Family medicine

1. COMECILLA | DIGNOS | ENJAMBRE |
GRAVADOR | LEORAG | MALABUYOC |
SANCHEZ | SEVILLENO | TIONGZON
WEEKLY
DIDACTICS 3
BLOCK 10
APRIL 27, 2022

2. PRAYER
Father God,
As we start this new day for new learning, we ask for Your
guidance.
Lead us all the way. May You let us see through Your eyes,
listen through Your ears, and speak with Your Mouth.
Be with us as we explore the world.
Give us the heart to love and be kind to one another. Please
watch over all our teachers, children, and families.
In Jesus’ name. Amen

3. Levels of
prevention

4. Levels of Prevention
PRIMARY PREVENTION
● preventing the development of the disease among those known to be risk.
● Modification of such behavior prior to the development of the disease
● Routine immunization programmes
SECONDARY PREVENTION
● Early detection and prompt treatment of disease
● Periodic Health examination - prototype

5. Levels of Prevention
Criteria for Screening to be justifiable
1. Targeted condition should be serious and sufficiently prevalent in the
group being screened
2. Patient’s risk of future morbidity or mortality must be reduced as a result
of early detection of the condition.
3. Screening maneuver itself should be acceptable to the patient

6. TERTIARY PREVENTION
● Preventing further disability and providing access to rehabilitation services
● NCDCS has a standard package of support services - Health promotion,
health education, management of cases and complications, advocacy,
counseling and referral when necessary.

7. Periodic
Health Exam

8. History and Physical Examination
● Milestones at each visit
● Serial Measurement of Height, Weight, and Head Circumference
● Repeat examination of hips, eye, and hearing - especially in the First year of life
Immunization
● BCG, DPT, Polio Vaccine and MMR
● Hemophilus Influenza B (HiB) conjugate vaccine at 2, 4, 6, and 18 months.
● Hepatitis B Vaccination
Infants and Children

9. Infants and Children
Newborn Screening (RA 9288)
● After 24 hours of life but not later than 3 days
● Ill newborns - 7 days of age
Visual Screening
● Newborn to 3 years old
○ Ocular History
○ Vision assessment
○ External inspection of the eyes and lids
○ Ocular motility assessment
○ Pupil examination
○ Red Reflex Examination
● 3 - 5 years - additional visual acuity and
ophthalmoscopy
Hearing Screening
Iron Deficiency Anemia

10. Infants and Children
Birth - 6 months - Basic information about normal
function
- Nutritional guidance
- Psychological issues
- Accident prevention
7 months - 2 years old - Nutrition and weaning, development,
discipline, toilet training, oral hygiene,
regular exercise and safety
- New food every 4-5 days
- Temper tantrums and breath-holding
spells
- Self-stimulation (thumb-sucking)
Counseling and Anticipatory Guidance

11. Infants and Children
Counseling and Anticipatory Guidance
Pre-School (3-6 years) - Oral fluoride supplementation
- Health and hygiene, sleep, leisure,
separation issues and school
readiness
- Regular physical exercise
- Regular toothbrushing
- School readiness can be assessed
Elementary School Age ( 7-12 years) - Level of independence
- Responsibilities
- Physical fitness and sports
- Substance abuse and sexual
development
- Lifelong dietary habits

12. Adolescents
Periodic Health Examination
● Every 2-3 years
● Essential components:
○ Screening adolescents for health risks behavior
○ Getting a medical history
○ Performing complete physical examination
○ Creating a management plan and provide health guidance
Physical Examination
● Periodic height and weight and BMI
● Hypertension
● Skin care
● Assessment of sexual maturity
● Psychological status

13. Adolescents
Immunization
● Against Hepatitis B, Measles, Mumps, Rubella (MMR), Tetanus Toxoid
(Td), and Varicella at age 11-12
Screening
● PPD Screening - high risk for Tuberculosis
● CBC for any of the following risks:
○ Moderate to heavy menses
○ Chronic weight loss
○ Nutritional deficit
○ Athletic activity

14. Adolescents
Nutrition
● Optimal Calcium intake - 1,200 - 1,500 mg/day
Counseling
● Sex education and counseling
● drugs , smoking, alcohol use, sexual activity, venereal disease, and
contraception
● Higher education and job training
● Motor vehicle and firearm safety

15. Adults
Physical Examination
BMI
Central Adiposity
Waist circumference
Men with waist circumference > 102cm (>40 inches)
Women with waist circumference >88cm (>35 inches)

16. BMI

17. Screening
Screen for Lipid Disorders
With the use of Lipid Panel Lab results
Men aged 35 years and older
women aged 45 years
Risk factors
a) diabetes,
b) family history of cardiovascular disease before age 50 years in male relatives or age
60 years in female relatives,
c) family history suggestive of familial hyperlipidemia,
d) Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension).

