PATHFIT

DANCE
 Plays an important part in the PE curriculum because it will allow students to experience
cultures from the different and around the world.
 Is masterful movement in a rhythmically coordinated, and expressive way. It is a vital
part of a child’s movement education.
 Creating dances means exploring the movement framework, selecting movement
elements and refining dance sequences.

DANCE is a HEALTH
 It has become an important factor in the prevention, treatment and management in
several health circumstances.
 It can benefit both physical and mental health and subsidizes social communication.
 The correlation between dance and health has been subject of a number of research
studies that show dance to be a largely healthy exercise

THREE TYPES OF LEARNING EXPERINCE DURING DANCE

 Creating – students use the cognitive processes of application, analysis, synthesis and
evaluation to create dances.
 Performance – students recall and reproduce movements from existing dances.
1. Responding – learners observe, interpret, analyze, and evaluate as they describe
movement, qualities of movements, compositional structures and their feelings and
understanding of a dance.

FUNDAMENTAL DANCE POSITION

 1st Position
 ARMS: Both arms raised in a circle in front of the chest with the finger tips
about an inch apart.
 FEET: Heels close together, toes apart with an angle of about 45 degrees.

 2nd Position
 ARMS: Both raised sideward with a graceful curve at shoulder level.
 FEET: Feet apart sideward of about a pace distance

 3rd Position
 ARMS: One arm raised in front as in 2nd position; other arm raised upward.
 FEET: Heel of one foot close to instep of other foot.

 4th Position
 ARMS: One arm raised in front as in 1st position; other arm raised overhead.
 FEET: One foot in front of other foot of a pace distance.

 5th Position
 ARMS: Both arms raised overhead.
 FEET: Heel of front foot close to big toe of rear foot.
HISTORY AND DEVELOPMENT OF DANCE FROM THE DIFFERENT PERIODS
DURING THE 18th Century (1701-1800)
DURING THE PRE-HISTORIC PERIOD  Classical Persian Dancing (1795)
 It had been a major form of religious ritual and social expression within the primitive  This style of dance evolved from courtroom dancing.
culture.  An era influencing Persian dance was the Qajar Dynasty which lasted from
 It was used as a way of expression and reinforcing tribal unity and strength. 1795 to 1925.
 It is based in superstition and infused with magic. Shamans as lead dancers acted as  Dancers would perform artistic and lively dances for the Shah.
physicians and religious leaders and kept tribes healthy, prosperous and safe.  The music is usually played by a small band.
 Tippity Tappity, Time for Tap (1800)
DURING THE ANCIENT CIVILIZATION  Tap dancing originated from African tribe dancing.
 ANCIENT EGYPT  Tap dancing makes percussion sounds because of dancers most commonly
 3300 BCE( First dancing) believed that the 1st people to dance were the wearing leather shoes with two pieces of metal and clip and clap against hard
Egyptians. Archaeologists discovered paintings of dancing figures in rocks, floors.
shelters and caves.  Tap is still very popular to this day.
 As a way of expressing religious service and teaching ancient myth;
 Three major dancers were involved; DURING THE 19th Century (1801-1900)
o The king  Merengue Dancing (1890)
o The priests who perform magical dances  It is a Caribbean dance style that involves partners holding each other in a
o Virgin dancers who were trained to perform during ceremonies led tango-like position and moving their hips side to side.
by the priest.  Jazz and Acro (1900)
 ANCIENT CRETE  It involves doing smooth and flexible movements, and lots of back bending and
 Cretan used dance to perfect their military training which made excellent. tricks. Both styles are widely popular to this day.
 ANCIENT GREECE  Ballroom dances also emerged during this period like Cotillion, Polonaise, Quadrille,
 Dance is also a form of entertainment and display. Waltz and Polka.
 Plato high lightened the two kinds of dance and music; the noble (fin and 20th Century Dances (1901-2000)
honorable) ignoble (imitating what is mean or ugly)  Described as a period of “dance fever” wherein the young and old alike were not limited
 ANCIENT ROME to express emotions through dance.
 Gave less importance to dancing which eventually became an integral part of  Contemporary Dance (1950).
the corruption in the latter days of the roman empire resulting the  a style that combines jazz, ballet, and modern dance. It can be many different
condemnation of dance by early Christians. styles, but most of the time it is melancholy and or intense.
 Dance was primarily performed for religious, social and entertainment.  Hip Hop Dance(1970)
However, theatrical entertainment was prohibited but still existed and was  There are many styles of hip hop that include breaking, popping, locking, and
performed within church during religious ceremonies. more. Street dance was performed both in night clubs and on Hip Hop Danc
 It is associated with funk, breakdancing, and hip-hop.
DURING MIDDLE AGES AND RENAISSANCE  Several social dance movements also evolved such as castle walk, tango, foxtrot,
 Ballet (1440) Charleston, Lindy Hop, Rumba, Mambo, Cha-Cha-cha, Samba, Bossa Nova, Boogaloo
 Ballet started in this year in Italy, but didn’t really become popular until around and Twist.
the year 1500.  Popular fad dances also emerged like YMCA and Macarena.
 Ballet gained its popularity when a lady of the arts, Catherine de Medici,
married King Henry 11 and threw festivals where they would perform ballet 21st Century Dance (2001- Present)
dances.  Dance Nowadays (2018)
 Ballet is believed to be the main core of every single dance style.  Today’s dance style has taken a turn towards more hip-hop dances.
 A vast dance movement occurred throughout the courts of Europe in the 15 th and 16th  Small and popular dances that involve hip hop and that most everyone can
centuries. During these times, new court dances performed by the nobility came about as achieve include the whip and nae nae, Gangnam Style (it’s a little old),
well as the rise of the art of ballet in Italy and France. shooting, and more.
 Several other dance forms continued to sprout and spread across several countries.

DURING THE LATE 16th and 17th Centuries (1501-1700)

 Masque Dancing (1600)
 started from elaborate pageants and shows in the 16th century.
 involved intricate costuming and stage designing that also incorporated
singing and acting as well as dancing.
 It was often used as a court entertainment.
 A period in the history of dance in Italy, France, and England which was considered to be
pleasantly deep and rich. France became the forerunner in dance during this period.
 Dance increased as a court amusement and later transformed into professional
entertainment.
 Physical energy
 Is basically the ability of the body system to work together efficiently with the least
LIFESTYLE amount of effort.
 refers to overall way of living – attitudes, habits, and behavior of a person in daily life.  A person who is fits is able to carry out the typical daily activities and still has
According to studies, lifestyle contributes greatly to the leading causes of mortality and enough energy or vigor to respond to emergency situation and to enjoy leisure
morbidity in the Philippines. time activities as well.
 People who smoke cigarettes and drink alcoholic beverages for example are likely to
develop a wide range of diseases.
 It includes the way in which people carry out major parts of their lives such as working,
The PICTURE 1 shows physical activity because you are just doing a desired task or activity
playing, eating, coping, and so on and sdiseases
without any goal while the PICTURE 2 shows physical exercise because you are doing an
 So below are the ways to know what lifestyle is suitable for you.
activity with a desired goal or plan to target.

Health and Wellness Benefits

Active lifestyle
If you are a hyperactive, outgoing, or a person who loves to always become busy or 1. Looking Good- Experts agree that regular physical activity is one healthy
productive, this lifestyle is for you. An active lifestyle consists of having exercises daily, socializing lifestyle that can help you look your best. Of course, other are proper
with people, join groups or clubs in your neighborhood, and an active and healthy body and mind. nutrition, good posture, and good body mechanics.
Having an active lifestyle doesn’t mean you should overuse your body or mind — keep in 2. Feeling Good – People who do regular physical activity fell better. If you are
mind your body or mind, don’t drain your energy. active and therefore more physical fit, you can resist fatigue, you are less
likely to injured and you are capable of working more efficiently.
Healthy lifestyle 3. Enjoying Life- Like most people, enjoyment of life is probably important to
A healthy lifestyle is close and fitting with an active lifestyle. In order to have a your personal wellness. But what if you are too tired most of the days to
healthy lifestyle, you should choose your food, avoid junk foods, saturated fats, and sugar. participate in activity you really enjoy? Regular physical activity results to
Eat healthily. Have a diet and don’t overeat since it is not and never healthy plus it makes physical fitness which is the key to being able to do more of the things you
your kidney tired, which is not healthy too. Have a daily exercise like yoga, just simple want to do.
exercises to keep your body and mind active and fit. Avoid bad habits and be a responsible 4. Meeting Emergencies- health and wellness allow you to be fit enough to
person for your own body. meet emergencies and day- to- day demanding situations.
5. Being Physical Fit- Being physically active can build physical fitness which
Bohemian lifestyle in turn provides you with many health and wellness benefits.
If you are an artistic, spiritual, musical person, this lifestyle fits you. To have a
bohemian lifestyle you will tend to travel a lot, seek adventures, make time for you spiritual
culture, artistic performances, and musical desires. You unleash the beast and go party, be
an outsider, put in some boho outfits, and make a lot of friends.

Nomadic lifestyle
A nomad constantly moves from one place to another, a person who doesn’t want
to have any permanent place to be in. A lot of people don’t fit this lifestyle since most of us
need stability, security, and just can’t leave the place we were born or a place where we fell
in love. A nomad feels comfortable and spends most of their time with some other people
from time to time, but nomads avoid attachments since it might restrain them from leaving a
certain place.

Solo lifestyle
For people who want to live solo or incapable of not having anyone to be with
them, mostly the very independent people. In solo lifestyle you will learn a lot like how to be
much more responsible, you’ll learn to entertain yourself, you can do anything you want with
no one judging you or controlling you, and you discipline yourself. Having a solo lifestyle is
not lonely, you can still have friends of course, and who knows one day you might move on,
on having a solo lifestyle if you meet the right person for you.

Rural lifestyle
If you love to grow crops, animals, and love nature and rural areas, then the rural
lifestyle is for you. You grow your own food, you put up a farm and grow fruits and veggies
and maybe animals. A rural lifestyle could be enjoyed by just sitting on your front porch,
looking at the field, enjoying your cup of coffee or tea and just enjoy the fresh breeze.
Having a rural lifestyle doesn’t mean it’s just you, your family, your plants and animals, you
also have that active community, which has a lot of festivities to gather the community
having a consistently happy community.
Topic 3: MOVEMENTS NON - LOCOMOTOR MOVEMENT SKILLS

Movement – is a change of position in space. Whenever there is no change of position,

there is no movement. Learning how to move is the most basic element of learning
experience in physical education. Non-locomotor movement skills are performed without appreciable movement from
place to place.
LOCOMOTOR MOVEMENT SKILLS

Locomotor Movement Skills are used to move the body from one place to  Bending – is contracting or shortening of body part from a joint.
another. They form the foundation of gross motor coordination and involve large muscle  Stretching – is extending or straightening a body part from a joint.
movements.
 Rocking – occurs when the center of gravity is fluidly transferre from one body
part to another.
 Swaying – is moving the body or body parts from joint side to side.
 Walking – is the regular pacing of the feet; a simple transferring of body  Pushing – is an act of shoving an object away form the body.
weight from one foot to the other on the ground. (A transfer of one foot to
the other foot is called a step.) Scientifically, it is a process of losing
 Pulling – is an act of lugging or towing an object towards or with the body.
balance and recovering it while moving forward upright position, the body  Turnings – is rotation around a long axis of the body.
displaying a little up and down or side to side movement.  Twisting- is turning the body or body parts to oneside.
 Running – is an increased speed in walking by lifting the foot off the  Circling – is moving the body or body part forming a circle.
contact ground. Each leg in a mature running pattern goes through a  Swinging – is moving the body or body parts from a joint resembling a
support phase and a recovery phase and full sequence produces two pendulum.
periods of non-support. It is done with a slight body lean and knees are
flexed and lifted.
 Hopping – is a springing action from one foot and landing on the same foot
in any direction. It involves propelling the body up and down on the same
foot. The knee seldom straightens fully. It can be produced in place or as a
locomotor movement. Knowledge of safety techniques in gymnastics activities is a very important teaching prerequisite.
 Leaping – is an extension of a run, where the greater force is used to To prevent injuries while learning gymnastics, the class is divided into three periods.
produce a higher dimension than a run. The springing from one foot
propels the body upward and landing on the opposite foot, actually, it is an Pre-Workout Period.
elongated step to cover a distance or move over a low obstacle.  This includes all activities and procedures that prepares the individual for actual
 Sliding – is when the lead step is quickly followed by the free foot closing instruction and practice of all gymnastic skills.
to replace the supporting foot. It involves gliding sole of one foot along the o Check-up of uniforms
floor. The lead foot quickly springs from the floor into a direction of intended
travel. The same foot always leads in a slide producing an uneven rhythm: o Warm Up
slide-close, slide-close, slide-close.
 Galloping – is a combination of a step (full transfer of weight on one foot) Workout Period. (Actual Practice)
and a cut by the transfer of weight on the other foot. A cut is a  In every plan, safety instructions should be incorporated when reviewing and
displacement of one foot with the other foot. It is an exaggerated slide in demonstrating the skills; the class should be aware of the maximum safety precautions
forward direction. The lead leg lifts and bends and then thrusts forward to while it is performing the exercises and skills.
support the weight. The rear foot quickly closes to replace the supporting
 SAFETY SUGGESTIONS FOR ALL
leg as the lead springs up into its lifted and bent position.
a. Full attention is needed when a new skill is discussed and demonstrated
 Skipping – is a combination of a step and a hop, first on one foot and then
on the other foot on a faster tempo. It is done on the balls of the feet. b. When in doubt, ask questions.
 Jumping- is a locomotor pattern in which the body propels itself off the c. When doing a skill for the first time, have a ready spotter.
floor or apparatus into a momentary period of flight. It can be done in place d. Master the fundamentals before doing the skill.
or as a locomotor activity to cover the ground. The fundamental jumping e. Stop when instructions are given to stop.
pattern consists of five basic variations (Graham, 2011): f. Foolish acts have no place in the class
g. Learn to relax and fall to prevent injuries.

Post-workout period
 Relaxation exercises
 Keeping of equipment used in their proper place

MODULE I: NCM104
 Regardless of Family structure and configuration there are four famous types of a family structure;
FAMILY 1. Nuclear
 is the basic unit of society 2. Single Parent
 It is a unity of interacting persons related by ties of marriage, birth or adoption, whose 3. Extended
central purpose is to create and maintain a common culture which promotes the physical, 4. Childless
mental, emotional and social development of each of its members (Duval).
 Is defined as composed of two or more people who are emotionally involved with each UNIVERSAL CHRACTERISTICS OF FAMILIES
other and live in close geographical proximity. (Friedman)  Universality
 is a separate entity with its own structure, functions and needs, the most basic unit of  Family is the basic unit structure of a society and is found in every culture and
society (Kristjanson and Chalmers) almost all geographical locations and at all times.
 Means two or more individuals who share a residence or live near one another, possess  Emotional Basis
some common emotional bonds, engage in social positions that are interrelated, roles,  Emotional attachment between father-mother, parent-children and between
and tasks, and share a sense of affection and belonging. (Murray and Zentner 1997; siblings, keeps the family members together as a unit.
Friedman 1998)  Limited Size:
 Since family is a group of people related to each other by the bonds of blood,
4 MAJOR FUNCTIONS OF A FAMILY: (FRIEDMAN, 1981) adoption or marriage; the number of members in each group is limited thus
 Physical Function restricting the size of the family.
 Family members carry out this function by providing a safe, comfortable  Nuclear position in the social structure:
environment necessary for growth, development and rest/recuperation of each  Family is like a unit block in the formation of a social set-up and it performs
family member. various functions. Although today many of its functions are taken upon by the
 Economic Function various social institutions, yet the central status of family is indispensable.
 The family should be the one to provide financial aid for members, as well as,  Responsibility of Members:
meeting monetary needs of society.  Each member of the family has a responsibility towards other family members,
 Reproductive Function towards family and towards society.
 It is met by the birth of children. We all come from a family by virtue of birth.  Social Regulations:
 Socialization Function  Family is bound to run by certain family and social regulations. These various
 It is from our own family that we are taught to socialize with others. rules called taboos, customs, laws etc., vary in different cultures.
 An individual is not free to overlook these (family and social) regulations which
TYPES AND FORMS OF FAMILY were rather more strict in olden days as compared to the present-day society.
1. On the basis of marriage: Family has been classified into three major types:  Permanent and Temporary Nature:
a. Polygamous or polygynous family  Family as an association is temporary in nature.
b. Polyandrous family  When one of the partners in a marriage dies, the association ends; thus the
c. Monogamous family association is temporary in nature. On the other hand, family as an institution
keeps changing its members and has permanent existence.
2. One basis of the nature of residence family can be classified into three main forms.
a. Family of matrilocal residence
CHARACTERISTICS OF A HEALTHY FAMILY
b. Family of patrilocal residence
 Quality time – Family members who have healthy relationships spend time with one
c. Changing Residence
another.
3. On the basis of ancestry or descent family can be classified into two main types:  Communication – Ideas will be exchanged in families with good communication skills.
a. Matrilineal family  Trust – Healthy families have family members who trust one another.
b. Patrilineal family  Fulfilling Needs – Individual family members can go through times of duress and need.
4. Jja During these times, other family members step up to provide support in a healthy family.
5. On the basis of the nature of relations among the family members the family can be  Family Goals – Healthy families not only talk about family goals, further enhancing the
classified into two main types. channels of communication, they work together to achieve family goals.
a. Conjugal family which consists of adult members among there exists sex  Boundaries – Parents and grandparents must accept the duties of managers and
relationship. teachers, and children must understand that the family depends upon their abilities to
b. Consanguine family which consists of members among whom there exists learn and perform maintenance tasks.
blood relationship-brother and sister, father and son etc.  Mutual Respect – When people follow through on their obligations, an atmosphere of
mutual respect is created.
STAGES OF FAMILY LEVELS OF PREVENTION IN FAMILY HEALTH
 It is the duty of the health care practitioner to assess whether the family performs the  Primary
family task in accordance to what stage the family undergoes.  concerned with health promotion activities that prevent the actual occurrence
 Family health tasks will also be the guide of the care practitioner in performing the role of of a specific illness or disease.
the nurse as a health care educator and counsellor towards making a family healthy and  Secondary
functional thus achieving the highest possible level of functioning of family members  promotes early detection or screening and treatment of disease and limitation
moreover towards family and societal development. of disability.
 This level of prevention is also called HEALTH MAINTENANCE.
 Tertiary
STAGES TASK  directed towards recovery or rehabilitation of a disease or condition after the
disease has been developed.
Beginning Family  establishing a mutually satisfying marriage  The individual is on the process of healing and recovery.
 planning to have or not have children  Activities are done to prevent complications from the disease or injury of an
individual or family.
Child – bearing Family  having and adjusting to infant
 supporting the needs of all the members What are the current major problems in health and in the delivery of health care?
 renegotiating marital relationship  Global average life expectancy increased by 5 years between 2000 and 2015, the fastest
increase since the 1960.
Family with Pre- school  adjusting to costs of family life  Healthy life expectancy (HLE) at birth was estimated at 63.1 years.
Children  adapting to needs of pre-school children to simulate  More than 16,000 children under age 5 died every day.
growth and development  (45%) of deaths among children under 5 yrs. Occur during the 1 st weeks of life.
 coping with parental loss of energy and privacy  An estimated 2.6 million babies were stillborn.
 1.3 million deaths were attributable to hepatitis.
Family with School Age  adjusting to the motility of growing Children  Non communicable diseases (NCDs) caused 37% of deaths in low income countries, up
Children  promoting joint decisions between children and parents from 23% in 2000.
 encouraging and supporting children's educational  Ischemic heart and stroke killed 15 million people.
achievements  Diabetes are among the 10 leading causes of deaths & disability worldwide.
 Injuries claimed nearly 5 million lives in 2015
Family with Teenagers and  maintaining open communication among members  Persistent Inequities in Health Outcomes
Young Adults  supporting ethical and moral values within the family  Every year, around 2000 mothers die due to pregnancy-related complications.
 balancing freedom with responsibility for teenagers  A Filipino child born to the poorest family is 3 times more likely to not reach his
 releasing young adults with appropriate ritual and 5th birthday, compared to one born to the richest family.
assistance  Three out of 10 children are stunted
 strengthening marital relationship  Restrictive and Impoverishing Healthcare Costs
 maintaining supportive home base  Every year, 1.5 million families are pushed to poverty due to health care
expenditures
Post- Parental Family  preparing for retirement  Filipinos forego or delay care due to prohibitive and unpredictable user fees or
 maintaining ties with older and younger generations co- payments
 Php 4,000/month healthcare expenses considered catastrophic for single
Aging Family  adjusting to retirement income families
 adjusting to loss of spouse  Poor quality and undignified care synonymous with public clinics and hospitals
 closing family house  Long wait times
 Limited autonomy to choose provider
 Less than hygienic restrooms, lacking amenities
 Privacy and confidentiality taken lightly
 Poor record-keeping
 Overcrowding & under-provision of care
What will it take to transform health care?  Extends the realm of public health to include organized health efforts at the community
 Building blocks and tools level through both government and private efforts.
 Workforce or Human Resources  “The utilization of the nursing process in the different levels of clientele- individuals,
 Health Information Technology families, population groups and communities, concerned with the promotion of health,
 Patient-centered Outcomes Research prevention of disease and disability and rehabilitation.” – Maglaya, et al
 Quality Improvement
Philosophy of CHN
PUBLIC AND COMMUNITY HEALTH NURSING  Is based on the worth and dignity of men. (M. Shetland)
 This is based on the belief that care directed to the individual, family, and the group
PUBLIC HEALTH contributes to the health care of the population as a whole.
 “Is the science and art of preventing disease, prolonging life, and promoting health and
efficiency through organized community effort for Goal of CHN
 Sanitation of the environment  Assist the individual, family and community their highest level of holistic health which is
 Control of communicable disease attained through multidisciplinary effort and to promote reciprocally supportive
 Education of the individual in personal hygiene relationship between people and their physical and social environment.
 Organization of medical and nursing services for the early diagnosis &
preventive treatment of disease. Basic Principles of CHN
 Development of the social machinery to a standard of living as to enable every  In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care.
citizen to realize his birthright of health and longevity.  The community is the patient in and the family is the unit of care.
 “It connotes organized, legislated & tax-supported efforts that serve all people thru health  There are four levels of clientele:
departments.”  Individual
 Family
Primary Function  Population group (those who share common characteristics, developmental
 Assessment stages and common exposure to health problems – e.g. children, elderly), and
 regular collection, analysis & information sharing about health conditions, risks  Community.
and resources in a community.
 Assurance Salient Features of CHN
 focuses on the availability of necessary health services throughout the  Population – the hallmark of CHN is that it is population focused.
community.  Greatest good for the greatest number – the nurse looks at the health needs and
 Policy development problems of the community rather than focusing solely on the needs of individuals or
 use of information gathered during assessment to develop local and state families.
health policies and to direct resources toward those policies.  Utilizes the nursing process
 Promotive-preventive by nature
Goal of Public Health  Uses a variety of instruments
 To improve the health of the public by promoting health lifestyles, preventing disease and  Requires managerial skills
injury, and protecting the health of communities.
ROLE OF CHN
Public Health Workers  Case manager
 Rural Sanitary Inspector (RSI)-must be a sanitary engineer  Advocate
 Pharmacist  Teacher
 Medical Technologist  Partner and collaborator
 Nutritionist  Health
 Dentist  Planner/Programmer
 Rural Health Midwife (RHM)-Registered Midwife  Manager/supervisor
 Public Health Nurse (PHN)-Registered Nurse  Community organizer
 Medical Officer (MO)-Physician  Health educator/trainer
 Case finder
 Epidemiologist
 Recorder/reported and statistician
 Community leader
 Researcher
COMMUNITY HEALTH
Many of these roles may overlap and the CHN may perform several roles at the same time.

