Community Health Nursing

COMMUNITY HEALTH NURSING BULLETS

The framework for the implantation of the Health Sector Reform Agenda is the FOURmula ONE for Health.
The elements of the FOURmula ONE for Health are: health financing, health regulation, health service delivery, and good
governance.
The 4 Pillars in Primary Health Care are: active community participation, intra and inter-sectoral linkages, use of appropriate
technology, and support mechanism made available.
The DOH has 3 roles: leadership in health, enabler and capacity builder, and administrator of specific services
Winslow defines public health as the science and art of preventing disease, prolonging life, promoting health and efficiency through
organized community effort.
Primary health care is essential care made universally acceptable at an affordable cost through their full participation towards self-
reliance and self-determination
The goal of PHC is: Health for ALL Filipinos and Health in the Hands of the People by the Year 2020
A health deficit is a gap between actual and achievable health status.
A health threat is a condition that promotes injury or prevents people from realizing their full health potential.
Stress points are periods of unusual demand that require adjustment.
A wellness state is indicated by competency, performance and explicit expression of desire to achieve a higher state of health.
Nature of the condition/problem categorizes the problem as wellness state, health threat, health deficit, or foreseeable crisis.
Modifiability of the condition is the probability of success in improving wellness state or remedying the problem.
Preventive potential refers to the nature and magnitude of future problems that can be avoided if intervention is done.
Salience is the familys perception of the condition/problem.
The home visit must have a purpose, based on priorities and flexible to the needs of the client.
The public health bag contains the essential and indispensable equipment of the nurse.
The bag technique is a tool utilized by the nurse to perform nursing procedures with ease. The 4 Cs must be considered in the use of the
bag: complete contents, clean very often, contact with patients articles avoided, convenient arrangement.
The epidemiologic triad is affected by 3 factors: agent, host and environment.
Sporadic pattern is the intermittent occurrence of few isolated and unrelated cases.
Endemic is the continuous occurrence of a disease throughout a period of time in a given locality.
Epidemic is the unusually large number of cases in a relatively short period
A pandemic is the simultaneous occurrence of an epidemic of the same disease in several countries.
Pregnant women are given 10,000 u of Vitamin A every 2 weeks starting on the 4
th
month of pregnancy. It must not be given in the first
trimester.
Pregnant women are encouraged to iron with folate supplements daily for 6 months.
The first dose of tetanus toxoid is given anytime during the pregnancy.
The second dose of tetanus toxoid is given 4 weeks after the 1
st
dose, giving 80% protection for 3 years.
The third dose of tetanus toxoid is given 6 months after the 2
nd
dose, giving 95% protection for 5 years.
The fourth dose of tetanus toxoid is given 1 year after the 3
rd
dose, giving 99% protection for 10 years.
The fifth dose of tetanus toxoid is given 1 year after the 4
th
dose, giving 99% protection for a lifetime.
At least 4 antenatal visits are recommended to pregnant women. The first before the 4
th
month of pregnancy, second around 6-7
months, third on the 8
th
and fourth on the 9
th
month.
To be qualified for home-delivery, the baby must be full term, less than 5 pregnancies, cephalic, no existing disease, no history for
risk, and adequate pelvis.
The first post-partum visit is recommended on the 1
st
week of life and the second visit in 6 weeks.
Ideal pregnancy is between the ages of 20 to 30 years old, with a spacing of 3 years and a number of 3 children. Outside these
ranges, the woman is at a greater risk for complications.
Female sterilization is one of the permanent methods of contraception that can be used immediately after giving birth.
Vasectomy is a permanent FP method. However, pregnancy can still occur within 3 months after surgery.
Pills must be taken every day at the same time. They are contraindicated in patients over 35, with hypertension, smokers, or
breastfeeding.
Male condoms protect from pregnancy and sexually-transmitted diseases. Condoms encourage male participation in family planning.
Injectables do not affect breast milk quantity and quality.
The Lactating Amenorrhea Method is 85% effective until the baby is 6 months old or until menstruation returns.
The Mucus/Billings method encourages women to abstain from sexual intercourse during fertile/wet days.
The IUD is best inserted and removed during menstruation by trained health workers only. It must be removed during pregnancy to avoid
abortion, prematurity and infection.
