BED BATH PROCEDURE

• Bathing can be one of the most enjoyable and refreshing activities of the day for many elderly individuals. For individuals who are confined to bed, a bed bath can provide the same refreshing experience. The bath can also improve blood flow around the individual's body, help ease any discomfort the individual may be experiencing, help the individual relax, and give you, the caregiver, an opportunity to observe the person's needs.

• Bed bathing is an exceptionally good time to inspect the person's skin for pressure areas. These areas can develop in individuals who remain in one position for long periods of time. Circulation may be cut off to certain areas of the body resulting in skin breakdown. This lack of circulation can be a serious problem if not cared for immediately.

• If, while giving a bed bath, you should notice any early warning signs, such as reddened areas on the person's skin, try to place the individual in a position which relieves pressure on that area until the redness goes away. From then on, try to make sure that the person changes position approximately every half hour to minimize the chance of additional pressure areas.

• Elderly individuals should be encouraged whenever possible to assist in the bed bath. You should listen, consider, and follow the older adult's wants and needs, such as the use of body powder, perfumes, and skin lotions. Non-perfumed lotions and powders may be necessary if the person has sensitive skin.

• Privacy should be an important part of the bed bath. The use of a light cover at all times and the closing of doors and curtains to the bedroom helps maintain the individual's sense of privacy.

• A bed bath can be an opportune time to change bed linen. Remember to support the individual during turning. Always keep alert to ensure the person's safety.

• You, as a caregiver, can make the bed bath relaxing and refreshing by following some of the basic procedures listed in this section and by maintaining light conversation with the individual. By being aware of the individual's abilities and limitations and by applying patience and understanding, the bed bath can be enjoyable for both of you.

• In preparation for giving the bed bath, discuss what you will do with the person. Encourage the person to select a change of clothing. Wash your hands before beginning. Be sure your hands are body temperature so as not to shock the person being bathed.

• The basic steps to use when giving a bed bath are outlined as follows:

• Prepare area for bath.

a. Make the room comfortable. Especially notice and adjust the room temperature, if necessary.

b. Close the windows to prevent drafts.

c. Close doors and curtains for privacy.

• Gather supplies and equipment as listed below.

a. Two chairs with hard seats,

b. Wash bowl or large pan,

c. Soap and container (A dish is fine.),

d. Bath towel(s) and wash cloth,

e. Change of clothing,

f. Newspaper (To protect the chair from water), and

g. Body powder, deodorant, and perfume.

• Place chairs close to the bed.

• Cover one chair with newspaper.

• Place the wash bowl, soap, and dish on the newspaper covered chair.

• Use the second chair for the extra bedcovers.

• Remove any extra bedcovers, but leave on a light cover for warmth and privacy.

• Place extra bedcovers on the chair until you are finished with the bath.

• Remove the person's clothing. Invite the person to help.

a. Begin at the top leaving bottom clothing on until the top part of the person has been cleaned, dried, and covered.

b. Remove paralyzed or weakened limbs from clothing last when undressing a person.

c. Remove bottoms by slipping pants down over the legs and off the feet. Ask the person to help by lifting his or her bottom. If the person can't lift, remove clothing one side at a time by turning the individual.

• Cover all the body except the small area being washed.

• Fill the bowl with warm water.

a. Half fill the bowl, and test the water with your elbow.

b. Adjust water temperature as needed.

• To avoid excessively sudsy water, keep the soap in the dish and use with washcloth only as needed.

• Wash the person's face.

a. Place a towel below the person's neck and over the bedcovers.

b. Dampen the washcloth, squeeze out excess water, and give it to the person to wash the face, if possible.

c. If the person cannot manage to wash the face, dampen the wash cloth and squeeze out excessive water. Catch up the washcloth's edges in your hand to avoid dripping water.

d. With the person's eyes closed, wash the eye area wiping from the inner corner toward the ear. Use your forefinger for one eye and your little finger for second eye. You may need to wash each eye several times to remove "matter."

e. Only use soap on the cloth if the person requests it for face washing.

f. Wash in order the forehead, nose, cheeks, and chin.

g. Rinse the wash cloth and the person's face in the same order.

h. Place the wash cloth in the bowl. Pat the person's face dry with a towel. (When drying, do not rub as rubbing could irritate the skin.)

