MINOR ALIMENTS OR-STANDING
INTRODUCTION:
A community health nurse is responsible for providing primary health care in the community.Treatment of minor ailments and management of critical conditions is one of the components of Primary Health Care (PHC).
Although there are no proper guidelines about nurse prescribers in India, but according to the capabilities and following the limitations, nurses have to handle the situations in case of casualties and illnesses in the community.
A nurse should be able to diagnose signs and symptoms of illness and treat minor ailments as best she can.
To define minor ailments:
A minor ailment refers to a mild or relatively inconsequential health condition or illness that typically does not require extensive medical intervention or hospitalization. These are generally self-limiting and can often be managed with over-the-counter medications, home remedies, or simple lifestyle adjustments. Examples of minor ailments include common colds, headaches, mild digestive issues, minor cuts and bruises, and other similar conditions that may cause discomfort but are not considered serious or life-threatening. People often address minor ailments with self-care measures, such as rest, hydration, and over-the-counter medications, without the need for professional medical assistance.
A minor illness refers to a mild or relatively inconsequential health condition or illness that usually does not require extensive medical intervention or hospitalization. These are usually self-limiting and can often be improved with over-the-counter medications, home remedies, or simple lifestyle changes. Examples of minor ailments include the common cold, headaches, mild digestive problems, minor cuts and bruises, and other similar conditions that may cause discomfort but are not considered serious or life-threatening. People often address minor ailments with self-care measures, such as rest, hydration, and over-the-counter medications, without the need for professional medical help.
Minor ailments indicate a few illnesses and also include emergencies of minor nature.
Sometimes the illness can be acute, requiring immediate care
Or it can be chronic, requiring long-term treatment and constant monitoring.
But the associated minor complications require the help of a nurse
To discuss principles of managing minor ailments:
A safe and healthy environment should be maintained for the patient.
Treat the risk/injured person immediately to prevent any possible complication.
In case of communicable diseases, take proper precautions to prevent spread of infection.
To keep checking patients’ condition and vital signs throughout the period of care.
Help the patient recover as soon as possible and assist him in activities of daily living (ADLs).
Giving health education to the patient during treatment.
Always follow the physician’s instructions for treatment.
Help the family members cope emotionally with the patient’s situation and make them understand how to take care of the illness at home.
Respect the patient’s beliefs, if they have used any others, keep that in mind during treatment.
Refer the patient without any delay in case of serious condition or doubt about the diagnosis.
: Classification of minor ailments:
Minor ailments can be broadly classified under two minor headings:
(1). General minor ailments:
It includes common accidents and emergency conditions that require immediate primary care.
In this category, injuries and fall down, fracture, burns, dog bite, high fever, heart stroke, diarrhea, fainting etc. Included.
(2). Systemic minor ailments:
It includes diseases that affect various body systems.
Some of them are listed here as follows:
Systemic minor ailments:
Eyes:
Eye accident, foreign bodies, infections, poor eye sight, dry eyes, blindness, etc..
Ear:
Earache, foreign body in ear, otitis media, discharge from ear, temporary deafness, etc…
Respiratory Tract:
Allergic rhinitis/common cold, sinusitis, sore throat, cough, dyspnoea, chest pain, asthmatic attack, etc…
Cardiovascular system:
Hypertension, anemia, Rheumatic heart
Disease, etc..
Digestive system:
Toothache, stomatitis, soreness in mouth, constipation, diarrhea, indigestion, vomiting, abdominal distension and pain, intestinal obstruction, haemorrhoids, etc..
Urinary system:
Burning micturition, retention of urine, urinary infection, renal stones.
Neuromuscular system:
Headache backache, convulsions, epileptic fits etc.
Reproductive system:
Dysmenorrhoea, heavy bleeding, sore and discharge from genitals, breast pump, etc.
Along with the above ailments, behavioral problems like maladjustment or emotional disturbance etc. can also be included in the category of minor ailments.
All these require proper diagnosis and proper management.
To enlist the general steps in management of minor ailments:
Management of minor ailments:
Management of minor ailments
The following general measures may be helpful in managing minor ailments:
(1) Assessment (Assessment) – Taking history of the patient. -Physical examination to be done quickly.
(2). Finding the cause, diagnosing and planning for care.
(3). Providing treatment and nursing.
(4). To evaluate the care and condition of the patient.
