Unit 6

UNIT 6
ASSISTING INDIVIDUALS AND GROUPS TO PROMOTE AND MAINTAIN HEALTH
A. ASSESSMENT OF SELF AND FAMILY
GROWTH AND DEVELOPMENT
Growth:
It is the process of physical maturation resulting an increase in size of the body and
various organs. It occurs by multiplication of cells and an increase in in intracellular substance. It
is quantitative changes of the body
Development:
It is the process of functional and physiological maturation of the individual. It is

progressive increase in skill and capacity to function. It is related to maturation and myelination
of the nervous system. It includes psychological, emotional and social changes. It is qualitative
aspects
Principle of Growth and Development:
1. Cephalocaudal direction:
The process of cephalocaudal direction from head down to tail. This means that
improvement in structure and function come first in the head region, then in the trunk,
and last in the leg region
2. Proximodistal direction:
The process in proximodistal from center or midline to periphery direction.
development proceeds from near to far - outward from central axis of the body toward the
extremities
3. General to Specific:
 Children use their cognitive and language skills to reason and solve problems.
 Children at first are able hold the big things by using both arms, In the next part
able to hold things in a single hand, then only able to pick small objects like peas,
cereals etc.
 Children when able to hold pencil, first starts draw circles then squares then only
letters after that the words
 Development proceeds from general to specific responses
Factor influencing Growth and Development:
1. Genetic factors:
 Genetic predisposition is the importance factors which influence the growth and
development of children.
 Sex
 Race and Nationality
2. Prenatal factors:
Intrauterine environment is an important predominant factor of growth and
development. Various conditions influence the fetal growth in utero:
 Maternal malnutrition
 Maternal infection
 Maternal substance abuse
 Maternal illness
 Hormones
 Miscellaneous
3. Postnatal factors:
 Growth potential
 Nutrition
 Childhood illness
 Physical environment
 Psychological environment
 Cultural influence
 Socio economic status
 Climate and season
 Play and exercise
 Birth order of the child
 Intelligence
 Hormonal influence
GROWTH AND &DEVELOPMENTAL AGE PERIODS:
1. Infancy:
 Neonate: birth to one month
 Infancy: one month to one year
2. Early childhood:
 Toddler: 1-3 years
 Preschooler: 3-6 years
3. Middle childhood:
 School age: 6-12 years
4. Late childhood:
 Adolescents : 13 years to approximately 8 years
GROWTH AND DEVELOPMENT MONITORING:
1. Assessment of Growth:
a. Weight:
☻ Weight is one of the best criteria for assessment of growth and a good
indicator of health and nutritional status of child.
☻ Among Indian children, weight of the full terms neonate at birth is
approximately 2.5 kg to 3.5kg.
☻ there is about 10% loss of weight first week of life, which regains by 10 days
of age
☻ Then, weight gain is about 25- 30 gm per day for 1st 3 month and 400gm/
month till one year of age.
☻ The infants double weight gain their birth weight by 5month of age, trebled by
one year, fourth time by two years, five times by three year, six times by five
year, seven times by seven year and ten times by ten year.
☻ Then weight increases rapidly during puberty followed by weight increase to
adult size
b. Length and height:
☻ Increase in height indicates skeletal growth. Yearly increments in height
gradually diminished from birth to maturity.
☻ At birth average length of a healthy Indian newborn baby is 50 cm.
☻ it increases to 60 cm at 3 months, 70 cm of 9 month and 75 cm at one year of
age
☻ In second year, there is 12 cm increase, third year it is 9 cm, fourth year it is 7
cm and in fifth year it is 6 cm.
☻ so the child double the birth by 4 to 4.5 years of age afterwards there is about
5 cm increase in every year till onset of puberty
c. Body Mass index (BMI):
☻ It is an important criteria which helps to assess the normal growth or its
deviations i.e. malnutrition or obesity.
☻ BMI =Weight in Kg/(Height in meter) 2
☻ BMI remains content up to the age of 5 years. If the BMI is more than 30
kg/m2, it indicates obesity and if it is less then 15Kg/m2 , it indicates
malnutrition
☻ BMI Categories:
 Underweight = <18.5
 Normal weight = 18.5–24.9
 Overweight = 25–29.9
 Obesity = BMI of 30 or greater 30
d. Head circumference:
☻ It is related to brain growth and development of intracranial volume. Average
head circumference measured about 35 cm at birth.
☻ At 3 months it is about 40 cm, at 6 month 43 cm, at one year 45cm, at 2 years
48 cm, at 7 year 50 cm and at 12 years of age it is about 52 cm, almost same a
adult
☻ If head circumference increase more than 1 cm in two weeks during the first 3
month of age then hydrocephalus should be suspected.
☻ Head circumference is measured by ordinal tap, placing it over the occipital
protuberance at the back, above the ear on the side and just over the
supraorbital ridges in front measuring the point of height circumference
e. Fontanelle Closure:
☻ At birth, anterior and posterior fontanelle are usually present. Posterior
fontanelle closes early few weeks(6-8week) of age.
☻ The anterior fontanelle normally closes by 12- 18 months of age. Early
closure of fontanelle indicates craniostenosis due to premature closure of skull
sutures
f. Chest circumference:
☻ chest circumference or thoracic diameters is an importance parameter of
assessment of growth and nutrition status.
☻ At birth it is 2-3cm less than head circumference. At 6 to 12 months of age
both become equal.
☻ After first year of age, chest circumference is greater than head circumference
by 2.5 cm and by the age of 5 year, it is about 5 cm larger than head
circumference
☻ Chest circumference is measured by placing the tape measure around the chest
at level by placing the tape measure around the chest at the level of the nipple,
in between inspiration and expiration
g. Mid Upper Arm Circumference (MUAC):
☻ This measurement helps to assess the nutritional status of younger children.
☻ There is growth due to inadequate nutritional, which can be this simple
particle and useful measurement
☻ The average MUAC at birth is 11 to 12 cm, at one year of age it is 12 to 16
cm, at 1 to 5 years it is 16 to 17 cm, at 12 years it is 17 to 18 cm and at 15
years it is 20 to 21cm
h. Eruption of teeth:
☻ There is a variation for the time of eruption of teeth. First teeth commonly the
lower central incision may appear in 6 to 7 months of age.
☻ It can be delayed even up to 15 months, which also can be considered within
the normal range of time for teething.
☻ So dentition is not dependable parameters for assessment of growth.
☻ There are ‘two sets of teeth, temporary teeth bigger in size for two sets of
teeth
i. Osseous growth:
☻ Bony growth follows a definite pattern and time schedule from birth to
maturation.
☻ It is calculated by the appearance of ossification center by X – ray study.
☻ Skeletal maturation or bone growth is an indicator of physiological
development and continue up to 25 years of age
Growth monitoring:
☻ Assessment of growth may be done by longitudinal & cross sectional studies. The
common parameters used for growth monitoring include, head circumference, chest
circumference, UL/LS ratio. The following are the 3 measures used for comparisons:
 Use of mean/median values.
 Use of percentile
 Use of indices as weight for height & weight for age.
 Common reference values: WHO reference value & Indian standards
Indian standards:
 ICMR under took a national wide cross sectional study during the year 1956- 1965. this
tool is widely used in India as the reference value to assess growth
2. Assessment of development:
Normal development is a complex process & has a multitude of facets. However, it is
convenient to understand & assess development under the following domains:
A. Gross motor development:
Motor development progress in an orderly sequence to ultimate attainment of
locomotion & more complex motor tasks thereafter. In an infant it is assessed &
observed as follows:
B. Fine motor skill development:
Fine motor development upon neural tract maturation. Fine motor development
promotes adaptive actives with fine sensorimotor adjustments and include eye
coordination, hand eye coordination, hand to mouth coordination, hand skill as
finger thumb apposition, grasping, dressing etc.
C. Personal & social development:
Personal and social development includes personal reactions to his own social and
cultural situations with neuromotor maturity and environment stimulation. It is related
to interpersonal and social skill as social smile, recognition of mother, use of toys
Assessment of Development:
 Healthy development, in all forms, particularly social/emotional, communication, and

behavior, should be monitored by parents and physicians through screenings at each well
visit
1. The Denver Developmental screening test:

Developmental originally by Franken – burg and dodds(1967), this simple,
economic and useful test screens for developmental delays during infancy and the
preschool period.
On the test, the age division are monthly unit 2 years of age , and half yearly from
2 to 6 years of age
2. Baroda Screening test:
It was developed by Dr. Promila phatak with 25 test items primarily for
psychological aspects. The test is relevant for age 0 to 30 months. Gross motor,
fine motor and cognitive aspects are evaluated in 10 mints mainly by the
psychologist
3. Trivandrum development screening test:
It is simplified version of Baroda DST that can be used by the health worker,
nurses and pediatricians/ physicians. It has17 test items relevant for 0 to 2 years of
age. The children are evaluated in three domains ( gross motor, fine motor and
cognitive for 5 minutes only)
BREAST SELF EXAMINATION
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms
on your hips.
Here's what you should look for:
 Breasts that are their usual size, shape, and color
 Breasts that are evenly shaped without visible distortion or swelling
If you see any of the following changes, bring them to your doctor's attention:
 Dimpling, puckering, or bulging of the skin
 A nipple that has changed position or an inverted nipple (pushed inward instead of sticking
out)
 Redness, soreness, rash, or swelling
 Step 2: Now, raise your arms and look for the same changes.
 Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both
nipples (this could be a watery, milky, or yellow fluid or blood).
 Step 4: Next, feel your breasts while lying down, using your right hand to feel your left
breast and then your left hand to feel your right breast. Use a firm, smooth touch with the
first few finger pads of your hand, keeping the fingers flat and together. Use a circular
motion, about the size of a quarter.
 Cover the entire breast from top to bottom, side to side — from your collarbone to the top
of your abdomen, and from your armpit to your cleavage.
 Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple,
moving in larger and larger circles until you reach the outer edge of the breast. You can
also move your fingers up and down vertically, in rows, as if you were mowing a lawn.
This up-and-down approach seems to work best for most women. Be sure to feel all the
tissue from the front to the back of your breasts: for the skin and tissue just beneath, use
light pressure; use medium pressure for tissue in the middle of your breasts; use firm
pressure for the deep tissue in the back. When you've reached the deep tissue, you should
be able to feel down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the
easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step
in the shower. Cover your entire breast, using the same hand movements described in step 4.
EXAMINATION OF TESTICLES
Self-examination of the testes is important for early detection of testicular cancer. The
most common method of early detection is performing a monthly exam. Since TC is usually
isolated to a single testicle, comparison of your testicle with the other can be helpful. It is normal
for one testicle to be slightly larger than the other. Your focus should be noticing any changes
from the previous month.
Upon reaching puberty, all men should conduct a monthly testicular self-exam and ask
your doctor during your yearly physical to perform one as well
It is best to carry out testicular self-examination after a warm bath or shower. Warmth
relaxes your scrotum, making it easier to feel anything abnormal.
STEPS:
 Stand in front of a mirror
 check for any external swelling on the skin
 Examine each testicle with both hands. Place your index and middle fingers under your
testicle with your thumbs placed on top. Roll each testicle gently between your thumbs
and fingers. You should not feel any pain when doing this. Do not be alarmed if your
testicles are not exactly the same size
 Find the epididymis, a soft tube-like structure behind the testicle that collects and carries
sperm. If you are familiar with this structure, you will not mistake it for a suspicious
lump. Cancerous lumps are usually found on the sides or in front of the testicle. Lumps in
the epididymis are virtually never cancerous.
If you find a lump, ask to see a doctor right away. The abnormality may not be cancer but could
simply be an infection. If it is testicular cancer, it will spread if it is not stopped by treatment.
Waiting and hoping will not fix anything. Free-floating lumps in the scrotum that are not
attached to your testicle are not cancerous.
What other abnormalities may be important?
 any enlargement of a testicle

 significant loss of size in one of the testicles
 feeling of heaviness in the scrotum
 dull ache in the lower abdomen or in the groin
 sudden collection of fluid in the scrotum
 pain or discomfort in a testicle or in the scrotum
URINE FOR SUGAR AND ALBUMIN TEST
ARTICLES REQUIRED:
 Container for specimen

 Benedict solution
 Acetic acid
 Test tubes & holder.
 Kidney tray
 Paper bag
 Spirit lamp with spirit
 Newspaper
 Matchbox
 Cotton balls in bowl
PROCEDURE : -
 Select a proper place.

 Spread the newspaper.
 Unbutton the bag.
 Take out the kidney tray and specimen bottle
 Give the specimen bottle to the client for collecting urine.
 Take out hand washing articles and wash the hands
 Take the articles required for the test
Test for sugar : -
 Pour 5 ml of benedict’s solution in the test tube.

 Boil it to find out the color change, if no change that shows the purity of benedict’s
solution.
 Add 8 drops of urine into the solution and reheat it; allow it to cool.
 Observe the color change which indicates the sugar level.
 Blue : 0%
 Green : 1%
 Yellow : 2 %
 Orange : 3 %
 Brick red : 5%
Test for albumin:-
Fill the test tube 3/4th with urine, check the reaction, if it is alkaline make it
acidic.
Boil the top portion.
If there is cloudy appearance it indicates albumin/phosphate.
Add 5 drops of acetic acid & reheat.
If cloud still presents it indicates albumin presence and if it disappears it shoes
phosphate presence
Termination of articles:-
After the procedure it is essential to terminate the articles in a proper manner.

After the result, recording & reporting, dispose the urine sample, as well as the liquid
from the used test tube.
Take the articles to the hand washing area.
Wash each article clearly.
Put the articles on newspaper for drying up.
Wash your hands
Give health education
Wipe all the articles with spirit swab before placing them into the bag
Replace all the articles
Close the bag
Fold the newspaper and place it in the outer pocket
ESTIMATION OF BLOOD PRESSURE
WHAT IS BLOOD PRESSURE?

