as food deserts.




Factors that can lead to Diet Related Disease
o
Education level
o
Income determine food choices and behaviours
The origins of many of the problems faced by people on low incomes emphasises the
need for a multidisciplinary approach to targeting social needs and improving health
Inequalities.
Factors influencing food choice are not only based upon individual preferences, but are
constrained by circumstances that are
o
Social
o
Cultural
o
Economical
Low-income groups face specific challenges when attempting dietary change and
solutions need to be specifically targeted
MODERN DIETS

relates to ‘Junk food’ that simply means an empty calorie food.

Empty calorie food
o
is a high calorie or calorie rich food which lacks in micronutrients such as
carbohydrates, proteins, vitamins, minerals, or amino acids, and fibre but has
high energy (calories).

do not contain the nutrients that your body needs to stay healthy

has poor dietetic values is considered unhealthy and may be called as junk food.

Junk Food
o
food that is high in fat, sodium, and sugar and provides high calories yet useless
in value is
o
is easy to carry, purchase and consume.

Generally, a modern diet is given a very attractive appearance by adding food additives
and colours to enhance flavour, texture and for increasing long shelf life.
PEOPLE’S DIETS REFLECT THE TIMES AND SITUATIONS IN WHICH THEY LIVE

It is only relatively recent in history that urban- industrial ways of life have evolved, with
many or most people living in towns and cities rather than in the countryside.

In many Caribbean countries most people still live in rural communities, and farmworkeragricultural and urban-industrial ways of life still coexist in most countries.

Such patterns change very rapidly as countries become increasingly urbanized and
industrialized

The different food systems and diets that are part of these diverse ways of life affect the
o
food choices made
o
people’s levels of physical activity
o
body composition and physique
o
life expectancy
o
patterns of disease, including cancer

With the move to urban-industrial ways of life
o
populations have become taller and heavier,
o
their life expectancy has increased
o
they are usually adequately nourished (although poverty. And even destitution,
remains a major problem in most big cities).

On the other hand, urban populations are at increased risk of chronic diseases such as
obesity, type 2 diabetes, coronary heart disease, and also some cancers
Filipino Culture, Values, Practices, and Beliefs applicable in Nutrition
CULTURAL ASPECTS OF DIETARY PLANNING

Food is influenced by many factors.

For most people food is cultural not nutritional

A plant or animal may be considered edible in one society and inedible in another

In many cultures food has social or ceremonial role. Certain foods are highly prized others
are reserved for special holidays or religious feasts still others are a maric of social
position

In different cultures, certain foods are considered “heavy”, some are” light”, some as
“foods for strength”, and some as luxury.

The challenge to healthcare provider is to be culturally adaptable to display cross cultural
communication skills, to remain aware of nonverbal cues that are culturally motives, and
to move toward a trusting interpersonal relationship as quickly as possible

Examples of dietary preferences according to some cultural and religious belets


ASIAN
o
High incidence of lactose intolerance, traditional alternative sources of calcium
include tofu soy milk, small bones in fish and poultry
o
A variety of protein rich in foods are often preserved by salting and drying
o
Make Pastes of shrimp and legumes
o
Wheat and rice and primary gran products
o
Fresh fruits and vegetables, also pickled dried preserved

AFRICAN AMERICAN
o
Diet varies greatly according to the region of the country and lifestyle
o
They have a high incidence of lactose intolerance, low consumption of dairy
products
o
Most popular meat dishes include pork (variety cut fish small game and poultry
o
Frying and boiling are the most common preparation methods
o
Primary grain product is corn
o
Honey, molasses and sugar products are preferred as snacks

LATIN
o
o
o
o


BUDDHISM
o
Vegetarian with pungent foods excluded garlic, leek, scallion, chives and onion
ISLAM
o
o
o

have a high incidence of lactose intolerance, low consumption of dairy products
Vegetable proteins are more common in countries with large rural and urban
poor populations
Principle bread is tortilla
Foods are often heavily spiced
No consumption of unclean foods (carrion or dead animals, swine)
No consumption of animals slaughtered without pronouncing the name of Allah
or killed in a manner that prohibits the complete draining of blood from their
bodies
No consumption of carnivorous animals with fangs, birds of petty, and land
animals without earn (frogs snakes)
HINDUISM
o
vegetarian except in northern Indian where meat is consumed (except for beef).
NATIVE AMERICAN