BCG vaccine is given at birth, 0.05 mL intradermally. It is stored at the body of the refrigerator.
Hepa B vaccine is first given at birth, again after 6 weeks and a third time after 8 weeks, 0.5mL intramuscularly (vastus lateralis). It is
stored in the body of the refrigerator.
DPT vaccine is first given at 6 weeks with an interval of 4 weeks, 0.5mL intramuscularly (vastus lateralis). It is stored in the body of he
refrigerator.
OPV is first given at 6 weeks with an internal of 4 weeks, 2 drops PO. It is stored in the freezer.
Measles vaccine is given at 9 months, 0.5 mL subcutaneously. It is stored in the freezer.
RA 9288 is the Newborn Screening Act mandating all newborns to undergo testing (ideally between the 48
th
to 72
nd
hours of life).
Newborn screening tests for congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, and
G6PD deficiency.
The case management process in IMCI is: Assess, Classify, Identify, Treat, Counsel and Follow-up.
The general danger signs in IMCI are vomiting, convulsions, inability to drink and sleepiness.
In IMCI, cases needing referral are classified pink, cases managed at the health center are classified yellow, and cases managed at
home are classified green.
The Sentrong Sigla Movement is a joint effort of the DOH and LGUs to promote quality health services. Its 4 pillars are: quality
assurance, grants and technical assistance, health promotion, and award.
The 4 Non-Communicable Diseases targeted by the DOH are: cardiovascular diseases, diabetes mellitus, cancer and COPDs.
PTB is transmitted via airborne droplet (of Mycobacterium tuberculosis) and is characterized by cough longer than 2 weeks, low fever,
chest pain, hemoptysis, and weight loss.
The 5 drugs used to treat PTB are: Streptomycin, Pyrazinamide, Ethambutol, Rifampicin and Isoniazid.
Patients classified under PTB Category 1 (new PTB, seriously ill) undergo 2 months intensive phase and 4 months maintenance phase.
Patients classified under PTB Category 2 (relapse, failure case, return) undergo 3 months intensive phase and 5 months maintenance
phase.
Patients classified under PTB Category 3 (new PTB, not serious extrapulmonary symptoms) undergo 2 months intensive phase and 4
months maintenance phase.
Drugs used to treat PTB have side effects: Ototoxicity/CN VIII damage (Streptomycin), peripheral neuritis (Isoniazid), GI disturbance
(Pyrazinamide), optic neuritis (Ethambutol).
Level 1 sources of water (Point Source) are protected wells or developed springs catering to 15 to 25 households.
Level 2 water sources (communal faucets/stand-posts) have a reservoir, a piped distribution network and communal faucets serving
around 100 households.
Level 3 water sources (waterworks system) have a source, a reservoir, a piped distribution network and household taps. It requires
minimum treatment or disinfection.
The 4 Rights in Food Safety are: right Source, right Preparation, right Cooking, and right Storage.
Level 1 toilet facilities require little or no water to wash waste into the receiving space.
Level 2 toilet facilities are the water carriage type such as water-sealed or flush toilet types with septic tanks.
Level 3 toilet facilities are connected to a sewerage system to a treatment plant.
A comprehensive community diagnosis contains the following data about a community: demographic variables, socio-economic
and cultural variables, health and illness patterns, health resources, and political/leadership patterns.
The steps in community diagnosis are: determining the objectives, defining the study population, determining the data to be collected,
collecting the data, developing the instrument, actual data gathering, data collation, data presentation, data analysis, identifying the CHN
problems, priority-setting,
The phases of community organizing are: Preparatory phase, Organizational phase, Education and Training phase, Collaboration
phase, and Phase-Out.
Leprosy can be transmitted via skin contact or airborne transmission. It is diagnosed via Slit Skin Smear and is treated with
Rifampicin, Ofloxacin, Minocycline, Dapsone, and Clofazimine.
Schistosomiasis is a blood fluke that enters the body through skin penetration in infected water. The drug of choice is Praziquantel.
Filariasis is a parasitic infection that affects the lymphatic vessels and lymph nodes, transmitted through bites of the Aedes poecilius
mosquito. The drug of choice is Hetrazan.
Malaria is a serious disease transmitted through Plasmodium mosquitoes (Female anopheles). Drug of choice is Quinine.