Blood pressure (BP) is a measure of the force that the circulating blood exerts against the
arterial wall.
SYSTOLIC PRESSURE:
 Systolic pressure is the maximum pressure exerted by the blood against the arterial walls.
 It results when the ventricles contract ( systole )
DIASTOLIC PRESSURE:
 Diastolic Pressure is the lowest pressure in the artery.
 It result when the ventricles are relaxed (diastole )
Time of measurement:
 Use multiple readings at different times during the waking hours of the patient.
 For patient taking antihypertensive medications monitoring of blood pressure should be
done before taking the scheduled dose.
Patient position:
 BP should be measured in sitting position. Patient should sit for 5 minutes before
measuring BP.
 In elderly, supine and standing position can be used to detect postural hypotension.
Where to listen for blood pressure sounds:
1. Locate the antecubital fossa of the patient’s arm and palpate the brachial artery. This
location is the point over which the stethoscope is placed to listen for Korotkoff sounds
later.
2. Wrap the cuff approximately 2.5 inch above the antecubital fossa.
Determining the palpated systolic pressure and the maximum inflation level:
3. While palpating the radial pulse, inflate the cuff until you feel the radial pulse disappear.
Note the pressure on the manometer at this point and rapidly deflate the cuff.
4. Measurement of BP 4- Place the stethoscope lightly over the brachial artery and inflate
the cuff to a pressure 30 mm Hg greater than estimated systolic pressure.
5. Deflate the cuff slowly at a rate of 2 mm Hg per heartbeat.
6. Systolic pressure equal the pulse first heard by auscultation
7. Deflate the cuff until the sounds become muffled and then disappear. The disappearance
of sound estimate the diastolic pressure.
8. Record the blood pressure reading in even numbers. Note patient’s position, cuff size,
and arm used for measurement.
Korotkoff sounds:
These noises are produced from under the distal half of the BP cuff between systole and
diastole because the artery collapses completely and reopens with each heartbeat. As the
artery wall rapidly opens it causes a snapping or tapping sound (like the sail of a boat
snapping in the wind).As the cuff pressure falls below the diastolic pressure, the sound
disappears as the vessel wall no longer collapses but gently expands with each beat. The first
appearance of the sound (phase 1) indicates systole. As the pressure is reduced, the sounds
muffle (phase 4) and then disappear (phase 5). Inter-observer agreement is better for phase 5
and this is recorded as diastolic BP. Occasionally muffled sounds persist (phase 4) and do not
disappear; in this case, record phase 4 as the diastolic pressure.
RECOMMENDED BLOOD PRESSURERECOMMENDED BLOOD PRESSURE
MEASUREMENT TECHNIQUEMEASUREMENT TECHNIQUE:
 The patient should be relaxed and the arm must be supported
 Ensure no tight clothing constricts the arm
 The cuff must be level with heart.
 If arm circumference exceeds 33 cm, a large cuff must be used.
 Place stethoscope diaphragm over brachial artery
 The column of mercury must be vertical
 Inflate to occlude the pulse
 Deflate at 2 to 3 mm/s. Measure systolic (first sound) and diastolic (disappearance) to
nearest 2 mm Hg
Common problems in BP measurement:
 BP different in each arm: A difference >10 mmHg suggests peripheral vascular disease
and raises the possibility of renal artery stenosis as the cause of hypertension. Record the
highest pressure and treat this
 Wrong cuff size: A cuff of 12.5 × 23 cm is suitable for only 60% of Europeans. The
bladder should encircle between 80% and 100% of the arm. In obese patients with large
arms a normal-sized cuff will over- estimate BP and the error is greater when the centre
of the cuff is not over the brachial artery. Therefore for obese patients a larger cuff must
be used. Using too large a cuff produces only a small under-estimation of BP (2-3 mm in
systolic BP)
 Auscultatory gap: Up to 20% of elderly hypertensive patients have phase 1 Korotkoff
sounds which begin at systolic pressure but then disappear for varying lengths of time,
reappearing before diastolic pressure. If the first appearance of the sound is missed, the
systolic pressure will be recorded at a falsely low level. Avoid this by palpating the
systolic pressure first
 Excess pressure of stethoscope: Excess pressure can artificially lower the diastolic
reading by 10 mmHg.The systolic pressure is not usually affected
 Patient's arm at the wrong level: The patient's elbow should be level with his heart.
Hydrostatic pressure effects mean that if the arm is 7 cm higher, both systole and diastole
pressures will be 5 mmHg lower. If the arm is 7 cm lower than the heart, they will be
about 6 mm higher
 Postural change: When a healthy person stands, the pulse increases by about 11 bpm
and stabilizes after 1 min.The BP stabilizes after 1-2 min. Check the BP after a patient
has been standing for 2 min; a drop of ≥20 mmHg on standing is postural hypotension
 Abnormal pulse pressure: The pulse pressure is the difference between the systolic and
diastolic pressures. A pulse pressure of ≥80 mmHg suggests aortic regurgitation, while a
low pulse pressure may occur in aortic stenosis.
BLOOD SUGAR ESTIMATION WITH GLUCOMETER
Time Required: 10 to 15 minutes

STEPS:
1. First, set out your glucometer, a test strip, a lancet and alcohol prep pad.
2. Wash your hands to prevent infection.
3. Decide where you are going to obtain the blood from, usually a finger. Some of the newer
monitors let you use your forearm or another less sensitive place.
4. Sometimes it helps to warm your hands first to make the blood flow easier. You can rub
your hands together briskly or run them under warm water.
5. Turn on the glucometer and place a test strip in the machine when the machine is ready.
Watch the indicator for placing the blood to the strip
6. Make sure your hand is dry and wipe the area you've selected with an alcohol prep pad
and wait until the alcohol evaporates.
7. Pierce your finger tip on the soft, fleshy pad and obtain a drop of blood. The type of drop
of blood is determined by the type of strip you are using (some use a "hanging drop" of
blood versus a small drop for strips that draw blood in with a capillary action)
8. Place the drop of blood on or at the side of the strip.
9. The glucometer will take a few moments to calculate the blood sugar reading. Follow
your doctor's orders for whatever blood sugar reading you get.
10. You may use the alcohol prep pad to blot the site where you drew the blood if it is still
bleeding.
11. Write down your results. Keeping a record makes it easier for you and your doctor to
establish a good treatment plan. Some glucometers can store your results in a memory,
for easier record keeping.
HEALTH ASSESSMENT OF INFANT FROM 2-6 MONTHS

I. Demographic profile:
a) Name
b) Age
c) Date of birth
d) Sex
II. History of the child:
a) Family history
b) Antenatal history
c) Natal history
d) Postnatal history
e) Immunization history
Vaccine Weeks Dose 0 Dose 1 Dose 2 Dose 3
BCG
OPV
Hepatitis
DPT
Measles
GROWTH AND DEVELOPMENT ASSESSSMENT:
SL. BOOK PICTURE CHILD’S REMARKS

NO. PICTURE
1. BIOLOGICAL DEVELOPMENT:-
 Weight: 3-6kg
 Height: 50-60cm
 Head circumference: 40-45cm
 Chest circumference: 40-42cm
FORMULA TO CALCULATE WEIGHT FOR AGE:
Weech’s Formula
For infants <12 months:
Weight (kg)= (age in months+9)
2
APLS FORMULA:
2
Vital signs:
 Temperature: 990F
 Pulse: 1220-140b/mt
 Respiration: 30-40breaths/ mt
 Blood pressure: 90/60mmHg
2. MOTOR DEVELOPMENT:-
a) Gross Motor:
 When lying prone, lifts head almost 450 above
 Turns from side to back
 Symmetric posture of head and body
 Very slight head lag when pulled from supine to
sitting position
 When in prone, raises chest supported on forearms
 Holds head erect and steady
 Attempts to roll over (front to back)
 Rolls from back to front
 Pulls feet upto mouth when supine
 While sitting with support, sits back rounded and
knees flexed position
 Sits alone briefly if placed in a favorable leaning
position
 Springs up and down when sitting
 Lifts chest and upper abdomen when prone putting
the weight on the arms and hands
b) Fine Motor:
 Hands may be open or closed loosely
 Holds rattle briefly when placed in the hand
 Holds hand in front of face and stares at them and plays
with fingers
 Carries hand or objects to mouth at will
 Grasps objects with both hands
 Drops one object when another is offered
 Manipulates small objects
 Grasps with simultaneous flexion of fingers
 Begin to bang objects that are held (rattles, spoon, toys)
3. SENSORY DEVELOPMENT:
 Turns head to side when a sound occurs at ear level
 Eyes follow moving person nearby
 Localizes sounds made above the ear
 Beginning ability to coordinate various sensory stimuli
4. PSYCHOSOCIAL DEVELOPMENT:
“Sense of Trust vs Mistrust”
 Mutual regulations of mother and infant
 Trust occur by mother or caregiver
 Smiles back in response to another smile
 Shows eagerness when mother comes to breast feed or
feeding bottle appears
5. PSYCHOSEXUAL DEVELOPMENT:
Oral stage: ( 0-1yr)
(Oral dependant stage or passive stage.)
 Oral pleasure
 Baby get satisfaction with sucking
 Enjoy with sucking breast, finger and pacifier
6. SPIRITUAL DEVELOPMENT:
Undifferentiated (0-1yr)
 They are not able to recognize faith
7. INTELLECTUAL DEVELOPMENT:
Sensorimotor stage:
Substage 2(1-4months)
a) Substage 2:
Primary circular reactions:
The beginning of voluntary actions replacing reflexive
behavior.
b) Substage 3:
Secondary circular reactions:
 Events that occur by accident in the environment are
repeated by the infant if they produce interesting
results
 Objective permanence begins
8. MORAL DEVELOPMENT:
Level- 1: pre conventional morality: stage : 0
 The good is what I like and I want
9. LANGUAGE DEVELOPMENT:
 Recognizes familiar words
 Cries easily on slight or no provocation
 Vocalizes syllables
10. PLAY:
Unoccupied play:
 It indicates no play activity in the usual sense of word
HEALTH ASSESSMENT OF INFANT FROM 7-12 MONTH
a) Name
b) Age
c) Date of birth
d) Sex
f) Family history
g) Antenatal history
h) Natal history
i) Postnatal history
j) Immunization history
Vaccine Weeks Dose 0 Dose 1 Dose 2 Dose 3
BCG
OPV
Hepatitis
DPT
Measles
III. GROWTH AND DEVELOPMENT ASSESSSMENT:

NO. PICTURE
 Weight: 7-10kg
 Height: 65-70cm
 Head circumference: 40-45cm
 Chest circumference: 40-42cm
WEECH’S FORMULA
For infants <12 months:
2
APLS FORMULA:
2
Vital signs:
 Temperature: 990F
 Pulse: 1220-140b/mt
 Respiration: 30-40breaths/ mt
 Blood pressure:110/70mmHg
a) Gross Motor:
 Sits alone on hard surface steadily
 Pulls self into standing position with help
 Hand eye coordination perfected
 Crawls instead of hitching
 Moves from prone to sitting position
 Creeps well
 Stands erect with minimal support
 Walks holding on to furniture
 Stands alone for variable length of time
 Sits down from standing position alone
b) Fine Motor:
 Holds two toys at once

 Transfers a toys from one hand to the other
 Imitates simple acts of others
 Bangs objects that are held
 Holds cup
 Drinks from cup with assistance
 Pokes objects with fingers
 Attempts to use a spoon but spills contents
 Develop spincer grasp
 Explore toys and other objects more easily
 Removes covers from boxes
 Beginning to hold crayon
 Enjoys eating with fingers
 Turns pages in a book
 Transfers the objects more easily
3 SENSORY DEVELOPMENT:
 Listen for recurring sounds
 Follows fast moving objects with eyes
 Has preference in taste for foods
“Sense of Trust vs Mistrust”
 Responds socially to own name
 Emotionally instable
 Increased fear of strangers
 Capacity to discriminate between family members
and strangers
 Attachment developed through primary caregiver
 When disliked food offers, lips are closed tightly
Oral stage: ( 0-1yr)
 Oral aggressiveness is evidenced
 Reality principles
Undifferentiated (0-1yr)
 They are not able to recognize faith
Sensorimotor stage:
Substage 4 (8-12 months)
c) Substage 3:
Secondary circular reactions:
 Intentional thought develops
 Object permanence develops
d) Sub stage 4:
Coordination of secondary schemas:
 Learns to deal with new situations
 Perceptions of space
 Object permanence present
 Beginning to responds to simple commands
 Cries when scolded
 Imitates specific speech and sounds
 Speaks 2 or more words
10. PLAY:
Unoccupied play:
 No play activity in the usual sense of world
Onlooker play:
 A child watches others play but doesn’t engage in
that play
HEALTH ASSESSMENT OF TODDLER (1-3 yrs)
a) Name
b) Age
c) Date of birth
d) Sex
e) Family history
f) Antenatal history
g) Natal history
h) Neonatal history

NO. PICTURE
1 BIOLOGICAL DEVELOPMENT:-
 Weight: 10-12kg
 Height: 80-90cm
 Mid arm circumference: >12.5cm
 Anterior fontanelle: closed
WEECH’S FORMULA
1-6yrs: Weight (kg)= (age in years x 2)+8
APLS FORMULA:
1-5 YRS: 2 X (age in yrs + 5)
FORMULA TO CALCULATE HEIGHT FOR AGE:
WEECH’S FORMULA
1-12yrs:Height=(age in yrs x 6)+77
Vital signs:
 Temperature: 98.40F
 Pulse: 100-110b/mt
 Respiration:20-30breaths/ mt
2 MOTOR DEVELOPMENT:-
a) Gross Motor:(1-2yrs)
 Able to walk without support
 Kneels without support
 Able to creeps up stairs
 Walks sideways and backward
 Runs stiffly, often falls
 Jumping attempted using both feet
 Seats self in small
 Climbs on furniture
 Pushes light furniture around room
 Throws ball over hand without falling
Gross motor(2-3yrs):
 Stands on one foot at one
 Walks on tip toe for few steps
 Jumps from step or low chair
 Rides a walker or pedal
 Picks up objects from floor without losing balance
b) Fine motor( 1-2yrs):

 Builds a tower of 2-3 cubes
 Opens boxes in whole
 Scribbles spontaneously
 Inserts pellets in narrow necked bottle
 Turns pages in a book
 Transfers object hand to hand
 Opens door by turning door knob
 Folds paper once imitatively
Fine motor (2-3 yrs):