HISTORY OF CHN DEVELOPMENT

1901 Act no. 17 created the board of health for manila and Act 309 for provincial &
municipal boards.

1905 Act 1407 re-organization act – abolished the board of health and was replaced by
the bureau of health under the dept of interior.

1912 The PGH sent 4 nurses to Cebu to take care of mothers and babies

1915 Reorganization Act 2462 created the office of General Inspection w/c organized the
Office of District Nursing headed by Dr. Rosario Pastor, also a nurse.

1919 The 1st Filipino nurse supervisor under the Bureau of Health, Ms. Carmen del
Rosario.

1990- RA 7160 the LG Code of 1991 resulted to the devolution of authority from the
1992 national to the local government units.

Jan DO No 29 designated Mrs. Nelia F. Hizon, Nurse VI, as nursing adviser – where
1999 matters affecting nurses are referred to her.

May EO No 102 redirecting the functions and operations of the DOH. Nursing positions
1999 were transferred to other offices.

1999 - Health Sector Reform Agenda was dev to describe major strategies, org and policy
2004 changes and public investments to improve health care delivery.

2005 A plan to rationalize or streamline the bureaucracy which includes the DOH.

PHILIPPINE HEALTHCARE DELIVERY SYSTEM

WORLD HEALTH ORGANIZATION PHILIPPINE DOH
 MISSION:
UN Millennium Development Goals (MDGs) o To lead the country in the development of a productive, resilient, equitable and
 Are the world’s time- bound and quantified targets for addressing extreme poverty in its many people- centered health system.
dimensions-income poverty, hunger, disease, lack of adequate shelter, and exclusion-while  VISION:
promoting gender equality, education, and environmental sustainability o Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia
by 2024.
Millennium Development Goals
1. Eradicate extreme poverty and hunger DOH COMPOSITION
2. Achieve universal primary education  PUBLIC SECTOR
3. Promote gender equality and empower women o is largely financed through a tax- based budgeting system at both national and
4. Reduce child mortality local levels and where health care is generally given free at the point of
service. Socialized services is also considered.
5. Improve maternal health
 PRIVATE SECTOR – (profit/non-profit)
6. Combat HIV/AIDS, malaria and other diseases o is largely market-oriented and where health care is paid through user fees at
7. Ensure environmental sustainability the point of service.
8. Global partnership for development
TYPES/LEVELS OF PHC WORKERS
17 Sustainable Development Goals:  VILLAGE OR BHW’S
1. No Poverty o refers to trained community health workers or traditional birth attendant or
2. Zero Hunger healer.
 INTERMEDIATE LEVEL HEALTH WORKERS
3. Good Health and Wellbeing
o refers to doctors, nurses, sanitary inspectors, and midwives.
4. Quality Education
5. Gender Equality LEVELS OF HEALTH CARE
6. Clean Water and Sanitation  PRIMARY LEVEL
7. Affordable and Clean Energy o is devolved to the cities and municipalities, provided by doctors, PHN, PHM,
8. Decent Work and Economic Growth BHW’s at the barangay health stations, and the area for first contact between
9. Industry, Innovation and Infrastructure the community members and other levels of health facility.
10. Reduced Inequalities  SECONDARY LEVEL
o health services are usually given in health facilities either privately or
11. Sustainable Cities and Communities
government owned, such as municipal and district hospitals, OPD.
12. Responsible Consumption and Production o It can perform minor surgeries and simple laboratory examinations.
13. Climate Action  TERTIARY LEVEL
14. Life Below Water o is rendered by specialists in health facilities including medical centers as well
15. Life on Land as regional and provincial hospitals.
16. Peace, Justice and Strong Institutions o The higher the level, the more qualified the health personnel and the more
17. Partnerships for the Goals sophisticated the health equipment.

CRITERION MDG SDG EO 102 mandates the DOH

 To provide assistance to local government units, people’s organization, and other members of
civic society in effectively implement programs, projects and services that will promote the
Goal 8 17
health and well-being of every Filipino;
 Prevent and control diseases among population at risks;
Geographic Developing Country Entire world  Protect individuals, families and communities exposed to hazards and risks; and
Coverage  Treat, manage and rehabilitate individuals affected by diseases and disability.

Delivery focus Poverty Reduction Global Development with and for sustainability

Goal Creators Produced by group Consultation among 193 UN member states,

of experts civil society and other stakeholders

Implementation Time 2000 - 2015 2016-2030

Frame
ROLES AND FUNCTIONS OF DOH
 LEADERSHIP IN HEALTH RESTRUCTURED HEALTH CARE DELIVERY SYSTEM
o serves as the national policy and regulatory institution, leads in formulation,  To strengthen and to effect a more efficient and effective delivery of health services in
monitoring, and evaluation of national health policies, plans and programs, and the country by combination of main health center and satellite barrio health stations.
to serves as advocate in the adoption of health policies.
 ENABLER AND CAPACITY BUILDER
o innovate new strategies in health to improve the effectiveness of health Main Health Center Barrio Health Station
programs, initiate public discussions, undertake and disseminate policy
research outputs to ensure public participation in policy decision making.  Location: Municipality  Location: 3-5 km radius from the
 ADMINISTRATOR OF SPECIFIC SERVICES  Staff: MHO, Rural MD, PHN, Sanitary Inspector, main health center
o Manage selected national health facilities Midwife  Staff: Rural health midwifes
o administer direct services for emergent health concerns, and  In RHU some headed by a PHN based on RA serves 24 hrs./day
o administer health emergency response services. 1891, an amendment of RA 1082

DEVOLUTION OF HEALTH SERVICES POPULATION-BASED RURAL HEALTH MANPOWER NEEDS

 In 1992, health services were devolved or transferred from DOH to the LGU.
 LOCAL GOVERNMENT CODE (RA 7160) Rural Health Population Ratio
AIMS: Manpower
o Transform LGU into self-reliant communities and active partners in the
attainment of national goals through a more responsive and accountable local Physician 1/ 20,000
government structure instituted through a system of
Nurses 1/ 10,000
DECENTRALIZATION
 transfer of authority for decision making, planning, resource allocation finance and mgt.
Midwife 1/ 5,000
LOCAL HEALTH BOARD (LHB)
 this body is a good venue for making the local health system more responsive to the Sanitary Inspector 1/ 20, 000
needs of the people.
 It is mandated to propose annual budgetary allocations for the operation and Dentist 1/ 50,000
maintenance of health facilities and services within the municipality, city or province.
Medical Technician 1/ 20,00
COMPOSITION of LOCAL HEALTH BOARDS:
Provincial level
 Chair: Governor REFERRAL SYSTEM:
 Vice-Chair: PHO  BHS-RHUMHO→ PHO→ RHO→ National Agencies→ Specialized Agencies
 Members:
o Chairman on the Committee on Health of the Sangguniang Panlalawigan, PHILIPPINE HEALTH AGENDA 2016-2022 Healthy Philippines 2022
o DOH Representative, and  All for Health Towards Health for All
o NGO representative
HEALTH SYSTEM WE ASPIRE
Municipal level  FINANCIAL PROTECTION
 Chair: Mayor o Filipinas, especially the poor are protected from high cost of health care
 Vice-Chair: MHO  BETTER HEALTH OUTCOMES
 Members: o Filipinos attain the best possible health outcomes with no disparity
o Chairman on the Committee on Health of the Sangguniang Panglungsod/  RESPONSIVENESS
Bayan o Filipinos feel respected, valued, and empowered in all of their interaction with
o DOH Representative, and the health system
o NGO representative  EQUITABLE & INCLUSIVE TO ALL
 TRANSPARENT & ACCOUNTABLE
Barangay level  USES RESOURCES EFFICIENTLY
 Chair: Mayor  PROVIDES HIGH QUALITY SERVICES
 Vice-Chair: Brgy. Kagawad Committee on Health
 Members: OUR STRATEGY
o BHW, BNS, DOH representative and other leaders of the organizations such  A – Advance health promotion, primary care and quality
as DepEd Principal, Day Care worker, PWD Pres., Senior Citizen Pres., etc…  C – Cover all Filipinos against financial health risk
 H – Harness the power of strategic HRH
 I – Invest in eHealth and data for decision-making
  E – Enforce standards, accountability and transparency
 V – Value clients and patients
 E – Elicit multi-stakeholder support for health

NUTRITIONAL STATUS (NUTRITURE)

NUTRITION AND DIET THERAPY
 Is the condition of the body resulting from the utilization of essential nutrients.
A. Optimum or Good Nutrition
NUTRITION
 the body has an adequate supply of essential nutrients that are
 Is the science of food and nutrients, their action and interaction, in the relation to
efficiently utilized and maintained in highest possible level
providing the body with the necessary substances to maintain homeostasis.
B. Malnutrition – poor nutrition (mal meaning “ BAD”) can be either nutritional
 Nutritional imbalance impacts the health maintenance and disease prevention and is
deficiency or overnutrition and hypervitaminosis.
essential for growth hand optimal bodily function
 Primary – Faculty diet both in quantity and quality
 Secondary – multiple and include all conditions within the body that
FOOD
reduce the ultimate supply of nutrients to the cell after he food goes
 Is any substance, ORGANIC or INORGANIC, when ingested or eaten, nourishes the
beyond the mouth
body by BUILDING AND REPAIRING TISSUES, SUPPLYING HEAT AND ENERGY,
REGULATINNG BODY PROCESSES.
DIGESTION
 According to the FDA (Food and Drug Administration), food includes articles used as
 It is a mechanical and chemical breakdown of food into smaller components.
drink or food, and the articles used for the component of such
ABSORPTION
FOOD QUALITY
 It is a process where nutrients from foods are absorb by the body into bloodstreams.
1. It is safe to eat
2. It is nourishing or nutritious
METABOLISM
3. Its palatability factors (color, aroma, flavor, texture, etc.) satisfy the costumer.
 Is a chemical process of transforming foods into other substances to sustain life.
4. It has safety value
 CATABOLISM – is the BREAKDOWN of complex substances into simpler
5. It offer variety and planned within socio-economical context
ones, resulting energy.
6. It is free from toxic substance
 ANABOLISM – is the SYNTHESIS of simple substances into complex
substances. Provides energy for tissue growth, maintenance and repair
NUTRIENT
 Is a chemical component needed by the body to achieve health Three General
ENZYMES
Functions:
 An organic catalyst that are protein in nature and are produced by living cells. A catalyst
 To provide energy (FUEL NUTRIENTS)
speeds up or slows down chemical reactions without itself undergoing change.
 To build and repair tissues (BODY BUILDING)
 To regulate life processes (REGULATORY) Health
CALORIES
 Fuel potential in a food. One calorie represents the amount of heat required to raise one
NUTRIENT CLASSIFICATION:
liter of water to one degree Celsius.
 According to function:
 Function as energy giving, body building and body regulating
3 GROUPS OF DIGESTIVE ENZYMES:
 According to chemical nature/properties:
 AMYLASE – carbohydrate splitters
 Organic – protein, lipids, carbohydrates and vitamins
 LIPASE – fat splitters
 Inorganic – water and minerals
 PROTEASES – protein splitters
 According to concentration:
 Macro nutrients – Carbohydrates, Proteins and Fats
DIGESTABILITY OF AN AVERAGE PERSON
 Micro nutrients – Vitamins, Minerals and Water
 CHO – 90%
 PROTIENS – 92%
HEALTH
 FATS – 95%
 State of complete physical, mental and social well being and not merely the absence of
disease or infirmity (WHO) 1948
FACTORS THAT AFFECT DIGESTION AND ABSORPTION
 Crude Fibers – skin and seed of fruit
DIETITIAN
 Preparation and cooking
 Professional trained to assess nutrition status and recommend appropriate diet therapy
 Disease – intestinal cancer, diarrhea
 Surgery – gastrectomy
  Parasitism  Obtained from starch by the application of heat or acids and used mainly
 Presence of interfering substance as adhesive and thickening agents.

MACRONUTRIENTS
 Are the nutritive components of food that the body needs for energy and to maintain the o Cellulose – Non-digestible by humans.
body’s structure and systems, (MD Anderson Wellness Dietitian Lindsey Wohlford.)  They lower the blood glucose level of people with diabetes, that is
 Carbohydrates composed of glucose units from the main constituent of the cell wall in
 Fats most plants
 Protein  important in the manufacture of numerous products such as paper, textile
and pharmaceuticals.
MICRONUTRIENTS o Pectin – source from fruits and are often used as base for jellies
 Are one of the major groups of nutrients your body needs. o Glycogen – animal starch. The store form of carbohydrates in the body (LIVER and
 They include: MUSCLES).
 Vitamins are necessary for energy production, immune function, blood clotting o Inulin – a complex of sugar present in the roots of various plants and used medically
and other functions. to test kidney function. It is a polysaccharide based on fructose.
 Minerals play an important role in growth, bone health, fluid balance and
several other processes. FUNCTION OF CARBOHYDRATES
 Main source energy for the body.
CARBOHYDRATES  Protein sparing action.
 Originally known as saccharides, a Greek word, meaning sugar.  Necessary for normal fat metabolism
 These are organic compounds composed of carbon, hydrogen, and oxygen.  Cellulose (fiber) stimulates peristaltic movement of the gastrointestinal tract. Absorb
 Source of ENERGY for the body water to give bulk to the intestine.
 Consist of 60-100% of calories  Lactose encourages the growth of beneficial bacteria, resulting in a laxative action.
 1 gram of carbohydrates contains 4 calories  Glucose is the sole source of energy in the brain. Proper functioning of tissues.
 CHEMICAL NATURE: Ratio of hydrogens to oxygen is 2:1 CHO
SOURCE OF CARBOHYDRATES
CLASSIFICATION OF CARBOHYDRATES  Whole grain
COMPLEXITY – number of sugar unit  Sweet potatoes and white potatoes, Bananas, dried fruits.
1. Monosaccharides – simple sugar (ones sugar unit)  Milk (lactose)
o Glucose – also known as dextrose, grape sugar, and physiologic sugar.  Sugar, sweets, honey, maple sugar
o Fructose – also known as fruit sugar or levulose sweetest of all sugar.  “Empty Calories” – foods which do not contain any other nutrients except carbohydrates.
o Galactose – also known as milk sugar. An important of the brain and nerve tissue.
o Sugar alcohols – examples are mannitol and sorbitol. COMMON PROBLEM AND DISEASES
o Pentose – (ribose ang ribulose) – meat and seafood  Overweight
o > simple sugar are water soluble and quickly absorb in the blood stream  Diabetes
2. DISACCHARIDE – “Double Sugar”. Made up of monosaccharide.  Tooth Decay
o Sucrose – Ordinary table sugar (glucose + fructose).  Depressed appetite
o Lactose – Milk Sugar (glucose and galactose).  Fermentation causing gas formation
 necessary in calcium absorption and production of bacteria that necessary in  Cancer
vitamin K production in the intestines.
 LAXATIVE EFFECT. DEFICIENCY
o Maltose – is produced during the malting of cereals such as barley.  Ketosis – disease caused by lack of carbohydrates, in which the acid level of the body is
raised.
 Also called as malt sugar because it is derived from the digestion of starch
 Headache
with the aid of the enzyme, DIASTASE, found in sprouting grain
 Fatigue
3. POLYSACCHARIDES – complex carbohydrates, composed of many sugar units.
 Weakness
o Starch – most important in human. They supply energy for longer period of time
 Difficulty in concentrating
 Example: rice, wheat, corn, carrots and potatoes.
 Bad breath
 Starch are not water – soluble and require digestive enzymes called
amylase to break them apart.
o Dextrin – formed by the breakdown of starch.
 CLASSES
FAT AND OTHER LIPIDS  Omega 3
 Fats, oils and waxes belong to the group of naturally occurring materials called LIPIDS  have a positive effect on reducing mortality from cardiovascular disease.
 LIPIDS are those constituents of plants or animals which are insoluble in water but  Provide the starting point for making hormones that regulate blood clotting,
soluble in other organic solvents. contraction and relaxation of artery walls, and inflammation. Reduce blood
 Most concentrated form of energy. pressure.
 Contains 9 calories per gram fat  Omega 6
 It is recommended 15-25% fat in the diet  “linoleic acid” polyunsaturated fatty acid.
 The basic unit of fat is called “triglyceride” which consist of molecule of glycerol attached  Lowers cholesterol level in the blood and helps in the prevention of heart
to the 3 fatty acids. disease.
 It is composed of carbon, hydrogen, and oxygen, in glyceride linkage.
 Chemical Nature: CnH2nO2 or CH3(CH2) －COOH FUNCTIONS
 Important source of calories to provide a continuous supply of energy.
3 FORM OF FATTY ACIDS  Protein sparing
 Saturated Fat – shown to raise cholesterol  Maintain the constant blood temperature
 the most “dangerous” type of fat that lead to raise blood cholesterol may lead  Cushions vital organ such as kidney against injury.
to coronary heart disease.  Facilitates the absorption of fat-soluble vitamins (A D E K)
 Difficult to metabolize causing weight gain.  Provides satiety and delays onset of hunger.
 Source: butter, lard, meat, cheese, eggs, coconut oil, chocolate, cakes,  Contributes flavor and palatability to the diet.
cookies.
 Monosaturated Fats – lower level of “bad” cholesterol. CHOLESTEROL
 Source: Nuts, avocado, canola oil, olive oil, sunflower oil, peanut oil and butter,  Is a major component of all cell membranes. It is required for synthesis of sex hormones,
sesame oil. bile acids and vitamin D. It is also a precursor of the steroid hormones
 Polyunsaturated Fats – Lower levels of cholesterol.  Is also made in the body and is taken also thru foods
 Source: Sunflower, soybeans, flaxseed oils, wall nuts, fish  a major factor in the development of heart disease
 Daily intake should not exceed 300 mg/day

TYPES OF LIPOPROTEINS
 Low-density Lipoprotein (LDL)
 sometimes called the “bad” cholesterol because a high LDL level leads to a
buildup of cholesterol in your arteries.
 High-density Lipoprotein (HDL)
 sometimes called the “good” cholesterol because it carries cholesterol from
other parts of your body back to your liver
 Your liver then removes the cholesterol from your body.

SOURCES OF DIETARY CHOLESTEROL

 RICHEST: egg yolk, fish roes, mayonnaise and shell fish
 MODERATE: fat on meat, duck, goose, cold cuts, whole milk, cream, ice cream, cheese,
butter and most commercially made cakes, biscuits and pastries.
 POOR: all fish and fish canned in vegetable oil, very lean meats, poultry without skin,
skimmed milk, low fat yoghurt and cottage cheese.
 CHOLESTEROL FREE: All vegetable and vegetable oils, fruit (including avocados and
olives), nuts, rice, egg and sugar.

SOURCES OF FAT
 Animal Fats-fat from meat, fish, poultry, milk, milk products and eggs.
 Vegetable Fats – margarine, seed and vegetable oil, nuts
 Visible Fats – butter, cream, margarine, lard, fish liver oils, pork fat
 Invisible Fats – cheeses, olives, cakes, nuts, pastries
Diseases:
 Heart Disease
 Cancer

10 Foods High Transfats

 Spreads – mayonnaise, margarine, butter
 Package foods – cake mixes, biscuits
 Soups – noodle soups
 Fast foods – Mcdonalds, Kentucky Fried Chicken
 Frozen foods-frozen pies, pizza, breaded fish sticks, breaded chicken
 Baked goods – cupcakes
 Cookies & cakes
 Donuts
 Cream Filled cookies
 Chips & Crackers
PROTEIN (CHON)  Complete Protein
 the building blocks of the body.  contains all essential amino acid in sufficient quantities to supply the body’s
 It contains the elements of CARBON, HYDROGEN, OXYGEN AND NITROGEN need
 Proteins is made up of amino acids which is the basic component of protein  are those that have all nine essential amino acids that our bodies cannot
 There are 20 different amino acids naturally make
 Comes from the Greek word proteinos meaning to hold or is the prime importance. o Source: proteins from animals
 This are complex organic compounds composed of amino as a building unit by a peptide o Meat-beef, pork and lamb
bond. o Poultry-chicken, turkey and duck
 Chemical Nature: NH2 H-C-COOH o Fish
o Dairy Products-milk, yogurt, cheese
AMINO ACIDS
 are the basic building blocks of proteins, and they serve as nitrogenous backbones for  Incomplete Protein
compounds like neurotransmitters and hormones  deficient in one or more essential amino acids
 Although there are hundreds of amino acids found in nature, only about 20 amino acids  incomplete protein sources may have a few of the nine, but not all of them
are needed to make all the proteins found in the human body and most other forms of Grains – beans, corn, oats, posta, whole grain breads
life. Legumes, seeds arid Nuts-sesame seed, sunflower seed, peas, rice,
Peanuts and cashew
TYPES OF AMINO ACIDS  Vegetable-Broccoli
 Essential Amino Acids  Source: Plant (grains, legumes, seeds and nuts)
 are those that are necessary for good health but cannot be produced by the
body and to must be supplied in the diet  Complimentary Proteins– two incomplete proteins combined to make a complete protein.
 Isoleucine  Source: munggo and rice, soybean and wheat, soybean and nuts, peanut
 Leucine butter and sandwich, cereal and milk
 Lysine
 Methionine FUNCTIONS OF PROTEINS
 Threonine  Structural Role
 Phenylalanine  build and repair tissue
 Serine  1/5 or 20% of an adult body weight in protein
 Tryptophan  1/3 is in the muscle
 Valine  1/5 is in the bones and teeth
 Non- Essential Amino Acids  1/10 is in the skin, and the rest is in the body fluids and tissues
 are those that are produced by the body so not as necessary in the diet.  Fuel Nutrient –Supplies energy
 Alanine  1 gram of protein supplies 4 kcal
 Arginine  10-15% of diet.
 Asparagine  Regulator of the Physiologic Processes.
 Aspartic Acid regulates osmotic pressure (Plasma proteins)
 Cysteine Maintaining a normal pH of the body.
 Glycine  Hemoglobin and myoglobin, lipoproteins, insulin and epinephrine, and interferon,
 Glutamine thrombin and digestion
 Glutamic Acid  Contributing to enzymes activity that promotes chemical reaction in the body.
 Histidine  Play a large role in the resistance of the body to disease.
 Praline
 Tyrosine DIETARY REQUIREMENT
 The average adults daily requirement to be 0,8 gram of protein each kilogram of the body
weight.
 Divide body weight by 2.2(the number of pounds per kilogram) 2. Multiply the answer
obtained in the step 1 by 0.8 gram of protein per kilogram of the body weight)

COMPLETE AND INCOMPLETE PROTIEN: COMMON DISEASE

 2. Heart Diseases
3. Cancer (Prostate, Pancreas, Kidney, Breast and Colon)
4. Osteoporosis NOMENCLTURE OF VITAMINS
5. Weight Control  Vitamin A – Retinol  Vitamin B1 – Thiamine
6. Kidney Diseases  Vitamin D – Calciferol  Vitamin B2 – Riboflavin
 Vitamin E – Tocopherol  Vitamin B3 – Niacin
7. Ketosis
 Vitamin B4 – Pantothenic Acid
 Vitamin K – Phylloquinone
8. Protein- energy Malnutrition  Vitamin C – Ascorbic Acid  Vitamin B6 – Pyridoxine
 Marasmus – deficiency of all macronutrients  Vitamin B8 – Biotin
 Kwashiorkor – deficiency in protein predominantly CLASSFICATION OF VITAMIN  Vitamin B12 – Cyanocobalamin
 Fat Soluble
Difference between Kwashiorkor and Marasmus  Water Soluble

Kwashiorkor Marasmus FAT SOLUBLE VITAMIN (VIT. A, D, E, K)

 They are absorbed in the presence of fats and stored in the body (lymphatic system)
It develops in children whose diet are It is due to deficiency of proteins and proteins.  Fat soluble vitamins generally have pre cursors or pro vitamins
deficient of protein.  They can be stored in the body; deficiencies are slow to develop
 Net absolutely needed daily from food sources
It occurs in children between 6 months It is common in infants under 1 year age.  Stable especially in daily cooking
and 3 years of age.