Dengue Hemorrhagic Fever is an invasive disease transmitted by the Aedes Egypti mosquito, causing bleeding, shock and possibly,
death.
Measles is spread through the secretions of the nose and throat and is characterized by Kopliks spots. It is highly teratogenic so
pregnant women must stay away from infected persons.
Chicken pox is spread through direct contact and droplet. Children with chicken pox should not go to school until a week after the first
eruption of skin lesions.
Mumps are transmitted through the secretions of nose and mouth and cause swelling of neck, front of ear and jaw angles.
Diptheria is a respiratory infection transmitted caused by Corynebacterium Diptheria) through contact with soiled articles of infected
persons.
Pertussis or whooping cough is transmitted through the laryngeal and bronchial discharges of infected persons.
Cholera is spread through contaminated food and water and is characterized by rice-water stool. Nursing care should focus on the
prevention and treatment of dehydration.
Typhoid fever is contracted through direct or indirect contact with a patient or carrier through food and water. Flies are common vectors of
the disease.
Shigellosis or Bacillary dysentery is an acute bacterial infection causing bloody mucoid stools. It is transmitted through ingestion of
contaminated food or water.
Paragonimiasis is caused by a lung fluke causing signs and symptoms resembling that of pulmonary tuberculosis. Domestic and wil d
animals can act as reservoir hosts. Drug of choice is Praziquantel.
Hepatitis A is a form of acute hepatitis causing influenza-like symptoms, anorexia, jaundice. It is transmitted through fecally-
contaminated food and water.
Red Tide poisoning is caused by ingestion of raw or inadequately cooked seafood. Vomiting must be induced and pure coconut mi lk can
waken the toxic effect.
Leptospirosis is a zoonotic infection caused by leptospires with pigs, cattles, rabbits, hare, skunk, and other wild animals as reservoir
hosts. It is transmitted through contact of the skin (open wounds) with infected water, soil or vegetation.
Rabies is a viral infection transmitted through bites of animals with infected saliva. It is fatal once signs and symptoms appear.
Scabies is caused by an itch mite that produces eruptive lesions in the skin.
Anthrax is an acute bacterial disease that affects the skin. It is transmitted via tissues of dead or infected animals and soil.
Gonorrhea is passed through direct contact between infectious membranes. It causes a burning sensation upon urination and pus
discharges in males.
Syphilis is characterized by a painless chancre. It is transmitted through direct contact with an infected sore.
Chlamydia is characterized by itching and burning in the genital area. Infants can become infected during vaginal delivery.
Hepatitis B is a severe liver disease transmitted through blood contact.
HIV Aids is caused by a retrovirus. It is transmitted through sexual contact, blood contact, contact with secretions, and contact with
contaminated syringes, needles and razor blades.
For HIV, ELISA is a presumptive test. Western blot is the confirmatory test. Drug of choice is Zidovudine (Retrovir).
Pneumocystis carinii is the most common opportunistic infection in HIV patients. Kaposis sarcoma is the most common malignancy.
Meningococcemia is a respiratory infection transmitted through direct contact with respiratory droplets of infected individuals. Common
signs and symptoms are weakness, joint and muscle pain, stiff neck.
Avian Flu is caused by the H5N1 virus strain found in birds. Symptoms include fever, body weakness or muscle pain, cough, sore throat,
and sore eyes.
SARS is a respiratory infection transmitted through close contact with respiratory droplets from an infected person. It is highly infectious
and has 2 phases: prodromal and respiratory.


Community Health Nursing
CHW group of people with common chrematistics or interest within a territory or geographical
boundary
Community
1. Patient/Client
2. Setting - outside curative institutions
o home family HNSg
o school SHSg
o places of work occupational HNSg
World Views:
1. Community integral part of society compose of families
Eg. poor community
o under nutrition
o poor food supply
o level of knowledge poor
2. Conflicts/contradiction always present in the community
o intrapersonal conflict choosing what to wear
o intrapersonal family
o intrapersonal community (interfamilial) regionalism parochial
o intra sociedad (inter societal)
Note: Should be positive in dealing with conflict.