• Wash person's neck and ears.

a. Wet the wash cloth, and hold edges to avoid dripping.

b. Apply soap to wash cloth. Squeeze out excess water.

c. Wash the person's neck and ears, including behind the ears. (Do not use a Q-Tip or any other device to cleanse the ears. If needed, notify a doctor to order an ear lavage by a licensed person.)

d. Rinse wash cloth, and rinse person's neck and ears.

e. Dry person's neck and ears with the towel.

• Wash person's arms.

a. Place a towel under the arm farthest from you.

b. Wet and soap the wash cloth. Squeeze out excess water.

c. Lift the arm to be washed, and support it at the elbow.

d. Wash the arm with long, firm strokes.

e. Wash the underarm while still supporting the elbow.

f. Rinse the wash cloth, and rinse the arm and underarm area following the same procedure.

g. Dry the arm and underarm well.

h. Wash, rinse, and dry the other arm in the same manner.

• Check to see if the person can wash hands with assistance.

a. Place the towel at the person's side, about waist level.

b. Place the bowl of water on the towel.

c. Hold the bowl by one hand to balance it and to prevent spilling water.

d. Place the soap in the person's hand.

e. Place the person's hands into the bowl.

f. Help the person to soap and clean hands.

g. Place soap back into dish, and allow the person to rinse and soak the hands.

h. Remove the person's hands from the bowl. Place hands on towel.

i. Return the bowl to the chair.

j. Dry the person's hands well, especially between the fingers.

k. Trim fingernails, if necessary.

(If the water is exceptionally soapy after this procedure, empty and refill being sure to retest temperature.)

• Wash the person's chest and abdomen.

a. Cover arms with towels.

b. Fold a towel over the blanket at lowest portion of abdomen.

c. Wet and soap the wash cloth. Wring out excess water.

d. Wash the person's chest and abdomen using circular motions.

e. Wash the folds of skin under the person's chest or breasts.

f. Rinse the wash cloth. Rinse and pat dry the person's chest and abdomen. g. Cover the washed areas with a towel.

• Wash the lower front part of the body.

a. Wet and soap wash cloth. Squeeze out excess water.

b. Wash the lower abdomen, using circular motions.

c. Be sure to clean the naval area and any skin folds.

d. Rinse using firm, circular motions.

e. Dry well.

• Wash the person's legs.

a. Uncover the leg farthest from you. Tuck a draping blanket under the closest leg and cover all the person's body except the leg farthest from you.

b. Raise the leg while supporting it behind the knee.

c. Place a towel under the leg.

d. Wet and soap the wash cloth. Squeeze out excess water.

e. Wash the leg with long firm strokes moving from hip to knee.

f. Rinse and dry the upper leg in the same manner. Cover with a towel.

g. Repeat from knee to ankle.

h. Repeat this procedure with the unwashed leg.

i. Drape blanket to cover the person except for the feet.

• Wash the person's feet.

(If someone is able to sit in a chair, do this while the person sits up. Place a tub of water on newspaper. If the tub is large enough, place both feet in the tub to soak. Trim nails after soaking feet.)

a. Help the person to bend a knee to place one foot on the bed.

b. Place a towel on the bed close to the foot.

c. Put the bowl of water on the towel.

d. Balance the bowl of water with one hand to avoid spilling water.

e. Guide the person's foot slowly into the bowl of water.

f. Wash the foot, especially between the toes, with a soapy wash cloth.

g. Rinse and help the person remove the foot from the bowl.

h. Dry foot completely.

i. Follow the same procedure for the unwashed foot.

j. Have the person keep knees bent. Remove wash bowl to the chair. (Check to see if the person can keep knees bent without support.)

k. Straighten the person's legs while providing support behind the knees.

l. Trim nails if needed.

(Nail trimming should not be done for someone with diabetes or who has a circulation problem. Professionals only should provide this service.)

m. Change water.