 Builds tower of 8 cubes
 Able to imitate vertical or circular strokes
 Has good hand finger coordination
 Holds crayon with fingers
c) Self care:
 Self feeding with occasional spilling
 Plays with food
 Gets a drink without assistance
 Chews with mouth closed
 Imitates eating habits of others
 Puts arms through large armhole
 Verbalizes toilet needs
 Turns head to side when a sound occurs at ear
level
 May respond to unpleasant odors
 Develop the sensation of touch and pain
 Normal hearing
“Sense of autonomy vs doubt and shame”
 Child develops into dependent to independent
creatures
 Controlling his body functions
 Children able to do work himself
 Tolerates separation
 Less fearful of strangers
 They won’t attempt to do the task which is felt
insecure
Anal stage: ( 1-3yr)
 Obtain pleasure from the feeling of distended
bladder and from the masses of feaces in the
rectum
 Conscious sense of self and learning to tolerate
frustration
Intuitive projective faith:
 Believe on parents
 Imitates religious behavior such as bowing the
head in prayer, but doesn’t know the meaning
a) Sensorimotor stage:
o Substage 5(12-18months)
o Substage 6 (18-2 yrs)
b) Pre operational stage
 Pre conceptual stage
Substage 5:
Tertiary circular reactions:
 Symbolism thought develops
 Complex object develops
Stage6:
 Begins casual thinking
 Thinks some solutions to problems
 Carry the past events in the mind
 Deffered imitations
 Invisible displacement
c) Pre conceptual stage:
 Egocentric
 Concrete thinking and perceptions
 Use one word to indicate several rather similar
persons or actions
 Object permanence, existing even when out of
sight
Stage 1:
 If punished for doing certain things, it is wrong, if
not punished it must be right.
 Recognizes names of various parts of body
 Responds to familiar, simple commands
 Understands more complex sentences
 Names familiar pictures
 900 words able to speak
10. PLAY:
Solitary independent play:
 The child plays alone independent of others
nearby children.
HEALTH ASSESSMENT OF PRESCHOOLER (3-6 yrs)

a) Name
b) Age
c) Date of birth
d) Sex
a) Family history
b) Antenatal history
c) Natal history
d) Neonatal history

NO. PICTURE
 Weight: 12.5-16.5kg
 Height: 90-110cm
 Mid arm circumference: >12.5cm
WEECH’S FORMULA
1-6yrs: Weight (kg)= (age in years x 2)+8
APLS FORMULA:
1-5 yrs: weight (kg)=2 X ( age in yrs + 5)
WEECH’S FORMULA
Vital signs:
a) Gross Motor:
 Rides tricycles
 Jumps from height
 Hops on preferred feet
 Skips alternate feet
 Walks and runs on tiptoes
 Kicks a ball
 Balance on one foot 3-5 seconds
 Catches ball with extended arms
 Tries to dance
b) Fine motor:
 Place small pellets in narrow necked bottles
 Can copy a circle, square, cross, diamond and triangle
 Able to use scissors
 Able to draw a picture
c) Self care:
 Manage spoon with little spilling of food
 Able to tie shoe lace
 Can go to toilet alone
 Brush teeth with assistance
 May bath self with assistance
 Combs hair with help
 Establish depth perception and color vision
 Can hear normally
 Develop the sense of taste and smell
 Enjoy in stroking their bodies
“Sense of initiative vs guilt”
 Child learns about world and other people
 Less dependent on parents but needs reassurance and
help
 Attempt to imitate adult behavior
 Feels guilty for their errors
 Spend too much time and energy in purposeless
activity
 Able to solve problems
Phallic stage:
 More aware of their sex organs
 Attachment to the parent of the opposite sex
 Touching and manipulation of the genitals
 Ask simple question about sex
 After temporary parental separation, either feels
happy or shows anger
Intuitive projective faith:
 Able to understand religion
 Learn about other religion
 Can’t be kept spiritually neutral
a) Pre operational stage
 Able to rationalize their actions
 Has social awareness
 Understands time
 Use time oriented expressions
 Develops transductive reasoning
 Has magical thinking
 Describes events
 Highly imaginative
Pre conventional morality
Stage 2:”instrumental hedonism & concrete reciprocity”
 Follow to rules strictly
 Accept changes in the rules
 Pleasure motive
 Uses complete sentence of 3-4 words
 Knows songs, colors
 Constantly asks questions
10. PLAY:
Parallel play:
 Playing beside and watching each other but not
interacting directly
GROWTH AND DEVELOPMENT OF SCHOOL AGE (7-12 yrs)

a) Name
b) Age
c) Date of birth
d) Sex
e) Family history
f) Antenatal history
g) Natal history
h) Neonatal history

NO. PICTURE
 Weight: 17-25kg
WEECH’S FORMULA
7-12yrs: Weight=(age in yrs x 7)-5
2
APLS FORMULA:
5-14YRS:Weight= 4 X Age In Yrs
WEECH’S FORMULA
Vital signs:
a) Gross Motor:
 Rides bicycles
 Jumps, runs, climbs
 Performs tricks on bicycle
 Throws a ball skillfully, overhand and underhand
 Enjoys all the physical activities
 Coordination improving
b) Fine motor:
 Uses both hand independently
 Draws persons with 18-20 parts
 Coordination continues to improve
c) Self care:
 Criticize table manner of parents
 Can brush and comb hair
 Handles eating utensils skillfully
 Dresses self completely
 Enjoy wearing current style of cloths
 Needs constant reminding of personal hygiene
 Visual acuity 20/20 (adult value)
“Sense of industry vs inferiority”
 Has greater self control, sincere, confident
 Able to control anger
 Develops more social interactions
 Considers peer opinions, more important than parents
 Still fears the darkness
 Ashamed of failures
 Relationship with siblings improved
 Aware of appropriate sexual role
Latency stage:
 Children form closer relationship with others of their
own age and sex
 Children begins to perceive sex role in a near adult
fashion
Mythic literal faith:
 Children develops many specific things about their
own religion
Pre operational stage
 Intuitive phase:(6-7yrs)
 Can describe objects in picture and knows their uses
 Knows date, month and season
 Can see differences more than similarities
 Concrete operational phase: (7-11yrs)
 Learns to understand and uses of symbols
 Shows interest in casual relationships
 Understands explanations
 Able to ordering and classifying the objects and other
things
 Formal operational phase: (11-12yrs)
 Develops abstract and deductive reasoning
 Uses problem solving methods
 Interested in the “why” and “how”
 Preoccupied with right and wrong
 Begins to think about vocation
 Collects facts for future use
Conventional morality
Stage 3: “interpersonal relations of mutuality”
 Wants to gain approval of others
Stage 4: “ Maintainance of social orders”
 Need law and order
 Oral vocabulary of 7200 words
 Reading vocabulary of 50,000 words
 Uses more compact sentences
 Able to give precise dictionary definitions
10. PLAY:
 Likes group play
 Prefer active play
 Enjoy dramatic play
 Continues collection-hobbies begin to develop
HEALTH ASSESSMENT OF EARLY ADOLESCENT (12-13 yrs)
a) Name
b) Age
c) Date of birth
d) Sex
e) Family history
f) Neonatal history
g) Developmental history

NO. PICTURE
 Weight: 40-60kg
FORMULA TO CALCULATE WEIGHT FOR AGE: APLS
FORMULA
5-14YRS: weight =4 x age in years
Vital signs:
 Pulse: 80b/mt
 Rapid physical growth
 Eye hand coordination developed
 Clumsiness occur due to rapid physical growth
 Visual acuity 20/20
“Sense of identity vs diffusion”
 Egocentric
 Has intense loyalty to peer groups
 Shows mood swings
 Day dreams
 Continues same sex friendships
 Negative counterpart is self diffusion occurs
Genital stage:
 Secondary sex character develops
 Masturbation occurs
Synthetic conventional faith:
 “mutual interpersonal perspective”
 To know about various religious concepts and beliefs
Formal operational stage
 Uses scientific methods for problem solving
 Hypothetical deductive reasoning
Post conventional morality
Stage 8: “social contract”
 Higher level of law and conscience orientation
 Individual confirmation to maintain other’s respect
 Uses distinct meaning for words
 Uses slang within and outside peer group
10. PLAY:
Cooperative play:
 Play with the purposes that making some material
 There are leaders and followers: the leader assigns
tasks to other children
HEALTH ASSESSMENT OF LATE ADOLESCENT (14-16 yrs)

a) Name
b) Age
c) Date of birth
d) Sex
e) Family history
f) Neonatal history
g) Developmental history

NO. PICTURE
 Weight: 40-60kg
Vital signs:
 Motor function comparable to that of adult
 Eye hand coordination at adult level
 Possesses manual dexterity
 Visual acuity 20/20
“Sense of identity vs diffusion”
 Egocentrism diminishes
 Hetero sexual relationships
 Verbally attacks parents beliefs and values
Genital stage:
 Secondary sex character develops
 Masturbation occurs
Synthetic conventional faith:
 “mutual interpersonal perspective”
Formal operational stage
 Uses scientific methods for problem solving
 Hypothetical deductive reasoning
Post conventional morality
Stage 8: “social contract”
 Higher level of law and conscience orientation
 Uses distinct meaning for words
 Uses slang within and outside peer group
10. PLAY:
 Competitive play
 Day dreaming
GERIATRIC ASSESSMENT
Definition:
“A Multidimensional interdisciplinary diagnostic process focused on determining a frail older

person’s medical, psychological and functional capability in order to develop a coordinated and
integrated plan for treatment and long term follow up.”
Use:
 Develop treatment and long-term follow-up plans,

 Arrange for primary care and rehabilitative services,
 Organize and facilitate the intricate process of case management,
 Determine long-term care requirements
 Make the best use of health care resources.
Implications of Geriatric Assessment:
 Improve the assessment of the medical and the psychological Problems

 To provide Therapy and Rehabilitation services
 To determine optimal post therapy placement for an independent functioning
 To provide healthcare both by Healthcare Professionals and care takers
Geriatric Assessment – Why it is important?
 Focuses on elderly individuals with complex problems,

 Emphasizes functional status and quality of life, and
 Frequently takes advantage of an interdisciplinary team of providers.
 Effectively addresses The "Five I's of Geriatrics” i.e.,
1. intellectual impairment,
2. immobility,
3. instability,
4. incontinence and
5. iatrogenic disorders.
Comprehensive Geriatric Assessment:
1. Medical:
 Comorbidities
 Continence
 Fall risk
 Nutritional Status
 Medication
 Advanced care
 Vision and hearing
2. Functional:
 Gait and balance
 Mobility and transfers
 Basic activities of daily living, e.g. feeding, washing, toileting
 Instrumental activities of daily living, e.g. shopping, cooking,
 Advanced activities of daily living, e.g. hobbies
3. Psychological:
 Mood
 Cognition
 Ideas, concerns and expectations
4. Social or Environmental:
 Formal care support
 Home safety and appropriateness
 Social network providing informal support
 Accessibility to local resources and Financial assessment
Periodic Geriatric Assessment:
 Detailed health assessment once they are 45-50 years

 Once in 5 years till 65 years of age
 Thereafter every year or at least once in 2 years
Comprehensive Geriatric Assessment:
A. Medical History
1. Demographic details
2. Chief complaints
3. Present Illness
4. Past history
5. Social History
6. Family History
B. Medical Examination:
1. Visual Impairment/ complaints
2. Locomotive disorders, joints, muscles
3. Neurological complaints
4. Cardiovascular disease
5. Respiratory disorders
6. Weight Changes
7. Gastro-intestinal/ Abdominal disorder
8. Psychiatric problem
9. Hearing loss
10. Genitourinary disorder
Geriatric Assessment Tools:
1. Visual Impairment- Snellen Test

2. Falls/Gait Disturbance - Fall Screening Test, Balance Assessment Tools
3. Neurological Complaints:
 Mini Mental State Examination
 Abbreviated mental status test
 Clock drawing
 Mini-cog
 Montreal Cognitive Assessment
4. Hearing Loss: Watch tick test
5. Genitourinary: 2-item questionnaire, Single question and The 3IQ questionnaire
6. Psychiatric Problems:
 Geriatric Depression Scale
 Hospital Anxiety and Depression Scale, and
 Patient Health Questionnaire.
7. Weight Changes: Nutritional Health Checklist, Detailed Dietary Assessment using 24-
hour recall, Physical Examination – over-consumption or inadequate nutrition
8. Functional Assessment Tools:
1. As a measure of overall impact of health conditions in the context of a patient’s
environment and social support system
2. This can be assessed at 3 levels:
a. Basic activities of daily living (BADLs),
b. Instrumental activities of daily living (IADLs), and
c. Advanced activities of daily living (AADLs).
9. Social Assessment:
 There is a great deal of interdependency between patients’ social situations and
their functional status.
 Living arrangements, financial security, transportation, access to medical services
 Psychosocial/ interpersonal relations
 A variety of private and public resources
 Home assessments
ANTENATAL ASSESSMENT FORMAT AND CASE STUDY FORMAT
IDENTIFICATION DATA
Name :
Age :
I P No :
Address :
Education :
Occupation :
Date of Admission :
Reason for Admission :
Obstetrical score :
LMP :
EDD :
Gestational weeks :
PRESENT OBSTETRIC HISTORY

Date of Registration :
First Trimester :
Second Trimester :
Third Trimester :
PAST MEDICAL/SURGICAL HISTORY

H/o Communicable disease :Rubella/UTI/STD/PID/Vaginal
Infections/TB/Hepatitis/Malaria
H/o Non-Communicable diseases :DM/HT/Cardiac diseases/Epilepsy/Psychiatric
illness/Thyroid
H/o Operation :Type of Surgery
H/o Blood transfusion :Yes/No, Reason for transfusion
PAST OBSTETRIC HISTORY

H/o infertility treatment:
Sl. Year Duration of Nature of Delivery Condition of Remarks

No Pregnancy Children
FAMILY HISTORY (family tree)