Subcutaneous fat us preserved. Subcutaneous fat is not preserved.

Edema is present. Edema is absent.

Enlarged fatty liver. No fatty liver.

Ribs are not very prominent. Ribs become very prominent.

Lethargic Alert and irritable.

Muscle wasting mild of absent. Severe muscle wasting.

Poor appetite. Voracious feeder.

The person suffering from Kwashiorkor The person suffering from Marasmus needs
needs adequate amounts of proteins. adequate amounts of protein, fats and
carbohydates.

VITAMINS AND MINERALS

 Vitamin” comes from the Latin word (vita” meaning life, “amine” means nitrogen
compound)
 Complex organic compound to regulate body processes and maintain body tissues
 Vitamins do not give the body energy-
 Therefore, we cannot increase our physical capacity by taking extra vitamins
 Vitamins do not have caloric value.
WATER SOLUBLE VITAMINS
 Water soluble vitamins are B-Complex group and Vitamin C
 Dissolve in water and are not stored, they are eliminated in Urine so we need
continuously supply of this vitamins in the diet everyday
 are easily destroyed or washed out during food storage or preparation
 To reduce vitamin loss, refrigerate fresh product, keep milk and grain 1 away from strong
light
 Use the cooking water from vegetable to prepare soup
 Chloride Cl Body fluid balance Salt, processed foods

Wernicke – Korsakoff syndrome

 Spectrum of Disorder
Wernicke Encephalopathy → Korsakoff Syndrome
TRACE MINERALS
Wernicke Encephalopathy
 Opthalmoplegia – weakness or paralysis of eye muscle Mineral Symbol Function Deficeincy Food Source
 Ataxia or unsteady gait
 Changes in mental state – confusion, apathy, difficulty concentrating Iron Fe Red blood cell structure Iron deficiency Dark green leafy
 Untreated – coma or death anemia vegetables, liver and
legume
Pellarga
 Inability to absorb niacin or amino acid tryptophan may cause pellarga Iodine I Thyroid hormone Goiter Seafoods, iodized
 It is characterized by dermatitis, diarrhea, and mental disturbance development, energy salts
metabolism
MINERALS
 are not organic, but needed by the body in relatively small amounts to help regulate Zinc Zn Fetal development, Whole grain meat, egg
body process and maintain tissue structure. wound healing
 Mineral DO NOT broken down during digestion nor destroy by heat or light.
Flouride Fl Teeth maintenance Dental carries Fortified water, tea,
TRACE AND MAJOR MINERALS fish bones
 TRACE MINERALS – are required in our diet at amount not less than 100g/day.
 MAJOR MINERALS – are required in our diet at amounts greater than 100mg/day Selenium

PRIMARY ROLES Manganese

 Metabolic Health
 Antioxidant Chromium
 Blood Health
 Bone Health
 Electrolyte Balance
Normal Values of Electrolytes in the Body
 Sodium: 135-145 mEq/L
MAJOR MINERALS
 Potassium: 3.5-5 mEq/L
 Calcium: 4.5-5.5 mEq/L
Mineral Symbol Function Deficiency Food Sources
 Magnesium: 4.5-5.5 mEq/L
 Phosphate: 1.7-2.6 mEq/L
Calcium C Maintenance of bone Osteoporosis, Dairy Products, green
 Chloride: 98-108 mEq/L
and teeth Convulsion, leafy vegetables, fish
Muscle spasm with bones
WATER
 Most important constituent
Phosphorus Ph Bone Growth Milk, cereal, all foods  Major component of the body
 60-70% part of a body
Magnesium Mg Muscle contraction, Green leafy vegetables,  Has no nutritional values and calories
bone and teeth sea foo and legume  Necessary to transport nutrients.
structure  Regulate body temperature
 Remove waste materials
Sodium Na Body fluid and acid Hypertension, Salt, processed foods  Participates in the chemical reaction and energy production
base balance edema  Recommended to drink at least 8 glasses a day
 If trying to loose weight 12-15 glasses a day is recommended
Potassium K Body fluid balance All whole foods  A high intake of water aids in fat loss
 Vital every day
  is set to meet the needs of nearly all (97-98%) healthy people in each gender and life
stage.
 This is the amount that should be consumed on a daily basis.
 The RDA is two standard deviations above the EAR based on variability in requirements,
or if the standard deviation is not known, the RDA is 1.2 times the EAR

Nutrient Recommendations-Standards and guidelines

 Are set of Standards for healthy people’s energy and nutrient intakes. Estimated Average Requirement (EAR).
 Nutrition experts use these recommendations to assess intakes and offer advice on  is the estimated mean daily requirement for a nutrient as determined to meet the
amounts to consume requirements of 50 percent of healthy people in each life stage and gender group
 These recommendations are issued by the Food and Nutrition Board of the of Medicine (different amounts are provided based on age ranges and life stages. Such as pregnancy
National Academy of Sciences. and lactation)
o This board addresses issues of safety, quality, and adequacy of the food  is based on the reduction of disease and other health parameters,
supply:  It does not reflect the daily needs of individuals but is used to set the RDA and for
 establishes principles and guidelines of adequate dietary intake and research purposes.
renders authorative judgments on the relationships among food
intake, nutrition, and health. Adequate Intake (AI)
 is the recommended average daily nutrient level assumed to be adequate for all healthy
Applications for Reference Intakes people.
 Are used by governments, industry, academia, health services  is based on estimates-observed or experimentally determined approximations – and
 Benefits used when the RDA cannot be established because of insufficient data.
o Serve as guide for procuring food supplies for groups of healthy persons
o They form the basis for planning meals for groups Tolerable Upper Intake Level (UL) for safety.
o They are used as reference point for evaluating the dietary intake of population  The Upper Limit is the maximum daily amount of nutrient that appears safe for most
subgroups. healthy people
 Basis for food and nutrition education programs  The UL represents average daily intake from all sources, including food, water, and
o Reference point for the nutrition labeling of food and dietary supplements supplements
 Intake above upper limits is associated with toxicity symptoms > Most often seen with
Dietary Reference Intakes (DRI): overuse of supplements or intake of fortified foods.
 the general term for a set of reference values used to plan and assess nutrient intakes of  Lack of a published UL does not indicate that high levels of the nutrient are safe. Instead,
healthy people. it means there isn’t enough research available at this time to establish a UL
 It is the Standard Set average nutrient requirement values.
 It suggest upper limit of intakes, above which toxicity is likely to occur. The Naïve View Versus the Accurate View of Optimal Nutrient Intakes
 It also sets average nutrient requirements for use in nutrition research  Consuming too much nutrients endangers health (toxicity) and low levels (deficiency)
 These values, which vary by age and sex, include:  DRI recommends intake values within a safety range
o Recommended Dietary Allowance
o Adequate Intake (AI) Acceptable Macronutrient Distribution Range (AMDR).
 It indicates the range of adequate intake of a macronutrient associated with reduced risk
o Telecotah Level (UL)
of chronic diseases.
 The DRI committee has set values for all vitamins, minerals, carbohydrates, fiber, lipids,
 is a range given as a percentage of total calorie intake – including carbohydrate, protein,
protein, water and energy.
and fat – and is associated with a reduced risk of chronic disease and adequate intake of
 The advantage of DRI values is that it can be applied to diet goals of individuals.
essential nutrients.
 Suggest upper limit of toxicity
 To set average nutrient requirements in researh
SUMMARY ON DIETARY REFERENCE INTAKE STANDARDS
 DRI values have changed over the year
Goals of DRI committee Nutrient Recommendations
 DRI are estimates of the needs of healthy persons only.
 The values are based on scientific research based on probability and risk, they are set
 Medical problems alter nutrient needs
for optimal intake (not minimum requirements), reflect daily intakes (DI)
 RDA & Al. Used by individuals for nutrient intake goals
Recommended Dietary Allowance (RDA).
o RDA-solid experimental evidence
o Al-scientific evidence and educated
  Guesswork Facilitating nutrition research & policy – EAR  USDA eating patterns helps diet planners in planning a healthy diet that accurately
o Requirements for life stages and genders provides the needed amount of food from each food group
 Establish safety guidelines – UL  Vegetarians who eat no meat or its products can use USDA food patterns to make a
o Identification of potentially toxic levels balanced diet
o Danger zones
 Preventing chronic diseases
o Acceptable Macronutrient Distribution
o Ranges (AMDR) proportions
Nutrient density
Estimated Energy Requirement (EER)
 A measure of nutrients provided per calorie of food.
 is the average daily energy intake that should maintain energy balance in a healthy
 A nutrient dense food provides vitamins, minerals and other beneficial substances with
person.
few calories.
 Set to maintain healthy body weight. Factors such as gender, age, height, weight, and
activity level are all considerations when calculating this value.
GRAINS
 Energy intake recommendation is set at a level predicted to maintain body weight.
 Make at least half of the grain selections whole grains.
 The guidelines recommend physical activity to help balance calorie intakes to achieve
 These foods contribute folate, niacin, riboflavin, thiamin, iron, magnesium, selenium, and
and sustain healthy body weight.
fiber.
 It also suggest intake of vegetables, nutrient dense foods, whole grains
o 1 oz grains is equivalent to 1 slice bread; c cooked rice, pasta, or cereal;
Calculations o 1 oz dry pasta or rice; 1 c ready-to-eat cereal; 3 c popped popcorn.
 Calculate the percentage of calories from an energy nutrient in a days meals by using  Whole grains (amaranth, barley, brown rice, buckwheat, bulgur, millet, cats, quinca, rye,
this general Formula. (A nutrients calorie amount + total calories) X 100 wheat) and whole-grain, low-fat breads, cereals, crackers, and pastas; popcorn.
Calculate the percentage of calories from a protein in a days meals.A days  Enriched bagels, breads, cereals, pastas (couscous, macaroni, spaghetti), pretzels, rice,
meal provide 50 grams of protein and 1,754 total calories. rolls, tortillas.
First, Convert the protein grams to protein calories (protein provides 4 calories per gram)  A Biscuits, cakes, cookies, cornbread, crackers, croissants, doughnuts, french toast,
Therefore, 50x 4/1754 x100 =? fried rice, granola, muffins, pancakes, pastries, pies, presweetened cereals, taco shells,
Solve the following in the similar manner waffles.
a. For carbohydrate (carbohydrates provide 4cal/gram)
B. For fat (Fats provide 9cal/gram) FRUITS
 Consume a variety of fruits and no more than one-half of the recommended intake as
Dietary Guidelines Established for Americans fruit juice.
 Is a Science-based advice to Promote health and Reduce risk of major chronic disease  These foods contribute folate, vitamin A, vitamin C, potassium, and fiber
Apply to most people age 2 and older o 1 c fruit is equivalent to 1 c fresh, frozen, or canned fruit: /½e dried fruit;
 Choose nutritious foods based on USDA (The United States Department of Agriculture o 1 c fruit juice.
(USDA) Food Guide  Apples, apricots, avocados, bananas, blueberries, cantaloupe, cherries, grapefruit
 It uses food group plan- a diet planning tool. grapes, guava, kiwi, mango, nectarines, oranges, papaya, peaches, pears. Pineapples,
plums, raspberries, strawberries, tangerines, watermelon: dried fruit (dates, figs, raisins);
Dietary Guideline- FOOD GROUP PLAN unsweetened juices.
 Food group plan is a diet planning tool that sorts foods into groups based on nutrient  Canned or frozen fruit in syrup: juices, punches, and fruit drinks with added sugars fried
content and then specifies that people should eat certain minimum numbers of servings plantains.
of food from each group
o Help people achieve goals VEGETABLES
o Specifies portions  Choose a variety of vegetables each day, and choose from all five subgroups several
o Foods are sorted by nutrient density times a week.
o Seven main classes of nutrients that the body needs. These are  These foods contribute folate, vitamin A, vitamin C, vitamin K, vitamin E, magnesium,
carbohydrates, proteins, fats, vitamins, minerals, fiber and water. potassium, and fiber.
 Limit potentially harmful dietary components o 1 c vegetables is equivalent to 1 c cut-up raw or cooked vegetables;
o Fat, sugar, cholesterol, salt, and alcohol o 1 c cooked legumes; 1 c vegetable juice; 2 c raw, leafy greens.
 Vegetable subgroups
USDA MyPyramid Food Guide o Dark Green Leafy Vegetables
 Always evaluate your diet by comparing the total food amounts that it provides with those o Orange and deep Yellow Vegetables
recommended by USDA o Legumes
 o Starchy Vegetables  It deliver saturated fat and trans fat, and intake should be kept low.
 Baked beans, candied sweet potatoes, coleslaw, french fries, potato salad, refried  It contribute abundant calories but few nutrients, and intakes should not exceed the
beans, scalloped potatoes, tempura vegetables. discretionary calorie allowance calories to meet energy needs after all nutrient needs
have been met with nutrient-dense foods.
 Alcohol also contributes abundant calories but few nutrients, and its calories are counted
among discretionary calories.

 Solid fats that occur in foods naturally such as milk fat and meat fat (see in previous
MILK, YOGURT AND CHEESE lists).
 Make fat-free or low-fat choices. Choose lactose-free products or other calcium-rich  Solid fats that are often added to foods such as butter, cream cheese, hard margarine,
foods if you don’t consume milk. lard, sour cream, and shortening.
 These foods contribute protein, riboflavin, vitamin B12, calcium, magnesium, potassium,  Added sugars such as brown sugar, candy, honey, jelly, molasses, soft drinks, sugar,
and, when fortified, vitamin A and vitamin D. and syrup.
o 1 c milk is equivalent to 1 c fat-free milk or yogurt;  Alcoholic beverages include beer, wine, and liquor.
o 1½ oz fat-free natural cheese;
o 2 oz fat-free processed cheese. Calories aren’t bad for you. Your body needs calories for energy. But eating too many calories –
 Fat-free milk and fat-free milk products such as buttermilk, cheeses, cottage cheese, and not burning enough of them off through activity can lead to weight gain…. Some people watch
yogurt; fat-free fortified soy milk. their calories if they are trying to lose weight.
 1% low-fat milk, 2% reduced-fat milk, and whole milk; low-fat, reduced-fat, and whole-
milk products such as cheeses, cottage cheese, and yogurt; milk products with added Empty calories
sugars such as chocolate milk, custard, ice cream, ice milk, milk shakes, pudding,  calories from solid fats and/or added sugar.
sherbet; fortified soy milk.  Solid fats and added sugars add calories to the food but few or no nutrients. For this
reason, the calories from solid fats and added sugars in a food are often called empty
MEAT, POULTRY, FISH, LEGUMES, EGGS, AND NUTS calories
 Make lean or low-fat choices. Prepare them with little, or no, added fat.
 Meat, poultry, fish, and eggs contribute protein, niacin, thiamin, vitamin B. vitamin B12 DISCRETIONARY CALORIE ALLOWANCE
iron, magnesium, potassium, and zinc: legumes and nuts are notable for their protein,  Are excess calories to enjoy once your required nutrient needs are met.
folate, thiamin, vitamin E, iron, magnesium, potassium, zinc, and fiber.  They can be used toward higher-fat forms of foods like milk, cheese and meat, and high-
o 1 oz meat is equivalent to 1 oz cooked lean meat, poultry, or fish; fat and sugary toppings such as butter, sauce, sugar and syrup.
o 1 egg: ¼ c cooked legumes or tofu;  Discretionary calories can also count towards soda, candy and alcohol.
o 1 tbs peanut butter: ½ oz nuts or seeds.
PORTION CONTROL
 Poultry (no skin), fish, shellfish, legumes, eggs, lean meat (fat-trimmed beef, game, ham,
 important when you’re trying to lose weight and keep it off.
lamb, pork); low-fat tofu, tempeh, peanut butter, nuts (almonds, filberts, peanuts,
 PORTION
pistachios, walnuts) or seeds (flaxseeds, pumpkin seeds, sunflower seeds).
o is the amount of food you put on your plate, while a serving is an exact
 Bacon; baked beans; fried meat, fish, poultry, eggs, or tofu; refried beans; ground beef:
amount of food.
hot dogs: luncheon meats: marbled steaks; poultry with skin: sausages; spare ribs.
 Important because it allows for you to have a tight handle on how many calories you are
presumably taking in..
OILS
 This means eating what your body needs instead of mindlessly overindulging.
 Select the recommended amounts of oils from among these sources.
 The Portion Plate is an interactive tool for teaching consumers
 These foods contribute vitamin E and essential fatty acids (see Chapter 5), along with
 Is an actual melamine, dishwasher-safe plate that offers a tangible demonstration of how
abundant calories.
much food we should eat.
o 1 tsp oil is equivalent to 1 tbs low-fat mayonnaise;
o 2 tbs light salad dressing: 1 tsp vegetable oil; 1 tsp soft margarine.
FOOD LABELS
 Liquid vegetable oils such as canola, corn, flaxseed, nut, olive, peanut, safflower,
 carry useful information to help you make good choices about food.
sesame, soybean, and sunflower oils: mayonnaise, oil-based salad dressing, soft Trans-
 will tell you if the food contains an additive that you may want to avoid.
free margarine.
 The nutrition information panel helps you to compare the nutrient profile of similar
 Unsaturated oils that occur naturally in foods such as avocados, fatty fish, nuts, olives,
products and choose the one that suits your needs.
seeds (flaxseeds, sesame seeds), and shellfish.
 All food labels should have Daily values.

SOLID FATS AND ADDED SUGAR

 Limits intakes of food and beverages with solid fats and added sugars.
Foods with more than one ingredient must have an ingredient list on the label. Ingredients are  Familiarize yourself with the different food groups and the amounts indicated in your
listed in descending order by weight. meal plan.
Those in the largest amounts are listed first. This information is particularly helpful to individuals
with food sensitivities. Standard measurement used in this present:
Those who wish to avoid pork or shellfish, limit added sugars or people who prefer vegetarian  1cup = 236ml
eating.  1 tbsp = 14.8ml
 1tsp = 4.2ml
 1oz = 29.57ml
DAILY VALUES HANDY GUIDE TO PORTION SIZE
 It is a food labelling standard, found in food labels.  PALM not including fingers and thumb – 3 ounces of cooked and boneless meat.
 It was established by Food and drug administration (FDA)  FIST – a cup or 30 grams of carbs for foods
 Has 2 values  THUMB – 1 tablespoon or serving of regular salad dressing reduced-fat mayonnaise, or
o DRV or Daily Reference value: reduced-fat margarine.
 Established for total fiat, saturated fatty acids, proteins, cholesterol,  THUMB TIP –1 teaspoon or 1 serving of margarine, mayonnaise, or other fats or oils.
carbohydrate, fiber, sodium. Hand sizes vary. These portion estimates are based on a woman’s hand size. Measuring or
 Values apply to average person eating 2000-2500 calorie level a day weighing foods is the most accurate way to figure out portion size.
 These values are set for things that do not have an RDA.
 For example, Low fat food label should contain 3 grams of fat or less STARCHES
per serving  Whole grain products average about 2 grams of fiber per serving
o RDI or Reference Daily value  A good source of B vitamins
 is based on RDA (recommended dietary allowance):  Measurement units after cooking
 It is established for 25 essential vitamins and minerals
 Separate RDI exist for infants, toddlers, aged 4+ pregnant and FRUITS
lactating women  High in vitamins and minerals
 RDI and DRV are combined under daily value (DV) on food labels.  Fresh, frozen and dry fruits have fiber
 beta carotene, vitamin C, and other antioxidants like lyco -pene
EXCHANGE SYSTEM
 The exchange system is the basis of your meal plan. VEGETBLES
 Diabetes diet  High in vitamins and minerals
 Weight loss, CVD, Renal, HTN, hyperlipidemia, atherosclerosis  Vegetables contain 2-3 grams of dietary fiber
 Excellent tool for:  brightly color
o Meal planning
o Calorie control MILK AND OTHER ALTERNATIVES
o Meeting AMDRs and DRIS  an excellent source of calcium.
 Saturated fat content dairy
Advantages  Healthy bones and teeth,
 More than one energy source gives us  Reduce high blood pressure
 variety of healthful food choices  Control weight.
 According to different age groups
 allows individuals to be accountable for what they eat MEAT AND ALTERNATIVES
 Primary source of protein
Disadvantages  Choose lean Meat
 Possibility of measurement error  Eat fish at least twice a week
 Absorption rates vary in different individuals  Beans fiber source
 Portion sizes are based on:
 Grams of protein FATS
 Grams of carbohydrate >Grams of fat  Vitamins (A, D, E, and K)
 Total number of Calories  essential fatty acids
 weight gain
To use the exchange system  increase in blood cholesterol levels
OTHER FOODS
 Contain added sugar
 low in vitamins, minerals, and fiber

Starch Fruits Vegetables Milk Meat Fats Others

Carbo 15g 15g 5g 12g 0 0 15g

Protein 3g 0 2g 8 7 0 Vary

Fats 0 0 0 0-8g 3-8g 5g Vary

Calorie 80 cal 60 cal 25cal 90-150 35-100 cal 45 cal Vary

cal

Combining Food Guide Pyramid Plan with the Exchange Lists

Helps choose foods that provide all nutrients Promotes adequacy, balance and variety
exchange system uses calorie control and moderation
 o less than 18 years old and over 35 years of age,
o women with low education and financial resources,
o women with unmanaged chronic illness
o and women who had just given birth in the last 18 months.