• Assist person in washing between the legs (perineal area).

a. Cover chest and abdomen with towel.

b. Fold draping blanket to upper thigh level.

c. Place a towel on the bed beneath the person's bottom. Roll the person towards you. Place half the towel on the bed with the second half rolled next to person's bottom. Roll the person away from you, and unroll the towel. Roll the person back.

d. Fold the wash cloth, wet it, and squeeze out any excess moisture.

e. Sparingly soap the cloth.

f. Hand the cloth to the person.

g. Turn your back briefly to give the person privacy.

h. Rinse the cloth when the person finishes washing the perineal area. Allow the person to rinse the just washed areas.

• Wash between the legs if the person is unable to perform the task. (If the person is unable to hold legs apart with knees bent, gently spread the person's legs on the bed.)

a. Repeat Steps a, b, and c, from above.

b. Wet and lightly soap wash cloth.

c. Wash the area with strokes from the front of the person's body to the back.

d. Rinse and resoap cloth after every stroke.

e. Rinse thoroughly, especially the skin folds.

f. Dry completely.

g. Cover for warmth and privacy. Change water.

(If knees are bent, help the person straighten them. Check about the use of powder. Use powder sparingly.)

• Wash the person's back. (The side with the most strength and movement should be washed last for comfort.)

a. Help the person turn over onto the side.

b. Keep person covered for warmth.

c. Fold back the cover to expose the person's back.

d. Fold a towel lengthwise and lay it behind the person on the bed. (The towel can be used as a support to help hold the person.)

e. Wet the wash cloth, and put soap on it.

f. Wash the person's back and the back of the neck using long, firm strokes.

g. Rinse and dry. Apply lotion gently. Remove towel.

h. Turn the person onto the just washed side. Put the towel in place.

i. Wash the side that was not washed earlier.

j. Dry completely. Apply lotion while the person is still on his or her side.

(At this time, check with the person and see if powder or deodorant is desired.)

• Wash the back part of the person's body between the legs.

a. Place the towel beneath or next to the person's bottom.

b. Bend the person's upper leg at the knee.

c. Place a pillow between the person's knees for support.

d. Wet and soap the cloth.

e. Wash hip and then buttocks using a single stroke from the front to the back.

f. Rinse and resoap cloth after each stroke.

g. Rinse thoroughly.

h. Dry completely. Apply lotion.

(Begin bed linen change while the person is lying on his or her side.)

• Put pajama top on the person, or cover with a blanket to ensure warmth and privacy if the person doesn't wear pajamas.

a. Place pajama top on the person starting with any physically involved limb.

b. Keep pajama top loose on top of the person's head while inserting other arm.

c. Pull pajama top down in back by grasping at sides and slowly moving it under the person.

(Check the person's comfort at this time. Be sure wrinkles in pajama top are minimal.)

• Dress the person if the person desires clothing other than pajamas.

a. Check with the person on desired clothing.

b. See the "Dressing" section for guidelines, especially when the person has a
physically involved limb.

INFANT REFLEXES

There are many different reflexes. Some of the most common reflexes that babies have are:

• Rooting Reflex: The rooting reflex is most evident when an infant's cheek is stroked. The baby responds by turning his or her head in the direction of the touch and opening their mouth for feeding.

• Gripping Reflex: Babies will grasp anything that is placed in their palm. The strength of this grip is strong, and most babies can support their entire weight in their grip.

• Toe Curling Reflex: When the inner sole of a baby’s foot is stroked, the infant will respond by curling his or her toes. When the outer sole of a baby’s foot is stroked, the infant will respond by spreading out their toes.

• Stepping Reflex: When an infant is held upright with his or her feet placed on a surface, he or she will lift their legs as if they are marching or stepping.

• Sucking Reflex: The sucking reflex is initiated when something touches the roof of an infants mouth. Infants have a strong sucking reflex which helps to ensure they can latch onto a bottle or breast. The sucking reflex is very strong in some infants and they may need to suck on a pacifier for comfort.

• Startle/Moro Reflex: Infants will respond to sudden sounds or movements by throwing their arms and legs out, and throwing their heads back. Most infants will usually cry when startled and proceed to pull their limbs back into their bodies.

• Galant Reflex: The galant reflex is shown when an infants middle or lower back is stroked next to the spinal cord. The baby will respond by curving his or her body toward the side which is being stroked.