H/o DM/HT/Cancer/Any other
Birth anomalies/Mental Retardation/Multiple pregnancies
MENSTRUAL HISTORY
Age of Menarche :
Number of days in cycle :
Regularity of cycle :
Other Problems :
MARITAL HISTORY
Duration of marriage in years, Consanguineous marriage, Use of contraceptive devices, Age at
marriage husband and wife.
PERSONAL HISTORY
Diet :Veg/Non-Veg
Attitude towards pregnancy
Bowel and Bladder elimination pattern
Rest and sleep
Hygiene
Habits
Allergies
Hobbies
SOCIOECONOMIC STATUS
Family income
Husbands Occupation
Relationship with family members
PHYSICAL EXAMINATION
Height
Weight – Pregnant and Pre-pregnant state
BMI
Vital Signs – TPR, BP
General Appearance
Body Built : Thin/Obese/Emaciated
Posture : Lordosis/Normal
Gait : Normal/Waddling/Limping
Hygiene
Mental status : Stable/Anxious/tired
Head to foot examination
Skin : Changes in skin colour or pigmentation, colour, turgor,

nails
Head : Hair – dry/brittle/black/shiny/colour
Scalp : clean/scaly/sores/discharge/rashes/mass/lump
Face : facial puffiness, chloasma gravidarum
Eyes : Pallor/puffiness of eyelids/jaundice
Ears : Ear wax/redness/discharge
Nose : DNS/patent, sinuses
Mouth : Halitosis/toothache/mouth lesions/pallor/cyanosis
Lips : Pink/Pale/cyanosed/cracked/blisters
Teeth : Normal/dental carries/stained
Gums : Pink/swollen/bleeding/gingivitis/moist/dry/ulcerated
Tongue : Pale/pink/red/dry/coated/glossitis
Mucosa : Pale/pink/red/dry/moist/masses/stomatitis
Tonsils : normal/infected
Neck : Thyroid enlargement/lymphadenopathy
Thorax and lungs : Shape and respiration
Heart : Heart sounds/murmurs
Axilla : Lymph node enlargement
Breasts
Well developed/small/pendulous/symmetrical/asymmetrical/masses/tenderness/palpable
lymph nodes
Nipple : Inverted/everted/discharge/colostrums/primary and
secondary areola/Montgomary tubercles
Back : Lordosis/deviations/straight
Gastrointestinal : Heart burns/change in bowel habits – diarrhea or
constipation
Abdomen:
Inspection:
Size - Over distended/pendulous/according to gestational age, shape – round or
oval/contour – anteriorly convex, umbilicus – normal/flat/herniated, flanks – full/not full,
bladder, skin changes – striae/linea nigra/scars/lesions, visible fetal movements others –
pulsation and dialated veins.
Palpation:
Abdominal circumference
Fundal height (cm and weeks)
Fundal palpation
Lateral palpation – left and right
Pelvic grip
Pawliks grip and descent
Auscultation
Impression
Lie:
Presentation:
Engagement:
Descent:
Position
Attitude
Extremities
Symmetry/range of motion/Homan’s sign/pitting edema
GenitoUrinary
Candidiasis/itching/haemorrhoids/lesions/uterine prolapse/odour/swelling
Nervous system
Memory/speech/judgement/orientation/concentration/Attention
Investigations
Hb, platelet, blood group, TSH, GTT, HIV/HBsAg, Urine sugar test/urine albumin
USG – estimated fetal birth weight, AFI, BPP, gestational age per scan
Disease condition
Related Anatomy and Physiology
Definiton
Pathophysiology
Etiology – Book Picture and Patient picture
Types - Book Picture and Patient picture
Clinical features - Book Picture and Patient picture
Investigations - - Book Picture and Patient picture
Medical management - Book Picture and Patient picture
Surgical management - Book Picture and Patient picture
Nursing management
Prognosis - Book Picture and Patient picture
Complications - Book Picture and Patient picture
Drug study
List of Nursing Diagnosis
Care Plan (10)
Health education
Progress notes
POSTNATAL ASSESSMENT AND CASE STUDY FORMAT
IDENTIFICATION DATA
Name :
Age :
Education :
Occupation :
IP No :
Address :
Date of Admission :
Reason for Admission :
Obstetrical score :
LMP :
EDD :
Type of Labour :
Date and time of delivery :
Any complications during pregnancy
LABOUR HISTORY
Client admitted to Labour room on _________ at ____ am/pm with complaints of
________. Regular contractions started at __________ am/pm. Inj Pitocin __ units started at
____am/pm. ARM done/not done at _________ am/pm. With good uterine contractions she
delivered a ________ ________ _________ baby of birth weight _________ kg at ________
am/pm with APGAR score ___. Placenta and membranes expelled completely. Episiotomy
closed in layers. Total duration of labour _____ hrs ____ mts.
PRESENT OBSTETRIC HISTORY (problems)

I TRIMESTER –
II TRIMESTER –
III TRIMESTER -
POST NATAL HISTORY

Mother and baby had/did not have complications. Bleeding, Passed urine, breastfeeding
initiation, Blood group of mother and baby, if required Anti – D given/not.
PAST OBSTETRICAL HISTORY

Obstetrical score, FTND, male/female, age of child, birth weight, any complications
PAST MEDICAL/SURGICAL HISTORY

H/O chicken, appendicectomy or any surgery etc
FAMILY HISTORY
H/O DM, HTN in mother
MENSTRUAL HISTORY
Regular/Irregular, days in a cycle, dysmenorrhoea etc
MARITAL HISTORY
Duration of marriage
Age of marriage – Husband and wife
H/O consanguineous marriage, contraceptive use
PERSONAL HISTORY
Diet – Vegetarian/non – vegetarian, bowel and bladder elimination regular/irregular
Bad habits if any
PSYCHOSOCIAL HISTORY
Middle class family/rich, relationship with friends and family members. Attitude towards
pregnancy.
PHYSICAL EXAMINATION
MOTHER
Vital signs – TPR, BP
General appearance – body built, Height, Weight, BMI, Hygiene
Head to foot examination (particularly BUBBLE HE)
Head and scalp – Dandruff, size and shape
Eyes - pale, yellow discoloration
Ears - Hearing acuity
Face - Symmetrical/non symmetrical
Nose - DNS, polyps
Mouth - Dental carries, bleeding gums
Neck - Thyroid enlargement
Breast - Enlarged, soft/hard, tender/non tender, consistency, nipple
erect/inverted/cracked, colostrum expressed/not.
Chest - Heart sounds, murmurs, Heart rate
Abdomen - Uterus consistency contracted/relaxed, Fundal height, striae gravida
present/absent. Bowel sounds
Perineum - Lochia rubra/serosa/alba, Episiotomy - REEDA, pain, amount of
bleeding, laceration, cleanliness
Genitalia - Vulval edema present/absent, Urine passed/not passed
Extremities - Homan’s sign
Emotional status - stable/not
SYSTEMWISE EXAMINATION
CNS
Respiratory system
CVS
GIT
Genitourinary system
Investigations
Hb, platelet, blood group, TSH, GTT, HIV/HBsAg, Urine sugar test/urine albumin
USG – estimated fetal birth weight, AFI, BPP, gestational age per scan
BABY
Baby – normal/preterm/postmature
Date of birth
Type of delivery
Apgar 1st min:________ 5th min:________
Sex: -Male/female
Any complications
Birth weight
Length
Head circumference
Chest circumference
Vital signs – TPR, BP
Head to foot examination

Activity
Cry
Feeding
Posture
Skin
Head and scalp
Nose
Ears
Chest
Abdomen
Umbilicus
Bladder
Bowel
Sleep
Reflexes
Disease condition
Related Anatomy and Physiology
Definiton
Pathophysiology
Etiology – Book Picture and Patient picture
Types - Book Picture and Patient picture
Clinical features - Book Picture and Patient picture
Investigations - - Book Picture and Patient picture
Medical management - Book Picture and Patient picture
Surgical management - Book Picture and Patient picture
Nursing management
Prognosis - Book Picture and Patient picture
Complications - Book Picture and Patient picture
Drug study
Medications
List of Nursing Diagnosis for mother and child
Care Plan (10)
Health education
Progress notes
C. SENSITIZE AND HANDLE SOCIAL ISSUES AFFECTING HEALTH OF

FAMILY
WOMEN EMPOWERMENT
Definition:
It is the process, and the outcome of the process, by which women challenge gender-
based discrimination against women/men in all the institutions and structures of society.
Process aimed at changing the nature and direction of systematic forces which
marginalize women and other disadvantaged sections in a given context. (Sharma 1992).
Concepts:
 The ability to make decisions about personal/collective circumstances

 The ability to access information and resources for decision making
 Ability to consider a range of options from which to choose
 Ability to exercise assertiveness in collective decision making
 Having positive thinking about the ability to make change
 Ability to learn and access skills for improving personal circumstances
 Ability to inform others perceptions through exchange, education and engagement
 Involving in the growth process and changes that is never ending and self-initiated
 Increasing one’s ability in discreet thinking to sort out right and wrong
Principles:
 Establish high-level corporate leadership for gender equality

 Treat all women and men fairly at work –respect and support human rights and
nondiscrimination
 Ensure the health, safety and well-being of all women and men workers.
 Promote education, training and professional development for women.
 Implement enterprise development, supply chain and marketing practices that empower
women.
 Promote equality through community initiatives and advocacy.
 Measure and publicly report on progress to achieve gender equality.
Objectives:
 To identify gaps in the empowerment of women, development of children and

adolescents;
 Create a national network of public, private and NGO centres for delivering reproductive
and child health services free to any client;
 To increase awareness in women, for their development to use their talent
optimally not only for themselves, but also for the society as a whole;
 To develop the skills for self-decision- taking capabilities in women and to allow them
to present their point of view effectively in society;
 To create awareness among women to be truly ambitious and to dream for
betterment;
 To make efforts in organising the women for fighting against the problems and
difficulties related to them;
 To integrate socio-economic activities with concern for health and environment
protection in the light of the rural women culture.
PROBLEMS FACED BY WOMEN:
1. Problems of education:
 Many Women and girls in the developing countries are denied opportunities for
education.
 Lack of education limits prospects, decreases family income, reduces health, puts
women and girls at risk of trafficking and exploitation, and limits the economic
advancement of entire countries.
2. Problems related to unemployment:
 Female unemployment rates are still high in most countries, especially in the
developing world.
 Women are considered weaker sex by most employers, therefore, will always
overlook them for men. The high unemployment rate among women is mainly
because of the perception of women, culture, and tradition.
 In most countries, Men's average wages are higher than women, in both rural and
urban areas. Rural women work longer hours than men.
3. Problems of eve teasing:
 Eve teasing problem is faced by women all over the world. It is a sort of
harassment involves nonverbal, verbal, physical, or visual attention, intimidation
that is unwelcome and unwanted.
4. Dowry system:
 The marital custom of dowry is widely practiced. A dowry is a transfer of wealth
from the bride’s family to the groom’s family It is practiced among many cultures
through out South Asia.
 In almost all cases, the practice directly or indirectly oppresses women, it leads to
abuse and violence.
5. Problems of gender equality:
 Gender inequality is a situation when women and men are not equal. Measures of
gender equality include access to basic education, health and life expectancy,
equality of economic opportunity, and political empowerment.
 Women lag behind men in many areas, such as education, labor market
opportunities and political representation and in salary.
6. Problems of female abortion:
 Female foeticide or abortion is a big social problem mainly because of “traditional
thoughts” of our society.
 Illegal abortion of the female foetus is done due to family pressure from in-laws,
husband or the woman’s parents, and the reasons for this are preference of son,
girls being considered as a burden.
7. Problems of sexual assault:
 Around the world, sexual abuse/abduction/assault / violent crimes against woman
is something which is happening every day, affecting close to a billion women
and girls over their lifetimes.
 Gender-based violence, including sexual violence, is being faced by women in
epidemic proportions. If it were a medical disease, sexual violence would have
had serious attention and the funding to address it from governments and large
institutions.
8. Problem of acid attacks:
 Acid attacks are fast becoming a weapon of choice for many offenders with
women often in mind. In some parts of the world, it’s happening weekly. Acid
Attacks that melt the faces off victims in an instant are on the rise globally. The
attacks are particularly common in South Asia, where male attackers use the
weapon to disfigure women as a form of punishment or control.
9. Problem of women trafficking:
 Human trafficking is a multi-billion dollar enterprise, and it’s one of the fastest-
growing illicit industries in the world. It involves exploitation which comes in
many forms, including: forcing victims into prostitution, subjecting victims to
slavery, etc. 71% of trafficking victims around the world, victims of exploitation
are mostly women and girls. In some parts of the world, women trafficking
women is the norm. Trafficking involves labor exploitation, trafficking for tissue,
cells and organs, people smuggling, etc. An estimated 40.3 million victims are
trapped in modern-day slavery.
10. Child marriage
PRE-REQUISITES OF EMPOWERMENT:
 Active participation in social economic and political spheres.

 Process of decision making empowerment.
 Desired self-respect.
 Social dignity.
 Involvement of women in decision making process
 Active participation in social economic and political spheres.
 Process of decision making empowerment.
 Desired self-respect.
 Social dignity.
 Involvement of women in decision making process.
FACILITATING FACTORS FOR WOMEN EMPOWERMENT:
 Existence of women's organizations

 Availability of support systems
 Availability of women-specific
 Availability of funds
 Feminist leadership
 Networking
 Favourable media coverage
 Favourable policy climate.
CONSTRAINING FACTORS FOR WOMEN EMPOWERMENT:
 Heavy work load of women.

 Isolation of women from each other.
 Illiteracy.
 Traditional views limit participation.
 No funds.
 Disagreements/conflicts among women's groups.
 Structural adjustment policies.
 Negative and sensational coverage of media
ADVANTAGES OF WOMEN EMPOWERMENT:
 Next generation will be empowered because of her.