3. Condition in the family is always changing
Health
1. Wellness Illness continuum
Optimum internal ------------- death
Wellness - external
External
Macro system
o political
o economic
o socio cultural education, customs, beliefs, practices, tradition,
mass media
2. High Level Wellness
o maintain continuum balance and purpose direction with environment
o progress toward a high level of FXU, lice to the fullest potential
3. Agent Host Environmental Model
o Epidemiologic model
Agent (Etiologic Facts)
a. Infections/biological factor
b. Mechanical
c. Physical
d. Carcinogenetics pringels, tobleron (GMOs chemical
e. Poison eg. MSG
f. Allergies
g. Nutritive elements
h. Psychological
Host intrinsic factor age, sex
o exposure
o response susceptibility
- resistance
environment extrinsic factor
4. Health Belief Model
o relationship bet a persons belief and his behavior in health
3 components
1. Susceptibility to illness
2. Seriousness of an illness
3. Benefits taking the action
AN/AIDS
Common in
1. Commercial Sex Worker unprotactive penetrated sex
2. Sea farers
3. Religious Nums
Vaginal male and female 1:000
Oral male to male also common in male to female 1:200
Felacio mouth to penis
Oral cumaningus mount to vagina
Aningus mouth to amus
Preventive :
A. abstinence sex (safe)
B. Be Faithful Mutual/Monogamy
C. Correct continous consistent use of condom
D. Do no penetrate
5. Evolutionary Based Model
o illness and death sometimes serves an evolutionary function
Elements:
o life events
o life style determinants
o control perception
o viability emotions
o health out comes
6. Health Promotion Model
o clients won being
7. WHO Definition 1978 Alma Ata
o health is not merely the absence of DSE illness of infirmity
o state of complete physical mental, and social wen being
Health
1. Social phenomenon Health outcome is interplay of different societal factors
outcome with interplay of different factors and society:
o biological
o physical
o ecologic multiple causation Theory
o political (Holistic)
o economic
o socio-cultural
Community Health
Part of medical paramedical intrapersonal which is concerned and the heath of the whole population.
Major Concept
1-health promotion & DSE prevention
2- people participation
Individual Applied Community
Client Study As Client
- Anatomy - structure - demography
- Physio - functions - Sociology
- Patho - malfunction - epidemiology
Public Health & Longetirity (CBQ)
WINSLOW contribution to the most effective total development and life on the
Individual and the society.
HANLON priority the survival of the species the prevention of condition which
lead to the structure destruction or retardation of human function and
potential in early year of life.
Communication Health Nursing
- special field of nursing that combines the skills of nursing public health, and some phases of social
assistance and FXUS as part of the total health project and promotion of health.
JACOBSON is a learned practice discipline with the ultimate goal of contributing as individual and in
collaboration with others, promotions of clients optimum level of fractioning through teaching and
delivery care.
Jacobson Major Roles
1. Health Educator
2. Provider of Nursing Care
FREEMAN aimed developing and enhancing health capability of people,
Individual, families and communities.
Community
People Organization (PO)
Agency
1. Ngo
2. GO DOH National Regional Province Municipal BHW
RA 7305 Magna Corta of PHWorker
RA 7160 Local Government Code
Devolution of Health Services
CHN CONCEPTS:
1. 10 Focus on CHN is an heath promotion
2. CHN practice is extended to benefit not only individual but whole & family
3. CHN are generalist in terms of their practice throughout lifes continuum its full range of Health
problems and need.
4. Contact with client may continue over a long period of time which includes all ages and types of HC
Levels
Primary HC community
2
0
HC Regimal, Provincial, Municipal & District
Tertiary sophisticated medical center
Assessment:
Community Dx
o health problems and needs
o sources of solve to problem
Principle of Community Health Nursing
1. Recognize needs of individual
2. Knowledge and understanding of agency and policies facilitates goal achievement
3. The family is the unit of service
Planning
1. Prioritization
2. Goal setting
3. Objectives
4. Actions/Intervention
5. Evaluation out come:
- criteria
- standard
Health Education and Counseling
o common goal behavior change or modification
Basic Different
Health Education dive advice
Counseling provide all option
Implementation:
Community family focus of /unit of care
4. Respect values, customs and beliefs of clients as nurse we should not be judgmental
5. Health education and counseling are vital parts of CHN
6. Collaborative working relationship with the health team facilitates goals achievement.
7. Continuing staff education ensures quality client care and upgrade nursing practice.
8. Indigenous and communication resources
appropriate tech methods and tech both scientifically sound and socially
and acceptable
9. Individual families and communities must actively participate in decision making
10. Supervising of nursing services be qualified personnel provides guidance and direction to work.
11. Accurate recording and reporting serve as bases for evaluation and guide for future actions.
12. Periodic and continuing education
board quest
how would you evaluate objective if both present answer this
criteria
HEALTH SITUATION
1. Health Indices
A. Basic Indicators Anemia
1. Nutrition 48% of Filipinos
2. DSE Pattern 58% of pregnant women
- morbidity
- mortality
infant mortality rate according to DOH 18.7
life expectancy: Female 69.2
Male 63.7
HEALTH PROMOTION
Consist of activities directed towards increasing the fever of well being and actualizing the health
potential of individuals families communication and societies.
Different with prevention
o not desl dysixy or health problem financial
o approach behavior not
o avoidance behavior
o seeks to expand (+) potential for health
Multidimensional Nature of Health Promotion
1. Individual lifestyle
- personal habits & practices affecting health
-lifestyle
- lifestyle responsibility
2. Family health behavior and belief
3. Community norms
4. Environment harmony and bal bet human and surroundings
5. Society basic human needs
HEALTH PROMOTION METHODS
health education
Good standard nutrition adjusted to development phases of life
Attention to personality development
Provision of adequate housing
Recreation and agreeable working condition
Genetics counseling
Periodic selective examination self breast examination (SBE)
SCREENING METHOD
Presumptive identification of unorganized dse or defect by the application of test, examination or other
procedures that can be applied rapidly and inexpensively population.
o mass screening
o case finding
o contact tracing
o multi phasic screening eg HIV antibody testing
o surveillance
RA 7305 Jon reporting of communicable dse
Tertiary Prevention
methods
Dx
Tx
Mx
Rehabilitation
Community Organizing
Awareness raising
Organizing
Mobilizing / responsible action
Key Concepts and Principles
1. Objective analysis of objective condition scientific
2. Basic trust among people
3. By the people from the people, for the people
4. People want and can change
5. Self-willed changes will have move meaning and performance than imposed changes.
Primary Health Care
- Essential care based on scientifically sound and socially acceptable methods and technology made
universally available to individuals families and communities at the cost they can afford at any given
stage development than their full participation towards self-reliance and self determination.
8 Primary Health Care
1. Health Education
2. Food Supply and Nutrition
3. Immunization
4. Hw and Basic Sanitation
5. Prevent & control of common dse
6. Tx of endemic dse
7. MCH including FP
Individual
1. Assessment
a. Data collection
2 types data subject & objective
2 methods interview & observation
4 Instruments
1. Nursing History (subjective)
2. Physical Examination
3. Laboratory Exam
4. Process Recording
b. Data Analysis
2. Nsg. Dx
Health Care V/E Etiology
3. Planning
a. Prioritization
b. Goal
c. Objective
d. Nsg. Intervention
e. Evaluation Outcomes - Criteria , standard
4. Implementation
- health educator
- provider of HC
- supervisor Client /Patient Advocate
- researcher
- health organizer
- CH, Monitor
8 Basic Tasks:
1. Physical Maintenance
2. Allocation of Resources
3. Division of Labor
4. Socialization of Family Members
5. Reproduction, recruitment and releases
6. Maintenance of order
7. Placement of members in larger society production of good member
8. Maintenance of motivation and morale
Nuclear Family Mother, Father, son & daughter
Extended grandparent relation or daughter in law.
First Level Assessment
o Health Threats
o Health Deficits
o Forcible Crisis/Stresspoints
Family Tasks
1. Ability to recognize the presence of the problem
2. Ability to make decisions.
3. Ability to perform nursing care to sick
4. Ability to provide home environment
5. Ability to utilize community resources
Incubation Pd- entry of Pathogen to appearance of 1st SK
IMMUNITY
Passive quick to come/to go active slow to come / to go
1. natural utero, breast feeding 1. Natural getting the dse
2. Artificial sevum prob. Antitoxin 2. Artificial utanus toxoid
Pregnant
TT1 4
th
month
TT2 8
th
month
Pregnancy 2
TT3 booster 1
st

Pregnancy 3
TT4 booster 2
nd

Pregnancy 4
TT5 booster lifelong immunization
Community Mental Health Nursing
1. A unique process which includes an integration of concepts from nursing mental health, social
psychology community network.
