Workshopupsj

WORKSHOP on TEACHERS AS HEALTH PARTNERS APRIL 28-29, 2009 SAN JUAN, BATANGAS

INTRODUCTION • School health of school-aged children is not only a responsibility of the health professionals but as well as teachers.

INTRODUCTION • We need to understand that health and education are closely intertwined” – Blum et.al, 2003

• “Only when students are healthy will schools be able to fully meet their goals” - Health is academic,1998

INTRODUCTION • This may be an overwhelming task for teachers BUT this is not the case. • Partnership following a structured system is the KEY. • This workshop is the 1st step towards this partnership.

INTRODUCTION • Role of teachers in health care: 1. Recognize problems related to health of a student 2. Identify common illnesses that warrants referral to a health care specialist 3. Help achieve the 7 goals of a school health program

• • •

•

7 Goals of a School Health Program

Assure access to primary care Provide a system for dealing with crisis medical situations Provide mandated screening and immunization monitoring

Provide a system for identification and solution of students’ health and emotional problems

7 Goals of a School Health Program 1. Provide comprehensive and appropriate health education 2. Provide a healthful and safe school environment that facilitates learning 3. Provide a system of evaluation of the effectiveness of the school health program

GENERAL OBJECTIVE OF THE WORKSHOP •

Provide a system for identification and solution of students’ health problems

SPECIFIC OBJECTIVES • 1. To identify the component information included in the DepEd circulated school health record • 2. To recognize the medical signs and symptoms included in the school health record • 3. To formulate a referral system for identified health problems of students

EXPECTED OUTCOME • Public school elementary teachers in San Juan, Batangas who are included in the workshop should have: – 70% increase in knowledge in recognizing abnormalities that warrants referral to a health care provider

EXPECTED OUTCOME • Public school elementary teachers in San Juan, Batangas who are included in the workshop should have: – Serve as front-liners in identifying communicable and non-communicable disease, thereby decreasing morbidity and mortality in elementary school children

FLOW CHART OF REFERRAL NORMAL

ACCOMPLISH FORM

TEACHERS NORMAL

(SCREENING) ABNORMAL

NURSE ABNORMAL

Important: If emergency or need immediate attention, refer directly to a Doctor.

DOCTOR

MECHANICS OF THE WORKSHOP • General Mechanics > 200 participants will be divided into 8 groups (25 teachers/group) > Each group will be assigned to one Facilitator, who will be their mentor for the day. > Each group will be given an adequately ventilated and appropriately sized room.

MECHANICS OF THE WORKSHOP •

General Mechanics > A total of 3 hours will be given to each facilitator to lecture the 5 modules, namely: – – – – –

Introduction to School Health Program Vital Signs and Antropometrics Skin/Scalp/Head (Eyes/Ears/Nose/Mouth/Throat) Chest/Abdomen/Spine/Extremities Filling up the School Health Record Form

> It is up to the facilitator to allot more time to modules they think need more attention in their group.

MECHANICS OF THE WORKSHOP • Part I: Introduction • Part II: Module presentation • Part III: Demo-Return Demo - each group will be divided further into 4 subgroups. - each subgroup will be assigned a child/student for them to examine. - each teacher will then fill up the school health record form, which can be found in their kit, after applying what they’ve learned. - the facilitator, together with 2 interns, will check their work and teach or correct them as necessary.

SCHEDULE OF ACTIVITIES 8:00 - 8:30 AM Registration 8:30 - 10:00 AM Lecture 10:00 -10:30 AM SNACKS 10:30 - 12:00 NN Lecture 12:00 - 1:00 PM Lunch 1:00 - 3:00 PM Demo-Return Demo 3:00 - 3:30 PM SNACKS 3:30 - 4:00 PM Awarding of Certificates/ Closing Remarks

VITAL SIGNS

What are Vital Signs? • Vital signs are measurements of the body's most basic functions. • Vital signs are indicators of one's overall health. They offer clues to diseases and help evaluate progress toward recovery. • The four main vital signs routinely monitored by medical professionals and healthcare providers include: * Body Temperature * Pulse Rate * Respiration Rate (rate of breathing) * Blood Pressure • Vital signs should be taken at rest. • Any abnormal findings should be repeated in order to verify the findings. •Vital signs can be measured in a medical setting, at the site of a medical emergency, at home, or even in school.