 If woman will be empowered she will not be a burden on anyone.
 Financial burden of man can be shared with her support.
 Family can be stronger because of both working hands.
 When financial problems will be shared than results of conflict.
GOVERNMENT SCHEMES FOR EMPOWERMENT OF WOMEN:
1. ICDS PRGRAMME:
 This is a flagship programme of the Department of Women Empowerment and
Children Development.
 While providing anganwadi services and health and nutritional supplements to
infants, ICDS also provides pre and post natal care for pregnant and lactating
mothers
 Anganwadi workers have to dispense iron and folic acid tablets and iodine-
fortified salts to pregnant and lactating mothers. The mothers also gets dietary
rations from the anganwadi workers
2. KISHORI BALIKA YOJANA
 As a part of ICDS Programme, a special scheme for adolescent girls was initiated
from 2011 onwards, with assistance from Government of India as well as from
world bank. The scheme is intended for adolescent girls in 11-18 age group who
belongs to BPL. The scheme intents to provide training to these girls inorder to
bring overall development. The areas of training includes hygiene, balanced diet,
family welfare, inter personal skills, self- confidence and vocational skills
training.
 Other programmes:
 Old age pension scheme: Rs. 400/- per month for above 60 years of age
 Pension schemes for widows/homeless/aged/disabled: applicable only in
rural areas
 Financial assistance to destitute widows: Rs. 1000/- per month for widows
in rural areas, provided by Grama Panchayat
 Grant to female student who have passed intermediate from BPL family to
pursue higher studies: a onetime grant of Rs. 25,000/-
3. EMPOWEMENT THAT PROMOTES GENDER EQUITY
 Early Child Care Education Centres (ECCE):
Early childhood care and education (ECCE) is more than preparation for primary school. It aims
at the holistic development of a child’s social, emotional, cognitive and physical needs in order
to build a solid and broad foundation for lifelong learning and wellbeing. ECCE has the
possibility to nurture caring, capable and responsible future citizens.
In this way ECCE is one of the best investments a country can make to promote human resource
development, gender equality and social cohesion, and to reduce the costs for later remedial
programmes. For disadvantaged children, ECCE plays an important role in compensating for the
disadvantages in the family and combating educational inequalities.
UNESCO’s approach is reinforced in the Education 2030 agenda and in particular in target 4.2 of
Sustainable Development Goal 4 which aims to ‘By 2030, ensure that all girls and boys have
access to quality early childhood development, care and pre-primary education so that they are
ready for primary education.’
 National Programme on Education for Girls at Elementary level:

The National Programme for Education of Girls at Elementary Level (NPEGEL), is a focussed
intervention of Government of India, to reach the “Hardest to Reach” girls, especially those not
in school. Launched in July 2003, it is an important component of Sarva Shiksha Abhiyan (SSA),
which provides additional support for enhancing girl’s education over and above the investments
for girl’s education through normal SSA interventions.
 The Kasturba Gandhi Balika Vidyalaya or KGBV is a residential girls’

secondary school run by the Government of India for the weaker sections in India.
The objective of KGBV is to ensure that quality education is feasible and
accessible to the girls of disadvantaged groups of society by setting up residential
schools with boarding facilities at elementary level.
Scheme now provides for access and quality education to girls from disadvantaged groups of
girls in the age group of 10-18 years aspiring to study in Classes VI to XII; belonging to SC, ST,
OBC, Minority communities and BPL families to ensure smooth transition of girls from
elementary to secondary and upto class XII wherever possible. KGBV provides the facility to
have at-least one residential school for girls from Classes VI-XII in every educationally
backward block (EBBs)
4. ECONOMIC EMPOWERMENT OF WOMEN:

 Microcredit: Microfinance institutions aim to empower women in their
community by giving them access to loans that have low interest rates without the
requirement of collateral. More specifically, they(microfinance institutions) aim
to give microcredit to women who want to be entrepreneurs
 Political empowerment: Political empowerment supports creating policies that
would best support gender equality and agency for women in both the public and
private spheres. Popular methods that have been suggested are to create
affirmative action policies that have a quota for the number of women in policy
making and parliament positions
5. National Policy for Empowerment of Women:

National Policy for the Empowerment of Women was adopted in the year 2001. The goal of the
policy is to bring about the advancement, development and empowerment of women.
Aims:
 Creating an environment through favorable economic and social policies
for the full development of women to enable them to realize their full
potential.
 The de-jure and de-facto enjoyment of all human rights and fundamental
freedoms by women on equal basis with men in all spheres-political,
economic, social, cultural and civil
 Equal access to participation and decision-making of women in the social,
political and economic life of the nation.
 Equal access to women in health care, quality education at all levels,
career and vocational guidance, employment, equal pay, occupational
health and safety, social security and public office, etc.
 Strengthening legal systems for the elimination of all forms of
discrimination against gender basis of women.
 Changing societal attitudes and community practices by active
participation and involvement of both genders: men and women.
 Mainstreaming a gender perspective into all policies and programmes for
women development in the Indian system.
 Elimination of discrimination and all forms of violence against woman
and the girl children.
 Building and strengthening partnerships with civil society, particularly
with women’s organizations.
6. Mother and Child Tracking System:

 The Mother and Child Tracking System was launched in 2009, helps to monitor
the health care system to ensure that all mothers and their children have access to
a range of services, including pregnancy care, medical care during delivery, and
immunizations. The system consists of a database of all pregnancies registered at
health care facilities and birth since 1 December 2009
7. Indira Gandhi Matritva Sahyog Yojana (IGMSY), Conditional Maternity Benefit

(CMB) is a scheme sponsored by the national government for pregnant and lactating
women age 19 and over for their first two live births.
8. The Rajiv Gandhi Scheme for Empowerment of Adolescent Girls – Sabla is an

initiative launched in 2012 that targets adolescent girls. The scheme offers a package of
benefits to girls between the age group of 10 to 19. It is being offered initially as a pilot
programme in 200 districts. It offers a variety of services to help young women become
self-reliant, including nutritional supplementation and education, health education and
services, and life skills and vocational training
9. Rashtriya Mahila Kosh (The National Credit Fund for Women) was created by the
Government of India in 1993. Its purpose is to deliver women from lower income group
with access to loans to begin small businesses
10. Priyadarshini, initiated in April 2011, is a programme that offers women in seven
districts access to self-help groups.
11. Digital Laado: This program is a nationwide initiative in which every daughter will be
taught and trained to develop their talent and skills to work from home itself and get
connected with the global platform. Daughters can register themselves to avail these
benefits from anywhere in the world - online & offline.
WOMEN ABUSE
DEFINITION:
The UN Declaration on the Elimination of Violence Against Women (Article 1) defines as ‘Any
act of gender-based violence that results in, or is likely to result in, physical, sexual or
psychological harm or suffering to women, including threats of violence, coercion or arbitrary
deprivation of liberty, whether occurring in public or private life.
VIOLENCE AGAINST WOMEN:
 Physical, sexual, and psychological violence occurring in the family

 Sexual abuse of female children in the household
 Dowry related violence
 Marital rape
 Traditional practices harmful to women
 Violence related to exploitation
 Acts of violence against women also include forced sterilization and forced abortion and
forced use of contraceptives
 Kidnapping and selling of minor girls
 Eve teasing
 Slavery
CAUSES OF WOMEN ABUSE:
 Historically unequal power relations between women and men
 Influence of culture
 Lack of access to legal information, aid or protection
 Insufficient laws to effectively prohibit violence against women
 Absence of means to address the causes and consequences of violence against women
 Media image
 Unemployment
 Strained family relationships
STRATEGIES TO COMBAT VIOLENCE AGAINST WOMEN:
 Educational system should promote self-respect, mutual respect and cooperation between
women and men
 Boys and girls should be brought up equally without discrimination from the childhood
assigning a stereotyped role
 Parents should be role models by sharing work and responsibility equally
 Property should be jointly owned by parents
 Ensure joint decision making in upbringing of children
 Educate family members not to give or take dowry
 Son preference syndrome should be changed through awareness programmes
 Ensure implementation of existing legislations to provide equal opportunities in
employment
 Equal opportunity for women in decision making bodies in all institutions must be
mandatory
 Women’s reservation policy
 Ensure equal representation of women in all political parties and its decision making
bodies
 Women and men can be mobilized to overcome violence in all its forms and that
effective public measures can be taken to address both causes and consequence of
violence
TYPES OF WOMEN ABUSE
 Physical abuse
 Includes assaults involving beating, burning, slapping, choking, kicking, pushing,
biting or using any weapon
 It may also include physical neglect through denial of food or medication,
inappropriate personal or medical care, rough handling or confinement.
 Physical abuse and neglect can also result in serious injuries or death
 Emotional or psychological abuse
 Include constant yelling (shout very loudly), screaming, name calling, insults,
threats, humiliation or criticism, excessive jealousy or suspiciousness, threatening
or harassing a women, isolating a women from her neigbours, friends or family,
or depriving a women of love and affection
 For some women the effects of emotional abuse may be worse than the
consequences of physical violence. Women who are emotionally abused are at
high risk for experiencing physical violence.
 Sexual abuse:
 Include rape, unwanted sexual touching, sexual harassment, sexual exploitation,
or forcing a women to participate in any unwanted, unsafe sex, degrading or
offensive sexual activity.
 Sexual abuse may also include denying or ridiculing a women’s sexuality or
controlling her reproductive choices
 The practice of Female Genital Mutilation (Female circumcision) has serious
consequences for young adult women, especially during the child bearing years
 Economic or financial abuse
 Include preventing a women from working, controlling her occupational choices,
preventing her from achieving, or maintaining financial independence, denying or
controlling her access to financial resources or exploiting her financially
 Spiritual abuse
 Include preventing a women from participating in spiritual or religious practices,
ridiculing her beliefs or using spiritual beliefs to justify controlling her
HEALH CONSEQUENCES OF WOMEN ABUSE:
 Physical health effects

 Include broken bones, bruises, burns, cuts, stabs and firearm wounds, abrasions,
bites, lacerations, sprains, concussions, skull fractures, scaring, perforated
eardrums, detached retina, injuries to the voice box, chipped or lost teeth, hair
loss, chronic gastro intestinal pain, irritable bowel syndrome, chronic neck, back
or other muscular skeletal pain, chronic headache, hypertension, palpitations,
hyper ventilation and substance abuse problems.
 Pregnant women who are abused experience direct and indirect impacts, which
can result in serious complications to the mother, fetus and later on infant
 Sexual health effects:
 Includes STD’s like HIV, chronic pelvic, genital or uterine pain, chronic vagina
or urinary infection, bruising or tearing of vagina or anus, frequent pregnancy,
infertility or early hysterectomy, and sexually addictive behavior.
 Psychological effects
 Includes low self-esteem, self-degradation, self-abuse, difficulty with
relationships, acute anxiety, frequent crying, unusual or pronounced fear
responses, uncontrolled or rapid anger responses, chronic stress, phobia,
flashback, insomnia, sleep disturbances nightmares, lack of appropriate
boundaries, arrested development, passivity, memory loss, loss of concentration
and productivity
 Psychiatric effects
 Includes depression, suicidal thoughts, dissociation (lack of continuity in
thought), post traumatic stress disorder, eating disorders, adjustment disorder with
depressed mood, OCD
MEASURES FOR PREVENTING WOMEN ABUSE AND ROLE OF COMMUNITY
HEALTH NURSE
 A massive cultural sensitivity programme are to be aimed for bringing changes in heart
and psychology of people is needed to bring down number of cases with women abuse
 Advocacy and awareness raising
 Education for building a culture of non violence
 Training and resource “at risk” families
 Direct service provision for victim survivors and direct intervention to help victim
survivors to rebuild their lives
 Monitoring interventions and measures by data collection and analysis
 Orient the public on legal issues
LAW AGAINST WOMEN ABUSE:
 The Protection of Women from Domestic Violence Act 2005 is an Act of the Parliament
of India enacted to protect women from domestic violence.
 In 1983, domestic violence was recognised as a specific criminal offence by the
introduction of section 498-A into the Indian Penal Code. This section deals with cruelty
by a husband or his family towards a married woman.
 The Prajnya Trust has been working since 2008 to prevent gender and sex-based violence
against women. This NGO for women conducts workshops, facilitates discussions,
provides legal advice and sensitizes service providers who might encounter cases of
sexual violence at work.
 Guria India’s approach is to focus on rescue and legal intervention. Due to the stigma
surrounding sexual assault, it helps the victim with all the necessities to fight their case
starting from filing an FIR to helping them collect evidence.
 Gauravi is the 24×7 one-stop crisis center of ActionAid. The center caters to domestic
and sexual violence victims of any age including minor boys.
 Majlis Manch’s legal center provides socio-legal support to victims of sexual abuse.
 Sayodhya runs short stay home for women/young girls in distress and provides an
emergency response through its 24 hours telephone helpline.
 Shikshan Ane Samaj Kalyan Kendra is dedicated to helping women through activities
like health, education, women empowerment, etc.
 International Foundation for Crime Prevention and Victim Care was set up in response to
the need for a support agency for victims and survivors of domestic violence. This NGO
for women provides several necessary services like crisis management, legal advocacy,
support and resource services.
 Sakshi is a capacity building organization, (regd NGO, 1992) that began as a rights
initiative NGO. It was founded in 1992 with the purpose of giving voice to the silence
that masked women’s Equality and Sexual Rights in context of violence.
 Anweshi Women's Counselling Centre is a non-governmental organization based in
Calicut district of Kerala, headed by former naxalite leader K. Ajitha. Anweshi has been
involved with a challenging task of exposing one of the several `sex rackets’ in Kerala
that trapped adolescent girls and young women in Kozhikode city.
 Vimochana deals with many women issue from domestic violence to labor issues
 The Lawyers Collective Women’s Rights Initiative (“LCWRI”)’s mission is the
empowerment of women through law. This is based on the belief that law is an
instrument of social change and can be used in different ways to further the constitutional
and human rights of women.
CHILD ABUSE
DEFINITION:
According to WHO: Child abuse or maltreatment constitutes all forms of physical and or
emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child’s health, survival, development or
dignity in the context of a relationship of responsibility, trust or power.
TYPES OF CHILD ABUSE:
 Physical abuse: The application of unreasonable force by an adult or youth to any part of
a child’s body
 Sexual abuse: involvement of a child, by an adult or youth, in an act of sexual
gratification, or exposure of a child to sexual contact, activity or behavior
 Neglect: failure by a parent or caregiver to provide the physical or psychological
necessities of life to a child
 Emotional harm: adult behavior that harms a child psychologically, emotionally or
spiritually
 Exposure to family violence: circumstances that allow a child to be aware of violence
occurring between a caregiver and his/her partner or between other family members
SIGNS OF PHYSICAL CHILD ABUSE:
 Withdrawing: child become loner, withdraw from social contacts

