Question

1. As a community health nurse, how do you promote health in a 56 year old man with no significant medical history and with a body mechanic index (BMI) of 36.

2. As a community health nurse, how do you promote health in pregnant women?

3. As a community health nurse what effective method will you utilize in order to provide health teachings/health education to families in a community where you are assign? Explain why?

Answer 1

Question 1

Explain to be patient that his BMI indicates obesity.Explain to him about the ill effects of obesity such as increased risk for developing heart disease, diabetes mellitus,hypertension etc.Since obesity is caused by interaction of several factors such as lifestyle, behavioral and genetics, intervention should be done at various levels.Listen to patient's views and experiences .This will help to assess their willingness to change.If the patient is not willing for weight reduction at this point, tell him that he can come back at any time or give him information on where to seek help when needed.

If he is willing for weight reduction,

- encourage healthy eating

A diverse diet from the 5 food groups, more from group 1and 2 ,than from 4 and 5

Group1 :-fruits and vegetables .5 portions a day,each portion 80g

Group 2:- bread,other cereals and potatoes. One third of total food intake

Group 3:-milk and milk products. 2-3 servings per day

Group 4:- fish,meat.Moderate amounts recommended.2 portions of fish each week.Vegetarians should include other sources of protein

Group 5:- fatty and sugary foods.Sparingly.

-increase physical activity and decrease sedentary behavior

Moderately intensive activity for 150 minutes over aa week

-increase self awareness about day to day behaviours

-Make time to clarify patient's expectations

-discuss on options how to support weight reduction

Provide details about community dieticians and weight reduction protocols.

Protocols should include:-

Advice on reducing calorie intake by about 600kcal /day to total of 1200-1600kcal/day,decreased fat intake with increased fruits and vegetables intake.The aim should be to achieve moderate weight loss in about 12 weeks time.

Specific foods to include and avoid should be explained with detailed menu sheets

Advice should be supported by weight management information leaflets,activity and food diaries etc

Regular follow up and assessment should be done

Question 2

Antenatally classes should be given on antenatal care and preparation for parenthood.The aim of the classes at to provide realistic information on what they should expect,to provide skills for them to cope with the labor, to discuss the emotional and social aspects of birth and parenthood, and to prepare them to take care of their baby.

The contents of the classes are growth and developing of fetus and what the pregnant lady should expect, antenatal tests/screening tests , healthy eating during pregnancy, how to prepare for delivery and what things to take to the hospital, how to identify labor signs and when to seek advice, common pain relief measures available during labor, breastfeeding and care of baby, problems during postnatal period and how family can help.

Women should be advised to have antenatal visits regularly. Before 12 weeks,an initial visit to do a dating scan and tests such as complete blood count, blood grouping and Rh typing, screening for Syphilis,HIV,hepatitis and rubella.At around 14 weeks, nuchal translucency scan.At around 18-20 weeks, to do an anomaly scan.At 28 weeks,to take anti D injection, if she is Rh negative. At 34,36,38 weeks to assess the maternal and fetal conditions.

Iron,folic acid and calcium tablets should be taken as advised by the obstetrician.

There can be difficulties such as nausea, vomiting and indigestion in first trimester.Give advise on when to seek medical help.Advise on taking small,frequent foods throughout the day,avoid caffeine, spicy food.Consult the doctor if she is vomiting more than 4 times a day and losing weight.Plenty of fluids to be taken.An additional 350kcal of energy and 78 grams of protein per day is needed and food intake should be advised accordingly.