“Standing Orders for Minor Ailments: Role of Community Health Nurse in MCH Care”

Learn how standing orders guide community health nurses in managing minor ailments like fever and diarrhea. Explore their role in MCH care, referrals, and health education.

Standing Orders for Treatment of Minor Ailments

1. Fever:

• Record vital signs (temperature, pulse, respiration, BP).
• Identify accompanying symptoms (e.g., headache, nausea, shivering).
• Provide rest, light meals, and hydration.
• Administer paracetamol for high fever and perform cold sponging if >39°C.
• Prepare blood slide for malaria parasite test.
• Refer for severe symptoms (delirium, convulsions, unconsciousness).

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2. Heat Stroke:

• Place patient in a shaded, ventilated area; wrap in a wet sheet.
• Monitor temperature; give salted cool water if conscious.
• Refer to the hospital once stabilized.

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3. Diarrhea:

• Monitor dehydration signs.
• Provide ORS, coconut water, lemon juice, or light meals.
• Refer severe dehydration cases to the hospital.
• Ensure proper hygiene, and report epidemic cases promptly.

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4. Burns:

• Cool the burn with water; do not touch blisters.
• Cover with a clean cloth, and remove tight items like rings or belts.
• Administer analgesics if needed and refer for severe cases.

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5. Drowning:

• Clear lungs by laying the person on the abdomen.
• Perform resuscitation and refer to the hospital.

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6. Dog Bite:

• Wash the wound thoroughly with soap and running water.
• Apply antiseptics (betadine/tincture iodine).
• Administer tetanus toxoid and refer for ARV therapy.

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7. Snake Bite:

• Immobilize the patient and tie a tourniquet above the bite (loosen every 30 mins).
• Suction the venom carefully or use a vacuum syringe.
• Clean with saline; provide fluids like tea/coffee and refer for ASV therapy.

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8. Scorpion Bite:

• Remove sting, apply ice, and clean thoroughly.
• Use tourniquet and give analgesics or sweetened milk.

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9. Fainting:

• Lay the person down with feet elevated.
• Ensure fresh air; help them take deep breaths upon regaining consciousness.
• Refer if unconsciousness persists.

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10. Injuries and Fractures:

• Clean wound with soap and antiseptic; apply sterile dressing.
• Immobilize fractured parts with a splint.
• Administer analgesics and tetanus toxoid, and refer for further care.

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11. Wounds:

• Wash with clean water and antiseptic.
• Remove foreign bodies and apply sterile bandage with betadine.
• Administer tetanus toxoid and manage bleeding.
• Refer large or severe wounds for sutures.

Standing Orders for Maternal and Child Health (MCH) Care

Maternal Care

• Provide tablets for morning sickness during early pregnancy.
• For pregnancy-induced toxaemia:
• Advise restricted salt intake and complete rest.
• Refer to the hospital immediately if edema develops.
• In cases of Antepartum Hemorrhage (APH) or Postpartum Hemorrhage (PPH), refer the mother to a hospital.
• Manage fever post-delivery with antipyretics and refer for further treatment if necessary.
• Support mothers with perineal care, excess breast milk, or stillbirth issues, and guide them for further treatment.

Newborn Care

• Observe for abnormalities and refer if needed.
• Ensure the newborn is kept warm.
• Initiate breastfeeding as early as possible.

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Common Pediatric Issues

Convulsions in Children

• Place the child safely on a bed and loosen tight clothing.
• Clear mouth secretions to ensure proper breathing.
• Use cold sponging if fever is present.
• Identify possible causes and refer for treatment.

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Emergency Conditions

Hemorrhage

• Lie the patient flat on their back.
• Press a pad on the bleeding site until it stops, then bandage.
• Monitor for shock and provide liquids.
• Refer to the hospital if bleeding or shock persists.

Unconsciousness

• Ensure the patient is in a well-ventilated position to support breathing.
• Remove dentures and loosen tight clothing.
• Clear mouth secretions and provide artificial respiration if needed.
• Refer to the hospital urgently.

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Minor Ailments

Sore Throat

• Inspect for redness or white patches and take swabs if needed.
• Advise saline gargles and fluid intake.
• Refer recurrent cases to the hospital.

Cough

• Determine duration and type; check for associated symptoms.
• Provide cough mixtures and steam inhalation as required.
• Collect sputum samples if tuberculosis is suspected.

Conjunctivitis

• Irrigate eyes with saline and clean with cotton.
• Apply drops/ointments and refer if severe.

Toothache

• Provide aspirin for pain relief.
• Refer to a dentist for further care.

Earache and Discharge

• Clean ears carefully without probing.
• Use hydrogen peroxide for discharge and administer ear drops.
• Refer complex cases to the hospital.

Foreign Bodies in Nose/Ears

• Avoid pouring water on seeds; refer immediately for removal.

Constipation

• Advise fluids, fruits, and leafy vegetables.
• Use mild laxatives as per protocol.

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Chronic Cases

Chronic Ulcers

• Clean with soap and water and apply prescribed ointments.

Pediculosis (Lice Infestation)

• Apply 5% DDT, Benzyl Benzoate, or kerosene-oil mixtures.
• Use fine-toothed combs for removal.

Scabies

• Scrub, bathe, and apply Benzyl Benzoate or neem-based treatments.
• Wash clothes in boiling water and dry in sunlight.
• Repeat treatment if required.

Role of a Community Health Nurse in Implementing Standing Orders

The Community Health Nurse (CHN) plays a pivotal role in executing standing orders effectively within the scope of their practice. Their responsibilities include the following:

Assessment and Data Collection

• Patient History: Collect comprehensive information about:
• General health status.
• Onset, intensity, and symptoms of the disease.
• Family history of illnesses.
• Past medical history and any prior treatments.
• Vital Signs: Measure and document temperature, pulse, respiration, and blood pressure. Conduct urine tests as necessary.
• Problem Identification: Recognize patient problems and determine personal needs.

Nursing Services

• Provide nursing care as outlined in the standing orders.
• Offer emotional support and reassurance to the patient and their family.

Referral and Follow-Up

• Referral System: Facilitate referrals to higher healthcare facilities when required.
• Health Education: Explain the causes of illness, possible complications, follow-up care, and preventive measures to the patient and their family.

Documentation and Review

• Assess the outcomes of nursing care provided.
• Regularly review and stay updated on standing orders and health manuals.
• Document and inform the health officer about communicable diseases promptly.

Communication and Advocacy

• Represent the nurse’s perspective during the review of standing orders.
• Clarify doubts about standing orders by gathering relevant information promptly.

Professional Conduct

• Be mindful of the scope of practice and maintain professional boundaries.
• Foster trust and collaboration with doctors and health administrators.

Environmental Safety

• Ensure a safe and healthy environment conducive to patient well-being.

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COURSES

GNM

BSC NURSING