 Injuries
 Showing signs of neglect
 Tiredness or sleeping in class
 Reluctance to visit specific places
 Sudden emotional changes
Signs of emotional abuse:
 Inadequate physical care

 Absence of medical attention
 Inadequate medical care
 Cruel or abusive treatment
 Improper supervision
 Exploitation of child’s earning capacity
 Unlawfully keeping the child out of school
 Exposing the child to criminal or immoral influences that endanger his/her morals
CHILD NEGLECT:
 Physical neglect
 Failure to provide adequate food, clothing or hygiene
 Not paying attention to child’s safety
 Refusal to provide necessary health care
 Abandoning children without providing for their care
 Educational neglect
 Not enrolling a child in school
 Permitting reasons whereby a child misses too many days of school
 Not paying attention to a child’s special educational needs
 Emotional neglect
 Inadequate nurturing or display of affection
 Permitting a child to drink alcohol
 Failure to intervene and prevent child’s anti-social behavior
 Refusal of or delay in providing necessary psychological care
EFFECTS OF CHILD ABUSE:
 Emotional effects
 Low self-esteem
 Depression and anxiety
 Aggressive behavior/anger issues
 Relationship difficulties
 Withdrawal
 Flashbacks and nightmares
 Behavioral effects
 Problems in school and work
 Teen pregnancy
 Suicide attempts
 Criminal or anti-social behavior
 Alcohol and drug abuse
 Eating disorders
MEASURES OF CHILD ABUSE:
 Child labor protection and regulation Act

 National policy on education emphasized universal enrollment and universal retention of
children at elementary school stage
 Crèche services to children of poor working women in unorganized sector were expanded
 Juvenile justice Act: enacted in 1986 deal with problems of neglect
 Article 24: no child below 14 years shall be employed to work in any factory or in any
hazardous employment
 Article 39: the state shall direct its policy towards securing that children are given
opportunities and facilities o develop in a healthy manner and in conditions of freedom
and dignity
 Article 45: state should provide free and compulsory education to all children till the age
of 14 years
PREVENTION OF CHILD ABUSE:
 Primary level prevention

 Creating general awareness among the people about the extent and nature of the
problems through the mass media
 Education of the general public about the causes, prevention and control of child
abuse
 Encourage family support system , interpersonal communication and equal
distribution of resources
 The nurse can teach the parents acceptable and workable way to discipline
children
 Developing self-care services
 Special care to the mothers who are predisposed to hysterical or emotional illness
 Improving general health status and socio-economic status
 Training of health and social welfare personnel
 Secondary and tertiary level of prevention
 Recognition of child abuse cases and report to authorities
 Establish rapport
 Provide specific care
 Encourage parents to participate in the care of children
 Individual counseling and psychotherapy
ELDER ABUSE
DEFINITION:
WHO defines elder abuse as “a single or repeated act, or lack of appropriate action,
occurring within any relationship where there is an expectation of trust which causes harm or
distress to an older person”
TYPES OF ELDER ABUSE:
1. Physical abuse: Physical elder abuse is non-accidental use of force against an elderly
person that results in physical pain, injury, or impairment. Such abuse includes not only
physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints,
or confinement.
2. Emotional abuse: In emotional or psychological senior abuse, people speak to or treat
elderly persons in ways that cause emotional pain or distress.
Verbal forms of emotional elder abuse include:

. Intimidation through yelling or threats
. Humiliation and ridicule
. Habitual blaming or scapegoating
Non-verbal psychological elder abuse area:

. Ignoring the elderly person
. Isolating an elder from friends or activities
. Terrorizing or menacing the elderly person
3. Sexual abuse: sexual elder abuse is contact with an elderly person without the elders
consent. Such contacts can involve physical sex acts, but activities such as showing
elderly person pornographic materials, forcing the person to watch sex acts, or forcing the
elder to undress are also considered sexual elder abuse.
4. Neglect: elder neglect, failure to fulfill a caretaking obligation, constitutes more than half
of all reported cases of elder abuse. It can be active or passive
5. Financial exploitation: this involves unauthorized use of an elderly person’s fund or

property, either by a caregiver or an outside scam artist.
 Misuse an elder’s personal cheques, credit cards, or accounts

 Steal cash, income checks or household goods
 Forge the elder’s signature
 Engage in identity theft
6. Health care fraud and abuse: carried out by unethical doctors, nurses, hospital
personnel and other professional care providers like:
 Not providing healthcare, but charging for it

 Overcharging or double billing for medical care and services
 Getting kickbacks for referrals to other providers or for prescribing certain drugs
 Over medicating or under medicating
 Recommending fraudulent remedies for illnesses or other medical conditions
 Medicaid fraud
SIGNS AND SYMPTOMS OF SPECIFIC TYPES OF ABUSE:
PHYSICAL ABUSE  Unexplained signs of injury

 Broken bones, sprains, or dislocations
 Report of drug overdose
 Broken eyeglasses or frames
 Signs of being restrained
 Caregiver’s refusal to allow to see the elder’s alone
EMOTIONAL ABUSE  Threatening, belittling (unimportant), or controlling
caregiver behavior
 Behavior from the elder that mimics dementia
SEXUAL ABUSE  Bruises around breast or genitals
 Unexplained veneral diseases
 Unexplained vaginal or anal bleeding
 Torn, strained or bloody underclothing
NEGLECT  Unusual weight loss, malnutrition, dehydration
 Untreated physical problems
 Unsanitary living conditions
 Being left dirty or unbathed
 Unsuitable clothing
 Unsafe living conditions
 Desertion of the elder at public places
FINANCIAL  Significant withdrawal from elder accounts
EXPLOITATION  Sudden change in the elder’s financial condition
 Items or Cash missing from elder’s household
 Suspicious changes in wills and property documents
 Addition names in the senior’s signature card
 Unpaid bills or lack of medical care
 Financial activity the senior couldn’t have done
 Unnecessary services, goods or subscriptions
HEALTH CARE FRAUD  Duplicate billing for the same medical service
AND ABUSE  Evidence of overmedication or under medication
 Evidence of inadequate care
 Problems with health care facility:
 Poorly trained, poorly paid, or insufficient staffs
 Crowding
 Inadequate responses to questions about care
HOW TO ASSESS THE ELDER ABUSE:
 Assess the elderly person’s general appearance.

 Looking or signs of abuse
 Look for signs of neglect
 Examine financial history
 Observe the relationship between the patient and her caregiver
ROLE OF COMMUNITY HEALTH NURSE IN PREVENTION OF ELDERLY ABUSE:
 Create mass awareness about the problem and education regarding causes, prevention and
control of the problem
 Helping the family to develop the family support system and coping abilities to deal with
the family situation and limited resources
 Guidance and counseling of family members
 Identification of older abuse cases, participating in their diagnosis and treatment as
prescribed
 Providing specific care according to the trauma, good physical care and love the abused
person and encouraging the family participation in the care
 Participating in the individual and group psychotherapy session and activating the
implementation of the care.
FEMALE FETICIDE
DEFINITION:
Female feticide is a practice that involves the detection of the sex in the womb of the mother and
the division to abort if it is the sex of the child is detected as a girl through:
 Amniocentesis
 Chronic villus sampling
 Ultrasonography
“Female infanticide is the intentional killing of baby girls due to the preference for male babies
and from the low value associated with the birth of females”
CAUSES:
 Money
 Poverty
 Lack of proper education
 Future speculation: marriage, dowry
 Mindest: age old traditional practices
 Obsession for son
 Gender discrimination
 Female is considered as greater responsibility than a male mainly due to security issues
CONSEQUENCES OF FEMALE FETICIDE:
 Decrease in the female population.

 Adverse effect on women's health physically , mentally and emotionally.
 Women are abused and sexually exploited.
 Leads to women trafficking. Women are kidnapped, bought and sold for marriage.
 Suicide rates in women will increase
PREVENTION OF FEMALE FETICIDE:
 Prohibition of pre-sex determination tests

 Free education for women
 Provide extra incentives for families having more than one female child
 A move away from religious teachings and the advocacy of a scientific, rational and
humanist approach regarding sex determination
 The empowerment of women and strengthening of women’s rights
 Ensuring the development and access to good health care services
 Inculcating a strong ethical code of conduct among medical professionals, beginning with
their training as undergraduates
 Simple method of complaint registration, accessible to the poorest and most vulnerable
women
 Wide publication in the media of the scale and seriousness of the practice
 Regular assessment of indicators of status of women in the society
LEGAL INITIATIVES:
1. THE PRENATAL DIAGNOSTIC TEST ACT (PNDT ACT) OF 1994:

 This Act was enacted in the year 1994 in all of the states in India, but it came into
force in the year 1996.
 Through this Act the use of pre-natal diagnostic techniques is prohibited and
regulated.
 PNDT Act was amended in 2003 with its main aim to ban the use of sex-selection
techniques as well as the misuse of pre-natal diagnostic techniques for sex-
selective abortions.
 More than 21,600 centres conducting pre-natal diagnostic procedure have been
registered.
2. MTP Act 1971
3. THE DOWRY PROHIBITION ACT, 1961:
 Prohibits the request, payment or acceptance of a dowry, demanded or given as a
precondition for a marriage.
 Asking or giving of dowry can be punished by an imprisonment of up to six
months, or a fine of up to Rs.5000.
 Indian government has modified property inheritance laws and permitted
daughters to claim equal rights to their parental property.
COMMERCIAL SEX WORKERS
MEANING OF PROSITUTION:
It is an exchange of money for sexual purpose that is offering sexual intercourse for pay
or in other words it is an act of sexual intercourse in exchange of money.
CAUSES OF PROSTITUTION:
 Bad company
 Social customs
 Inability to arrange marriage
 Lack of sex education
 Prior incest and rape
 Early marriage and desertion (difficult situation)
 Lack of recreational facilities, ignorance and acceptance of prostitution
 Economic causes include poverty and economic distress
 Psychological causes include desire for physical pleasure, greed and dejection (unhappy)
LAWS RELATED TO PROSTITUTION IN INDIA:
1. The Immoral Traffic (Prevention) Act, or ITPA, also called the Prevention of
Immoral Trafficking Act (PITA) is a 1986 amendment of legislation passed in 1956 as
a result of the signing by India of the United Nations' declaration in 1950 in New York on
the suppression of trafficking.[41] The act, then called the All India Suppression of
Immoral Traffic Act (SITA), was amended to the current law. The laws were intended as
a means of limiting and eventually abolishing prostitution in India by gradually
criminalizing various aspects of sex work.
HEALTH RISKS FOR PROSTITUTES:
 Cervical cancer
 Traumatic brain injury
 HIV
 STD
 Psychological disorder
PREVENTION OF PROSTITUTION:
 Strengthening the economic status of women

 Improving status of women to make their lives on their own
 Improve the standards of living
 Protecting young workers when placed in employment
 Creating awareness for teenage girls
 Sex education in schools
 Severe punishment for persons running prostitution
 Providing rehabilitative services
 Guidance and counseling
 Family adjustments
 Creating awareness by mass media
 Strict implementation of laws
ALCOHOLISM
DEFINITION:
Alcoholism is a chronic illness marked by dependence on alcohol consumption that interferes

with physical or mental health, and social, family or job responsibilities. This addiction can lead
to liver, circulatory and neurological problems.
Alcoholism is a chronic disease defining serious problems with alcohol. This term is generally
used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the
detriment of the drinker's health, personal relationships, and social standing. Cravings for alcohol
and an inability to stop drinking, irrespective of all rules of common sense, are quite a feature of
alcoholism. Alcohol abuse generally refers to people, who have a problem with alcohol, but they
have not yet completely lost their control over its consumption.
SIGNS AND SYMPTOMS:
 Using alcohol in situations where it’s physically dangerous, such as drinking and driving,
or mixing alcohol with medicines against doctor’s orders.
 Being insular and withholding the fact of drinking alone.
 Not being able to limit how much alcohol is consumed.
 Blacking out - not being able to remember some periods of time.
 Giving up hobbies and activities the person used to enjoy; losing interest in them.
 Feeling a desire to drink.
 Feeling irritable when an alcoholic can't get a drink at his regular time and making up for
it later.
 Having tough problems with relatives, work, money and law and as a result feeling
insecure of future.
 Requiring a larger quantity of alcohol to feel its effect.
 Having withdrawal symptoms when you stop drinking, such as nausea, sweating,
shakiness, and anxiety.
CAUSES OF ALCOHOLISM:
 Genes
 The age of first alcoholic drink
 Smoking, especially non-daily smokers
 Easy access
 Stress
 Peer drinking
 Low self-esteem
 Depression and nervous disorder
 Media and advertising
COMPLICATIONS OF ALCOHOLISM:
 Fatigue
 Memory loss
 Liver diseases
 Gastrointestinal complications
 Hypertension
 Heart problems
 Diabetes
 Fetal alcohol syndrome
 Thinning bones
 Nervous system problems
 Cancer
 Mental illness
PREVENTIVE CARE FOR TEENS:
 Stay involved and interested in the teenager's life.

 Talk openly to children, especially pre-teens and teens, about the widespread presence
and dangers of alcohol and drugs.
 Have clear rules about not using alcohol and drugs.
 Act as a model for children - don't drink excessively, use other drugs, or smoke.
 Strongly urge children not to smoke.
 Encourage children to become active in sports, music, the arts, or other activities.
 Know where children and teens are at all times and make sure they always have adult
supervision.
 Observe teenager for aggressive behavior, feelings of anger or depression, and poor
school performance. If any of these develop, consider whether alcohol may be a reason.
 Never drink and drive or allow a teenager to be driven in the car by someone who has
been drinking.
TREATMENT:
 Do-it-yourself
 Counseling
 Treating underlying problems
 Residential programs
 Drug that provokes a severe reaction to alcohol
 Detoxification
IMMEDIATE HEALTH RISKS:
 Unintentional injuries, including traffic injuries, falls, drowning, burns, and unintentional
firearm injuries.
 Violence, including intimate partner violence and child maltreatment.
 Risky sexual behaviors, including unprotected sex, sex with multiple partners, and
increased risk of sexual assault. These behaviors can result in unintended pregnancy or
sexually transmitted diseases.
 Miscarriage and stillbirth among pregnant women, and a combination of physical and
mental birth defects among children that last throughout life.
 Alcohol poisoning, a medical emergency that results from high blood alcohol levels that
suppress the central nervous system and can cause loss of consciousness, low blood
pressure and body temperature, coma, respiratory depression, or death.
LONG-TERM HEALTH RISKS:
 Neurological problems, including dementia, stroke and neuropathy.