Millennium Development Goals

NCM 107 :
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
MOTHER and CHILD HEALTH
3. Promote gender equality and empower women
 Refer to mother and child relationship to one another and consideration of the entire
4. Reduce child mortality
family as well as the culture and socio-economic environment as framework of the
5. Improve maternal health
patient.
6. Combat HIV/AIDS, malaria and other diseases
 It involves the care of the woman and family throughout pregnancy and childbirth and the
7. Ensure environmental sustainability
health promotion and illness care for the children and families.
8. Global partnership for development
Goals of MCH
17 Sustainable Development Goals:
 To ensure that every expectant and nursing mother maintains good health, learns the art
18. No Poverty
of child care, has normal delivery and bears healthy child.
19. Zero Hunger
 That every child, wherever possible lives and grows up in a family unit with love and
20. Good Health and Wellbeing
security, in healthy surroundings, receives adequate nourishment, health supervision and
21. Quality Education
efficient medical attention, and is taught the elements of healthy living (Reyala, 2000).
22. Gender Equality
 Promotion and maintenance of optimum health of the women and newborn.
23. Clean Water and Sanitation
24. Affordable and Clean Energy
Philosophy of MCN
25. Decent Work and Economic Growth
 Is community-centered
26. Industry, Innovation and Infrastructure
 Is research-centered
27. Reduced Inequalities
 Is based on nursing theory
28. Sustainable Cities and Communities
 Protects the rights of all family members
29. Responsible Consumption and Production
 Uses a high degree of independent functioning
30. Climate Action
 Places importance on promotion of health
31. Life Below Water
 Is based on the belief that pregnancies or childhood illness are stressful because they
32. Life on Land
are crises.
33. Peace, Justice and Strong Institutions
 Is a challenging role for the nurse and is a major factor in promoting high level wellness
34. Partnerships for the Goals
in families.
 Pregnancy, labor and delivery and the puerperium are part of the continuum of the total
DEFINITION OF TERMS:
life cycle.
SEXUALITY
 Personal, cultural and religious attitudes influence the meaning of pregnancy for
 Includes how you feel about your body, - interest in sexual activity,
individuals and make each experience unique.
 Your need for touch,
 Maternal-child nursing is family centered. The father of the child is as important as the
 The ability to communicate your sexual needs to a partner, and
mother.
 The ability to engage in satisfying sexual activity
Strategic thrusts
SEXUAL HEALTH
 Launch and implement the Basic Emergency Obstetric Care strategy in coordination with
 integration of the somatic, emotional, intellectual and social aspects of sexual being, in
the DOH.
ways that are positively enriching and that enhance personality communication and love
 It entails the establishments of facilities that provide emergency obstetric care
(WHO)
for every 125,000 population and which are located strategically.
 Improves the quality of prenatal and postnatal care
SEX
 Reduce women’s exposure to health risks through the institutionalization of
 used to identify biologic male of female status.
responsible parenthood and provisions of appropriate health care package to
 also used to describe sexual behavior in general
all women of reproductive age especially those who are
  Culture
GENDER – indicates biologic male or female  Personal Ethics
 Religious Values
GENDER IDENTITY  Medications
 is one’s self image as a female or male  Health Status
 it is the result of a long series of developmental events that may or may not conform to HUMAN SEXUAL RESPONSE
one’s apparent biologic sex  Phase 1: EXCITEMENT
SEXUAL DEVELOPMENT  Muscle tension increases.
 Puberty – stage where an individual reaches sexual maturity and is physically capable of  Heart rate quickens and breathing is accelerated.
sexual reproduction  Skin may become flushed (blotches of redness appear on the chest and back).
 Primary sex characteristics – sex organs directly involved in reproduction  Nipples become hardened or erect.
 Secondary sex characteristics – develop during puberty, not directly involved in  Blood flow to the genitals increases, resulting in swelling of the woman’s
reproduction, but distinguish male from female clitoris and labia minora (inner lips), and erection of the man’s penis.
 Adolescent growth spurt – period of accelerated growth during puberty  Vaginal lubrication begins.
 Menarche – female’s first menstrual period  The woman’s breasts become fuller and the vaginal walls begin to swell.
 The man’s testicles swell, their scrotum tightens and begin secreting a
WHAT MOTIVATES SEXUAL BEHAVIOR? lubricating liquid
 Necessary for the survival of the species (but not of the individual)  Phase 2: PLATEAU
 Lower animals motivated by hormonal changes (in the female)  The changes begun in phase 1 are intensified.
 Higher species are less influenced by hormones (more by learning and environmental  The vagina continues to swell from increased blood flow, and the vaginal walls
influences) turn a dark purple.
 The woman’s clitoris becomes highly sensitive (may even be painful to touch)
SEXUAL ORIENTATION and retracts under the clitoral hood to avoid direct stimulation from the penis.
 direction of a person’s emotional and erotic attractions  The man’s testicles tighten.
 Breathing, heart rate, and blood pressure continue to increase.
TYPES:  Muscle spasms may begin in the feet, face, and hands.
 Heterosexual – sexual attraction for the opposite sex  Muscle tension increases.
 Homosexual – sexual attraction for the same sex  Phase 3: RESOLUTION
 Gay – typically used to describe male homosexuals  male ejaculates, female vaginal contractions
 Lesbian – typically used to describe female  shortest phase of cycle, blood pressure & heart rate at their peak
 Bisexual – sexual attraction for both sexes  men typically experience one intense orgasm, many women can have multiple
 Transsexual – transgendered person  Phase 4: RESOLUTION
 During resolution, the body slowly returns to its normal level of functioning, and
DETERMINATION OF SEXUAL ORIENTATION swelled and erect body parts return to their previous size and color.
 Genetics  This phase is marked by a general sense of well-being, enhanced intimacy
 role suggested by twin and family studies -16% of fraternal twins-one sibling is and, often, fatigue.
 48% of identical twins and homosexual
 Brain structure -differences found in hypothalamus of homosexual and heterosexual men TYPES OF SEXUAL EXPRESSION
 Complex issue with no clear answers  CELIBACY
 is abstinence from sexual activity.
SOME GENERAL FINDINGS  Its advantage is the ability to concentrate on means of giving and receiving
 Sexual orientation is an early-emerging, ingrained aspect of the self that probably does love other than through sexual expression
not change  MASTURBATION
 Bell (1981) reported that sexual orientation is determined before adolescence  is self-stimulation for erotic pleasure
and usually 3 years before beginning sexual activity  it can also be a mutually enjoyable activity for sexual partners
 No consistent relationship between orientation and childhood experiences (e.g.,
parenting, abuse, sexual experience) SEXUAL DISORDERS AND PROBLEMS
 Controversial findings suggest a possible relationship among prenatal stress, androgens,  Sexual dysfunction – consistent disturbance in sexual desire, arousal, or orgasm that
and the development of brain systems that play a role in sexual attraction causes psychological distress and interpersonal difficulties
 41% of women and 31% of men report sexual problems
FACTORS AFFECTING SEXUALITY  Low desire and arousal problems common among women
 Developmental level
  Premature ejaculation and erectile problems common among men

To determine if the child would be male or female

PARAPHILIA  Male
 Any of several forms of nontraditional sexual behavior where sexual gratification  The mother’s stomach is set on high as is pointy in contour
depends on an unusual experience, object, or fantasy  The mother retains her beauty throughout pregnancy
 Exhibitionism – arousal from exposing one’s genitals to strangers  When walking, the mother would step with her left foot first
 Fetishism – arousal in response to use of certain objects (shoes, leather) or  Female
situations  The mother’s stomach is set lower & is more round in contour
 Frotteurism – arousal from touching or rubbing against a non-consenting  Melasma occurs (the mask of pregnancy) or swelling occurred because it was
person, such as in a bus or subway said that the mother’s beauty was stolen by her child
 Voyeurism – obtaining sexual arousal by looking at another person’s body  When walking, the mother would step with her right foot first
 Transvestism – an individual who dresses to take on the role of the opposite
sex LABOR AND DELIVERY
 Sexual sadisms – arousal achieved through intentionally inflicting  With the thin bamboo that was sharpened and then the hilot would cut the umbilical cord
psychological/ physical pain and the placenta.Hilot would bathe the baby and then wrapped the umbilical cord,
 Sexual masochism – sexual arousal achieved through intentionally being coconut oil and tobacco in a piece of cloth for 7 days. After that, the hilot would tell the
humiliated, beaten, bound, or made to psychological/physical pain family to burn the package in a pot filled with charcoal inside the house so the smoke fill
 Bestiality – sexual desire for animals the entire house to make the house a good environment for the baby
 Pedophilia – individuals who are interested in sexual encounters with children  The hilot would throw the placenta in the river. They believe this takes the bad luck away
from the baby
FILIPINO TRADITIONAL HEALTH BELIEFS  Ginger is either applied unto the stomach or boiled in water for the woman to drink to
help ease the pain
PRENATAL CARE  The placenta would be hang, with the child’s name written on a piece of paper so that
 Do not cross-over fence coz the baby will have the cord go over his/her neck and choke he/she would become intelligent
 Mother is discouraged to wear anything around the  Families prefer to have boys first to help the farm in the future
 Neck to prevent cord coil Do not go out at night, this will weaken the baby
 Do not wear black clothes, this is bad luck for the baby POST PARTUM
 Do not eat mangoes, this will cause a baby girl to have hair on her face  The hilot would teach the mother to bind her hips tightly to bring all the muscles used in
 Mother is given panigan, a wine marinated roots and herbs taken before eating to make the birthing process back to normal again. The tear on her vagina would also go back
the fetus healthy together and return to its pre- pregnancy state
 Mother is encouraged to eat raw eggs to build strength for labor, pigs tail to promote fetal  The hilot would come everyday to the house for 12 days to massage the mother’s body
movement, and calamansi so that the baby’s face would be smooth and hips.
 She is advised not to watch scary movies because it could cause her to go into preterm  Some refrained from hair washing for about one month to prevent excessive heat loss,
labor which would cause the head to shake
 She is advised also not to think negatively towards a person because it would cause the  Lighting of small fires around the bed while the mother and newborn were in it which is
baby to resemble that person believed to promote strength as the mother healed and the newborn grew
 It was believed that cleaning the toilet would cause the baby to be cute
 If the baby would be in breech position, the SO should walk down a fight of stairs, on all
fours, with the head down so that the fetus would turn and born normally
 Mother is restricted from walking outside without footwear to prevent her form becoming
ill
 Mother is restricted from wearing tight-fitted clothing because it could cause the fetus to
become handicapped
 Mother is told to rub coconut oil unto her abdomen to prevent the formation of stretch
marks
 PERINEUM
ANATOMY & PHYSIOLOGY- REPRODUCTIVE SYSTEM MENSTRUAL CYCLE  The muscle and tissue located between the vaginal opening and anal canal
EXTERNAL GENITALIA  It supports and surrounds the lower parts of the urinary and digestive tracts
 The vulva refers to those parts that are outwardly visible  The perineum contains an abundance of nerve endings that make it sensitive to touch
 The vulva includes:  An episiotomy is an incision of the perinium used during childbirth for widening the
 Mons pubis vaginal opening
 Labia majora
 Labia minora INTERNAL GENITALIA
 Clitoris  The internal genitalia consists of the:
 Urethral opening  Vagina
 Vaginal opening  Cervix
 Perineum  Uterus
 Individual differences in:  Fallopian Tubes
 Size  Ovaries
 Coloration VAGINA
 Shape of external genetalia are common  It connects the cervix to the external genitals
 It is located between the bladder and rectum
MONS PUBIS  It functions:
 The triangular mound of fatty tissue that covers the pubic bone  As a passageway for the menstrual flow
 It protects the pubic symphysis  For uterine secretions to pass down through the introitus
 During adolescence sex hormones trigger the growth of pubic hair on the mons pubis  As the birth canal during labor
 Hair varies in coarseness curliness, amount, color and thickness  With the help of two Bartholin’s glands becomes lubricated during SI

LABIA MAJORA (outer lips) CERVIX

 They have a darker pigmentation  The cervix connects the uterus to the vagina
 Protect the introitus and urethral openings  The cervical opening to the vagina is small
 Are covered with hair and sebaceous glands  This acts as a safety precaution against foreign bodies entering the uterus
 Tend to be smooth, moist, and hairless  During childbirth, the cervix dilates to accommodate the passage of the fetus
 Become flaccid with age and after childbirth  This dilation is a sign that labor has begun

LABIA MINORA (inner lips) UTERUS (womb)

 Made up of erectile, connective tissue that darkens and swells during sexual arousal  A pear shaped organ about the size of a clenched fist
 Located inside the labia majora  It is made up of the endometrium, myometrium and perimetrium
 They are more sensitive and responsive to touch than the labia majora  Consists of blood-enriched tissue that sloughs off each month during menstrual cycle
 The labia minora tightens during intercourse  The muscles of the uterus expand to accommodate a growing fetus and push it through
the birth canal
CLITORIS
 Highly sensitive organ composed of nerves, blood vessels, and erectile tissue FALLOPIAN TUBES (Oviducts/ Uterine Tube)
 Located under the prepuce  Serve as a pathway for the ovum to the uterus
 It is made up of a shaft and a glans  Male sperm fertilization site
 Becomes engorged with blood during sexual stimulation  Fertilized egg takes approximately 6 to 10 days to travel through the fallopian tube to
 Key to sexual pleasure for most women implant in the uterine lining
 Urethral opening is located directly below clitoris
OVARIES – female gonads/ sex glands
VAGINAL OPENING INTROITUS  They develop and expel an ovum each month
 Opening may be covered by a thin sheath called the hymen  A woman is born with approximately 400,000 immature eggs called follicles
 Using the presence of an intact hymen for determining virginity is erroneous  During a lifetime a woman release at 400 to 500 fully matured eggs for fertilization
 Some women are born without hymens  The follicles in the ovaries produce the female sex hormones, progesterone and
 The hymen can be perforated by many different events estrogen
  These hormones prepare the uterus for implantation of the fertilized egg  ESTROGEN in the Graafian follicle will cause the cells in the uterus to proliferate,
MENSTRUATION increasing it’s thickness to about eightfold. This uterine phase is called PROLIFERATIVE
 Consist of periodic changes occuring in the ovaries and uterus of a sexually mature, PHASE.
nonpregnant female that result in the  FOLLICULAR PHASE – change from primordial to Graafian follicle
 Production of secondary oocyte  Estrogenic Phase – predominance if estrogen
 Preparation of uterus for implantation  Postmenstrual Phase – since it comes after menses
 It is also called PREOVULATORY PHASE.
MENSTRUAL CYCLE
 Process in which females ripen or release one mature egg Ovulation Phase
 From beginning of menstruation to the beginning of next  On the 13th day of the menstrual cycle, there is now VERY HIGH LEVEL of ESTROGEN,
 Average menstrual cycle – repeat every 28 days or 21 to 40 days and VERY LOW LEVEL OF PROGESTERONE which will stimulate the
 Average menstrual period – 5 days HYPOTHALAMUS to produce LHRF (luteinizing hormone releasing factor)
 Blood loss- 50cc or ¼ cup of fibrinolysis  LHRF will stimulate the APG to produce LH (Luteinizing hormone)
 LH in turn will stimulate the OVARY to produce PROGESTERONE.
Key Terms and Definition  The increased amounts of both ESTROGEN & PROGESTERONE pushes the now
 Menarche – age at onset of menstruation mature OVUM to the surface of the ovary, until the following day (the 14 th day of
 Primary amenorrhea – absence of menstruation despite signs of puberty menstrual cycle), the Graafian follicle ruptures & releases the mature ovum =
 Secondary amenorrhea – absence of menstruation for 3-6 months in a woman who OVULATION
previously menstruated  Once OVULATION has taken place, the Graafian follicle appears yellowish because of
 Dysfunctional uterine bleeding – irregular bleeding due to anovulation or anovulatory large amounts of Progesterone. It is termed as CORPUS LUTEUM
cycle
 Oligomenorrhea – menstrual interval greater than 35 days Luteum / Secretory Phase
 PROGESTERONE causes the glands of the uterine endothelium to become twisted in
Normal Menstruation appearance because of the increasing number of capillaries.
 9 years → 12 years → 16 years  Progesterone is the hormone designed to promote pregnancy because makes the uterus
 Highest rate of anovulatory cycles < 20 or 40 > years old nutritionally abundant with blood in order for the fertilized ovum to survive should
 Duration of flow – 2-8 days conception takes place.
 Amount of flow depends on how rapid endometrium sheds  PROGESTATIONAL PHASE because progesterone makes the uterine
 Incomplete shedding – heavier flow, blood loss anemia environment rich, soft & spongy like a velvet for suitable implantation of the
 Counted from 1st day of flow fertilized ovum
 Normal 21 – 35 days  SECRETORY PHASE because it secretes the most important hormone of
 14 day luteal phase pregnancy
 Cyclic events  Progesterone – hormone of pregnancy
 Vaginal discharge  LUTEAL PHASE– In view of the change of Graafian follicle to Corpus luteum
 Mittleschmertz  POSTOVULATORY PHASE – occurs just after ovulation
 Molimina  And it is also called the PREMENSTRUAL PHASE.
 PMS
Menses
SEQUENTIAL STEPS IN THE MENSTRUAL CYCLE  By the 25th day of the menstrual cycle, if the mature ovum has not been fertilized by then,
Proliferative Phase the corpus luteum will start to contain diminishing amounts of estrogen & progesterone.
 On the 3rd day of the menstrual cycle, SERUM ESTROGEN level is at its lowest triggers  Since estrogen, which made the thickened uterine lining, & progesterone which
the HYPOTHALAMUS to produce FSHRF – follicle stimulating hormone releasing factor. increased the capillaries, have diminished, the thickened lining of the uterus will
 FSHRF stimulate the APG to produce FSH-(follicle stimulating hormone) which will act degenerate & slough off & the capillaries will rupture after 3 – 4 days, thus beginning
on one immature oocyte within the ovary inside a primordial follicle stimulating it’s another menstrual cycle.
growth.  The corpus luteum, which has now turned white, is called CORPUS ALBICANS.
 Because of FHS, ESTROGEN will now be produced in increasing amounts inside the
follicle, which is found inside the OVARY. Once the estrogen is produced, the primordial
follicle will now be termed as GRAAFIAN FOLLICLE (mature secondary oocyte)
 The graafian follicle is therefore the structure which contains high amounts of estrogen.

ADDITIONAL INFORMATION
  When the ovary releases the mature ovum from the graafian follicle on the day of  Stage 2 – Rapid follicle and egg growth
ovulation,  Stage 3 – Ovulation occurs; fully mature egg bursts out of the follicle (fertile) empty
 MITTELSCHMERZ – a normal pain sensation felt in either the right or left follicle transforms into the corpus luteum
lower quadrant of the woman’s abdomen  Stage 4 – Egg travels through fallopian tube (7 days) if not fertilized upon arrival in
 The fist 14 days of the menstrual cycle is a very variable period. The last 14 days (the uterus the corpus luteum shrinks triggering menstruation and ripening of new egg.
second half of the menstrual cycle) is a fixed period.
 Exactly two weeks after ovulation, menstruation will occur, unless pregnancy CHANGES IN IVARIAN HORMONE
takes place because the corpus luteum has 2 weeks life span.  Estrogen “Hormone of Women”
 In a 28 days cycle, ovulation takes place on the 14th day.  gradually increases during days 1-14
 In a 32 days cycle, ovulation takes place on the 18th day.  signals body to thicken the lining of the uterus
 In a 26 days cycle, ovulation takes place on the 12th day.  Levels drop sharply after ovulation.
 Subtract 14 days from the cycle.  Primary function:
 Menstruation takes place even without ovulation, as in women taking contraceptives.  Development of secondary sexual characteristics in female
 Ovulation can also occur even without menstruation, as in breastfeeding women.  Inhibits FHS
 Responsible for hypertrophy of the myometrium
PREMENSTRUAL SYNDROME  Responsible for Spinnbarkeit and Ferning (Cervical Mucus or billing
 Prevalence method)
 Variable symptoms, retrospective association  Spinnbarkeit – clear, slippery texture of the uncooked egg
 Cultural conditioning: negative view of menstruation typical of cervical mucus during ovulation
 Myriad of luteal phase symptoms in varying degrees  Ferning – test for the presence of estrogen causing the
 Premenstrual Dysphoric Disorder cervical mucus to dry on fernlike pattern
 Treatment options:  Billing method – estimating ovulation time by changes in
 Inhibition of prostaglandin release the mucus of the cervix during menstrual cycle
 SSRIS  Responsible for the development of ductile structure in the breast
 OCPs  Responsible for the increase osteoblastic activity
 Vaginal lubrication and sexual desire
Parts Responsible for Menstruation:  Sodium retention causing weight gain
 Hypothalamus  Progesterone “Hormone of Mother”
 Anterior pituitary gland  Levels remain low during the first half of the cycle
 Uterus  increase sharply during the second half of the cycle.
 Ovaries  Maintaining the growth of the endometrium lining.
 Primary function
Phases of Menstrual Cycle  Prepare the endometrium for implantation
 Proliferative Phase  Secondary function
 Secretory phase  Inhibit uterine contraction
 Ischemic phase  Inhibit LH
 Menstruation  Decrease GI motility
 Development of mammary gland
Changes in Pituitary Hormones Days 1-14:  Increase in the basal body temperature
 During the first half of the cycle (Days 1-14) the pituitary produces FSH, which stimulates  Mood swings in women
egg production.”
 This hormone also triggers the release of estrogen from the ovaries.

Changes in Pituitary Hormones Days 14-28

 On the 14th day the pituitary begins releasing LH causing ovulation
 LH also directs the production of progesterone which maintains the growth of the
endometrium..
 If the egg is not fertilized upon arrival in the uterus progesterone levels drop causing
estrogen levels to drop leading to menstruation.
CHANGES IN OVARIES CHANGES IN THE UTERUS
 Stage 1 – An egg is beginning to mature within a cluster of cells called a follicle
 Stage 1- Menstruation Endometrium breaks down and blood, mucus, tissue, and the egg
are shed through the vagina.
 Stage 2- Menstrual flow stops & endometrium begins to thicken.
 Stage 3-Endometrium continues to thicken
 Stage 4- The endometrium is at it’s thickest point.