• Tonic Neck Reflex: The tonic neck reflex is demonstrated in infants who are placed on their abdomens. Whichever side the child’s head is facing, the limbs on that side will straighten, while the opposite limbs will curl.

reaction on 4D baby ultrasound

4D BABY ULTRASOUND

What is a 4d ultrasound? It is a medical technique, which is normally used by doctors and nurses during pregnancy, to display 3D/4D dimensional images of the new born baby. It is referred to as a 4D baby ultrasound. Ultrasound is nothing new, but the technology is. Images can vary depending on the position of the baby, amount of fluid present, baby's gestational age, position, and mother's condition. Ultrasound has been around for many years but this 4D baby ultrasound is an evolution.

4D baby ultrasound is very functional to the mother and baby. Most mothers are anxious about their babies.

They worry if the baby is alive, has abnormalities, or what their baby looks like. Some people believe that “seeing is believing”, but because of this 4D ultrasound, they don’t have to worry. I think that the 4D baby ultrasound will have a positive impact during pregnancy and helps the mothers feel closer to the baby. The 4d ultrasound has also many benefits. It can enrich bonding between mommy and baby. The daddy will also be engage in the pregnancy and it increases the bonding of the baby and the daddy because the daddy sees the baby already even if it is still in the womb. It can also determine the gender which helps in planning for the baby and it gives opportunity for the parents to visualize their baby. It also brings excitement to the parents and the relatives. The family can also keep pictures of the baby which can be cherished for a lifetime. The most important thing that this ultrasound can give is it inspires the mother to further care for her health and well-being for the baby. It is very exciting to see your baby yawning, kicking, stretching, having hiccups, or whatever the baby do in the womb. It has been shown that viewing an ultrasound can cause marked improvement in maternal health habits because as what I’ve said, the mother gives further care to the baby because they have bonded with the baby already. The disadvantage of the 4D baby ultrasound is it is quite expensive and only the fortunate people can avail this product.

Technology can really bring change to each and every one of us. We just have to use it in the right manner. , we don’t know what’s going to be invented next, maybe something better than the 4D technology will be invented in the future.

FETAL HEART RATE

FETAL HEART RATE

The goal of fetal heart rate (FHR) monitoring is to detect signs that identify fetal
distress in its early stages. Some of the terms are defined below.

Accelerations

The FHR increases more than 15 BPM for more than 15 seconds. Accelerations usually appear as smooth patterns on electronic fetal monitoring and are a good indication of fetal well-being. Accelerations may be triggered in the normal mature fetus by fetal body motion, sounds, stimulation of the fetal scalp, and other stimuli.

Early decelerations

Early decelerations are normal and common. The deceleration pattern matches the contraction with the most deceleration occurring at the peak of the contraction. The FHR rarely goes below 100 beats per minute. The cause of these decelerations is head compression during uterine contractions.

Late decelerations

Decrease in FHR from the baseline rate with a lag time of greater than 20 seconds from the peak of the contraction to the nadir of FHR deceleration.
They first appear at or after the peak of the uterine contraction. The FHR improves only after the contraction has stopped. These decelerations may be mild or severe based on how low the FHR goes and how long it takes for the FHR to recover. It is thought to be caused by reduced blood flow to the uterus and placenta during a contraction. Late deceleration is associated with uteroplacental insufficiency and is a consequence of hypoxia and metabolic abnormalities. Late deceleration is the most ominous fetal heart rate pattern

Variable deceleration

Variable decelerations are a common type of FHR deceleration in labor and are caused by umbilical cord compression. Up to 80% of fetuses will have variable decelerations during labor. The significance of the these decelerations depends on how low the heart rate drops and how long the episode lasts. Variable decelerations are caused by umbilical cord compression and are classified as severe if they last more than 60 seconds or lead to a FHR of less than 90 BPM.

Severe bradycardia

FHR less than 80 b.p.m.

Persistent severe bradycardia

Severe bradycardia that persists for longer than 5 minutes.