 Cardiovascular problems, including myocardial infarction, cardiomyopathy, atrial
fibrillation and hypertension.
 Psychiatric problems, including depression, anxiety, and suicide.
 Social problems, including unemployment, lost productivity, and family problems.
 Cancer of the mouth, throat, esophagus, liver, colon, and breast.
 Liver diseases, including: a. Alcoholic hepatitis. b. Cirrhosis, c. Other gastrointestinal
problems, including pancreatitis and gastritis.
SOCIAL PROBLEMS:
 Alcohol use can make mild social problems worse by causing people to be more irritable
and likely to argue and by affecting judgment and control of behavior.
 Misuse of alcohol can lead to a number of moderate and serious social problems
including: 1. Losing friends; 2. Losing jobs; 3. Child abuse and domestic violence; 4.
Separation of family members; and 5. Divorce. 6. These disorders can have adverse
effects on fertility. 7. Further, continued drinking may lead to early menopause.
FINANCIAL PROBLEMS:
 Misuse of alcohol may make current money problems worse and cause new ones,
including: 1. Having less money for necessary expenses like food and clothing; 2.
Neglecting to pay bills; and • Creating additional expenses, such as extra medical costs,
fines, or car repairs.
SUBSTANCE ABUSE
DEFINITION:
According to W.H.O, “Substance abuse can be defined as using a drug in a way that it is
inconsistent with medical or social norms and despite negative consequences.”
Use of any chemical, drug or alcohol that is causing the individual, family, social, occupational,
financial, medial or legal problems.
TYPES:
1. LEGAL DRUGS: Tobacco and alcohol are legalized drugs that can be obtained by
anyone over the age of 21. These are the two commonly abused drugs. Tobacco can be
acquired in cigarettes, cigars, snuff, chew, and pipe tobacco. Its principle addictive
substance is nicotine. Due to the heavy rate of addiction, many experts contend that most
tobacco use is abusive. Alcohol is a drug that acts as a depressant on the body and affects
speech, decision making, and motor control. Alcohol abuse is typically a form of
alcoholism.
2. ILLEGAL DRUGS: There are a variety of ways to classify the wide range of illegal
drugs mainly they are divided into three general classes:
 Stimulants: Stimulants act on the nervous system and generally create feelings of
pleasure along with increased alertness and energy. Drugs like cocaine and
methamphetamines are stimulants.
 Depressants: Depressants act on the nervous system with a sedative effect and
can create euphoria. Marijuana, heroin, Gamma Hydroxyl Butyrate commonly
referred to as club drugs are depressants.
 Hallucinogens: Hallucinogens acts to alter perception and mood and can cause
hallucination. Peyote and LSD are hallucinogens.
CAUSES OF SUBSTANCE ABUSE:
 Family factors: Family situations that can increase a person’s risk for becoming a
substance abuser are
 Lack of parental supervision
 Absence of affection
 Chaotic home environment
 Social factors:
 Peer group pressure
 Modeling
 Easy availability of alcohol and drugs
 Familial conflicts
 Religious reasons
 Unemployment
 Poor social support
 Psychological:
 Curiosity
 Poor impulse control
 Low self esteem
 Poor stress management skills
 Childhood trauma
 Psychological distress
 Reaction to neglect
 Biological:
 Family history of Substance abuse
 Personality disorders
 Co-morbid medical disorders
 Re-enforcing effects of drugs
 Withdrawal effects and craving
 Biochemical factors.
 Physical: The drugs used for medical condition like Valium can develop an addiction.
Also, if a person suffers from an untreated condition that causes pain, it may turn to
illegal drugs such as cocaine or heroin to alleviate it.
 Emotional: drugs used to relieve various emotional problems such as anxiety,
nervousness or depression
 Others: previous habit of use of drugs, physically and psychologically dependent people,
easily availability of drugs etc
EFFECTS OF SUBSTANCE ABUSE:
 Medical effects:
 Tobacco: Use is related to lung cancer, oral cancer, heart disease, COPD, dental
problems, chronic bronchitis, impotence in males and fetal defects in unborn
children (in pregnant women)
 Chronic alcohol: Use may lead to hepatitis, cirrhosis of liver, gastritis,
pancreatitis, depression, impotence in males, cardiomyopathy, high blood
pressure, neuropathy, obesity, cancer and accidents. Those drugs that are inhaled
cause respiratory tract infections and may predispose to tuberculosis. Injected
drugs causes infection of the veins, infection in the blood, abscesses in various
internal organs and muscles, and spreads blood borne infections if needles are
shared between users. Opioids and sedatives may be dangerous if overdosed.
Inhalants may produce burns in mouth, nostrils, abnormal heart rhythms and
sudden death.
 Non-medical effects:
 Marital complications: Disapproval of drug use by the spouse, deteriorating
interpersonal relationships, impotence in males, frequent fights, separation and
divorce
 Familial complications: Disapproval of drug use by family members, frequent
fights, embarrassing events due to intoxication
 Social complications: Misbehavior with others, loss of prestige in society and
social standing, alienation, exclusion of drug user and family from social
occasions by other members of the society
 Occupational complications: Irregular work habits, absenteeism, poor work
output, accidents due to intoxication, misbehavior and insubordination, frequent
complaints, salary deduction, loss of pay, unemployment, difficulty on re-
acquiring job, frequent change of jobs.
 Financial complications: Cost of drugs and syringes, transport, additional
snacks, medical cost, diversion of household expenses for drug procurement,
stealing money from home, selling household items for drug, loans from family,
friends and other sources.
 Legal complications: Driving and traffic accidents, brawls (fight) during
intoxicated state, arrest for procession or use of illicit drug, peddling (stealing) of
drugs sustaining drug use habit.
CONTROL OF SUBSTANCE ABUSE:
Primary prevention:
 Provision of happy and healthy family life

 Establishment of healthy parent-child relationship
 Provision of love and care to the children
 Show interest towards the child’s activities
 Offer counseling to the teenagers
 Reduce the availability of drugs
 Legislation
Secondary prevention:
 Closely monitor the changes in the behavior of an individual.

 Early detection and treatment of addicts.
 Establishment of de-addiction centers, after care centers and day care centers.
 Proper treatment and specific therapies should be given to prevent complication of
disease.
Tertiary prevention:
 Provision of treatment in the state of severe dependence.

 Provision of rehabilitation measures for the drug addicts.
 Involvement of family in the restorative and rehabilitative activities.
 Involvement of social agencies for the rehabilitation.
C. UTILIZATION OF COMMUNITY RESOURCES FOR SELF AND FAMILY
VARIOUS GOVERNMENT SCHEMES FOR AGED
1. Integrated Programme for Older Persons (IPOP):

 Ministry of Social Justice and Empowerment is a nodal agency for the welfare of
elderly people.
 The main objective of the scheme is to improve the quality of life of older persons
by providing basic amenities like shelter, food, medical care and entertainment
opportunities, etc.
2. Rashtriya Vayoshri Yojana (RVY):
 This scheme is run by the Ministry of Social Justice and Empowerment. This is a
central sector scheme funded from the Senior Citizens’ Welfare Fund. The fund
was notified in the year 2016. All unclaimed amounts from small savings
accounts, PPF and EPF are to be transferred to this fund
 Under the RVY scheme, aids and assistive living devices are provided to senior
citizens belonging to BPL category who suffer from age-related disabilities such
as low vision, hearing impairment, loss of teeth and locomotor disabilities. The
aids and assistive devices, viz walking sticks, elbow crutches, walkers/crutches,
tripods/quad pods, hearing aids, wheelchairs, artificial dentures and spectacles are
provided to eligible beneficiaries.
 The scheme is being implemented by Artificial Limbs Manufacturing Corporation
of India (ALIMCO), which is a public sector undertaking under the Ministry of
Social Justice and Empowerment.
3. Indira Gandhi National Old Age Pension Scheme (IGNOAPS):
 The Ministry of Rural Development runs the National Social Assistance

Programme (NSAP) that extends social assistance for poor households for the
aged, widows, disabled, and in cases of death where the breadwinner has passed
away.
 Under this scheme, financial assistance is provided to person of 60 years and
above and belonging to family living below poverty line as per the criteria
prescribed by Government of India. Central assistance of Rs 200 per month is
provided to person in the age group of 60-79 years and Rs 500 per month to
persons of 80 years and above.
4. Varishtha Pension Bima Yojana (VPBY):
 This scheme is run by the Ministry of Finance. The Varishtha Pension Bima
Yojana (VPBY) was first launched in 2003 and then relaunched in 2014. Both are
social security schemes for senior citizens intended to give an assured minimum
pension on a guaranteed minimum return on the subscription amount.
5. The Pradhan Mantri Vaya Vandana Yojana:
 The Pradhan Mantri Vaya Vandana Yojana (PNVVY) was launched in May 2017
to provide social security during old age. This is a simplified version of the VPBY
and will be implemented by the Life Insurance Corporation (LIC) of India.
 Under the scheme, on payment of an initial lump sum amount ranging from Rs
1,50,000 for a minimum pension of Rs 1000 per month to a maximum of Rs
7,50,000/- for a maximum pension of Rs 5,000 per month, subscribers will get an
assured pension based on a guaranteed rate of return of 8% per annum payable
monthly/quarterly/half-yearly/annually.
 The Centre will bear 75 percent of the total budget and the state government will
contribute 25 percent of the budget, for activities up to district level.
6. Vayoshreshtha Samman:
 Conferred as a National award, and given to eminent senior citizens & institutions
under various categories for their contributions on International day of older
persons on 1st October.
VARIOUS GOVERNMENT SCHEMES FOR WIDOWS
The 2011 census indicates the number of widows in the country and not their social and
economic condition. There are a number of Schemes being implemented by various Ministries of
the Government of India through States Governments/UT Administrations which address the
common needs of widows also. While some schemes cover a broader segment of population of
which widows constitute a part, there are widow specific schemes also. The major schemes of
Government of India in this regard are as under:-
1. Home for Widows: A Home for Widows has been set up in Vrindavan, UP with a
capacity of 1000 inmates to provide widows a safe and secure place of stay, health
services, nutritious food, legal and counseling services.
2. SwadharGreh Scheme:-The Ministry of Women and Child Development implements
SwadharGreh Scheme which envisions a supportive institutional framework for women
victims of difficult circumstances so that they could lead their life with dignity and
conviction.
3. The Mahila Shakti Kendra Scheme: -The Mahila Shakti Kendra Scheme of Ministry of
Women and Child Development aims to empower rural women through community
participation and to create an environment in which they realize their full potential.
4. Indira Gandhi National Widow Pension Scheme (IGNWPS):- The Ministry of Rural
Development is implementing Indira Gandhi National Widow Pension Scheme
(IGNWPS) under which Pension Scheme for Widows as well as Pension Scheme for the
Elderly below poverty line are operated.
5. National Family Benefit Scheme (NFBS):- The Ministry of Rural Development
implements National Family Benefit Scheme (NFBS) under which monetary grant of Rs.
20,000 is given as lump sum assistance to the bereaved household in the event of death of
the bread-winner.
6. Annapurna Scheme :- Under Annapurna Scheme of the Ministry of Rural Development,
ten kg of food grain is given to those eligible aged persons who have remained uncovered
under the Indira Gandhi National Old Age Pension Scheme (IGNOAPS).
7. DeendayalAntyodayaYojana :- The DeendayalAntyodayaYojana National Rural
Livelihood Mission of the Ministry of Rural Development aims at creating efficient and
effective institutional platforms of the rural poor.
8. Prime Minister AwaasYojana (PMAY-G) :- The Prime Minister AwaasYojana
(PMAY-G) of Ministry of Rural Development and the Prime Minister AwaasYojana
(PMAY-U) of the Ministry of Housing & Urban Affairs aims at providing affordable
housing for women.
9. NariArthikSashaktikaranYojan - The Ministry of Social Justice and Empowerment
implements NariArthikSashaktikaranYojana to support Scheduled Castes, Single
Women/Widows to take up income generating activities.
10. Intergrated Programme for Older Persons:- The Ministry of Social Justice and
Empowerment implements Intergrated Programme for Older Persons to improve the
quality of life of senior citizens.
11. Assistance for vocational training of widows of ex-servicemen:- The Ministry of
Defence provides financial assistance for vocational training of widows of ex-
servicemen, treatment of serious diseases of non-pensioner ex-servicemen/widows and
daughter’s marriage/widows’ remarriage.
VARIOUS GOVERNMENT SCHEMES FOR MENTALLY DISABLED
1. DISHA (Early Intervention and School Readiness Scheme): This is an early intervention
and school readiness scheme for children upto 10 years with the disabilities covered
under the National Trust Act.
2. VIKAAS (Day Care): A day care scheme for persons with autism, cerebral palsy, mental
retardation and multiple disabilities, above 10 years for enhancing interpersonal and
vocational skills.
3. DISHA cum VIKAAS (Day Care Scheme): For the Registered Organisations, who were
implementing multiple schemes, an option for implementing merged scheme was given.
Based on the consent given by the ROs and the scheme guidelines, these ROs were
allotted the merged Disha-cum-Vikaas Scheme (Day Care) w.e.f. 1.4.2018.
4. SAMARTH (Respite Care): A scheme to provide respite home for orphans, families in
crisis, Persons with Disabilities (PwD) from BPL, LIG families with at least one of the
four disabilities covered under the National Trust Act.
5. GHARAUNDA (Group Home for Adults): This scheme provides housing and care
services throughout the life of the person with Autism, Cerebral Palsy, Mental
Retardation and Multiple Disabilities.
6. SAMARTH cum GHARAUNDA (Residential Scheme): For the Registered
Organisations, who were implementing multiple schemes, an option for implementing
merged scheme was given. Based on the consent given by the ROs and the scheme
guidelines, these ROs were allotted the merged Samarth-cum-Gharaunda Scheme
(Residential) w.e.f. 1.4.2018.
7. NIRAMAYA (Health Insurance Scheme): This scheme is to provide affordable Health
Insurance to persons with Autism, Cerebral Palsy, Mental Retardation and Multiple
Disabilities.
8. SAHYOGI (Caregiver training scheme): A scheme to set up Caregiver Cells (CGCs) for
training and creating skilled workforce of caregivers to care for Person with Disabilities
(PwD) and their families.
9. GYAN PRABHA (Educational support): A scheme to encourage people with Autism,
Cerebral Palsy, Mental Retardation and Multiple Disabilities for pursuing educational/
vocational courses.
10. PRERNA (Marketing Assistance): A marketing scheme to create viable & wide spread
channels for sale of products and services produced by persons with autism, cerebral
palsy, mental retardation and multiple disabilities.
11. SAMBHAV (Aids and Assistive Devices): This is a scheme to setup additional resource
centres in each city, to collate and collect the Aids, software and other form of assistive
devices.
12. BADHTE KADAM (Awareness, Community Interaction and Innovative Project): This
scheme supports Registered Organisations (RO) of The National Trust to carry out
activities for increasing the awareness of The National Trust disabilities.
VARIOUS GOVERNMENT SCHEMES FOR PHYSICALLY CHALLENGED PERSONS
1. Scheme of Assistance to Disabled Persons for Purchase/Fitting of Aids and