18. Papanicolau Smear
Cervical Cancer
3 years of the start of the sexual activity or age 21
Done atleast every 3 years for sexually active women
Annual Pap smears are not recommended

19. Mammogram
Screening for breast cancer
Done every 1-2 years for women age 40 and above

20. Other screening tests
- Prediabetes and type 2 diabetes in asymptomatic individuals
- Done to adults with BMI of 25
- With more than 1 risk factor
- Chest Xray
- VDRL/RPR Test
- Urinalysis
- Tuberculin Skin test
- ECG
- Fecal Occult Blood test

21. Depression Screening
-Zung Self-assessment depression scale
- Beck depression Inventory
- General Health Questionnaire
- Center for epidemiologic study depression scale
-Asking 2 simple questions about mood and anhedonia
DSM - V
Standard diagnostic criteria

22. Immunization
Tetanus Diphteria (Td)
Periodic every 10 years
Hepatitis B
Hepatitis A
Varicella Vaccine

23. Counseling
5A framework ( Assess, Advise, Agree, Assist, and Arrange)
Smoking
Physical Activity
Alcohol Use
Nutrition

25. Older Persons
Maximize Length of Life
Maintaining the quality of life

26. Screening
Pap Smear
is not advised
Tobacco
Exercise
Nutrition
Vit E
Calcium
Low Fat High Fiber
Alcohol
Accidental Injury
Medications

27. Immunoprophylaxis
INfluenza Vaccine
Pneumococcal Vaccine
Tetanus
Varicella Zoster
Hepatits A
Hepatitis B

28. Chemoprophylaxis
Aspirin
For people with risk factor of CHD
Estrogen Replacement Therapy
Discussing the balance between the risk and benefits

29. Special Populations
Pregnant Woman
Screening
Rh blood typing and antibody testing]
Screening for IDA
UA/ Papsmear
Supplementation
Counseling
Immunization
Breast feeding women

30. Family Care
Plan

31. Family Care Plan
A process which encompasses diagnostic, preventive, curative and rehabilitative
approach for the whole family
Components:
1. Diagnostic - labs & ancillary procedures
2. Preventive - health promotion & maintenance for each family member
3. Curative - pharmacologic & non-pharmacologic
4. Rehabilitative - exercises & rehabilitation measures

33. Lifted from Leopando

34. Case Scenario
A 34-year old female, mother of two and housewife
from a barangay near the private clinic came in to
consult for a fever (38.3C) of 3 days’ duration. Other
symptoms include a petechial rash over her face and
chest, anorexia, malaise, and abdominal pain.

35. Family Wellness (Care) Plan
Risk Assessment /
Identified Health
problem(s)
Diagnostics Therapeutics Screening /
immunization / lifestyle
modification
Education & Counseling
M.M 34/F Dengue fever
(-) HPN, DM, asthma
Non alcoholic, non
smoker, no illicit drug
use hx
● Serial CBC
● Urinalysis
● CXR
● ECG
● Dengue NS1
● Dengue
IgM/IgG
Pharmacologic:
● Take Paracetamol
500mg tab, 1 tab
q4h for fever
Nonpharmacologic:
● Constant oral
hydration
● Adequate bed
rest
● Gargle with
mouthwash and
avoid
tooth-brushing
and nose picking
● Start IV fluids
● Look for mosquito
breeding places in
and around the
home and eliminate
them
● Enhanced 4S Strategy
(search & destroy, seek
early consult,
self-protection, say yes to
fogging only during
outbreaks)
● Do not take aspirin,
mefenamic acid,
ibuprofen, or other NSAIDs
or steroids.
● Antibiotics are not
necessary
And continue on with each family member..

36. Thank you for
listening
🤗

37. REFERENCES
Yu-Maglonzo, E. I. (2008). The Filipino physician today: A practical
guide to holistic medicine. 2nd ed. Manila: UST Pub. House.

38. COMECILLA | DIGNOS | ENJAMBRE |
GRAVADOR | LEORAG | MALABUYOC |
SANCHEZ | SEVILLENO | TIONGZON
WEEKLY
DIDACTICS 3
BLOCK 10
APRIL 27, 2022