They have a high incidence of lactose intolerance, low consumption of dairy products

Meat is highly valued, mostly grilled, stewed or preserved through drying and smoking

Primary grain used is corn, wild rice is also popularly consumed
ORTHODON JUDAISM

Prohibits consumption of swine, shellfish, and carrion eaters

Ritual slaughtering of animals

Ritual breaking of bread
FILIPINO DIETARY PRACTICES
How to Eat Like a True Filipino

Everybody in the Philippines knows how much the Filipinos love to eat. Food is more than
real food.

It is an integral part of the culture, community, and celebration that they enjoy sharing with
anyone willing to participate.

To many non Filipinos not familiar with the Philippines, it is challenging to recognize
Pinoy’s food’s look and taste.

Unlike other Asian cuisines like Chinese and Japanese, Philippine cuisine is where
foodies can connect particular tastes with culture.

Neverthetheless, even among Filipinos, it is difficult to explain our food unless we talk of
typical dishes such as adobo, pinakbet, sinigang, and halo halo.
EATING IS TREATED AS A SOCIAL AFFAIR

Rarely will people see members of a Filipino family eating at different times of the day or
eating while fixated solely on the TV screen.

This is because mealtime in Filipino households is supposed to bring the family together.

It is the time to talk, tell each other about their days, and really just interact with one
another. Food in the Philippines brings people together.

This is also the reason a feast is always at the center of any Filipino celebration.
EAT THREE BIG MEALS AND SEVERAL SMALLER ONES IN BETWEEN

Many people are surprised at just how much Filipinos eat in a day.
o
Breakfast, lunch, and dinner are all typically big meals

Filipino breakfast, for example, consists of rice, eggs, and meat).

But don’t think these are enough to satisfy the Filipino appetite. Several snacks, what
Filipinos call merienda, are also eaten in between these big meals.

These snacks are basically anything that isn’t eaten with rice (Le, sweets, pastries,
sandwiches, noodles, etc.).
EAT WITH A FORK AND SPOON

Eating with a spoon instead of a knife is much easier for Filipinos as there is more room
for the rice to rest.

Although knives are usually placed on the table at restaurants, most Filipinos have
mastered how to cut meat using only the edges of their spoon, leaving little use for the
sharper utensil unless bigger cuts of meat, like steak, are served.
KNOW PROPER FOOD FORMATION ON THE PLATE

Filipinos also have a default way of how the food on their plate is arranged.

The rice is centered at the bottom of the plate, close to the eater, and the viands are
arranged around it.


This is the most convenient way since Filipinos will normally take a bit of the viand,
pushing it onto their spoon with the fork, and then portion off a a bigger amount of rice and
pushing it towards their spoon.
Such arrangement requires little utensil movement, mostly needing to only go across the
middle area of the plate..
KNOW HOW (AND WHEN) TO EAT WITH YOUR HANDS

A common Philippine joke is that when food is eaten with hands, it tastes better.

While this doesn’t improve the taste of the food, it makes it far more immersive and
pleasant to eat.

This also makes it possible to eat fish and bone meats.

Although peeling items like shrimp typically require both hands, the actual food portion
only really needs one to be used.

Meat and rice are first portioned on the plate and then mixed with the most significant four
digits.

The thumb pushes the food to the finger to compact it and supports it when the hand
reaches the mouth.

And, eventually, the thumb moves from the protection of the food to the mouth.

Eating with your hands is typically achieved in the comfort of your own home today, at
group gatherings, or in quiet businesses.