Temperature TEMPERATURE

What is Body Temperature? • The normal body temperature of a person varies depending on: • gender, • recent activity, • food and fluid consumption, • time of day, and, • in women, the stage of the menstrual cycle. • For example: body temperature is lower in the morning than it is in late afternoon and evening.

• Normal body temperature range from 36.5ºC - 37.5ºC • Acceptable range: 36.0ºC - 37.8ºC

• Body temperature is taken with a thermometer. • The most common places to measure temperature include: • the mouth (oral temperature),

• under the arm (axillary temperature),

• the anus (rectal temperature), and

• the ear (tympanic temperature).

Axillary method  3. Axilla must be clean and free from perspiration. 2. Place the thermometer horizontally in the axilla. Leave it for 2 minutes. 3. Check the temperature. 4. Replace the thermometer after cleaning. REMINDERS:

• Should be immersed in antiseptic solution to prevent infection. • Shake it before using it to bring the mercury down.  • Never hold the thermometer at the bulb, because the hand may cause inaccurate reading. 

HOW TO READ TEMPERATURE

Try this!

Temperature Reading: 38.7ºC

ABNORMAL • An elevated temperature is known as a fever or hyperthermia, and • A low body temperature is referred to as hypothermia. • Unless otherwise directed by your own health care provider, temperatures greater than 38ºC and lower than 36ºC need immediate intervention;

PULSE RATE

PULSE RATE • Your pulse is the rate at which your heart beats. • Your pulse is usually called your heart rate, which is the number of times your heart beats each minute (bpm). • Pulse rates vary from person to person. • Your pulse is lower when you are at rest and increases when you exercise (because more oxygen-rich blood is needed by the body when you exercise).

PULSE RATE • The pulse varies with age: • For resting pulse rate: * Newborn infants: 100 - 160 beats per minute * Children 1 to 10 years: 70 - 120 beats per minute * Children over 10 and adults (including seniors): 60 - 100 beats per minute * Well-trained athletes: 40 - 60 beats per minute

RADIAL PULSE • Pulse is often taken at the wrist (radial pulse). • The index and middle finger are used for this. You should not use a thumb as the thumb has a pulse as well and could give false readings. • Press your index and middle finger into the groove along the inside of the wrist. • You may need to move your fingers up or down the arm a few centimeters until you find the best spot to feel the pulse. • You may have to press a little harder if you don't feel it. But don't press so hard that you obliterate the pulse. • Once you find the pulse in the wrist, using a watch or clock with a second hand, begin counting the beats

Heart / Pulse Rate Abnormalities TACHYCARDIA • is a resting heart rate more than 100 beats per minute. • This number can vary as smaller people and children have faster heart rates than average adults.

Heart / Pulse Rate Abnormalities

BRADYCARDIA • is defined as a heart rate less than 60 beats per minute although it is seldom symptomatic until below 50 bpm when a human is at total rest. • Trained athletes tend to have slow resting heart rates, and resting bradycardia in athletes should not be considered abnormal if the individual has no symptoms associated with it. • Again, this number can vary as smaller people and children have faster heart rates than adults.

RESPIRATORY RATE

RESPIRATORY RATE • The respiration rate is the number of breaths a person takes per minute. • The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. • Respiration rates may increase with fever, illness, and with other medical conditions. • When checking respiration, it is important to also note whether a person has any difficulty breathing.

RESPIRATORY RATE • Average respiratory rates by age: * Newborns: average 44 breaths per minute * Infants: 20–40 breaths per minute * Preschool children: 20–30 breaths per minute * Older children: 16–25 breaths per minute * Adults: 12–20 breaths per minute * Adults during strenuous exercise: 35–45 breaths per minute * Athletes' peak: 60–70 breaths per minute[6]

RESPIRATORY RATE Method on checking respiration: • Student should be relaxed in a comfortable position. • Since respiration can be controlled voluntarily to some extent, as far as possible, the patient's respiration may be counted without making him aware of it. So after taking the pulse, count the respiration rate keeping the fingers in the student’s wrist. • Count the rise and fall of chest wall for 60 seconds (one minute) by using a watch. • Also note the depth and regularity of respiration, expansion of the chest on both sides and student’s color. 