DAY 1 -14 DAY 14-28

Pituitary Gland Pituitary Gland

↓ ↓
Produces FSH Produces LH (Luteinizing Hormone)
( Follicle Stimulating Hormone) ↓
↓ Triggers Ovulation and the formation of the
Triggers formation of the Follicle Corpus Luteum
Within the ovary Within the ovary
↓ ↓
Produces Estrogen & Ovum Produces Progesterone
↓ ↓
Triggers uterine lining thickening Continues uterine lining thickening
PHYSIOLOGY OF CONCEPTION  A. The decidua
 B. Chorionic villi
FERTILIZATION / conception, impregnation, fecundation  C. The placenta
 is the union of the sperm and ova  D. Umbilical cord
 Begins with 46 pair of chromosomes, splits off to 23 then combine for a unique new 46  E. Membranes and amniotic fluid
pair.
 Stages of fetal Development: DECIDUA
A. Pre-embryonic- 1st 2 weeks after fertilization  “Pregnant endometrium”
B. Embryonic-week 3 to 8th week or (14 to 60 days)  Latin term for “Falling off”
C. Fetal- 8th week until birth  3 Parts:
 decidua basales- lies directly where the embryo is implanted
FERTILIZATION PROCESS  establish communication with maternal blood vessels
A. Life span  decidua capsularis – it covers the fetus
 Ovum-28-48 hours  Decidua vera- the remaining portion of the
 Sperm-48-72 hours
 normally-2.5 ml containing 50-200 million of spermatozoa/ml or average of 400 FUNCTION OF DECIDUA
million per ejaculation  Contains hormone that makes possible the opposition of the floating blastocyst
B. Terms:  Attracts the floating blastocyst
 Fornix – where the sperm is deposited after the implantation  Has unique blood supply
 Capacitation – the final process the sperm undergoes to be ready to fertilize  Postulate to have growth factor that promote placenta growth
 Limit the extent of thropoblastic penetration
The development of a Fetus:  Limit infectious process for
 Ovulation to fertilization
 Zygote CHORIONIC VILLI
 Morula  are probing finger like structure that reach out to the endometrial lining that develops
 Blastocyst after 11 to 12 days
 Thropoblast  3 parts: (1 central core and 2 Outer covering layers)
 Stages and Time Frames  Mesoderm-central core layer that contains capillaries fetal
 Ovum  Syncytiotrophoblast-production of placental hormone
 Zygote  Cytotropoblast- inner part of the two layers “Langhan layers” and disappear
 Morula
 Blastocyst Hormones – Produces by the Chorionic Villi
 Embryo  HCG
 Fetus  Progesterone
 Estrogen
2. Implantation  HPL
 S/S-slight vaginal bleeding  Relaxin
 Three Processes of Implantation:
 Apposition-when the blastocyst begin to brush to the endometrial lining PLACENTA
 Adhesion- when the blastocyst begins the attach the endometrial lining  1 arises from the thropoblastic layer
 Invasion-when the blastocyst begin to settle down in the endometrial lining  a multifunctional organ for it serves as fetal lung, kidney and GIT and as a separate
endocrine organ
3. Development of Placenta  FUNCTION:
 A. Chorionic villi formation 1. Respiratory
 b. Placenta 2. GIT
 C. Decidua formation 3. Circulatory
4. Endocrine
5. Protects the fetus

Facts:
 Weigh-500-1000g
Embryonic and Fetal Structure:
  15-20 cm in diameter  Chorionic membranes- the outermost layer
 2-3 cm thick  Amniotic membranes- lies beneath the chorionic membranes
 contains 15-20 cotyledons – Dirty Duncan” and “Shiny Schultz”  FXN-produces amniotic fluid

Layers of the placenta: Fetal Membrane

 Maternal surface  Amnion
 Fetal surface  Chorion
Amniotic fluid or “Bag of Water”
Deoxygenated blood leaves fetus through the umbilical arteries and enters placenta, where it is  clear, musty or mousy odor with crystallized ferning pattern
oxygenated. Oxygenated blood leaves placenta through the umbilical vein, which enters fetus  Clear, yellowish fluid surrounding the developing fetus.
 Average amount 1000 ml.
PLACENTA produce protein hormones:
 Human chorionic gonadotrophin (HCG)- 8-10 days past conception, is basis for Facts:
pregnancy test  Normal amount-500-1000 cc
 Progesterone  Ph-7.2
 Estrogen  Problems: Poly and Oligo
 Human Placental Lactogen  Oligohydramnios – Having <300ml ; associated with fetal renal abnormalities.
 Hydramnios– Having > 2 L ;, associated with GI and other malformations.
Sieve/filter-allows smaller particles 0 through and holds back larger molecules. Passage of Functions:
materials in either direction is effected by:  Cushion fetus during sudden trauma
 Diffusion: gases, water, electrolytes D  Maintains temp
 Facilitated transfer: glucose, amino acids, minerals.  Facilitate musculoskeletal development
 Pinocytosis: movement of minute particle  Prevent cord compression
 Helps in the delivery process
 Mother transmits immunoglobulin G (IgG) to fetus providing limited passive immunity.  Protects Fetus
 Leakage: caused by membrane defect: may allow maternal and fetal blood mixing.  Supports Symmetrical Growth
 Facilitates gas and nutrient exchange between maternal and fetal blood.  Prevents Adherence to amnion
 The blood itself does not mix.  Allows Movement
 Source of oral fluid
Umbilical Cord  Acts as a excretion-collection repository
 is formed from the amnion and the chorion
 Connecting link between fetus and placenta. VIABILITY
 Contains: 2 arteries and 1 vein supported by mucoid material (Wharton’s jelly) to prevent  Capability of fetus to survive outside uterus at the earliest gestational age – 22-24 weeks
kinking and knotting.  Survival depends on:
 Contains NO pain receptors.  Maturity of fetal central nervous system
 Function:  Maturity of lungs
 Transports oxygen and nutrients to fetus from the placenta and returns waste
products from the fetus to the placenta. RESPIRATORY SYSTEM
 transport 02 and nutrient to the fetus and waste product from the placenta  Terminal SAC period- 24 Weeks to birth
Facts:  Growth of primitive alveoli
 53 cm or 21 inches long at term  Pulmonary surfactants produced which act as wetting agents that prevent alveolar walls
 2 cm thick or ¾ inches from sticking
 composed of: 1 vein and 2 arteries  Insufficient surfactant – RDS
 Contains: Wharton jelly  Lecithin/Sphingomyelin-Phospho Lipids
 Unique: absence of nerve endings and receptors  L/S Ratio
Problem:  30-32 Weeks 1.2:1
 Short cord- abruptio placenta (nauna placenta)  35 Weeks 2:1 (MATURITY)
 Long cord-cord coil or cord prolapse (presenting part umbilicus CARDIOVASCULAR SYSTEM
Membranes  1st System to function
 develops from the chorionic villi thus forming the fetal membranes  FHR 120-160/Min
 has 2 layers:  Can hear FHR with doppler at 10-12 Weeks
  Surgical correction now available, ideally completed around age two.
FETAL CIRCULATION  Many of these defects go undetected until child is at least school age.
 Arteries in umbilical cord and fetal body carry deoxygenated blood.
 Vein in cord and those in fetal body carry oxygenated blood HEPATIC SYSTEM
 Ductus venosus  Liver functions 4-6 weeks
 connects umbilical vein and inferior vena cava; bypassing portal  Full liver function after delivery
circulation
 Foramen Ovale MUSCULO-SKELETAL SYSTEM
 allows blood to flow from right to left atrium, bypassing lungs.  Bones and muscles develop by 4th week
 Blood is shunted from right atrium to left atrium, skipping the lungs.  Fontanels – areas where >2 bones meet
 More than one- third of blood takes this route.  7-8 Weeks arms & leg movements
 Is a valve with two flaps that prevent back-flow.
 Ductus Arteriosus GASTROINTESTINAL SYSTEM
 allows blood flow from pulmonary artery to aorta, bypassing fetal lungs;  Forms during 4th week
 The blood pumped from the right ventricle enters the pulmonary trunk.  Middle portion of the intestine projects out into cord during 5 th week. Returns during 10th
 Most of this blood is shunted into the aortic arch through the ductus week. If this does not occur-
arteriousus.  Omphalocele present at birth
 By the third month of development, all major blood vessels are present and functioning.  Meconium – Dark green to black tarry waste accumulated in the fetal intestine
 Fetus must have blood flow to placenta. near term
 Resistance to blood flow is high in lungs.
RENAL SYSTEM
UMBILICAL CIRCULATION  Kidneys form in 5th week and begin to function 4 weeks later.
 Pair of umbilical arteries carry deoxygenated blood & wastes to placenta.  Voiding into amniotic fluid
 Umbilical vein carries oxygenated blood and nutrients from the placenta.  Low volume can show renal dysfunction
 Renal malformation can be diagnosed in utero.
UMBILICAL VEIN TO PORTAL CIRCULATION  GFR is low at birth
 Some blood from the umbilical vein enters the portal circulation allowing the liver to
process nutrients. NEUROLOGICAL SYSTEM
 The majority of the blood enters the Ductus venosus, a shunt which bypasses the liver  Formed from the ectoderm during the 3rd week
and puts blood into the hepatic veins.  Respiratory effort 18 1/2 WKS – 4 months, 2 Weeks and ½ week
 Swallowing 12 ½ WKS – 3 months and ½ week
WHAT HAPPENS AT BIRTH?  Sucking 29 WKS – 7 months and 1 week
 The change from fetal to postnatal circulation happens very quickly.  Fetal movement felt 16-20 WKS – 4 or 5 months (Quickening)
 Changes are initiated by baby’s first breath.
 Fetal and Neonatal Circulation ENDOCRINE SYSTEM
 1/Req = 1/R, +1/R2  Thyroid gland 1st to develop
 Before birth R, is high. Thus most of blood bypasses the lung.  Insulin produced at 20 weeks
 After birth R1 decreases and blood is directed through the lungs.
INTEGUMENTARY SYSTEM
Foramen Ovale – Closes shortly after birth, fuses completely in first year.  7th week-Two layers of cells
Ductus arteriousus –Closes soon after birth, becomes ligamentum arteriousum in about 3 months.  Vernix caseosa-Protects skin
Ductus venosus – Ligamentum venosum  Lanugo – Fine hair
Umbilical arteries –Medial umbilical ligaments  10th week-Fingernails, toenails
Umbilical vein – Ligamentum teres

IMMUNE SYSTEM
 Passive Immunity- FROM MOM – breastfeed
PROBLEM WITH PERSISTENCE OF FETAL CIRCULATION  Active immunity- FROM FETUS
 Patent (open) ductus arteriosus and patent foramen ovale each characterize about 8% of
congenital heart defects. FETAL GROWTH DEVELOPMENTAL MILESTONES
 Both cause a mixing of oxygen-rich and oxygen- poor blood; blood reaching tissues not
fully oxygenated. Can cause cyanosis. Origin and Development of Organs – cephalocaudal manner
  Primary Germ Layers:  Heart, digestive system, backbone and spinal cord begin to form
 Endoderm  Placenta (sometimes called “afterbirth”) begins to develop
 Development Into linings of the GIT, Resp. tract,  The single fertilized egg is now 10,000 times larger than size at conception
 tonsils, thyroids-for basal metabolism
 parathyroid – for calcium metabolism 2 Months – 1-1/8 inches long
 Thymus gland-for development of immunity,  All vital organs are formed or developed
 Bladder and urethra  Placenta is developed
 Mesoderm – Forms into the supporting structures of the body  Sex organs are formed
 Connective tissues,  Corpus luteum last until end of second month
 Cartilage,  Heart is functioning
 bones,  Eyes, nose, lips, tongue, ears and teeth are forming
 Muscles, and  Penis begins to appear in boys
 Reproductive system,  Baby is moving, although the mother can not yet feel movement
 Kidneys, and ureters
 Ectoderm 3 Months – 2 ½ to 3 inches long ; Weight is about ½ to 1 ounce
 Formation of the Nervous system  Kidneys are functional
 Skin, Hair, Nails  Fetus begin to swallow amniotic fluid
 Mucous membrane of the mouth and anus  Sex is distinguishable
 FHT is audible using Doppler (10-12 weeks)
In cases of multiple congenital anomaly, the structures involved arise out of the  Placenta is complete
same germ layer  Buds of milk teeth appear
 Baby develops recognizable form. Nails start to develop and earlobes are formed
Fetal Developmental Milestones:  Arms, hands, fingers, legs, feet and toes are fully formed
 1st trimester- period of organogenesis  Eyes are almost fully developed
 2nd trimester- period of continued feta growth and development with rapid increase in  Baby has developed most of his/her organs and tissues
fetal length  Baby’s heart rate can be heard at 10 weeks with a special instrument called a Doppler
 3rd trimester- period of most rapid growth and development because of the rapid
deposition of the subcutaneous fat. 4 Months – 6 ½ to 7 inches long; Weight is about 6 to 7 ounces
 Lanugo begins to appear
NORMAL DURATION/LENGTH OF PREGNANCY  Buds of permanent teeth appear
 MONTHS:  FHT is audible by fetoscope (18-20 weeks)
 10 lunar month  Sex can be determined by ultrasound
 9 calendar month  Liver and pancreas are functional
 WEEKS: 38-42 Wks (ave. of 40 weeks)  Baby is developing reflexes, such as sucking and swallowing and may begin sucking
 DAYS his/her thumb
 280 days -singleton  Tooth buds are developing
 260 days – Twins  Sweat glands are forming on palms and soles
 247 – Triplets  Fingers and toes are well defined
 Sex is identifiable
 Skin is bright pink, transparent and covered with soft, downy hair
 Although recognizably human in appearance, the baby would not be able to survive
outside the mother’s body

5 Months – 8 to 10 inches long; Weight about 1 pound

FACTS OF FETAL DEVELOPMENTAL MILESTONES:  Lanugo covers the body
 Quickening
1 month – ¼ inch in length  primi- 18-20th week
 Fetal heart tones begins  Multi- 16-18th week
 CNS development  FHT is audible with stetoscope
 GIT and Respiratory tract remains as a single tube  fetal length of 19-25 cm
 2nd week-differentiation of the primary germ layers  Definite sleeping and activity pattern are distinguishable
  Hair begins to grow on baby’s head
 Soft woolly hair called lanugo will cover its body. Some may remain until a week after 10 months – bone ossification of the skull
birth, when it is shed.
 Mother begins to feel fetal movement MULTIFETAL PREGNANCY
 Internal organs are maturing  Twins
 Eyebrows, eyelids and eyelashes appear  Multifetal Pregnancies

6 Months – 11 to 14 inches long; Weight 1 ¾ to 2 pounds

 Vernix caseosa is present
 Passive antibody transfer
 Eyelids open
 Skin is red and wrinkled
 Low end age of viability (24th week)
 Eyelids begin to part and eyes open sometimes for short periods of time
 Skin is covered with protective coating called vernix
 Baby is able to hiccup

7 Months – 14 to 16 inches long; Weight 2 ½ to 3 ½ pounds

 Surfactant develops
 In males- testes descends to the scrotum
 In female- clitoris is prominent, labia majora are small and do not covers the minora
 Blood vessels of the retina is extremely susceptible to damage from high oxygen
 Taste buds have developed
 Fat layers are forming
 Organs are maturing METHODS OF EDC ESTIMATION
 Skin is still wrinkled and red
 If born at this time, baby will be considered a premature baby and require special care DIRECT NON-INAVASIVE PROCEDURE
 Naegele’s rule
8 Months – 16 ½ to 18 inches long ; 4-6 pounds  used to determine the expected date of delivery by determining the LMP
 Lanugo starts to disappear  count back 3 months from the LMP then add 7 days
 Subcutaneous fat deposits  January to March
 Birth position may be assumed  Ex. September 6, 2006 (LMP)
 Iron stores 9-6-06
 Active moro reflex -3+7
 Overall growth is rapid this month +1
 Tremendous brain growth occurs at this time 6-13-07
 Most body organs are now developed with the exception of the lungs  Ex: January 1, 2007 (LMP)
 Movements or “kicks” are strong enough to be visible from the outside 1-1-07
 Kidneys are mature +9+7
 Skin is less wrinkled 10-8-07 (EDC)
 Fingernails now extend beyond fingertips

9 Months – 19 to 20 inches long; 7 to 7 ½ pounds

 Lanugo and vernix caseosa completely disappear  Mc Donald’s Rule
 Sole of the foot has only one or two crisscross  determine the AOG by measuring the fundal height in cm.
 Amniotic fluid somewhat decreases  Formula:
 The lungs are mature o Length of the fundus in cm x 8/7 = AOG in weeks
 Baby is now fully developed and can survive outside the mother’s body o Length of fundus in cm x 2/7=AOG in lunar months
 Skin is pink and smooth o Fundic height in cm./4= AOG in months
 Baby settles down lower in the abdomen in preparation for birth and may seem less  Bartholomew’s Rule
active  use to determine the AOG by fundic location
 height of fundus to abdominal cavity
  Normal findings:
o 3rd month- just above the symphysis pubis
o 4th month- midway between the umbilicus and the Symphysis pubis
o 5th month- at the level of the umbilicus
o 9th month- just below the xyphoid process
o 10th month-level at 8th month due to lightening

DIRECT INVASIVE METHOD

 Ultrasonography
 is the use of sound waves against an object
 use:
o Diagnose pregnancy as early as 6 weeks
o Confirm the presence, size and location of the placenta and
Amniotic fluid
DETERMINATION OF FETAL STATUS AND RISK FACTORS
o Establish if the fetus is growing and has no gross defects
FETAL DIAGNOSTIC TESTS – used to:
o Establish the presentation and position of the fetus
 Identify or confirm the existence of risk factors
o Predict maturity by measuring the biparietal diameter  Validate pregnancy
o Note: Biparietal diameter Normal: 8.5 cm or more= 2500 grams  Observe progress of pregnancy
= 40 weeks  Identify optimum time for induction of labor if indicated
 Radiography
 Amniocentesis TYPES OF FETAL DIAGNOSTIC TESTS
 obtain a sample of the amniotic fluid by inserting a needle through the  Chorionic villi sampling (CVS)
abdomen  earliest test possible on fetal ceCVS
 use to determine fetal lung maturity and genetic abnormality  sample obtained by slender catheter passed through cervix to implantation
 Fetal lung maturity site.
o done at the 36th week AOG  Ultrasound
o use to measure the surfactant  use of sound and returning echo patterns to identify intrabody structures.
o Lecithin-sphingomyelin ratio= 2:1  Useful early in pregnancy to identify gestational sac(s)
o Phosphatiglycerol (PG+)= definitive test  later uses include assessment of fetal viability, growth patterns, anomalies
 Genetic screening – done 1st or 12th week and adnexal masses.
 Maternal Serum Alpha Feto-Protein  Used as an adjunct to amniocentesis; safe for fetus (no ionizing radiation).
o measures the quantity of fetal serum protein  Amniocentesis
o Increased-neural tube defect  location and aspiration of amniotic fluid for examination, possible after the 14 th
o Decreased-down syndrome week when sufficient amount is present.
 Chorionic Villi Sampling  Used to identify chromosomal aberrations, sex of fetus, levels of alpha-
 removal if tissue sample from the fetal portion of the developing placenta fetoprotein and other chemicals indicative of neural tube defects and inborn
 Purpose: Genetic counselling errors of metabolism, gestational age, Rh factor.
 done-9-12 week  X-ray
 Complication: fetal limb defect  can be used late in pregnancy (after ossification of fetal bones) to confirm
position and presentation
 not used in early pregnancy to avoid possibility of causing damage to fetus
and mother.
 Alpha-fetoprotein Screening:
 Maternal serum screens for open neural tube defects.
 Alpha-fetoprotein is glucoprotein produced by fetal yolk sac, GI tract, and liver.
Test done between 16 and 18 weeks gestation
 Creatinine level
 estimates fetal renal maturity and function, uses amniotic fluid
 Bilirubin level:
 high early in pregnancy; drops after 36 weeks gestation; uses amniotic fluid.
 L/S ratio: uses amniotic fluid to ascertain fetal lung maturity
  lung surfactants lecithin and sphingomyelin.  Infections Agents
 At 35-36 weeks, ratio is 2:1, indicative of mature levels; once ratio of 2:1 is o Rubella
achieved, newborn less likely to develop respiratory distress syndrome. o Toxoplasmosis
 Phosphatidylglycerol (PG) is found in amniotic fluid after 35 weeks. o Syphillis
 Fetal movement count: o Herpes Simplex
 teach mother to count 2-3 times daily, 30-60 minutes each time, should feel 5- o Cytomegalic Inclusion Disease
6 movements per counting time. o Varicella
 Mother should notify caregiver immediately of abrupt change or no movement
o Venezuelan Equine Encephalitis
 PUBS (Percutaneous Umbilical Blood Sampling)
 Mechanical Problems (deformations)
 uses ultrasound to locate umbilical cord.
o Amniotic band constrictions
 Cord blood aspirated and tested.
o Umbilical Cord constraint
 Used in second and third trimesters.
 Biophysical exams o Disparity in uterine size and uterine contents
 a collection of data on fetal breathing movements; body movements, muscle  Chemicals, drugs, radiation, hyperthermia
tone, reactive heart rate, and amniotic fluid volume.
 A score of 0-2 is given in each category and the summative number
interpreted by the physician.
 Primary suggested use to identify fetuses at risk for asphyxia.

ELECTRONIC MONITORING
 Non stress test (NST)
 Accelerations in heart rate accompany normal fetal movement
 In high risk pregnancies, NST may be used to assess FHR on a frequent basis
in order to ascertain fetal well-being.
 Non-invasive
 Contraction stress test
 based on a principle that healthy fetus can withstand decreased 02 during
contraction, but compromised fetus cannot.
 CST is never done unless willing to deliver fetus
TYPES:
 Nipple stimulated CST
o massage or rolling of one or both nipples to stimulate uterine activity
and check effect on FHR
 Oxytocin challenge test (OCT)
o infusion of calibrated dose of IV oxytocin “piggy backed” to main IV
line; controlled by infusion pump
o amount infused increased every 15-20 minutes until three good
uterine contractions are observed within 10-minute period.