DEFINE STANDING ORDER
DEFINITION ;; –
Standing Order Means one specific instruction, which nurses and other health workers can provide treatment in the condition that the doctor is not present when they go to home visit or go to school or industry. The Authority may grant treatment as exempted in these instructions. These instructions are given by the Medical Officer or the Authorizing Committee. This is made by standing order.
Generally, these instructions/orders are in written form.
Standing order is followed as a tradition in some medical institutions and health enterprises.
It is appropriate to follow standing instructions only on a temporary basis, or in case or emergency or when the doctor is absent.
Providing emergency and temporary treatment in absence of standing instruction doctor v
to define the minor ailments and standing orders
To define minor ailments and standing orders:
Minor ailments indicate a little illness.
It also includes emergencies of simple nature.
Sometimes the illness can be severe, requiring immediate care.
A standing order is a written document about policies, rules, regulations, or orders related to patient care.
Standing orders are specific instructions given to community health nurses by an authorized committee or agency regarding the treatment of certain conditions that nurses can fulfill in homes or in the community.
Purpose of Standing Orders :: –
Community Health Nurses need standing orders to handle the problems that usually arise in rural areas.
Where there is no facility to contact a doctor or a doctor is not readily available, only the community health nurse is immediately present to the family as a quality professional person who should use the standing order judiciously and cautiously.
Public relations can be strengthened with this standing order. Also health services can be improved.
A nurse should remember that he is not a doctor. Whenever there is any difficulty, when there is a suspicious case contact the Medical Officer to follow the standing instructions and give any treatment. An accurate record should be kept of it.
Enlist objectives of standing orders:
Objectives of Standing Order:
(I) To maintain continuity of patient treatment
(II) To save life/resuscitate the patient.
(III) Reducing health team members or creating responsibilities on team members.
(IV) Delivering care at home, school and community.
(V) To strengthen public relations. (To strengthen public relations.)
Accurate Condition OR Problem for Nurse :: – ( Matters to be kept in mind while following Standing Order ) ::
Collecting information from the patient and his family. So that nursing care can be given, besides collecting data, in which general health history, period of disease onset, symptoms, Pust History & Family History, etc.. should be taken. Also check the following things specially,
(1) Seeing what happened suddenly. that
(2) Recording of vital signs.
(3) Identifying problems and finding individual needs
(4) Providing nursing care as per standing instructions,
(5) PHC when required. or referring to hospital.
(6) Explain the causes of disease, preventive measures, complications and follow-up care. Evaluating progress after treatment.
(7) Reporting suspected communicable disease to appropriate authority.
Nursing Care ::
Enlist uses of standing orders:
To increase the confidence of the general public in medical institutions/community health services
(1) Bed rest
(2) Advising a light diet.
(3) Taking blood sample if there is malaria
(4) Giving drugs like Tablet Aspirin, PCM, Dislofenac, Ibuprofem, Antipuretic & Anargesic:
(5) Advise the patient to drink more water.
(6) Cold sponge or cold compress should be given if temperature is more than 39°C.
Observe for rise or fall in temperature for two days. Advise for treatment of malaria if temperature rises or reoccurs. If such a case is found in the family or in the neighborhood, it should be understood as an epidemic and reported to the appropriate authority.
Discuss types of standing orders:
Discuss the types of standing order:
Types of Standing Orders:
The authorized doctor and registered nurse jointly issue the standing order.
An administrative or advisory committee can also be formed for this but it is necessary to have a nurse representative.
General standing orders can be divided into three (3) categories:
specific standing orders
general standing orders
This category includes standing orders prepared keeping in mind the available resources, staffing conditions and objectives of the medical institution or hospitals.
E.g. Standing orders or primary health centers may be different from district hospitals.
Similarly, variations can be found in the standing orders of government, private clinics and higher medical institutions.
2.Specific standing orders: *Specific standing orders: ) These types of standing orders are prepared for trained medical personnel, mainly nurses.
Technical knowledge and special skills are required to execute these orders.
For example: giving injections, oxygen, home nursing etc… fall under this category.
These directives or orders reflect the doctor’s need and most treatment decisions are made by the institutional nurse or community health nurse.
Such mandates enhance the quality of health services.
3.General standing orders:
Due to the large population and geographical area and lack of health resources some standing order is used for the message. A common man is expected to follow this.
Such standing orders include advice to drink quinine tablets in case of fever, trimexozole for pneumonia and ORS in case of dehydration.