RESPIRATORY RATE • The aim is to determine if the respirations are: – normal – abnormally fast (tachypnea) • usually >30 cycles per minute in children at rest

– abnormally slow (bradypnea) • <12 cycles per minute

– or nonexistent (apnea)

• Abnormal respiration  – Dyspnea: difficult or painful breathing  – Orthopnea: inability to breathe in a horizontal position. It is relieved by sitting position. 

HEIGHT • Height is, like other phenotypic traits, determined by a combination of genetics and environmental factors. • Genetic potential plus nutrition minus stressors is a basic formula. • Humans grow fastest as infants and toddlers (birth to roughly age 2) and then during the pubertal growth spurt. • A slower steady growth velocity occurs throughout childhood between these periods;

Measuring Height Accurately 1. Remove the child's shoes, bulky clothing, and hair ornaments, and unbraid hair that interferes with the measurement. 2. Take the height measurement on flooring that is not carpeted and against a flat surface such as a wall with no molding. 3. Have the child stand with feet flat, together, and against the wall. Make sure legs are straight, arms are at sides, and shoulders are level. 4. Make sure the child is looking straight ahead and that the line of sight is parallel with the floor. 5. Take the measurement while the child stands with head, shoulders, buttocks, and heels touching the flat

Measuring Height Accurately 6. Use a flat headpiece to form a right angle with the wall and lower the headpiece until it firmly touches the crown of the head. 7. Make sure the measurer's eyes are at the same level as the headpiece. 8. Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape to measure from the base on the floor to the marked measurement on the wall to get the height measurement. 9. Accurately record the height to the nearest 1/8th inch or 0.1 centimeter.

• Most intra-population variance of height is genetic. • Short and tall stature are usually not a health concern. • If the degree of deviation from normal is significant, confirmation that exceptional height is normal for a respective person can be ascertained from comparing stature of family members and analyzing growth trends for abrupt changes, among others. • There are, however, various diseases and disorders that cause growth abnormalities. • Most notably, extreme height may be pathological, such as gigantism (very rare) resulting from childhood hyperpituitarism, and dwarfism which has various causes.

WEIGHT • Purpose: measuring body mass/weight can be valuable for monitoring hydration and nutritional level, or for monitoring body fat or muscle mass changes. • Equipment required: Scales, which should be routinely calibrated for accuracy. • Procedure: the person stands with minimal movement and with hands by their side. Shoes and excess clothing should be removed. Body weight is measured in kilograms mostly throughout

Underweight • is the most common assessment of child nutrition status. • Weight for age (WFA) is a simple index, but this index does not take height into account. • Children who are taller would be expected to weigh more than other children, just as children who are shorter would be expected to weigh a little less and still be healthy.

• is a measure of linear growth. • refers to shortness, and reflects linear growth achieved pre- and postnatal • with its deficits it is generally assumed to indicate long-term, cumulative effects of inadequate nutrition and poor health status • Height for age (HFA) is considered a measure of past nutrition, because a child who is short today, maybe did not have adequate nutritional intake at some point in

• A measure of acute or short-term exposure to a negative environment. • It is sensitive to changes in calorie intake or the effects of disease. • Wasting can be calculated without knowing the age of a child. • Weight for height (WFH) is a measure of current body mass. – It is the best index to use to reflect wasting malnutrition, when it is difficult to determine the exact ages of the children being measured.

• are defined as abnormal or excessive fat accumulation that presents a risk to health. • A crude population measure of obesity is the body mass index (BMI): a person’s weight (in kilograms) divided by the square of his or her height (in meters). • A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight

VISUAL ACUITY • By history: – “May panlalabo ba ng mata?” – “Saan mas gusto umupo? Sa harap o sa likod?” – “Sumasakit ba ang ulo o mata pagkatapos magbasa?” – “Hindi makakita sa gabi?”

• Activity: – Let the student read a paragraph in a book. – This way, the teacher not only assess vision, but also

Hearing Evaluation • By History/Observation: – “May problema ba sa pandinig?” – “Saan mas gusto umupo? Sa harap o sa likod?” – “Kinakailangan bang ilakas ang boses bago maintindihan ang sinasabi?”

Hearing impairment • A hearing impairment is a full or partial decrease in the ability to detect or understand sounds. • Caused by a wide range of biological and environmental factors • "Hearing impaired" is often used to refer to those who have hearing problems and those who are deaf.