TERATOGENS
 Environmental exposures that can adversely effect the developing fetus PHARMACOLOGY
 Maternal Conditions  the science that deals with the study of drugs and their interaction with the living
o Alcoholism, systems.
 derived from Greek – pharmacon means drug and logos means study.
o Diabetes
o Endocrinopathies
DRUG – a substance used in the diagnosis .prevention or treatment of disease.
o Phenylketonuria (PKU)
o Smoking PHARMACOKINECTICS:
o Nutritional problems  the study of the absorption distribution, metabolism and excretion of drugs
  what the body does the drug (in greek kinesis = movement).  the most common,oldest and safest routes of drug administration
 Things help effective absorption of the drugs given orally.
PHARMACODYNAMICS:  Large surface area of GI
 the study of the effect of the drugs on the body and their mechanism of action ie what the  Mixing of content
drug does the body.  Difference in pH at different part of gut
 ADVANTAGES:
THERAPEUTICS:  Safest route
 deals with the use of drugs in the prevention and treatment of disease.  Most convenient
 Most economical
TOXICOLOGY  Drugs can be self-administered
 deals with the adverse effect of the drug and also the study of poisons  Non-invasive route
 i.e detection prevention and treatment of poisoning.(Toxicon poison in greek.  DISADVANTAGES
 Onset of action is slower as absorption needs time.
CHEMOTHERAPHY:  Irritant and unpalatable drugs cannot be administered.
 the use of chemicals for the treatment of infections or malignancies.  Some drugs may not be absorbed due to certain physical characteristics, e.g
streptomycin.
PHARMACY:  There may be irregularities in absorption.
 the science of identification, compounding and dispensing of drugs .  Irritation to the GIT may lead to vomitting.
 Includes collection. Isolation, purification, synthesis and Standardization of medical  Some drugs may be destroyed by gastric juices.e.g insulin.
substances.  Cannot be given to unconscious and uncooperative patients.
 Some drugs may undergo extensive first pass metabolism in liver.
SOURCES OF DRUGS – Natural or Synthetic  Patients may forget to take the tablet which is the practical problem
NATURAL SOURCES:
 PLANTS,e.g Atropine Morphine Quinine digoxine, pilocarpine, physostigmine. ENTERIC COATED TABLET
 ANIMALS e.g. Insulin heparin gonadotrophins and antitoxic sera  Some tablets are coated with substances like cellulose-
 MINERALS e.g. Magnesium sulphate, Aluminium hydroxide, Iron,sulphur and radio  Acetate
active isotopes.  Phthalate
 MICROORGANISMS e.g. Antibacterial agents are obtained from some bacteria and  Gluten
fungi.we thus have pencillins,cephalosporins, tetracycline and other antibiotics.  which are not digested by the gastric acid but get disintegrated in the alkaline juices of
 HUMAN: some drugs are obtained from man,e.g Immunoglobulin from blood, growth the intestine.
hormone from anterior pituitary and chorionic gonadotrophins from the urine of pregnant  This will
woman.  Prevent gastric irritation.
 Avoid destruction of the drug by the stomach.
SYNTHETIC:  Provide higher concentration of the drug in the small intestine.
 Most drugs are now synthesized .e.g quinolones, ,sulfonamides, pancuronium,  slow the absorption,and there by prolong the duration of action.
neostigmine.  ADVANTAGES:
 Many drugs are obtained from cell culture .e.g urokinase from cultured kidney cells.  Frequency of administration may be reduced.
 some are now produced by recombinant DNA technology .e.g human insulin, tissue  Therapeutic concentration may be maintained for along time specially when
plasmogen activator and some drugs by Hybridoma technique, e.g monoclonal noctural symptoms are to be treated.
antibodies

ROUTES OF DRUG ADMINISTRATION  DISADVANTAGES:

 depends on the properties of the drug and the patients requirements.  It is more expensive.
 A knowledge of advantage and disadvantage of the routes of drug administration is  There may be releaes of the entire amount of the drug in a short time leading
essential. to toxicity.
 The route can be broadly divided into:
 Enteral PARENTERAL ROUTE
 Parenteral  Routes of administration other than the enteral route
 Local  Drugs are directly delivered into tissue fluids or blood.
 ADVANTAGES:
ENTERAL ROUTE (ORAL INGESTION)  Action is more rapid and predictable than oral administration.
  These routes can be employed in unconscious or uncooperative patients.  Small pellets packed with drugs are implanted SC
 Gastric irritant can be given parenterally and therefore irritation to the GIT can  The drug is slowly released for weeks or months to
be avoided. provide constant blood levels
 It can be used in patients with vomitting or those unable to swallow.  Sialistic implants
 In emergencies parenteral routes are very useful.  drug is packed in sialistic tubes and implanted SC.
 Digestion by the gastric and intestinal juices and the first pass metabolism are  The drug gets absorbed over months to provide constant
avoided. blood levels .e.g .hormones and contraceptives.
 DISADVANTAGES:  The empty nonbiodegradable implant has to be removed.
 Asepsis must be maintained.  INTRAMUSCULAR:
 Injection may be painful.  Aqueous solution of the drug is injected into one of the large skeletal muscle-
 More expensive less safe and inconvenient. deltoid, triceps, gluteus or rectus femoris.
 Injury to nerve and other tissues may occur.  Absorption into the plasma occurs by simple diffusion.
 Large molecules enter through the lymphatic channels. As the muscle are
PARENTERAL ROUTE INCLUDE vascular absorption is rapid and quite uniform.
 Injections  Drugs are absorbed faster from the deltoid region than gluteal region
 Inhalation especially in women .
 Transdermal route  The volume of injection should not exceed 10ml
 Transmucosal route  For infants rectus femoris is used instead of gluteus which is not well-
developed till the child
INJECTION  Suspensions and colloids can be injected by this route.
 Intradermal  ADVANTAGES:
 The drug is injected into the layers of the skin by:  Intramuscular route is reliable.
 Raising a bleb .c.g. BCG vaccine tests for allergy.  Absorption is rapid.
 By multiple punctures of the epidermis through a drop of the drug,  DISADVANTAGES:
e.g. Smallpox vaccine.  IM injection may be painful.
 Only a small quantity can be administered by this  It may result in an abcess.
 Route and it may be painful.  Risk of nerve injury -irritant solutions can damage the nerve if
 Subcutaneous (SC) injection injected near the nerve.
 Drug is deposited in the SC tissue,e.g.insulin, heparin. As this tissue is less  The needle may also be puncture the blood vessel.
vascular, absorption is slow and largely uniform and this make the drug long-  INTRAVENOUS (IV)
acting.  drug is injected into one of the superficial veins so that it directly reaches the
 DISADVANTAGES: circulation and is immediately available for action.
o As SC tissue is richly supplied by nerves irritant drugs cannot be  Drug can be given IV as:
injected.  Bolus
o In shock absorption is not dependable because of vasoconstriction  drug is dissolved in a suitable amount of vehicle and
o Repeated administration at the same site can causeLipoatrophy injected slowly. An initial large dose is given.e.g.heparin.
resulting in erratic absorption.  Slowly – over 15-20 min,e.g.aminophylline.
 Slow infusion
 when constant plasma concentration are
required ,e.g.oxytocin in labor or when large volume
 Have to be given.e.g.dextrose, saline.

 Drugs can also be administered subcutaneously as:  Administration of IV solutions

 Dermojet  Intraperitonial:
 a high velocity jet of drug solution is projected from a fine  Peritonium offers a large surface area for absorption.
orifice using a gun.  also used for peritonial dialysis.
 The solution gets deposited in the SC tissue from where it  Intrathecal:
is absorbed .  can be injected into the subarachnoid space for action on
 As needle is not required,this method is painless. the CNS.
 It is suitable for vaccines.  Some antibiotics and corticosteroids are also injected by
 Pellet implantation this route to produce high local concentrations.
  Intra-articular: o Rectum has a rich blood supply and drugs can cross the rectal
 are injected directly into a joint for the treatment of arthritis o Mucosa to be absorbed for systemic effect.
and other diseases of the joints o Drugs absorbed from the upper part of the rectum are carried by the superior
 strict aseptic precautions are required hemorrhoidal vein to the portal circulation
 Intra-arterial: o Enema
 drug is injected directly into the arteries  is the administration of a drug in liquid form into the rectum
 it is used only in the treatment of peripheral vascular  enema may be evacuant or retension enema.
disease, local malignancies and angiograms.  Evacuant enema
 Intramedullary: o In order to empty the bowel,about 600ml of
 involves injection into a bone marrow-now this rarely used. soap water is administered per rectum
o given prior to surgeries,obstetric proceduresand
 Before starting infusion the IV line should be flushed with saline
radiological examination of gut.
 Watch for sign of extravasation of fluid and thrombophlebitis.
 Retention enema:
 Make sure that there are no air bubbles in syringe and tubing.
o administered with about 100ml of fluids and is
retained in the rectum for local action.
INHALATION
TOPICAL
 Volatile liquids and gases are given by inhalation
 may be applied on the skin for local action as ointment cream, gel .powder,
 ADVANTAGES:
 may also be applied on the mucous membrane ascin the eyes,ears, and nose as
o Almost instaneous absorption of the drug is achieved because large surface
ointment .drops and sprays.
area of the lungs.
 Drugs may be administered as suppository for rectum,bougie
o Hepatic first pass metabolism is avoided.
o Absorption and excretion through lunges. SPECIAL DRUG DELIVERY SYSTEM
 DISADVANTAGES:  Used to improve drug delivery to prolong the duration of action and improve the patient
o Irritant gases may enhance pulmonary secretions and should be avoided by compliance special drug delivery system are used.
this route. o Ocusert
 are thin elliptical units that contains the drug reservoir which slowly
TRANSDERMAL ROUTE: release the drug by diffusion.
 Highly lipid soluble drugs can be applied over the skin for slow and prolonged absorption, o Progestasert
 Forms of transdermal drug delivery.  is inserted into the uterus where it delivers progesterone constantly
o Adhesive units: for one year.
 Adhesive patches of different sizes and shapes made to suit the o Trans dermal adhesive units
area of application site  Prodrug is an inactive form of a drug which gets metabolized to the
 application are chest, abdomen, upperarm back or mastoid region active derivative in the body.
o Inunction:  Osmotic pumps are small tablet shape units containing the drug
 drug is rubbed in to the skin and it gets absorbed to produce and an osmotic substances in two different chambers. The tablet
systemic effects swallowed and reaches the gut, water enter into the tablet through
o Iontophoresis SPM .the osmotic layers swells and pushes the drug slowly.
 galvanic current is used for bringing about penetration of lipid o Computerized miniature pumps:
insoluble drugs into the deeper tissues where its action is required,  Programmed to release drugs at a definite rate and continuously
o Jet injection: o Monoclonal antibodies are antibodies against the tumor.
 As absorption of drug occurs across the layers of the skin o Liposome are phospholipids suspended in aqueous vehicles to form minute
vesicles ;mainly used for malignant tumors.
TRANSMUCOSAL NURSES RESPONSIBILITIES:
 Drugs are absorbed across the mucous membranes.  Ensure the correct drug is administered by the right route and in the right dose.
 It includes:  History of allergy should be taken particularly before parenteral administration of the
 Sublingual: drugs.
o The tablet or pellet containing the drug is placed under the tongue  Monitor the adverse effect.
o it dissolved and the drug is absorbed across the sublingual mucosa  Drugs should be kept in safe place.
 Nasal  Check the prescription drug label and the patients name before the administration of
o Drugs can be administered through nasal route drugs.
 Rectal :
PHARMACOKINETICS  It should be cross several barriers before reaching the site of action.
 the study of the absorption distribution, metabolism and excretion of the drugs  also involves the same process.i.e filtration,diffusion and specialized transport.
 the movement of the drugs into,within and out of the body.  Various factors determine the rate and extent of
 once drug is administered it is absorbed,i.e .enters the blood, is distributed to different o Lipid solubility
parts of the body, reaches the site of action is metabolized and excreted. o Ionization
 Drugs may be transported across the membrane by Passive or active transport. o Blood flow
 Passive transport: o Binding to plasma proteins and cellular protein.
o Drug moves across a membrane without any need for energy  unionized and lipid soluble drugs are widely distributed through out the body.
 Active transport
o It is the transfer of drugs against a concentration of drugs against a Plasma Protein binding
concentration gradient and needs energy.  The free or unbound fraction of the drug is the only form available for action,metabolism
o It is carried by a specific carrier protein. and excretion,
o only drugs related to natural metabolites are transported by this process.  The protein bound form serves as a reservoir.
 PB prolongs the duration and action of drug
ABSORPTION o Tissue binding
 The passage of the drug from the site of administration  some drugs get bound to certain tissue constituent because of
 Administration into the circulation special affinity for them.
 occurs by one of the processes i.e passive diffusion o active transport.  TB delays excretion and thus prolongs the duration of drug.
 several factor influence the rate and extent of absorption of a drug,they are: o Blood brain barrier (BBB)
 Disintegration and dissolution time  The endothelial cells of the brain capillaries have tight junctions,
 Formulation moreover glial cells envelope the capillaries and together these form
 Particle Size the BBB.
 Lipid Solubility o Placental barrier: Lipid soluble unionized drugs readily cross the placenta.
 pH and ionization
 Area and vascularity of the absorbing surface METABOLISM / BIOTRANSFORMATION
 Gastrointestinal Motility  the process of biochemical alteration of the drug in the body
 Presence of food  Body treats most of the drugs as foreign substance and tries to inactivate and eliminate
 Metabolism them by various biochemical reactions.
 Disease  Theses processes convert the drugs into more polar,water soluble compounds so that
they are easily excreted through the kidneys.
FIRST PASS METABOLISM / PRESYSTEMIC METABOLISM / FIRST PASS EFFECT  Some of the drugs are largely unchanged in urine
 Is the metabolism of the drug during its passage from the site of absorption to the  Some are metabolized kidney,lungs,blood and skin.
systemic circulation.  The chemical reactions of biotrasformation can take place in two phases.
 Drugs given orally may be metabolized in the gut wall and in the liver before reaching the o Phase I (Non-synthetic reactions)
systemic circulation.  convert the drug to more polar metabolite by oxidation,reduction.or
 The extent of FPM differs from drug to drug and person to person. hydrolysis.
 may result in partial to total inactivation of the drug when it is partial, it can be  If the metabolites are not water soluble it undergoes phase II
compensated by giving higher dose of particular drug reactions.
o Phase II (Synthetic reaction)
 Water soluble substance present in the body combine with the drug
to form a highly polar compounds it excreted by the kidneys.
 Large molecules are excreted through the bile.
Bioavailability
EXCRETION
 is the fraction of the drug that reaches the systemic circulation following administration of
 major organs of excretion are the kidneys,intestine,biliary systemand the lungs.
any route.
 Drugs are small amounts are excreted in saliva,sweat,and milk.
Bioeqivalence
 Renal excretion
 It is the study of comparison bioavailability of different formulation of the same drug.
o Kidney is the most important organ of drug excretion.highly lipid soluble drugs
are reabsorbed in in the renal tubules,so their excretion is slow.
Distribution
o Unabsorbed portion of the orally administered drugs are eliminated through the
 After a drug reaches the systemic circulation it gets distributed to various tissues.
feces.large water soluble conjugates are excreted in the bile.
  The lungs are the main route of elimination for gases and liquids  Through ion cchannel
 By physical action
Plasma half-life (t1/2)  By chemical interaction
 is the time taken for the plasma concentration of a drug to be reduced to half its value  By altering metabolic processes
Minimum dose  Through receptor –Drugs may interact specific receptor in the body.
 the smallest dose required to produce a desired therapeutic effect of the drug  Through enzymes and pumps
Maximum dose o Drugs may act by inhibition of various enzymes, thus altering the enzyme-
 is the largest dose of the drug that can be safely given to a patient without producing mediated reaction
harmful effect.  Through ion channel
Toxic dose o Drugs may interfere with the movement of ions across specific channels, e.g.
 is the dose of the drug which produce undesirable effects in majority of the patients Ca channel blocker. K channel blocker.
Lethal dose – is the dose of the drug which can cause death
PHYSICAL ACTION
PHARMACODYNAMICS  The action of drug could result from its physical properties. E.
 the study of actions of the drugs on the body and their mechanism of action, CHEMICAL INTERACTION
 To know what drugs do and how they do it.  Drugs may act by chemical reaction.
 Drugs produce their effects by interacting with the physiological system of the organisms. o Antacids – Neutralize gastric acids
By such interaction drugs can only modify the rate of function of various systems o Oxidising agents – kmn04 (germicidal)
 Thus drugs act by: Alternating metabolic processes
o Stimulation is the increase in activity of the specialized cells  Drugs like antimicrobial alter the metabolic pathway in the micro organism resulting
o Depression is the decreased in activity of the specialized cells destruction of MO
o Irritation Receptor
 can occur on all types of tissues in the body and may result in  is a site on the cell with which an agonist binds to bring about a change.
inflammation, corrosion and necrosis of cells.  Are proteins. They may be present in the cytoplasm or on the nucleus.
o Replacement  Functions of receptors
 drugs may be used for replacement when there is deficiency of o identify the compound
natural substances like hormones metabolites or nutrients o when the Compound binds to the receptor,it has convey the messag
o Anti-infective and cytotoxic action o To bring about a response.
 drugs may act by specifically destroying infective organism
o Modification of immune status:  Agonist :a substance that binds to the receptor and produce a response.
 vaccines and sera act by improving our immunity while  Antagonist :binds to the receptor and prevents the action of agonist on the receptor.
immunosuppressant’s act by depressing immunity,  Partial agonist:It binds to the receptor but has low intrinsic activity that is, produce
partial response.

DRUG SYNERGISM AND ANTAGONISM

SITES AND MECHANISM OF DRUG ACTION When two or more drugs are given concurrently the effect may be additive, synergistic or
 Sites : drugs may produce their effects by locally or systematically antagonistic.
 Local: drugs may act at the site of application.e.g antibiotics, antifungal agent.  Additive effect
o the effect of two or more drugs get added up and the total effect is equal to the
Drugs may act by one or more complex mechanism of action. Fundamental mechanism of drug sum of their individual actions
action may be:  Synergism
 Through receptor o when action of one drug is enhanced or facilitated by another drug the
 Through enzymes and pumps combination is synergistic
 o the total effect of the combonation is greater than the sum of their o Acetylation of drugs
independent effect o G6PS Deficiency
o often called ‘potentiation’ or supra- additive effect.e.g acetylcholine +  Dose
physostigmine.  Disease
 Antagonism  Repeated Dosing
 one drug opposing or inhibiting the action of another drug is antagonism.  Cumulation
 Based on the mechanism antagonism may be:  Tolerance
o Chemical antagonism  Tracy phylaxis
 Two substances chemically interact to result in inactivation of the  Psychological Factor
effect
o Physiological antagonism:
 Two drugs act at different sites to produce opposing effect.
o Antagonism at the receptor level
 The antagonist inhibits the binding of the agonist to the receptor
such antagonism may be reversible or irreversible.
o Reversible competitive antagonism:
 The agonist and antagonist compete for the same receptor.
 By increasing the concentration of the agonist, the antagonism can
be overcome.it is thus reversible antagonism and atropine compete
at muscarnic receptor the antagonism can be overcome by
increasing the concentration of Ach at the receptor.
o Irreversible antagonism:
 The antagonist binds so firmly by covalent bonds to the receptor that
it dissociate slowly not at all.
 It block the agonist the blockade cannot be overcome by increase
the dose of agonist hence it is irreversible antagonism.

FACTORS MODIFYING DRUG ACTION PHARMACOLOGY

 Body weight – Dose: body wt(kg) × average adult dose  Is the study of drugs and its origin, chemical structure, preparation, administration,
 Age– age(years) / age+12 = adult dose action, metabolism and excretion
 Sex
 Species and Races Implication of Pharmacology to Nursing
 Diet and Environment The study of drugs that alter functions of living organisms.
 Route of Administration  Responsible for drug administration
 Genetic factor  Responsible for the administration of
  Medications that they direct others to give. o pH
 Ethical and legal responsibilities o Drug concentration
o Circulation to site of absorption
DRUGS o Absorbing surface
 Are chemicals that alter physiochemical processes in body cells. o Route of administration
 They can stimulate or inhibit normal cellular functions. o Presence of body conditions
 Used Interchangeably with medicines.
DISTRIBUTION
Drug Names
 Is defined as the way the drug moves from the circulating body fluids to its site of action.
 Generic or Nonproprietary Name
Note: The greater the blood supply in a body organ, the faster the medication is absorbed
o name approved by the Medical or Pharmaceutical Associations in the original
 Therapeutic effect-certain blood level is maintained for the drugs to be effective.
country of manufacture and is adopted by all countries.  Toxic effect – when blood level increase significantly over the therapeutic level.
o E.g. Paracetamol  Bioavailability
 Brand name or trade name: o Is defined as the extent to which active ingredients are absorbed and
o Name given by the manufacturer of the drug transported to sites of action.
o E.g. Adol or Panadol  Factors
 Chemical name o Drug solubility
o Name that describes the atomic or chemical structure o Pharmaceutical formulation
o PH
o Food
PHARMACOKINETICS
 activities within the body
METABOLISM / BIOTRANSFORMATION
 It includes:
 the process by which drug is converted by the liver to inactive compounds through a
o Absorption
series of chemical reactions.
o Distribution  Plasma, kidneys and membranes of intestines.
o Metabolism
o Excretion EXCRETION
 Is the elimination of drugs from the
Absorption
 Involves the way a drug enters the body and passes into the fluids and tissues. HALF LIFE
o Passive transport  the time required for the body to eliminate 50% of the drug. – It is important in planning
o Active transport the frequency of dosing.
o Pinocytosis o Short half-life (2-4 hours): needs to be given frequently
 Rate of Absorption: o Long half life: (21-24 hours): requires less frequent dosing
o Drug Solubility  Note: It takes 5 to 6 half lives to eliminate approximately 98% of drug the body
 Water soluble drugs  Liver and kidney disease patients may have problems of excreting a drug.
 lipodystrophy  Difficulty in excreting a drug increases the half-life and increases the risk of toxicity.
o Route of Administration  implication: may require frequent diagnostic tests . and measuring renal and hepatic
o Degree of blood flow through the tissues function.

 Factors affecting Absorption

o Drug Solubility PHARMACODYNAMICS – Drug + cellular components = response drug effect
 water soluble drugs  the study of biochemical, and physiologic and effect of drugs.
 lipodystrophy  “what the drug does to the body”
o Bioavailability- the extent to which active ingredients are absorbed and  Primary Effects – desired or therapeutic effect
transported to sites of action.  Secondary Effects – all other effects whether desirable or undesirable.
DRUG ATTACHMENT o Prognosis of patient’s condition
 Medication chemically
 Binds to specific sites called “receptor sites”
 Agonist – Full activation
o chemical fits at receptor site well Routes of Drug Administration
o Drugs that occupy receptors and activate them Enteral Medications
 Antagonist – No activatii  Administered directly into the G.I.T. through the oral, nasogastric (NG) or rectal routes
o a chemical blocks another chemical from getting to a receptor  Advantages:
o Drugs that occupy receptors but do not activate them o Convenience for nurse & patient
o Antagonists block receptor activation by agonists o Most medications are available in oral route Inexpensive to make oral
 Partial agonist – less activation preparations
o attach to the receptor but only produce a small effect o Can be removed by gastric lavage or make to make
 Disadvantages
BASICS OF DRUG ACTION o Cannot be administered to very nauseated/vomiting or unconscious persons
 Desired action – the expected response of a medication o some loose their effectiveness if with gastric secretions
 Side effects – known and frequently experienced, expected reaction to drug. o onset of action may vary due to changes in absorption in the GIT
 Adverse reaction – unexpected, unpredictable reactions that are not related too usual
effects of a normal dose of the drug. FORM OF ORAL MEDICATION
 Capsules-are gelatin containers that hold powder or liquid medicine.
DRUG INTERACTION  Emulsions-areiquids made up of drugs dissolved in alcohol & water with coloring &
 Takes place when one drug alters the action of another drug flavoring agents added.
 Some are helpful but often produce adverse effects.  Emulsions-are solutions that have small droplets of water & medication dispersed in oil,
 Common Drug Interactions or oil & medication dispersed in water.
o Additive effect  Lozenges – are medicines mixed with a hard sugar base to produce a small, hard
 takes place when 2 drugs are given together & double the effect is preparation of various shapes & sizes. Pharmacology
produced.  Suspensions– are liquids w/ solid, insoluble drug particles dispersed throughout.
 Alcohol + aspirin= Pain relief  Syrups –are liquids w/ a high sugar content designed to disguise the bitter taste of a
o Antagonistic effect drug. Pediatric use.
 takes place when 1 drug interferes with the action of another drug.  Tablets – dried, powdered drugs compressed into small shapes.
 – Protamine sulphate to counteract heparin toxicity
o Displacement effect PARENTERAL ADMINISTRATION
 takes place when 1 drug replaces another at the drug receptor site,  When the patient cannot take an oral medication
increasing the effect of the 1 drug.  When the medication must be given quickly
o Incompatibility  When medication might be destroyed by gastric enzymes
 occurs when 2 drugs mixed together in a syringe produce a  When medication must be given at a rate 5.
chemical reaction so they cannot be given.  When the medication is not available in an enteral form.
 E.g. Protamine sulfate & vitamin
o Interference  INTRAMUSCULAR – 90°
o Provides faster medication absorption because of muscle’s greater vascularity
 occurs when 1 drug promotes the rapid excretion of another, thus
reducing the activity of the 1”.  SUBCUTANEOUS-45°
o Synergistic effect o Placing medications in the loose connective tissue under the dermis
 takes place when the effect of 2 drugs taken at the same time is  INTRADERMAL-15°
greater than the sum of each drug given alone.
 E.g. combining diuretics & adrenergic blockers to lower the BP
OTHER ROUTES OF ADMINISTRATION
PHARMACOTHERAPEUTIC  Topical administration – skin
 the use of drugs to treat diseases. o Cleanse Soften
 Depends on: o Disinfect
o Severity o Lubricate
o Urgency o Eg. Clotrimazole-cream
o atropine-eye-dilate the pupil
  Transdermal route A patient is taking a drug that has a half- life of 12 hours. You are trying to determine when a 50-
o Nitroglycerin (skin patch) systemic vasodilation in angina mg dose of the drug will be gone from the body. – In 12 hours, half of the 50 mg (25 mg) would be
 Inhalation in body.
o provides rapid delivery of drugs to a large area of mucus membranes & tissues  In another 12 hours (24 hours) half
of the respiratory system. o My 25 mg (12.5 mg) would remain in the body.
o Anesthesia o After 36 hours, half of 12.5 mg (6.25 mg) would remain
o Bronchodilators – o After 48 hours, half of the 6.25 mg (3.125 mg) would remain
 Intranasal – desmopressin for diabetes insipidus o After 60 hours, half of the 3.125 mg (1.56 mg) would remain
o Calcitonin- a peptide hormone for tx of osteoporosis o After 72 hours, half of the 1.56 mg (0.78 mg) would remain
 Intrathecal injection- o After 84 hours, half of the 0.78 mg (0.39 mg ) would remain
o introduction of hypodermic needle into the subarachnoid space for the o Twelve more hours (for a total of 96 hours) would reduce the drug amount to
purpose of instilling a material for diffusion throughout the spinal fluid. 0.195 mg
 Intraventricular-space into the ventricle o Finally, 12 more hours (108 hours) would reduce the amount of the drug into
o Both gains access to the CSF e.g. amphotericin B in meningitis the body to 0.097 mg, which is negligible
 Therefore, it would take 4 ½ to 5 days to clear the drug from the body.
FIRST PASS EFFECTS
 Drugs taken orally are absorbed from the small intestine directly into the portal venous
system.
 The portal veins deliver these absorbed molecules into the liver, which immediately
transforms most of the chemicals delivered to it by a series of liver enzymes.