In restaurants, people rarely eat with their hands, unless it’s an exceptional seafood or a
“boodle fight” restaurant.
GET CREATIVE WITH SAWSAWAN OR CONDIMENTS

Filipinos are very fond of eating their ulam with sawsawan (condiments) since they enrich
the flavor of the dish.

Among the most famous kinds are fermented shrimp paste, banana (yes, banana)
ketchup, and combinations of soy sauce and kalamansi (lime), fish sauce and kalamansi,
and vinegar and chilli.

Different people have different preferences but the ulam sawsawan pairings will depend
on their tastes, based on how well one complements the other.

So a sweet meat will most likely be paired with vinegar (sour), and a plain tasting kind of
fish might be paired with soy sauce (salty) and kalamansi (sour).
BE AN ADVENTUROUS EATER

Filipino delicacies can appear unusual to some not everybody eats developing bird
embryo or skewered chicken intestines.

But to be able to truly immerse yourself in the rich food culture in the Philippines, it’s very
important to be a fearless eater, willing to try everything at least once.

It’s easy to turn things away when you’ve already given it a chance and decided that It’s
not for you. But otherwise, don’t knock it ‘til you’ve tried it.
NO ANIMAL PART GOES TO WASTE

Filipinos don’t like wasting food and are ingenious when it mes to making sure no animal
body part goes to waste cooking up a dish.

In fact, the nationally-loved dish sisig
o
made mostly of the parts of a pig’s face
o
was first created in an attempt to make use of the unwanted cuts thrown away
by what was then a US Air Force Base in the several don’t be surprised to find
entrails mixed into Filipino dishes

Do you think that lechon (whole roasted pig) is kept whole for aesthetic purposes? No
way! Go pinch off that ear!
INVITE PEOPLE TO EAT WITH YOU – WHETHER YOU MEAN IT OR NOT

In the country where instead of “how are you”, people greet each other with “have you
eaten?”, it is also common courtesy to invite someone to eat when you’re eating.
o
So for example, if someone were having lunch in the office pantry, and his
colleague happened to walk in for a glass of water, the guy eating would
normally say, “Tara, kain (Let’s eat),” simply out of courtesy. To which, the other
person would reply something along the lines of “Later, thanks,” or “Thanks, but
I just ate.”
AVOID TAKING THE LAST PIECE OF FOOD ON A SERVING PLATE

While doing otherwise isn’t exactly offensive, the practice of not taking the last pieces of
food from the center of the table is subconsciously practiced by most Filipinos.

This is mostly out of shyness in case anybody else at the table is still hungry.

Among close friends and family, it’s more common for someone to lightly and jokingly
announce that he’ll be taking the last piece upon doing so.

While in less intimate circles, someone who wants the last piece might first offer it around
the table, and after several refusals, only then take it for himself.
FILIPINO EATING HABITS

Breakfast
o
Either tea or coffee is served in the morning

Tea may be either drunk with lemon, cream, milk, or sugar
o
Rice or food left the night before it’s not reheated. Either rice is eaten as a
porridge-style cereal that can be flavored with a variety of ingredients

eggs, or vegetables in different types.
o
Filipinos have this bread called “Pandesal” that can be bought early in the
morning from vendors.

Merienda
o
is traditionally served around 3:00 pm after a siestas or an afternoon nap.
o
Cakes, farts, bread, and sweets paired with juice or soft drinks are usually
available.

Lunch
o
is usually the main meal of the day, and even today, it can on elaborate affair
with many courses in busy cities, and even in a few minutes,
o
it can be a simple noodle dish or fast food.
o
The lunch time of the Filpinos is 12:00 and 1:00 pm and includes

Soup poultry, meat stew flat ons vegetables served with rice, fruit, or
cakes.
o
The majority of the Philippines’ ethnic foods are made with fish sauce and fish
paste and have slightly pungent tastes.
o
Filipinos love sweet pastry, and with every meal, there is usually a lovely
dessert of fruit, pudding, or cake.
o
Often soft drinks, beer, and/or tea or coffee are consumed with lunch and dinner
Dinner
o
o
o
is served at 6 pm, late at 7:30 pm and typically served and vegetable dish as a
chicken or pork bowl.
Dinner is lighter than lunch.
Fish, pork, or chicken is served with vegetable soup at dinner.
FILIPINO EATING CUSTOMS: WHAT YOU NEED TO CONSIDER

As we all know the Philippine Islands diversity made food easy for fishers, farmers,
hunters, and collectors to reach, but also made it possible to prepare food with some of
the simplest cooking methods
SAY YES TO FOOD

It is never polite to reject food in the Philippines, even though you are already crowded.