Discuss standing orders for treatment of minor ailments:
Standing order for treatment of minor ailments:
Standing for treatment of minor ailments:
Discuss standing orders for treatment of minor ailments: While working in a health sub-centre, primary health centre, community health centre, hospital or institution or home or community, often other nurses, community health nurses provide treatment to patients. Copes with situations when necessary, e.g. At a time or place where a doctor is not available or likely to arrive late.
A standing order comes to the rescue of nurses in such situations, they help treat the patient.
Following are some of the standing orders related to common ailments that may be filed in the compliance community:
fever:
Collect information about other symptoms associated with fever (to know the cause of fever), such as headache, uneasiness, nausea, vomiting, chills, chills, running nose, allergies, skin infection, jaundice, fits, cough, etc.
Give the patient rest and light food. • Prepare a blood slide to check for malaria parasite (blood for MP). • Give paracetamol tablets to reduce fever.
Give the patient plenty of fluids. • Give cold sponging if fever is above 39°C (102.2°F).
Observe the fever pattern and wait for two days. If there is rash along with fever, isolate the patient. If necessary, inform the physician. • In case of delirium, convulsion, unconsciousness and hyperpyrexia with fever, refer the patient to a doctor.
(B) Sore Throat:-
Coryne Bacteria responsible for diptheria (exotoxin diptheri bacilli)
(1) TPIR Record If white patchiase is observed or signs of diphtheria are observed, then give medical care and ask for hospitalization.
(2) If facility is available, take a thought swab and send it to the laboratory. If there is pharyngitis, say for salie gargle. (sweet),
(3) Tablet Aspirin & PCM can also be given.
(C) Cough ::-
(1) Obtaining information on the type of cough and how long it has been present.
(2) If sputum comes along with phlegm, its color amount (amount) should be checked along with fever, sore throat, chest pain, breathing difficulty, vomiting, loss of weight etc…etc.
(3) If TB is suspected, get tested and refer to hospital for treatment.
(4) Advise rest if chill with phlegm and fever. Giving Tablet PCM, Aspirin, etc.
(5) asking to take more fluid, fight diet & bed rest,
(D) Eye With Discharge ::
(1) Clean the eye with clean water and clean it with a cotton swab. Use Sulphacedamid, eye drops, Sofiamycin, Gentumycin, whichever drops are available.
(2) To explain how to clean the eye, and how to insert the eye ie. Protecting the eye with a Sterile Pad & Bandage.
(3) Refer the patient to the hospital immediately if there is any kind of injury or eye ball rupture in the eye.
(E) Ear Ache ::-
(1) If the pain in the ear is with or without fever, clean the ear.
(2) Instillation of antibiotic drops like Solramycin, Sulphacitainine, Gentamycin etc.
(3) Referral to hospital if patient does not improve in three days.
(4) If there is soreness in the external ear due to ear discharge, clean it with Boric acid lotion and apply antibiotic drops.
heat stroke: heat stroke:
A person suffering from heat stroke should be kept in the shade and in a well-ventilated area.
Note temperature, pulse, respiration and blood pressure.
•Remove all the person’s clothing and wrap them in a wet sheet.
Keep it wrapped in a damp sheet until the temperature reaches 38 degrees Celsius.
If the patient is conscious, give him cold water, mixed salt water and other cool drinks. • Constantly observe the temperature.
Refer the patient to the hospital as soon as his condition improves slightly.
Diarrhea:
Monitor for signs of dehydration.
• If dehydration is severe or the patient is in a state of shock, hospitalize him immediately.
Give patient ORS.
Rice water, coconut water, lemon juice, mild tea, banana, khichdi etc. should be given to the patient.
If there is an epidemic of vomiting and diarrhoea, the sample should be sent for a stool test.
If cholera is prevalent, people should be vaccinated against it. Food and water should be protected from contamination and health authorities should be notified immediately (as early notification).
People should be educated about handling files, sanitation of water and food and proper disposal of excreta.
Medicines should be given as needed.
Burn:
Try to keep the burnt part of the body immersed in water.
Check how smooth the spread of the burn is.
If a cloth is stuck to the burn, do not try to remove it.
However rings, bangles, shoes, belts and other tight fitting items should be removed.
Do not touch the blisters unnecessarily.
Cover the burnt area with a clean cloth.
Assess the patient’s condition and percentage of burns.
If the patient is in shock, give first aid.
Administer ORT (oral rehydration therapy) to patient (if conscious and not vomiting)
If the patient is suffering a lot, give analgesic drug.