PROTEIN BINDING
 Most drugs are bound to some extent to proteins in the blood to be carried into
circulation.
 The protein-drug complex is relatively large & cannot enter into capillaries & then into
tissues to react. The drug must be freed from the protein’s binding site at the tissues.

 Tightly bound
o released very slowly
o These drugs have very long duration of action (not freed to be broken down or
excreted), slowly released into the reactive tissue.
 Loosely bound – tend to act quickly and excreted quickly
 Compete for protein binding sites
o alters effectiveness or causing toxicity when 2 drugs are given together.

HALF- LIFE
 the time it takes for the amount of drug in the body to decrease to one- half of the peak
level it previously achieved.
 E.g. – 20 mg of a drug with half-life of 2 hours, 10 mg of the drug will remain 2 hours
after administration. Two hours later, 5 mg will be left (one-half of the previous level); in 2
more hours, only 2.5 mg will remain.

Why to know half-life?

 To determine the appropriate timing for a drug dose or – determining the duration of a
drug’s effect on the body.
 Determining the Impact of Half-Life on Drug Levels PAGKILALA SA IBAT IBANG URI NG TEKSTO

Tekstong impormatib
 ay nag lalahad ng mga bagong kaalaman, pangyayari, paniniwala, at mga impormasyon.
  Ang mga kaalaman ay sistematikong nakaayos at inilalahad nang buong linaw upang  Isinulat ang tekstong persuweysib upang mabago ang takbo ng isip ng mambabasa at
lubos na maunawaan. makumbinsi na nag punto ng manunulat, at hindi sa iba, ang siyang tama.
 Kadalasang sinasagot nito ang mga batayang tanong na ANO, KAILAN, SAAN, SINO at
PAANO Tekstong Naratib
 Layunin nito na maging daluyan ng makatotohanang impormaasyon para sa mga  Ang tekstong ito ay pagsasalaysay o pagkukuwento ng mga pangyayari sa isang tao o
mambabasa, sapagkat marami ang nagtitiwala na may katiyakan ang mga impormasyon mga tauhan, nangyari sa isang lugar at panahon o sa isang tagpuan, nang may maayos
sa mga ganitong uri ng teksto. na pagkakasunod-sunod mula simula hanggang katapusan.
 Ito ay nag lalayong magbigay ng impormasyon o magpaliwanag ng malinaw at walang  Ang pag sulat nito ay maaring batay sa obserbasyon o nakikita ng may akda, maaari din
pagkiling tungkol sa ibat ibang paksa tulad ng sa mga hayop , sports, agham, o namang ito ay nanggaling mula sa sarili niyang karanasan.
siyensya, kasaysayan, gawain, panahon at iba pa.  Maaring hinango sa totoong pangyayari sa daigdig (di-piksyon), o nanggagaling lamang
sa kathang isip ng manunulat (piksyon)
SA PAG BUO NG ISANG TEKSTONG IMPORMATIBO, MAHALAGANG ISAMA ANG
SUMUSUNOD NA MGA ELEMENTO Tekstong prosidyural
PAMAGAT  ay nagpapaliwanag kung paano ginagawa o binubuo ang isang bagay.
 nag lalaman ng pangunahing ideya o paksa ng teksto.  Naglalahad ito ng wastong pagkakasunod sunod ng mga hakbangin, proseso o paraan
 nag lalayong hikayatin ang mga mambabasa na magpatuloy sa pag babasa. sa paggawa.
 Layunin nito na makapagbigay ng malinaw na instruksiyon o direksyon upang
INTRODUKSYON maisakatuparan nang maayos at mapagtagumpayan ang isang makabuluhanggawain.
 naglalaman ng pambubungad na mga pangungusap o talata na nagpapakilala sa paksa
o isyu na tatalakayin. Tekstong Argumentatibo
 Dito rin inilalatag ang layunin ng teksto at kung ano ang maaasahang impormasyon mula  Ay naglalayong manghikayat, naglalahad ito ng mga oposisyong umiiral na kaugnayan
sa pagbabasa. ng mga proposisyon na nangangailangang pagtalunan o pagpapaliwanagan.
 Ay isang uri ng teksto na ang pangunahing layunin ay makapaglahad ng katuwiran,
KATAWAN  Ang manunulat ay kailangang maipagtanggol ang kanyang posisyon sa paksa o isyung
 naglalaman ng malalim na pagsusuri, mga datos, at iba pang impormasyon na susuporta pinag uusapan.
sa pangunahing ideya o paksa ng teksto
 ang mga impormasyong ito ay dapat ayusin nang maayos at magkaroon ng malinaw na SAMARI
pagkasunod sunod.  Tekstong impormatib
o naglalahad ng mga bagong kaalaman, pangyayari, paniniwala, at mga
KONGKLUSYON impormasyon
 nagbibigay ng pagsusuri o pagsusumming up sa mga nailahad sa katawan ng teksto  Tekstong Deskriptib
 maaaring magbigay ng pahayag o panawagan na may kaugnay sa paksa o isyu o isang uri ng paglalahad at naisasagawa sa pamamagitan ng mahusay na
paglalarawan.
Tekstong deskriptib  Tekstong nanghihikayat o tekstong persuweysib
 ay isang uri ng paglalahad at naisasagawa sa pamamagitan ng mahusay na pag o naglalahad ng mga pahayag upang makapanghikayat o makapangumbinsi sa
lalarawan. mga tagapakinig o mambabasa.
 Ang uri ng sulatin ito ay nag lalayon na makapagpinta ng imahe sa hiraya ng  Tekstong naratib
mambabasa gamit ang limang pandama: PANINGIN, PANDINIG, PANLASA, PANG- o isang uri ng tekstong naglalayong makapag kuwento o magsalaysay.
AMOY, at PANDAMA.  Tekstong prosidyural
o nagpapaliwanag kung paano ginagawa o binubuo ang isang bagay
DALAWANG URI NG TEKSTONG DESKRIPTIB  Tekstong argumentatib
DESKRIPTIB IMPRESYUNISTIK o naglalayong manghikayat, naglalahad ito ng mga oposisyong umiiral na
 uri ng tekstong naglalarawan na nanagpapakita lamang ng pansariling pananaw o
kaugnayan ng mga proposisyon na nangangailangang pagtaluhan o
opinion at personal na pakiramdam ng sumulat.
pagpapaliwanagan.
DESKRIPTIB TEKNIKAL
 uri ng tekstong naglalarawan na nagpapakita ng obhetibong pananaw sa tulong ng mga
tiyak na datos, mga ilustrasyon, at dayagram.
Tekstong nanghihikayat o tekstong persuweysib
PAGBASA
 Ay naglalahad ng mga pahayg upang makapanghikayat o makapangumbinsi sa mga
 Tumangan et al. (1997).
tagapakinig o mambabasa.
o Ang pagbasa ay interpretasyon ng mga nakalimbag na simbolo ng ito ng mga
 Layunin nito ang manghikayat o mangumbinsi sa babasa ng teksto.
nakatitik na sagisag ng mga kaisipan.
  Austero et al. (1999). napili, ay mayroon na siyang ideya tungkol dito batay sa taglay niyang iskema. Ito ay
o Ang pagbasa ay ang pagkilala at pagkuha ng mga ideya at kaisipan sa mga ayonn sa bagong paniniwala asa proseso ng pagbasa.
sagisag na nakalimbag upang mabigkas nang pasalita.  Babasahin pa rin ang teksto upang mapatunayan sa sarili na ang mga haka o hula ay
o Ito rin ay pag- unawa sa wika ng awtor sa pamamagitan ng mga nasusulat na tama o may pagkakahawig o may pagkukulang. Sa ganitong pangyayari, masasabi na
simbolo. ang teksto ay isa lamang instrument sa proseso ng pagbuo ng kahulugan. Hindi ang
o Paraan din ito ng pagkilala, pagpapakahulugan at pagtataya sa mga teksto, kundi ang kaisipang nabubuo ng mga mambabasa ang mahalaga upang
simbolong nakalimbag maunawaan ito
 Lorenzo et al. (1994).
o Ang isang masining na pagbabasa ay yaong umaalinsunod sa mga alituntunin B. Interaktibong Proseso ng Pagbasa
nang maayos, tama at mabisang pagbabasa na nagiging kapaki- pakinabang Teoryang “Bottom Up”
sa bumabasa o mga nakikinig  Binibiyang diin na ang pagbasa ay nag pagkilala ng mga serye ng mga nakasulat na
 Richards, Platt at Platt (1992). simbolo upang maibigay ang kaakibat nitong tunog.
o Ang pagbasa ay pag-unawa sa nakasulat na teksto upang maunawaan ang  Ang pagkatuto sa pagbasa ay nag-uumpisa sa pagkilala ng mga titik o letra hanggang sa
nilalaman nito. salita, parirala o pangungusap patungo sa talata bago maibigay ang kahulugan ng
o Maaari itong gawin sa matahimik na paraan at maaari rin naman sa paraang binasang teksto.
 Ang unang hakbang upang makilala ang mga nakalimbag na anumang simbolo ng
oral.
binabasang teksto tulad ng mga letra na siyang bumubuo ng mga nakasulat na salita.
 Belvez et al. (1987),
o Badayos (1999), ang isang taong umaayon sa pananaw ng bottom up ay
o Ang pagbasa ay pagkilala at pagkuha ng mga ideya at kaisipan sa mga
naniniwala na ang pagbasa ay ang pagkilala ng mga salita, ang teksto ang
sagisag na nakalimbag upang mabigkas nang pasalita ang mga ito.
pinakamahalagang salik sa pagbasa
o A pagbasa’y isang bahagi ng pakikipagtalastasan na kahanay ng
 Maibibigay ang kabuuang kahulugan ng tekstong binasa sa huling bahagi nito.
pakikinigag,pagsulat.
 Ang pag- unawa sa binasa ay nagsisimula sa teksto patungo sa tagabasa na kung saan
o Ito’y pag-unawa sa wika ng may-akda sa mga nakasulat na simbolo paraan ng
ang teksto –“bottom” at tagabasa –“up”.
pagkilala, pagpapakahulugan at pagtataya ng mga kagamitang nakalimbag
Teoryang “Top Down”
Ang Proseso ng Pagbasa
 nagsisimula sa kaisipan ng tagabasa (top) patungo sa teksto (down) sapagkat ang
A. Prosesong Sikolohikalng pagbasa :
dating kaalaman o prior knowledge ang nagpapasimula ng pagkilala niya sa teksto.
 Habang nagbabasa ang isang indibidwal ito’y nakikipag-usap sa may-akda sa
Teoryang Iskema
pamamagitan ng teksto kung kaya’t masasabing ang tagabasa ay isang aktibong
 Ang teksto, pasalita man o hindi aywalang taglay na kahulugan.
indibidwal sapagkat gamit niya ang dating kaalaman
 Ang isang teksto ay nagbibigay ng direksyon sa tagapakinig o tagabasa kung paano
 Tunghayan ang tatlong impormasyon ayon kay Badayos (1999)
bubuuin ang kahulugan nito mula sa dating kaalaman o background knowledge na
o Impormasyong Semantika
tinatawag ding iskema.
 ang pagpapakahulugan sa mga salita at pangungusap
 ito ay nakaorganays na sa ating dating kaalaman at mga karanasan kung saan
o Impormasyong Sintaktik o impormasyong istruktura ng wika
nakalagay na sa ating isipan at maayos na nakalahad ayon sa kinabibilangan nito.
 Ang dating mga kaalamang ito ay hindi lamang basta o nananatiling nakaimbak sa ating  tungkol sa pagkakaayos at istruktura o kayarian ng wika.
mga utak, bagkus ang mga ito ay patuloy na ginagamit sa pag-uugnay ng ating mga o Impormasyong Grapho-Phonic
makabagong karanasan o kaalaman.  ugnayan ng mga letra (grapheme) at mga tunog (phonemes) ng
 Patuloy ang mga iskemang ito na nadaragdagan, nalilinang, napauunlad at nababago. wika kasama rito ang impormasyon tungkol sa pagbaybay na
 matatawag ding “kahon ng impormasyon” kung saan nakaimbak lahat ang ng mga naghuhudyat ng kahulugan
karanasan. Teoryang Interactiv.
 Ang isang indibidwal ay nakabubuo ng isang konsepto na nanggaling na sa dati niyang  Pinagsamang teoryang bottom up at top down
kaalaman. Tulad halimbawa ng konseptong “pagpasok sa eskwelahan”  hindi lamang ang teksto ang bibigyang atensyon, kasam dito ang pag-uugnay ng sariling
o Ang mga iskema ay nagmumula sa ating panlahat na karanasan na ating karanasan at pananaw o ang kaalaman.
naiuugnay sa kasalukuyan na kung saan mayroon nabubuong konsepto na
ang eskwelahan ay lugar kung saan nag-aaral ang mga bata, may malalaking
mga gusali ang makikita, at may mga masisipag na mga guro.
o Kasama na rin sa iskemang ito kung paano tinuturuan ang mga batang mag- C. Mga Elemento ng Metacognitiv na Pagbasa
Sa pagbabasa natin ng anumang teksto mayroon tayong sinusunod na proseso na kung saan
aaral pati na rin ang tamang pagkilos, pagsasalita, maging ang pagsasamahan
magiging magaan at maayos ang ating pag-unawa sa binabasa, May tatlong proseso ng pagbasa
ng mga guro sa eskwelahan.
ayon kay Lachica (1999)
 Ang lahat ng mga bagong impormasyong ating natutunghayan ay nananatili at naiimbak
sa ating dating kaalaman o iskema. Bago pa man magbasa ang isang tao ng tekstong
Bago magbasa  Makikita ang pagkakaayos ng mga kabatiran na binibigyang suporta
 Karaniwang itinatanong ng guro sa mga mag-aaral ang mga sumusunod bago basahin sa loob ng teksto.
ang isang akda  Kailangang alam nating tukuyin ang pangunahing ideya ng bawat
 Ang mga binibigyang halaga bago magbasa sa pagbasang kritikal ay ang mga talatang ating binabasa.
sumusunod:  Maisasagawa ang gawaing ito kung tatandaan natin na halos
o sanhi kung bakit naisulat ng awtor ang paksa argumento sa unahan o hulihan talata at ng mga pangatnig na
o Kaangkupan ng paraang ginamit at lapit sa pagsulat ng teksto naghuhudyat ng pinakagitna ng argumento. Ng Tulad ng mga
o Ang pagbubuo ng mga sariling kuro-kuro sa sulatin salitang dahil dito, samakatwid, alalaong baga, at iba pa.
 Dito natin nagagamit ang kritikal na pag-iisip kung bakit naisulat ang teksto at paano
ginawa ito ng may- akda. Maaari rin nating itanong ang mga sumusunod: Nagkakaroon ng malaking pagkakataon ang mga mambabasa na maunawaang mabuti ang bawat
o Ano ang pamagat ng akda? Ano ang gusting iparating sa atin ng teksto? pahiwatig ng manunulat sa tulong ng pagsasalungguhit, pagtatanong at pagbabalangkas
o Ano ang layunin nito? Magbigay ba ng impormasyon o magbigay ng kawilihan
sa mambabasa? o Analisa
o Ano ang ginamit na istilo ng may-akda? o Ang argumentong ito ay tumutukoy sa katotohanan o pahayag ng may-akda na
o May alam ka ba tungkol sa may akda? maaaring suportahan ng mga opinion o kuro-kuro.
o Dito maaari nating itanong ang mga sumusunod:
o Kailan naisulat ang akda?
 Ano ang nais bigyang diin ng may-akda sa kanyang sinulat?
 Maari nating gamitin bilang mga huwaran na magiging basehan upang makalikha tayo
 Alin sa mga nabanggit ang itinuturing niyang katotohanan?
ng pamamaraang interpretasyon at paglutas ng mga balakid na siyang kailangan sa
pagbasang kritikal ng teksto.  Konklusyon ayon sa
 Maituturing bang katotohanan ito?
Habang nagbabasa  Anu-ano ang mga katibayang isinaad ng may-akda o manunulat?
 Ang mga tekstong dumaraan sa yugtong ito ay dumaraan sa iba’t ibang uri ng pag- o Kapag mataman nating sinusuri ang ating pagbabasa sa kritikal na pamamaraan,
aanalisa rin tulad ng pagsagot sa mga tanong. ito’y nagpapahiwatig na:
 Ilan san mga katanungang ito ay kung tama o mali ang pagpili ng tamang salita.  Hindi basta naniniwala sa lahat nang binabasa
 Ayon kay Lachica (1999), ang mga sumusunod ay makatutulong upag matuto tayong  Handa tayong maglahad ng mga tanong na sa ating palagay ay
bumasa at magbigay ng reaksyon sa nilalaman at ginamit na wika sa pamamagitan ng hindi tama
anotasyon at analisa:  Dadaan sa malalim na pagsusuri ang argumento
o Anotasyon  May nakahandang katwiran o dahilan upang tanggapin ang ilan at
 napakahalaga dahil naitutuon natin ang atensyon sa nilalaman at salungatin ang iba.
wika ng teksto.  May kakayahan ang bawat indibidwal na ihiwalay ang payak na
 isang paraan ng pagbibigay kahulugan impormasyon sa teksto katotohanan sa mga opnion lamang, pati na ang pagkakaroon ng
 ginagawa sa pamamagitan ng pagsasalungguhi paggawa ng lakas ng loob na itanong ang pagkakaiba ng dalawa Mahalaga rin
katanungan at paggawa ng balangkas. na malaman natin kung paano ginamit ang wika sa paghahayag ng
o Pagsasalungguhit katotohanan at opinyon.
o Sa pag-aanalisa sa wikang ginamit, ang mga sumusunod ay ating kilalanin:
 pagsalungguhit sa mga salita o pariralang di mauunawaan.
 Ang kadalasang paglitaw ng mga magkakatulad na imahe
Pagkatapos ay bibigyang kahulugan ang mga salitang
sinalungguhitan batay sa pagkakagamit nito sa pangungusap  Magkakasunod na paglalarawan
 Maaaring hanapin ang kahulugan nito sa diksyunaryo o mga  Walang pagkakaiba ng paglalarawan sa tao at pangyayari
referensyang aklat o talakayan kasama Ang guro  Pag-uulit ng mga salita, parirala, mga halimbawa at ilustrasyon
o Pagtatanong  Parehong istilo ng pagsulat at marami pang iba
 Nakikita ang ating pagiging kritikal na mambabasa sa pamamagitan
ng pagsulat sa mga katanungang ito sa gilid ng pahinang binabasa.
 Maaaring tanda ito ng hindi natin pagkaunawa sa binabasang teksto
o may pag-aalinlangan tayo sa takbo ng pagtalakay ng may-akda sa
teksto, o kaya nama’y may kulang ang ating kaalaman tungkol dito.

o Pagbabalangkas.
 pagbabalangkas ng pangunahing paksa ng teksto at ang
Pagkatapos magbasa
pagkafocus ng talakay ay nakatutulong nang malaki sa pag-unawa
 Napapalawak pa ang kaalamang sa pamamagitan ng pagsulat ng buod, ebalwasyon,
natin sa mga impormasyong nakasaad.
paglilimi at muling pagbubuo.
  Itoang pamamaraang lohikal matapos ang pagbabasa ng teksto. uugali, kawilihan at saloobin at mga pagpapahalaga sa ikalilinang ng lahat ng mga ito,
 Sa paggawa ng lagom makikita ang mga natutuhan sa pagbabasa at pag-aalaala sa may mga panukatan sa pagtatanong, ito ay panukatan o dimension sa pagbasa.
binasang teksto bilang pagtatamo sa mga kaalaman  Narito ang limang panukatan o dimension sa pagbasa.
 Mahalaga ring matutuhan natin ang paggawa o pagsulat ng ebalwasyon, mga
komentaryo o m opinyon tungkol sa binasa. Unang Dimensyon-Pag-unawang literal (1)
 Ayon kay Carl Woodward a. Pagpuna sa mga detalye
o ang pagbabasa ng aklat ay isang mabisang upang maabo ang makabagong
b. Pagpuna sa wastong pagkakasunod-sunod ng mga pangyayari
karunungan at kaalaman ng tao magmula noong unang panahon hanggang
kasalukuyan.
c. Pagsunod sa panuto
d. Pagbubuod o paglalagom sa binasa
DALAWANG PARAAN NG PAGBABASA e. Paggawa ng balangkas ng binasa
f. Pagkuha sa pangunahing kaisipan
Tahimik na Pagbasa.
 mata lamang ang siyang ginagamit sa pagbabasa at walang tung o pasalitang ginagawa.
g. Paghanap ng tugon sa mga tiyak na katanungan
 mapabibilis kung isasaalang-alang ang mga sumusunod: h. Pagbibigay ng katotohanan upang mapatunayan ang isang nalalaman na
o Sapat na ilaw at tahimik na lugar upang mapangalagaan ang paningin. i. Paghanap ng katibayan para sa o laban sa isang pansamantalang konklusyon
o Isaisip ang buong diwa ng binabasa at hindi ang bawat salita lamang j. Pagkilala sa mga tauhan
o Sumangguni sa diksyunaryo kung may salitang hindi maunawaan
k. Pag-uuri-uri ayon sa pamagat
o Pakilusin ang mata simula sa kaliwa pakanan.
o Iwasan ang pagkibot ng labi kapag nagbabasa nang tahimik. Ikalawang Dimensyon (2)
 Pagkaunawang ganap sa mga kaisipanng may-akda lakip ang mga karagdagang
Pasalitang pagbasa kahulugan
 mata at malakas na tinig ang siyang ginagamit sa pagbasa.
a. Pagdama sa katangian ng tauhan
 higit na gamitin kung unang yugto ng pag-aaral ng pagbasa ang pag-uusapan dahil sa
yugtong ito ay nagsisimula pa lamang na kumilala at magbigay ng interpretasyon ang b. Pag-unawa sa mga tayutay at patalinghagang salita
mag-aaral sa mga nakatalang sagisag ng kaisipan. c. Paghinuha ng mga katuturn o kahulugan Pagbibigay ng kuro-kuro at opinyon
 Ginagamit kung may tagapakinig na nais makibahagi sa mga interpretasyon ng mga d. Pagkuha ng kalalabasan
nakalimbag na sagisag.
e. Paghinuha sa mga sinundang pangyayari
 Ang mga sumusunod na bagay ay sapat tandaan upang maging maayos ang pagbasa
nang malakas: f. Pagbibigay ng solusyon o kalutasan
o Kailangang katamtaman lamang ang agwat ng aklat buhat sa mata ng bumasa g. Pagkuha ng pangkalahatang kahulugan ng isnag binasa
o Kailangan ang sapat na lakas ng boses. h. Pagbibigay ng pamagat
o Dapat maging malinaw ang pagbigkas ng mga salita
o Sundin ang mga bantas upang malaman kung saan ang din ng binabasa. Ikatlong Dimensyon (3)
o Kailangang tumingin sa mga nakikinig paminsan-minsan  pagkilatis sa kahalagahan ng mga kaisipan at ng kabisaan ng pagkalahad
a. Pagbibigay ng reaksyon
b. Pag-iisip na masaklaw at malawak
c. Paghahambing at pagbibigay ng pagkakaiba
d. Pagdama sa pananaw ng may-akda
e. Pag-unawa sa mga impresyon o kakintalang nadarama
f. Pagpapahalaga sa binasa
g. Pagkakilala sa pagkakaroon o kawalan ng kaisipan ng mga pangungusap
h. Pagpuna sa mga detalye
i. Pagpuna sa wastong pagkakasunod-sunod ng mga pangyayari
j. Pagsunod sa panuto
k. Pagbubuod o paglalagom sa binasa
l. Paggawa ng balangkas ng binasa
m. Pagkuha sa pangunahing kaisipan
MGA PANUKATAN O DIMENSION SA PAGBASA n. Paghanap ng tugon sa mga tiyak na katanungan
 Ang mga babaasahin ay nakatutulong sa paghahandog sa mag-aaral ng mayayamang o. Pagbibigay ng katotohanan upang mapatunayan ang isang nalalaman na
karanasan na makatutulong sa paglinang ng mabubuting kaalaman, kasanayan, pag- p. Paghanap ng katibayan para sa o laban sa isang pansamantalang konklusyon
 q. Pagkilala sa mga tauhan TEKSTO
r. Pag-uuri-uri ayon sa pamagat  isang babasahin na puno ng mga ideya ng iba’t-ibang tao at impormasyon.