Refusal to eat can mean that you do not like o person who gives you food or that you do
not eat from the table.

A snack or meal is appropriate to demonstrate gratitude
SAY A PRAYER BEFORE MEALS

This is taught to the Philippines at an early age, so that Christian dinner tables have
become a popular, but compulsory, custom.

Praying before meal is another way we show respect for the food, and thank you for the
blessings that we have received.
FINAL WORDS

Despite the cliché, nourishment is one thing that brings people and Filipino eating customs
together.

Filipinos are friendly and hospitable at all costs using just one subject for a small
conversation; food.

Local guests, passengers, tourists, and ex-pats are loving the Philippines' company while
eating because we have not only appetite but also uncommon eating habits.
ENTREPRENEURSHIP IN THE FIELD OF NUTRITION & DIETETICS
ENTREPRENEURSHIP

is the process of starting a business or other organization where entrepreneur develops a
business plan, acquires the human and other required resources, and is fully responsible
for its success or failure with the capacity and willingness to develop organize and
manage a business venture along with any of its risks in order to make a profit.

It is a practice and a process that results in creativity, innovation and enterprise
development and growth that refers to an individual’s ability to turn ideas into action
involving and engaging in socially-useful wealth creation through application of innovative
thinking and execution to meet consumer needs, using one’s own labour, time and ideas.
NUTRIENTS AND DIETITICS

Nutrition
o
is the science that interprets the interaction of nutrients and other substances in
food in relation to maintenance, growth, reproduction, health and disease of an
organism.

Dietetics
o
is the interpretation and communication of the science of nutrition where
individual can make practical choices about food and life style in terms of both
health and diseases.
Nutripreneurship/ Dietitian Entrepreneurship

Nutripreneurship
o
is the practice and process that results in creativity, innovation, development
and growth of nutrition businesses.
o
As we know, entrepreneurship

is a self willing and approached business firm which starts with a
limited investment where they paved their own pathway with their
efforts and ideas in their corresponding field.
o
So, in the field of nutrition and dietetics entrepreneurship, a person is termed as:
NUTRIPRENEURS.
o
Nutripreneurs are nutritionists innovators who use a process of changing the
current situation of the existing products and services, to set up new products
and new services.

Basically, Nutripreneurs are the trained and skilled entrepreneurs who may engaged in a
field such as:
o
Private Nutrition/ Diet Clinics.
o
Researcher firms.
o
School Nutrition Facilitators.
o
Gyms and Workout firms Nutrition Counselor.
o
Bloggers, Webinars.
o
Consultant.
o
Nutraceutical based firms.

Nutritionists and Dietitians in private practice are entrepreneurs (Nutripreneurs) and
innovators in providing nutrition products (functional foods and services to consumers,
industry, media, and businesses.)

They can provide MNT (Medical Nutrition Therapy) to individuals and groups in all
populations.
o
They can be chief executive officers, business owners, consultants, professional
speakers, writers, journalists, chefs, educators, health and wellness coaches,
and spokespersons.
o
They can work under contract for organizations and government agencies, such
as health care or food companies, businesses and corporations, employee
wellness programs, and the media.
o
Nutritionists and Dietitians Entrepreneurs can provide comprehensive food (litto
malted products) and nutrition services to individuals, groups, foodservice and
restaurant managers.
o
Food vendors and distributors, athletes, sports teams, and company
employees.
o
They can act as expert witnesses and consultants on legal matters related to
food and nutrition.