SKIN

Normal Skin

Tinea Flava

• is a superficial, chronic fungal infection • Usually starts as small pale patches • Appear on the chest, neck, or upper arms and sometimes spreads to the abdomen, thighs, and back. • Affected skin may become slightly scaly. • The rash is usually pale, and is barely noticeable if you are fair-skinned. (Sometimes the rash is darker than the skin in fairskinned people, and it looks like brown marks.) • The pale patches are more obvious if you have dark skinned. • Sometimes it is slightly itchy.

Tinea Flava

Tinea Corporis / Ringworm • is usually a mild fungal infection of the

skin that causes a red circular lesion with central area of healing and a scaly border. • affects persons of all age groups, but prevalence is highest in preadolescents. • Ringworm acquired from animals is more common in children

Tinea Corporis / Ringworm

IMPETIGO • a bacterial skin infection. • often called "school sores" because it most often affects children. • It is quite contagious. • presents with pustules and round, oozing patches which grow larger day by day. • there may be clear blisters (bullous impetigo) or golden yellow crusts. • It most often occurs on exposed areas such as the hands and face, or in skin folds particularly the armpits.

Impetig

Impetig

Impetig

Boils / Furunculosis • A boil or a furuncle is a bacterial abscess or collection of pus and dead tissues that starts in the hair follicles. • Symptoms of boils include: * Red, shiny, and swollen lump filled with pus * Tenderness, the sensation of warmth and/or pain * When the lump is ready to rupture, a pointy white or yellow central area is noticed • Boils can occur in any part of the body, however, they are mostly found on the scalp, back, underarms, and buttocks.

Boils / Furunculosis

Bruise / Hematoma • A bruise is an area of skin discoloration. • Occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin. • Often caused by falls, sports injuries, car accidents, or blows received by other people or objects. • Begins as a pinkish red color that can be very tender to touch and eventually, changes to a bluish color, then greenish-yellow, and finally returns to the normal skin color as it heals.

Bruise / Hematoma

Cut / Incision and Laceration

• Incisions or incised wounds or cuts • caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter. • Lacerations: • irregular tear-like wounds caused by some blunt trauma. The term laceration is commonly misused in reference to incisions.

Cut / Laceratio n

Eczem • a forma of dermatitis,or inflammation of the epidermis. • The term eczema is broadly applied to a range of persistent skin conditions. • These include dryness and recurring skin rashes which can be: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. • Factors that can cause eczema include other diseases, irritating substances, allergies and your genetic makeup. Eczema is not contagious. • Eczema cannot be cured, but you can prevent some types of eczema by avoiding irritants, stress and the things you are allergic to.

Eczem

ALLERGY • Allergy is the term given to a reaction by a small number of people to a substance (known as the allergen) which is harmless to those who are not allergic to it. • Contact allergy occurs predominantly from the allergen on the skin rather than from internal sources or food. • The dermatitis is generally confined to the site of contact with the allergen. •The affected skin may be red, swollen and blistered or dry and bumpy.

Allergic Dermatitis

Contact Dermatitis

Important Note: • REFER if ABNORMAL • Only your doctor can diagnose the various skin lesions mentioned. • The features described above can appear in many types. • Diagnosis is based on a combination of the patient's recent medical history and family history, in addition to a physical examination.

Pediculosis • Refers to lice infestation of the human head. • Most frequent on children aged 3-10. • Females get head lice more often than males. • Head lice are spread through direct head-to-head contact with an infested person. • Lice feed on blood once or more often each day by piercing the skin with their tiny needle-like mouthparts. Lice cannot burrow into the skin.

Pediculosis

SQUINTING • a condition in which the eyes are not properly aligned with each other. • It typically involves a lack of coordination between the eye muscles that prevents bringing the gaze of each eye to the same point in space and preventing proper binocular vision

SQUINTING

Normal conjunctiva.

Pale conjunctiva.

Note the full reddness of the anterior rim and its dissimilarity to the posterior aspect of the conjunctiva.

Note that the color of the pale anterior rim and the posterior part of the conjunctiva are the same.