Appliances (ADIP Scheme)
 The ADIP Scheme is in operation since 1981 with the main objective to assist the
needy disabled persons in procuring durable, sophisticated and scientifically
manufactured, modern, standard aids and appliances that can promote their
physical, social and psychological rehabilitation by reducing the effects of
disabilities and enhance their economic potential.
 Assistive devices are given to PwDs with an aim to improve their independent
functioning and to arrest the extent of disability and occurrence of secondary
disability.
 The aids and appliances supplied under the Scheme must have due certification
 The scheme also envisages conduct of corrective surgeries, wherever required,
before providing an assistive device.
 Under the Scheme, grants-in-aid are released to various implementing agencies
(Artificial Limbs Manufacturing Corporation of India (ALIMCO)/National
Institutes/Composite Regional Centres/District Disability Rehabilitation Centres/
State Handicapped Development Corporations/ NGOs, etc.) for purchase and
distribution of aids and assistive devices.
 The Scheme was last revised w.e.f. 1.4.2014 and further modified and approved
for continuation during the remaining period of the 14th Finance Commission i.e.,
up to 31.3.2020.
2. Deendayal Disabled Rehabilitation Scheme (DDRS):

 DDRS is a Central Sector Scheme of Government of India which is being
implemented since 1999 for providing financial assistance to NGOs working for
education and rehabilitation of persons with disabilities.
 The objectives of the scheme are:
 To create an enabling environment to ensure equal opportunities, equity,
social justice and empowerment of persons with disabilities.
 To encourage voluntary action for ensuring effective implementation of
the Right of Persons with Disabilities Act 2016.
 NGOs are being given assistance under DDRS for providing a wide range of
services to children/persons with disability, e.g.
 programmes for pre-school and early intervention
 special education,
 vocational training and placement
 community based rehabilitation
 manpower development
 psycho-social rehabilitation of persons with mental illness
 rehabilitation of leprosy-cured persons, etc.
The "Scheme to Promote Voluntary Action for Persons with Disabilities" was revised and was
renamed as the "Deendayal Disabled Rehabilitation Scheme (DDRS) from April 2003.
3. Scheme for Implementation of the Rights of Persons with Disabilities Act, 2016
(SIPDA)
The Ministry has been Implementing the Scheme for Implementing of Persons with Disabilities
Act, 1995 (SIPDA) for providing financial assistance for undertaking various activities outlined
in the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation)
Act, 1995, particularly relating to rehabilitation and provision of barrier-free access. Grant-in-aid
is provided under this Scheme to State Governments and various bodies set up by the Central and
State Government, including autonomous bodies and Universities.
4. Financial Assistance Available to Persons With Disability as per NHFDC Schemes

 NHFDC, incorpoated by Ministry of Social Justice & Empowerment, govt of
India in 2017 runs several schemes to financially support PwDs:
 For setting up small business in service/trading sector: Loan up to Rs.
20.00 lakhs
 For setting up small industrial unit: Loan up to Rs. 20.00 lakhs
 For higher studies/professional training to cover tuition fees books,
stationery expenses, hostel facilities etc.
 For agricultural activities: Loan up to ` 5.00 lakhs.
 For manufacturing /production of assistive devicesfor disabled persons:
Loan up to Rs. 25.00 lacks
 For self employment amongst persons with mental retardation, Cerebral
Palsy and Autism: loan upto Rs 2.50 lacks
5. DIVYANGJAN SWAVALAMBAN YOJANA is a scheme introduced by NHFDC or

the welfare of people with disabilities. The main objective of the Scheme is to assist the
needy disabled persons by providing concessional loan for economic and overall
empowerment.
6. The National Fund for Persons with Disabilities was introduced by the Department of
Empowerment of Persons with Disabilities. Under the scheme, the Central Government
aims to provide financial assistance for the PwDs. The main target of the scheme is to
create equal opportunities, equity, social justice and empowerment of persons with
disabilities.
7. Exhibitions/workshops to showcase the products including paintings, handicraft etc
made by the PwDs.: The purpose of the scheme is to grant financial assistance for
organising exhibition or workshops at National, Regional or State level to exhibit the
products including paintings, handicrafts etc. made by persons with disabilities.
OLD AGE HOMES
DEFINITION:
A retirement home is sometimes called an old age home. It can also be said as a multi residence
housing facility intended for senior citizens
TYPES:
 Free Old Age Home: It cares for the destitute old people who have no one else to care for
them. They are given shelter, food, clothing, and medical care
 Paid Old Age Home: It is a type of old age home where care is provided for a fee. Either
the senior citizen himself should pay or any one from his family should pay for the care
provided. Nowadays such “Retirement” homes have become very popular in India and
they are well worth considering.
REASON:
 Migration of young couples from the rural areas to cities in search of better employment
opportunities to fend for themselves.
 Elders who have been in control of the household for a long time are unwilling to give
the responsibility to their children.
 Youngsters on their part are sometimes resentful of the attitude of their parents
 Many youngsters have moved to places far away from their native homes and in the
recent past to many countries abroad. So even if they want to they cannot accommodate
their parents in their own homes.
 Elders are sometimes too incapacitated or unwell to look after themselves or get medical
care especially in an emergency. All these have made the old age homes seem more
relevant in the Indian context than ever before.
CARE PROVIDED IN OLD AGE HOMES:
 Assisted living for food, clothing, drugs and other physical needs
 Nursing care
 Continuing care
 Independent living
NEEDS OF GERIATRIC PEOPLE IN OLD AGE HOMES:
 The time spent together is the most precious

 Emotional situation of elders and be patient
 Understands the problems of elderly and support them
 Create employment opportunities for the elderly
 Economic support
ORPHANAGE
DEFINTION:
Orphanage is the name to describe a residential institution devoted to the care of orphan children
whose parents are deceased or otherwise unable to care them.
 Parents and sometimes grandparents are legally responsible for supporting children but in
the absence of these or relatives willing to care for the children, they become a ward of
the state and orphanages are a way of providing for their care and housing.
 Children are educated within or outside of the orphanage.
ACTIVITIES UNDER ORPHANAGE HOMES:
 Education
 Recreation
 Skill training
 Sponsorship
 Medical care
 Creative art
 Documentation
 Awareness
PROCESS OF ENTERING CHILDREN IN ORPHANAGE:
PROCESS 1:
 Child is surrendered by the parent at one of the following places: police station,
government hospitals, nursing home, children’s home
 Parent signs a form to state that the child is legally surrendered
 Police station, government hospitals, nursing home, children’s home registers the child
with the Child Welfare Committee
 Chile Welfare Committee allots the child to one of the following:
 Less than 6 years: child is eligible for adoption-allots to a government home or
government approved adoption agency
 Child between 6-18 years: allots to a government home or government approved
children’s home
PROCESS 2:
 Child is abandoned and reported when found to any of the following places: police
station, government hospitals, nursing home, children’s home
 Files an FIR
 The child is kept at a government run institution for 3 months (incase of claims by
relatives)
 The organization where the child is kept registers the child with Child Welfare
Committee.
 If there is no claim, then Chile Welfare Committee allots the child to one of the
following:
 Less than 6 years: child is eligible for adoption-allots to a government home or
government approved adoption agency
 Child between 6-18 years: allots to a government home or government approved
children’s home
HOME FOR PHYSICALLY AND MENTALLY CHALLENGED
This home is set up to offer protection and rehabilitation to the differently abled men and
women. The Ministry of Social Justice and Empowerment implements a number of schemes for
the rehabilitation of persons with disabilities including physically challenged and mentally
retarded persons.
1. Cheshire Homes India- Central Trust:

 Cheshire Homes India, a National Organisation, for the last 58 years has been working
for people with disabilities, to make them contributing members of Society through
Residential Care, Community Based Rehabilitation (CBR) programs, such as Livelihood
Training and Employment, Access to Health, Inclusive Education and Advocacy/Young
Voices to sensitise the Government and the public at large. Today, the Cheshire Services
in India is reaching out to around 20,000 persons in a year with disabilities directly across
22 Districts in India.
 Each Home focuses on different disabilities and provides care and refuge for disabled
persons, the terminally sick, people with cerebral palsy, elderly men
and women by:
 Education and medical care including surgery.
 Impart training and opportunities for personal development
 Provide activities like Needle work centre, Craft training centre, Computer centre,
Workshop, Recreational centres
 Day care centres with physiotherapy and other support activities
 Inclusive education and professional training to enable the disabled youth to
become independent
2. Deendayal Disabled Rehabilitation Scheme (DDRS) – Under the Scheme funds for the
welfare of persons with disabilities are provided to non-Governmental organizations for
projects like Special Schools, Vocational Training Centres, Half Way Homes,
Community Based Rehabilitation Centres, Early Intervention Centres for disabled and
Rehabilitation for Leprosy Cured Persons etc.
3. Vikaas day care scheme:
This is a scheme for people with autism, cerebral palsy, and multiple disabilities above the age of
10 years. The aim is to improve interpersonal and vocational skills. A day care scheme that aims
to improve interpersonal and vocational skills.
 Each batch will have 30 disabled people.
 Day care open for at least 21 days in a month.
 Care-giving support offered to disabled person at the centers
 Provide family members of disabled people with a secure space where they
can leave them to meet other responsibilities.
 Day care offered for at least six hours in a day accompanied by age-specific
activities.
 Scheme available across India, except Jammu & Kashmir.
4. SAMARTH Respite Care:

A scheme to provide respite home for orphans, families in crisis, Persons with Disabilities (PwD)
from BPL, LIG families with at least one of the four disabilities covered under the National Trust
Act.
5. GHARAUNDA: Group Home for Adults

This scheme provides housing and care services throughout the life of the person with Autism,
Cerebral Palsy, Mental Retardation and Multiple Disabilities.

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UNIT 6

ASSISTING INDIVIDUALS AND GROUPS TO PROMOTE AND MAINTAIN HEALTH

A. ASSESSMENT OF SELF AND FAMILY

GROWTH AND DEVELOPMENT

It is the process of functional and physiological maturation of the individual. It is

Principle of Growth and Development:

Factor influencing Growth and Development:

GROWTH AND &DEVELOPMENTAL AGE PERIODS:

GROWTH AND DEVELOPMENT MONITORING:

 Healthy development, in all forms, particularly social/emotional, communication, and

1. The Denver Developmental screening test:

BREAST SELF EXAMINATION

Here's what you should look for:

 Breasts that are their usual size, shape, and color

 Breasts that are evenly shaped without visible distortion or swelling

 Dimpling, puckering, or bulging of the skin

 Redness, soreness, rash, or swelling

What other abnormalities may be important?

 any enlargement of a testicle

URINE FOR SUGAR AND ALBUMIN TEST

 Container for specimen

 Select a proper place.

Test for sugar : -

 Pour 5 ml of benedict’s solution in the test tube.

Test for albumin:-

After the procedure it is essential to terminate the articles in a proper manner.

ESTIMATION OF BLOOD PRESSURE

WHAT IS BLOOD PRESSURE?

BLOOD SUGAR ESTIMATION WITH GLUCOMETER

Time Required: 10 to 15 minutes

HEALTH ASSESSMENT OF INFANT FROM 2-6 MONTHS

Vaccine Weeks Dose 0 Dose 1 Dose 2 Dose 3

GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

Vaccine Weeks Dose 0 Dose 1 Dose 2 Dose 3

III. GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

 Holds two toys at once

III. GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

b) Fine motor( 1-2yrs):

Fine motor (2-3 yrs):

HEALTH ASSESSMENT OF PRESCHOOLER (3-6 yrs)

III. GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

GROWTH AND DEVELOPMENT OF SCHOOL AGE (7-12 yrs)

SL. BOOK PICTURE CHILD’S REMARKS

III. GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

HEALTH ASSESSMENT OF LATE ADOLESCENT (14-16 yrs)

III. GROWTH AND DEVELOPMENT ASSESSSMENT:

SL. BOOK PICTURE CHILD’S REMARKS

“A Multidimensional interdisciplinary diagnostic process focused on determining a frail older

 Develop treatment and long-term follow-up plans,

 Improve the assessment of the medical and the psychological Problems

 Focuses on elderly individuals with complex problems,

 Detailed health assessment once they are 45-50 years

1. Visual Impairment- Snellen Test

ANTENATAL ASSESSMENT FORMAT AND CASE STUDY FORMAT