	PARAMETERS	INTERPRETATION
Baseline Heart Rate	120-160 bpm	Normal
Tachycardia Moderate Marked	161-180 bpm >180 bpm	Nonreassuring Abnormal
Bradycardia Moderate Marked	100-119 bpm <100>	Nonreassuring Abnormal
Accelerations	>15 bpm for >15 sec	Stimulation Maternal fever
Decelerations Early Late Variable	10-40 bpm 5-60 bpm 10-60 bpm	Head compression Hypoxia/acidosis Cord Compression NonReassuring

Interventions for late or variable decelerations lasting more than 60 seconds:

1. Reposition patient
2. Administer oxygen by face mask
3. Discontinue oxytocin
4. IV fluids to increase maternal volume
5. Notify physician
6. Vaginal exam to check for prolapsed cord
7. Prepare for emergency cesarean section

COMMUNITY ORGANIZING THROUGH PATICIPATORY ACTION RESEARCH(CO-PAR)

COMMUNITY ORGANIZING THROUGH PARTICIPATORY ACTION RESEARCH
(CO-PAR)

The Philippine Center for population and Development in its effort to support the Department of Health in the implementation of Primary Health Care (PHC), designed the Health Resource Development Program (HRDP) to enable the health training institution e.g. school of medicine, nursing, and midwifery to effectively implement their community-based health programs. HRDP sees Community Organizing (CO) as a tool for people's empowerment in health. It is used to generate community participation and involvement in health activities and to prepare communities to set up their own health programs.

Specifically, community organizing is important in Primary Health Care (PHC) in the following contexts:

1. CO maximizes community participation and involvement
2. CO could be an alternative in situations wherein health interventions in PHC do not require direct involvement of modern medical practitioners.
3. CO gets people actively involved in selection and support of community health workers
4. Through CO, community resources are mobilized for selected health services.
5. CO improves both project's effectiveness during planning, implementation, and ultimate impact.
6. CO is critical in achieving the PHC goal of self-reliance and self-awareness

PRINCIPLES OF COMMUNITY ORGANIZING (CO)

General

1. People, especially the oppressed and exploited sectors are most open to change and are able to bring about change. Along this line, community organizations should be based on the following. a. Power must reside in the people.
   b. Development is fro the people to the people.
   c. People's participation should always be present.
2. Community organization should be for the interest of the poorest sectors of the society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and action.
3. Community organizations should lead to self-reliant communities.

WHEN PEOPLE LEAD, THE LEADERS FOLLOW...

Specific

Community Participation - active involvement of community members in decisions about how to improve the existing conditions or the mobilization of community people to take active part in the delivery of health services.

Levels of Community Participation

Level I

- The people are just physically involved in the implementation of programs designed by the organizing agency.

Level II
- When the people are involve in making a "yes-no" decision to the plans or programs presented by the organizing agency.

Level III
- When working committees are created to make decisions for the community.

Level IV
- Requires the active involvement of the majority of community members in making decisions throughout the entire problem solving process.

Reasons:
- To develop the capability of the people in solving problems.
- To let people acquire people acquire a sense of commitment and ownership/projects implemented.

Indigenous Leadership

Means recognizing the significance of the role of the existing leaders for effective community organizing.

Reason: the leaders have considerable influence in the acceptance of programs/projects.

Intragency Collaboration

Establishing intrasectoral and intersectoral linkaging with other agencies

Reason: the problems affecting the community are so varied and touch on the different aspects of life and no single agency possess all the resources and capabilities to respond to all of these needs/problems.

FIVE CRITICAL DIAGNOSIS

1. Community Diagnosis

It is both a profile and a process.

As a profile, it is a description of a community's state of health as determined by its physical, economic, political, and social factors. It is a definition and statement of problems of the community.

As a process, it is a continuous learning experience for the program coordinator and his/her staff and the community as they analyze and draw action plans regarding their identified problems. With the community diagnosis results, the staff may adjust or after the program for optimum effectiveness.

Community diagnosis can lead to a good start as basis for program planning, implementation and evaluation. it can help prepare the community to prioritize the multiple needs and tasks at hand.

When a program is being set up, a community diagnosis can assist in planning a series of health trainings wherein knowledge and skills are built up at the time that health education activities and medical services are undertaken.

2. Leaders Identification / Core Group Formation

Different leaders are needed in different tasks.