Ikaapat na Dimensyon (4) TEKSTONG PANG AKADEMIK

 pagsasanib ng mga kaisipang nabasa at ng mga karanasan upang magbunga ng  ay ginagamit ng mga mag-aaral sa paaralan at lumilinang sa ating kaisipan upang
bagong pananaw at pagkaunawa mapahusay ang ating kaalaman.
a. Pagbibigay ng mga opinyon at reaksyon  Hailimbawa ng mga Teksto tungkol sa Agham Panlipunan, kasaysayan, Ekonomiks,
b. Pag-uugnay ng binasa sa sarili at sa tunay na buhay Sosyolohiya at iba pa.
c. Pagpapayaman sa talakayan ng aralin sa pamamagitan ng paglalahad ng mga
kaugnay na karanasan TEKSTONG PROPESYONAL
d. Pag-aalaala sa mga kaugay na impormasyon  may kinalaman sa propesyon o kursong kinuha isang mag-aaral sa kolehiyo o
e. Pagbibigay ng katotohanan upang dagdagan ang mga nalalaman na pamantasan.
f. Pagpapaliwanag ng nilalaman o ng binasa batay sa sariling karanasan
 Ang pagbasa nito ay nangangailangan din ng masusing pag-aaral sapagkat may
Ikalimang Dimensyon (5) ginagamit na natatanging wika sa iba’t-ibang disiplina.
 pagkilala ng sariling kaisipan ayon sa mga kasanayan at  Ito ay may sariling rejister ng wika na kailangang maunawaan ng mambabasa.
a. Kawilihan sa binasang seleksyon  Mga paraan na ginagamit upanh maunawan ang teksto
b. Pagbabago ng panimula ng kwento o lathalain o paglalagay ng glosaryo sa hulihang bahagi ng aklat
c. Pagbabago ng wakas ng kwento o lathalain o paggamit ng talababa, ilustrasyon, dayagram, grap
d. Pagbabago ng pamagat ng kwento o pagbibigay ng depinisyonng salita,
e. Pagbabago ng katangian ng mga tauhan o pabibigay ng pahiwatig sa kahulugan ng salita batay sa paggamit nito sa
f. Pagbabago ng mga pangyayari sa kwento o lathalain pangungusap.
g. Paglikha ng sariling kwento batay sa binasa  Mahalaga ang mga nabanggit na paraan at nakatutulong sa mambabasa na maunawaan
ang mga teknikal na salita at mga terminolohiya na ginagamit sa teksto.

A. Pagbasa ng Tekstong Pang-Agham Panlipunan at Pangkasaysayan

AGHAM PANLIPUNAN
 isang disiplina na nagsusuri sa ugnayan ng mga tao sa lipunan at kung paano sila
nakikitungo sa isa’t isa at sa kanilang kapaligiran.
 ay batay sa pag-aaral at pagsusuri ng mga relasyong ito mula sa iba’t-ibang larangan
gaya ng antropolohiya o pamahalaan, sikolohiya at sosyolohiya.
 nangangailangan ng malaking panahon sa pagbabasa.
 Tiinatawag na “mga agham” dahil ang mga propesyonal sa larangang ito ay nagtitipon
ng mga datos sa pamamagitan ng eksperimentasyon, obserbasyon, at sarbey; nagsusuri
ng mga datos; at bumubuo ng kongklusyon mula sa mga sinuri
 Inihaharap sa mga propesyon sa larangang ito ang resulta ng kanilang pananaliksik
upag ang proyekto ay muling masubok o pagtuunan pa ng ibayong pag-aaral.

Halimbawa
PAGBASA SA TEKSTONG AKADEMIKO AT PROPESYONAL Ang Pagtuturo sa Filipino ng Agham Panlipunan II
Malaya C. Ronas
 Ang agham Pnlipunan II ay isa lamang sa labng-apat na kurso na kabilang sa lamang ang tunay na batayan ng kayamanan ng bayar Ang tubo na napupunta sa mga
programang malawakan edukasyon ng Unibersidad ng Pilipinas. Layunin nito na Hahad at siriin namumuhunan, ang may-ari ng mga instrumento produksyon, ay galing din sa mga manggagawa.
ang mga pangunahing tradisyon ng kanluran tungkol sa panlipunan, pang-ekonomiy, at Ang mga manggagawa ay hindi binabayaran ng sapat na sahod na dapat sana ay batay sa
pampulitikang kaisipan. Bilang malawakang sarbey, ang kurso ay sumasaklaw sa sinauna, kanilang produksyon, manapa’y ang kanilang sahod ay nasa antas lamang na kung tawagin ay
medyibal, at modrnong panahon ng sibilisasyong kanluran. subsistence wage.

Hindi na lubos na tinatanggap ang pananaw na ito sa ating modernong panahon. Sa Ang pagwasak sa buong sistema ng laissez faire o kapitalismo ang tanging paraan
katunayan, ito ay tinalikuran na ng sosyolohiya. Ayon kay Alvin Gouldner, ang pananaw na upang mawala ang “pagsasamantala ng tao sa kanyang kapwa tao.” Ito ay mangyayari, wika ni
pansosyolohiya ay nakatuon sa kabuuan ng lipunan. Ang lipunan ay tiuturing na may identidad na Marx, sa pamamagitan ng tunggalian ng mga uri. Lulupigin ng uring proletaryo ang uring burgis
iba sa mga indibidwal. Sa gaitong pananw, ang lipunan ay humuhubog ng mga paniniwala ng upang ang isang makatarungang lipunan- isang lipunang pantay-pantay na wala nang
indibidwal sa pamamagtan ng pamilya, simbahan, paaralan, at pamahalaan. mapagsamantalang uri. Sa makatarungang lipunan ni Marx, ang mapanikil na estado ay unti-unting
maglalable.
Ang kakanyahan ng lipunan ay idiniin din ni Emile Durkheim, tinaguriang “Ama ng
Sosyolohiya” sa France. Sinabi ni Durkheim na: Ang metodong pansosyolohiya na aming ginamit Bukod sa pagkakapantay-pantay, marami pang ibang prinsipyo ang nagging batayan ng
ay buung-buong nakatayo sa batayang prinsipyo na, ang mga kaganapang sosyal ay dapat pag- konseptong “katarungan” sa sibilisasyong kaunlaran. Sa mga Griyego, an armonya ng mga uri sa
aralan bilang mgabagay; bilang mga realidad na bukod sa indibidwal. Hindi nauunawaan na hindi bayan ang kahulugan ng katarungan. Ibig sabihin nito na ang bawat tao ay may natural na gawain
maaring magkaroon ng Sosyolohiya kung walang mga lipunan kung mayroon lamang mga na dapat gampanan sa bayan at tungkulin niyang manatili sa kanyang uri upang gampanan ang
indivbidwal. gawaing ito. Maaari siyang maging pinuno, mandirigma o manggagawa. Ngunit ang kanyang papel
sa bayan ay dapat na nakasalalay sa kanyang likas na kakayahan na maaaring alamin sa
Samakatwid, nakatuon ang pansin ng sosyolohiya sa buong lipunan at hindi sa pamamagitan ng sistemang edukasyon. Ang prinsipyong pagkakapantay-pantay ng proporsyon ay
indibidwal o sa kalikasan ng tao. Gayon pa man, mahirap na sabihing lipunan na ang dapat pag- ginamit ding batayan para sa konseptong “katarungan.” Ibig sabihin nito na ang mga taong
aralan. Sa katunayan, patuloy na pinag-aaralan ang kalikasan ng indibidwal sa disiplinang nagtataglay ng kabutihan(virtue) ang dapat na mamuno sa bayan. Ito ang nararapat na daan tungo
sikolohiya. Ang sikilohiya ng mga sinaunang pilosopo na tulad ni Plato ay makikita sa kanilang sa minimithing “mabuting buhay.”
metapisika. Ayon sa kanya, ang kalikasan ng tao ay nakasalalay sa elemento na nangingibabaw
sa kanyang kaluluwa. Kung katwiran ang nangingibabaw, siya ay marunong: kung katapangan, Ang espiritwal na mithiin ng buhay ay hindi kailanman makakamit sa lupa. Ito ang
siya ay matapang: at kung pagnanasa, siya ay mapag-angkin. Ang kalikasang ito ng tao ay paninindigan ng mga pangunahing pilosopong Kristiyano. Sa Kristiyanong pananaw ang tunay na
makikita rin sa kalikasan ng bayan,dagdag ni Plato. katarungan ay matatagpuan sa kaharian ng Tagapagligtas Ang kahariang ito ay wala sa ibabaw ng
lupa kundi nasa kalangitan. Walang makalupang bayan ang maaaring magdala sa tao sa
Ang aspekto ng sikilohiya ay makikita rin sa mga modernong pilosopong nag- aaral ng pangakong buhay na walang hanggan. Ang pagtalikod sa kanyang makasariling interes, at ang
ekonomiya na tulad ni Adam Smith at Alfred Marshall. Ayon kay Smith,ang pagkamakasarili ng tao ganap na pagpapasailalim sa mga utos ng Diyos, ang tanging daan tungo sa mithiing espiritwal ng
ay nagdudulot ng pangkalahatang pakinabang para sa lipunan. Lumihis si Smith sa tradisyon ng buhay. Nangingibabaw ang Kristiyanong pananaw na ito sa Europe mula nang huling bahagi ng
kaisipan na kailangang itakwil ang pagkamakasarili kung nais ng tao na maging mabuti. Ayon sibilisasyong hanggang sa panahong medyibal.
naman kay Marshall,ang kilos ng tao sa pamilihan ay mauunawaan kung siya ay itinuturing na
homo economicus, isang tao na naghahanap ng mas malaking kasiyahan bilang mamimili, o mas
malaking gantimpala bilang tagagawa ng mga produkto. Sa katunayan ay iginiit ni Joseph
Schumpeter na ang ekenomikong pagsusuri ay hindi pangunahing aspekto ng kaisipang kaunlaran
noong panahong klasiko. Ang modernong pagsusuri ng ekenomiya ay nagsimula noong huling
bahagi ng siglo 17 nang talakayin ni Locke ang konseptong “halaga at mga patakaran tungkol sa
pananalapi. Itinuloy ni smith ng suriin niya ang iba pang aspekto ng ekonomiya tulad ng “presyo,”
produksyon,” distribusyon, kalikasan ng pamilihan at ang kaugnayan nito sa estado.

Ang kaugnayan ng pamilihan at estado ay isa sa mga pangunahing isyung pampolitikang

ekonomiya. Sa pananaw na ganap ang kapangyarihan ng estado, itinuring sa mahabang panahon
na ang lakaran sa pamilihan ay sakop ng kapangyarihan ng estado. Ang kalakalan sa ibayong
dagat ay kasangkapan ng esta upang pagyamanin ang kaban ng estado. Ang layunin ay pagkalap
ng ginto at pla pamamagitan ng kalakalan at kolonyalismo. Ang patakarang ito ay tinawag na
merkantilismo, isang patakarang kumilala sa kapangyarihan ng estado na pamahalaan at
pakialaman ang lakaran sa pamilihan.

Mahigpit ang pagtutol ni Smith sa merkantilismo. Naniwala siya na dapat magkaroon ng

kalayaan ang pamilihan mula sa estado sapagkat ito ang paraan upa higit pang lumaki ang
produksyon ng ekonomiya. Tinawag niya ang patakarang it laissez faire. Ang patuloy na paglaki ng
ekonomiya ang daan tungo sa kabutihan pamumuhay ng mga taong doon ay naninirahan.
Ipinaliwanag niya na ang paglaki ekonomiya ay nakasalalay sa paglago ng kapital sapagkat mula
lamang sa mga namumuhunan nanggaling ang panibago at dagdag ng kapital na nagmula sa
kanilang tubo. PANANALIKSIK
 “Ang pananaliksik ay isang barometro ng kahusayan ng isang mag-aaral – pinatutunayan nito
Sa pagsusuri ni Karl Max, ang sistemang laissez faire ay mapagsaman sa produkto ng na napagtatagumpayan niya ang mga hamon ng akademya sa pagtuklas ng malawak na
mga manggagawa. Itinuring ni Marx na ang lahat ng halaga ay gal sa paggawa, na ang paggawa karunungang matatagpuan sa labas nito” – Mayor at Ganaban, 2011
 Isang maingat at sistematikong pag-aaral at pagsisiyasat sa ilang larangan ng kaalaman na o tumutukoy sa uri ng plagiarism kung saan maaring binigay ang pangalan ng
isinasagawa upang tangkaing mapagtibay ang katwiran. may-akda o pinagkunan pero hindi na madaling mahanap dahil kulang o hindi
sapat ang impormasyon na binigay.
RESEARCH o Minsan naman ay mali ang ibinibigay na pinanggalingan ng impormasyon o
 hango sa matandang salitang Pranses na recherché galing na ang ibig sabihin sa Ingles ay to pinagsasama ang ilang sariling sinulat sa akda ng iba
seek and to search again.  Ghostwriter
 isang ganap na plagiarist dahil gawain nila ang sumulat ng
KABUTIHANG DULOT NG PANANALIKSIK mga sulat na ginawa ng iba ang inaako na parang sila ang
 Nadagdagan at lumalawak ang kaisipan gumawa
o Lumalawak ang kaisipan ng isang mananaliksik dahil sa walang humpay na
pagbabasa, pag-iisip, panunuri, paglalahad at paglalapat ng interpretasyon.  Self-Plagiarism / Recycling Fraud
o uri ng plagiarism kung saan inilathala mo ang isang materyal na nalathala na
 Lumalawak ang karanasan pero sa ibang medium.
o Ang kasanayan sa paghahanap at pagtingin sa mga naisulat hinggil sa o Maaring sa iyong ginawang artikulo, libro atbp., ay may katulad o sadyang
paksang pinag-aralan ay napauunlad dahil sa marami siyang nakasalamuha ginaya at hindi mo tinukoy kung saan mo ito nakuha o ginaya.
sa pangangalap ng mga mahahalagang datos, pagbabasa at paggalugad sa o
mga kaugnay na literatura.  Intellectual Property Law
o uri ng batas kung saan ang mga nagimbentong mga manunulat, artist atbp.,
 Nalilinang ang tiwala sa sarili ay binibigyan ng ‘exclusive property rights’o sila ang kinikilalang nagmamay-ari
o pagkaroon ng respeto at tiwala sa sarili kung maayos at matagumpay na ng kanilang ginawa.
naisakatuparan ang alinmang pag-aaral na isinagawa,  Dahil sa exclusive property rights na ito, hindi natin basta-bastang
o Bilang isang mag-aaral sa pananaliksik, marapat na tingnan ang sarili bilang magagamit o makikita ang bagay na kanyang ginawa o naimbento
isang iskolar na masigasig na kabahagi ng isang gawaing pang iskolar. hanggang hindi niya pinapayagan.
o RA No. 8293 o Intellectual Property Code of the Philippines
TUNGKULIN AT RESPONSIBILIDAD NG MANANALIKSIK  Ilan sa uri ng intellectual property rights ay copyrights, trademarks,
 Tungkulin ng mananaliksik ang sumagot sa sarili niyang katanungan at patunayan sa sarili patents, industrial design rights and trade secrets. Sources:
ang kaniyang mga pag-aakala at pananaw nito. Plagiarism. (n.d.). Wikipedia Retrieved November 29, 2010.
 Dapat ding isaalang-alang ng mananaliksik ang paggalang sa mga datos na nakalap, sa
pamamagitan ng pagpapahalaga sa intellectual property at mga taong kakapanayamin.  O’Hare at Funk (2000 sa Bernales et al., 2012)
 Lalong-lalo na mahalaga ang kredibilidad ng isang mananaliksik. o Ang pananaliksik isang pangangalap ng impormasyon mula sa iba’t ibang
 Ang pagiging orihinal sa ginawang papel pananaliksik na magtatakda ng kahusayan sa hanguan sa pamamaraang impormatibo at obhektibo.
pagtuklas o Ito ay isang paraan o proseso ng pagtuklas o pagdiskubre sa pamamagitan ng
makaagham na paraan upang masagot ang mga katanungan, matugunan ang
PLAGIARISM / PANUNULAD mga pangangailangan, at mapagtibay ang mga dating kaalaman.
 mula sa salitang Latin “plagiaries” na ang literal na ibig sabihin ay kidnapper.
 ito ay isang paraan ng pagnanakaw; kung saan ang isang tao ay gumamit o ng hiram ng ETIKA NG PANANALIKSIK
ideya o gawa ng iba at hindi nilagay ang pinagkunan o binigyan ng credit ang kanyang  Paggalang sa karapatan ng iba
pinagkukunan.  Pagtingin sa lahat ng mga datos bilang confidential
 Pagiging matapat sa bawat pahayag
Mga Anyo ng Plagiarism  Pagiging obhektibo at walang kinikilingan
 Minimalistic Plagiarism
o ang mga ideya o konsepto na nakuha o nabasa mo mula sa kanilang sources
ay kanilang ginamit pero sarili nilang salita o paraphrasing.

 Full Plagiarism
o tumutukoy sa iyong ginawa na parehong pareho mula sa iyong pinagkunan.
o Bawat salita, parirala o talata ay gayang gaya mula sa pinagkukunan.

 Partial Plagiarism
o may dalawa o mahigit pa ang iyong pinagkukunan at kombinasyon ng mga ito
ang kinalabasan ng iyong ginawa. D
o ito nangyayari ang rephrasing o pagbabago ng ilang salita.

 Source Citation
PAGPILI NG PAKSA URI NG BALANGKAS
 Paksa o Papaksang balangkas (Topic Outline)
PAKSA o ito ay binubuo ng mga parirala o salita na siyang mahalagang punto hingil sa
 Ayon kay Dayag, Alma, et al 2016 paksa
o ang salitang paksa ay kadalasang tumutugon sa ideyang tatalakayin sa isang
sulating pananaliksik.  Papangungusap na Balangkas (Sentence Outline)
 ay isa sa pinakamahalagang bahagi ng isang papelpananaliksik. o binubuo ng mahahalagang pangungusap na siyang kumakatawan sa
 Ang pagpili ng isang paksa ay dapat nakapokus lamang sa isang direksyon upang hindi mahalagang bahagi ng sulatin.
mahirapan sa pagbuo ng pahayag. Mahalagang maisaalang-alang ang mga gabay sa pagpili
ng pinkaangkop na paksa  Patalatang Balangkas- Ang binibigyang-diin ay ang pagkakaugnay.
o Interesado ka o gusto mo ang paksang pipiliin mo
 Paksang marami ka nang nalalaman
 Paksang gusto mo pang higit na malaman
 Paksang napapanahon
o Mahalagang maging bago o naiiba at hindi kapareho ng mapipiling paksa ng
mga kaibigan mo
o May mapagkukunan ng sapat at malawak na impormasyon → Maaring
matapos sa takdang panahong nakalaan

HAKBANG SA PAGPILI NG PAKSA

1. Alamin kung ano ang inaasahan o layunin ng susulatin
2. Pagtatala ng mga posibleng maging paksa para sa sulating pananaliksik
3. Pagsusuri sa mga itinalang ideya
4. Pagbuo ng tentatibong paksa
5. Paglilimita sa paksa

PAGBUO NG TENTATIBONG BALANGKAS

BALANGKAS / OUTLINE
 ay kalansay ng mga ideya na pinagbabatayan ng aktuwal na proyektong gagawin
 Ang sistema ng isang maayos na paghahati-hati muna sa mga kaisipan ayon sa talatuntuning
lohikal na pagkasunud-sunod bago ganapin ang pagunlad ng pagsusulat. (Arrogante, 1992)
 Nagsisilbing gabay upang masagot ng mananaliksik mahalagang tanong
1. Ano-ano ang mga bagay na alam ko na o nasasaliksik ko na at maaari ko
nang i-organisa patungkol sa aking paksa?
2. Ano-ano ang mga batas o impormasyon ang wala pa o kulang pa at
kailangan ko pang saliksikin?
 Mahalaga ang pagbuo ng balangkas bago simulan ang pagsulat upang:
o Higit na mabibigyang-diwa ang paksa
 Ang paksa ang pinakasentro ng sulatin, kaya nakatutulong ang
pagbuo ng balangkas.
o Nakapagpapadali sa proseso ng pagsulat.
 Dahil nakaplano na ang bawat bahagi ng sulatin sa proseso ng
pagsulat ng pananaliksik.
o Nakatutukoy ng mahihinang argumento.
 Dahil sa pagbabalangkas ay nahahati ang malalaking ideya at
nilalagyan pa ng sumusuportang detalye para mapatibay ang
argumento at matutukoy kung alin ang mahina at dapat ayusin at
rebisahing mga argumento.
o Nakakatulong maiwasan ang writer’s block.
 Magkaroon ng direksiyon ang manunulat at mapag-isipan ang
kanyang isusulat.