Normal EAR

Ear Discharge • Ear discharge is drainage of blood, ear wax, pus, or fluid from the ear. • Most of the time, any fluid leaking out of an ear is ear wax. • However, discharge may also be caused by a minor irritation or infection. • A ruptured eardrum can cause a white, slightly bloody, or yellow discharge from the ear. • Bleeding from the ear may also be due to: * Cancer * Foreign object in the ear canal * Injury

Ear Discharge

Normal NOSE

Nasal Discharge • Any mucus-like material that comes out of the nose • Drainage from swollen or infected sinuses may be thick or discolored. • Excess mucus may run down the back of your throat (postnasal drip) or cause a cough that is usually worse at night. • A sore throat may also result from too much mucus drainage. • The mucus drainage may plug up the eustachian tube between the nose and the ear, causing an ear infection and pain. • The mucus drip may also plug the sinus passages, causing sinus infection and pain.

Nasal Discharge

Septal Deviation • Nasal septum deviation is a common physical disorder of the nose, involving a displacement of the nasal septum. • The septum that separates the two sides of the nose is usually straight. If the septum is not straight but shifted to one side it is known as a deviated septum. • A deviation in the septum of the nose can cause narrowing of the nasal passage, lessening the amount of secretions that can drain, sometimes leading to sinus infections. • It is most frequently caused by impact trauma, such as by a blow to the face.

Septal Deviation

Mouth

NORMAL

Fever Blisters / Cold sores • Definition – is the name for the appearance of an open sore in the epithelium on the lips or surrounding the mouth.

Fever Blisters / Cold sores

Oral Ulcers / Aphtous Ulcers • Definition – is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membranes or the epithelium on the lips or surrounding the mouth.

Oral Ulcers

Throat

Normal

Tonsillar Hypertrophy • Definition – The tonsils are small pieces of tissue in the back of the throat, on the right and left side – They produce antibodies against infection.  – Frequently, the tonsils enlarge in response to infection in and about the throat area.  – When they enlarge, this is called tonsillar hypertrophy.

Enlarged Tonsils without exudates

Enlarged Tonsils with Exudates

Enlarged Tonsils with Exudates

•

Pharyngitis/Inflammed Pharynx Definition – is an inflammation of the throat or pharynx. – is often referred to as a sore throat. It can result in very large tonsils which cause trouble swallowing and breathing. – Some are accompanied by a cough or fever. – Most cases are caused by • Viral infection (40%-60%) • Bacterial infections, • Fungal infections, or

Inflammed Pharynx

Infammed Pharynx

Chest

Normal

Pectus Excavatum • Definition – is the most common congenital deformity of the anterior wall of the chest – several ribs and the sternum grow abnormally. – a caved-in or sunken appearance of the chest. – present at birth and progresses during the time of rapid bone growth in the early teenage years.

Pectus Excavatum

Pectus Carinatum • Definition – also called pigeon chest, is a deformity of the chest characterized by a protrusion of the sternum and ribs.

Pectus Carinatum

Abdomen

Normal

Scaphoid Abdomen

• Definition – A condition in which the anterior abdominal wall is sunken, having a concave rather than a convex contour.

Scaphoid Abdomen

Distended Abdomen or “Malaking Tiyan”

Spin e

Normal

Scoliosis • Definition – is a medical condition in which a person's spine is curved from side to side, shaped like "s", and may also be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the spine

Scoliosis

Scoliosis

Kyphosis • Definition – also called "hunch back" or "hunchbackism" or "hunchbackedness", in general terms, is a common condition of a curvature of the upper (thoracic) spine. – “K” for “Kuba”

Kyphosis

Lordosis • Definition – is a medical term used to describe an inward curvature of a portion of the vertebral column. – “L” for “Liyad”

Lordosis

Extremities

Normal

Genu Varus/Bowlegs • (also called bow-leggedness or bandiness), is a deformity marked by medial angualtion of the leg in relation to the thigh, an outward bowing of the legs, giving the appearance of a bow.

Genu Varus/Bowlegs

Genu Valgum/Knock-knees • Definition – Commonly called "knockknees", is a condition where the knees angle in and touch one another when the legs are straightened.

Genu Valgum/Knock-knees

Feet

Normal

Pes Planus/Flatfeet • Definition – also called pes planus or fallen arches, is an informal reference to a medical condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or nearcomplete contact with the ground.

Flatfoot

Talipes Equinovarus/Clubfoot • Definition – The common ("classic") form of clubfoot. Talipes is made up of the Latin talus (ankle) + pes (foot). Equino- indicates the heel is elevated (like a horse's) and -varus indicates it is turned inward. With this type of clubfoot, the foot is turned in sharply and the person seems to be walking on their ankle.

Talipes Equinovarus/Clubfoot