3. Community Mobilization / Organization

Organizing people to act on the identified problems on a sustained level.

4. Resource mobilization / Project Management

The process of systematic identification, selection, acquisition, and utilization of resources towards attainment of project objectives. These resources include the 5M's: Money, Manpower, Man-hour, Materials, and Machine.

5. Value Formation / Clarification and Capability Building

Unjust structures are the creation of people and are products of the greed and egotism that are deeply embedded in human nature, the human spirit, the human spirit must be strengthened to the point that greed and egotism play a less dominant role, this will be done through Self Awareness and Leadership Training(SALT) and Action Reflection in Faith-Action(ARFA).

Consciousness raising and skills enhancement are considered crucial fr the projects / programs' sustainability. This will be achieved by conducting health and research trainings, refresher courses, meetings, seminars, conferences and through guided practice.

PARTICIPATORY RESEARCH

Results in a community diagnosis can best be obtained through the participatory research approach. It is defined as an investigation on problems and issues soncerning the life and environment of the underprivileged, whose representatives participate in the research process as equal partners - that is as researchers themselves, rather than outsiders doing research upon them or upon their problems.

-central element: PARTICIPATION



Phases of COPAR Process:

1. Pre-Entry Phase - is the intial phase of the organizing process where the community organizer looks for communities to serve and help. Acitivities include:

Preparation of the Institution

• Train faculty and students in COPAR.
  
• Formulate plans for institutionalizing COPAR.
• Revise/enrich curriculum and immersion program.
• Coordinate participants of other departments.

Site Selection

• Initial networking with local government.
• Conduct preliminary special investigation.
• Make long/short list of potential communities.
• Do ocular survey of listed communities.

Criteria for Initial Site Selection

• Must have a population of 100-200 families.
• Economically depressed.
• No strong resistance from the community.
• No serious peace and order problem.
• No similar group or organization holding the same program.

Identifying Potential Municipalities

• Make long/short list.

Identifying Potential Barangay

• Do the same process as in selecting municipality.
• Consult key informants and residents.
• Coordinate with local government and NGOs for future activities.

Choosing Final Barangay

• Conduct informal interviews with community residents and key informants.
• Determine the need of the program in the community.
• Take note of political development.
• Develop community profiles for secondary data.
• Develop survey tools.
• Pay courtesy call to community leaders.
• Choose foster families based on guidelines.

Identifying Host Family

• House is strategically located in the community.
• Should not belong to the rich segment.
• Respected by both formal and informal leaders.
• Neighbors are not hesitant to enter the house.
• No member of the host family should be moving out in the community.

2. Entry Phase - sometimes called the social preparation phase. Is crucial in determining which strategies for organizing would suit the chosen community. Success of the activities depend on how much the community organizers has integrated with the commuity.

Guidelines for Entry

• Recognize the role of local authorities by paying them visits to inform their presence and activities.
• Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model.
• Avoid raising the consciousness of the community residents; adopt a low-key profile.
  

Activities in the Entry Phase

• Integration - establishing rapport with the people in continuing effort to imbibe community life.
  
  • living with the community
  • seek out to converse with people where they usually congregate
  • lend a hand in household chores
  • avoid gambling and drinking

• Deepening social investigation/community study
  • verification and enrichment of data collected from initial survey
  • conduct baseline survey by students, results relayed through community assembly

Core Group Formation

• Leader spotting through sociogram.
  

  Key persons - approached by most people
  Opinion leader - approach by key persons
  Isolates - never or hardly consulted

3. Organization-building Phase

Entails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating community-wise activities. It is at this phase where the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their own concerns/programs.

Key Activities

• Community Health Organization (CHO)
  • preparation of legal requirements
  • guidelines in the organization of the CHO by the core group
  • election of officers
• Research Team Committee
• Planning Committee
• Health Committee Organization
• Others
• Formation of by-laws by the CHO
  

4. Sustenance and Strengthening Phase

Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different committees setup in the organization-building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs, with the overall guidance from the community-wide organization.

Key Activities

• Training of CHO for monitoring and implementing of community health program.
• Identification of secondary leaders.
• Linkaging and networking.
• Conduct of mobilization on health and development concerns.
• Implementation of livelihood projects.