Referring the patient for further treatment.
Drowning:
•Lay the person on his stomach and drain the water from his lungs.
•Resuscitate the patient and send him to a health center/hospital immediately.
Dog bite:
Wash the wound thoroughly with soap and water. Use running water.
Apply betadine or tincture of iodine.
If extensive, check for hemorrhage,
But stitches should be done after 24 hours.
ARS can be used for dressing if available but serum sensitivity test is required before its use.
•Inject tetanus toxoid (TT).
•Do not kill the dog and observe it for 10 days.
Snake bite:
•Tie a tourniquet just above the bite and keep loosening it every half hour.
1 cm in length and ½ cm at the site of the bite. Make a deep cut and try to suck the poison from the spot (there should be no wound in the mouth of the person sucking blood). These days vacuum syringes are used to suck up the venom.
Clean the bite site using salt or plain water liquid. Ice can also be used for this.
•Comfort the person and give him coffee or tea to drink.
Send him to hospital as soon as possible for ASV (anti snake venom) treatment.
Scorpion bite:
•Remove the sting and apply ice on the bite after cleaning it thoroughly.
Apply a tourniquet over the bite site and remove it after half an hour.
Also give analgesics and sweetened milk to drink.
fainting: fainting;
•If the person is sitting, keep his head bent between both the legs.
A person should get fresh air. There should be no crowd around him.
Once the person regains consciousness, ask them to take deep breaths and drink liquids.
If the patient is still unconscious, refer him for further treatment.
Injuries and fractures:
Injuries and fractures:
•Clean the injury with soap and water.
Apply the spirit around the wound site.
Apply betadine lotion and bandage using a sterile dressing.
•Monitor the condition of the patient with the feature.
•Treat a patient who has gone into shock.
•Cuts or injuries causing sores:
Here is the standing order for wounds:
•Wash the wound with clean, warm water and antiseptic lotion.
Apply spirit around the wound
•Remove all foreign bodies present on the wound;
Like, pieces of glass/ wood, stone or dirt etc.
Bandage using betadine
•Inject tetanus toxoid (TT).
Give tablets for vomiting and nausea (morning sickness) in the early stages of pregnancy.
•In case of toxemia of pregnancy, advise her on salt free diet and complete rest.
If he has swelling, send him to the hospital immediately.
•If the mother develops fever after delivery, try to find out the cause and give her antipyretic and then admit her to the hospital.
Similarly, in case of taking care of perineum, in case of excess milk supply in breast, still birth etc. ask the mother to rest and refer the mother for further treatment.
Keep the newborn in a warm place.
•After delivery, start breastfeeding as soon as possible.
•In case of any deformity or disease, refer the patient for further treatment.
convulsions in children:
Seizures in children:
Clean the secretions from his mouth so that the respiratory tract can work properly.
Try to find the possible cause of the seizure and refer the child for further treatment.
Haemorrhage:
Hemorrhage:
Press the point of bleeding with a pad. Continue doing this until the bleeding stops. Bandage after bleeding is controlled.
•Advise him to drink fluids.
•Try to find the cause of bleeding
•Monitor the shock condition and refer the patient for further treatment in case of bpeeding or if the shock condition goes out of control.
Un-consciousness:
Unconscious:
•Remove dentures if present.
•Clean the secretions from the mouth.
•Loose clothing from his neck, chest and waist.
Try to find out the cause of fainting and send the patient to the hospital as soon as possible. 🕳️Discuss the role of community health nurse in minor ailments:
Discuss the role of community health nurse in minor illnesses:
Standing orders role of community health nurse:
Role of Standing Orders Community Health Nurse:
The community health nurse should collect the following information before providing nursing care:
Finding the action taken, complication and any specifications.
Recording vital signs (TPR,BP) and doing urine test.
Identifying problems and determining individual needs.
Providing nursing services under standing orders.
Consoling the individual and the family.
Implementation of referral system
To disclose causes of illness, complication, follow-up treatment/preventive measures.
Evaluating the work done.
Regular study and monitoring of standing order manulas/health books
Immediate reporting of communicable diseases to health authority.
Keeping a medicine kit ready to comply with standing orders.
Representing the nurse’s point of view when reviewing standing orders. (Representative)
In case of doubt, collect complete information as soon as possible.
Be careful about your limits and keep faith in doctors and health administration.
Providing a safe and hygienic environment for the patient, and keeping in mind that the well-being of the patient should be paramount.