Occupational Health Nursing
- Application of Nursing principles and procedure conserving health of the healthworkers.
School Health Nursing
Components
1. School Health Services
2. Health Instruction
a. direct nurse doing the school teaching
b. indirect
3. Health School Living
4. School Community Linkage
Median age of Filipinos is 20 yrs old
50 % - 20 years old
50% - above 20 years old
Vital Statistics application of statiscal measure to vital events fertility , mortality, morbidity
RA 3753 Civil Registry Law
Requires the registration of births and deaths to local registrars
RA 3573 Law on reporting notifiable disease
Family Planning Program
Goal Improve material & child through:
o proper timing of pregnancy
o proper spacing of pregnancy
o number of pregnancies
Pregnancy :
Ideal age: 30-30- yrs.
20 -18 - 30 35 with risk
18 35 high risk
Ideal interval 3 years
2 years with risk
4 years high risk
ideal No 3
4 with risk
4 risk
Family Planning Method
1. Spacing Hormones, (pills injectable), IUD, Condoms, Natural, Standard Base bead
2. Permanent Tubal ligation, Vascetomy,
25 to 40 ejaculation - to know sterility

Focus: 1. Promotion of health, 2. Prevention of
disease, 3. Prolonging life
LEVELS OF CLIENTELE: Individual, Family, Population
Group, Community
COMMUNITY - A group of people sharing common
geographic boundaries and common values and
interests.
POPULATION GROUP - A group of people who share
common characteristics, developmental stage or
common exposure to particular environmental factors,
thus resulting in common health problems
POPULATION GROUP: Children, Men, Women,
Farmers, Factory workers, Prisoners, Military men,
Elderly
FAMILY
A number of persons joined together by bonds
of marriage, blood or adoption
Two or more persons who are joined together by
bonds of sharing and emotional closeness
and who identify themselves as being part of the
family
Basic unit of care in community health nursing
Locus of decision-making on health matters
Source of the most solid support and care to its
members, particularly the young, the elderly, the
disabled and the chronically ill
NATURE OF PRACTICE: Comprehensive, Generalists,
Not limited to a particular age or diagnostic group
CONCEPTS OF COMMUNITY HEALTH NURSING
HEALTH PROMOTION primary focus of
community health nursing practice
Practice is extended to benefit not only the
individual but the whole family, population
group and community
Community health nurses are GENERALISTS
HEALTH PROMOTION
Activities directed toward developing the
resources of clients maintain or enhance well-
being
GOAL: Increase in wellness level
PRINCIPLES OF COMMUNITY HEALTH NURSING
Community health nursing is based on
recognized needs of communities, families,
groups and individuals
FAMILY unit of service
HEALTH TEACHING primary responsibility of
the community health nurse
ULTIMATE GOAL: Raise the level of health of the
citizenry
GOAL: Maximize potential for high-level wellness,
Help communities and families to cope with the
discontinuities in health and threats
COMMUNITY HEALTH NURSING
Greater control for both the nurse and the client
in making decisions related to health care
Collaboration of the nurse and the client as
equals
Recognition of the impact of different factors on
health
Nurses greater awareness of their clients lives
and situations
Broader perspective than hospital nursing
HEALTH
1. State of complete physical, mental and social
well-being, not merely the absence of disease or
infirmity (WORLD HEALTH ORGANIZATION)
2. State characterized by soundness and
wholeness of human structures and bodily and
mental functions (Dorothea Orem)
FACTORS AFFECTING HEALTH
1. INCOME AND SOCIAL STATUS
2. EDUCATION
3. PHYSICAL ENVIRONMENT
4. EMPLOYMENT AND WORKING CONDITIONS
5. GENETICS
6. PERSONAL BEHAVIOR AND COPING
SKILLS
THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
1. PUBLIC SECTOR
Financed through a tax-based budgeting system
at both national and local level
Health care is generally given for free
2. PRIVATE SECTOR
Largely market-oriented
Health care is paid through user fees at the point
of service
PUBLIC HEALTH NURSING
1. C.E. WINSLOW
Public health as the science and art of
preventing disease, prolonging life and efficiency
to enable every citizen to realize his birthright of
health and longevity.


2. WHO EXPERT COMMITTEE OF NURSING
Public health as a special field of nursing that
combines the skills of nursing, public health and
some phases of social assistance
3. HANLON
Public health is dedicated to the common
attainment of the highest level of physical,
mental and social well-being and longevity
GOAL: contribute to the most effective total
development and life of the individual and his
society
4. JACOBSON
Community health nursing is a learned practice
discipline
Ultimate goal : contribute to the promotion of
clients optimum level of functioning
Through teaching and delivery of care
5. RUTH FREEMAN
Community health nursing is a service
rendered by a professional nurse with the
community, groups, families and individuals
GOAL: promotion of health, prevention of
illness, care of the sick at home and
rehabilitation
6. MARGARET SHETLAND
Philosophy of community health nursing is
based on the worth and dignity of man

SUBSPECIALTIES OF CHN PRACTICE
OCCUPATIONAL HEALTH NURSING
Nursing in the workplace
Clients: workers in all occupations
Focus: Health promotion, protection and
restoration
Workers health within the context of a safe and
healthy work environment
KEY ELEMENTS OF OCCUPATIONAL HEALTH
PROGRAMS
HEALTH PROTECTION health risk
management at work (health hazard
identification, health risk assessment, health
surveillance, information, instruction and training
HEALTH PROMOTION assessment of health
risk associated with the living environment and
lifestyle
COMMON HAZARDS IN THE WORKPLACE
PHYSICAL HAZARDS
Radiation
Temperature extremes
Noise
Electric and magnetic fields
Lasers
Microwaves
Vibrations
CHEMICAL HAZARDS
Anesthetic gases
Chemotherapeutic and antineoplastic agents
Tissue fixatives and reagents
Disinfectants and detergents
Sterilizing agents
Solvents
Latex
Mercury
BIOLOGICAL HAZARDS
Influenza
Tuberculosis
Hepatitis B
Human Immunodeficiency Virus (HIV) infection
MECHANICAL HAZARDS
Neck strain
Visual fatigue
Raynauds syndrome
Carpal tunnel syndrome
Back injury
PSYCHOSOCIAL HAZARDS
Interpersonal conflicts
Unsafe working conditions
Shift work
Sexual harassment
Absent/limited job reward
SCHOOL HEALTH NURSING
Clients: School population
GOAL:
Promote health and prevent health problems
that would hinder the learning process and
performance of their developmental task
Health is considered an important requisite for
education
HOME VISITATION OF THE SCHOOL NURSE
Pupils whose parents are afraid of some medical
procedures
Pupils who get reinfected because of home
conditions
Pupils suffering from communicable diseases
Pupils who are absent frequently because of
sickness
Pupils who are malnourished
LEADING AILMENTS/DEFECTS AMONG SCHOOL
CHILDREN
Dental Caries
Intestinal Helminthiasis
Colds
Pediculosis
Upper respiratory tract infection

NURSING PROCESS
Central to all nursing actions the very essence
of nursing
Systematic, scientific, dynamic, ongoing,
interpersonal process
Logical and systematic way of processing
information gathered from different sources and
translating meaningful actions or interventions
ASSESSMENT
Provides an estimate of the degree to which a
family, group or community is achieving the
level of health possible for them
METHODS OF DATA COLLECTION
Observation
Physical examination
Interview
Record review
Laboratory/Diagnostic test
STEPS in the ASSESSMENT PHASE
Initiate contact
Be objective and non-judgmental
Develop mutual trust and confidence
Collect data from all possible sources
Identify problems
Analyze and interpret data
PLANNING
Formulation of steps to be undertaken to
achieve desired end
Objectives of care: specific, measurable,
attainable, realistic, time-bound (SMART)
STEPS
Prioritization
Goal setting
Construct nursing care plan
Devise evaluation parameters
Revise plan as needed
IMPLEMENTATION
Translation of care plan into action
INTERVENTIONS
Help the family recognize the problem
Guide the family on how to decide on
appropriate health actions to take
Develop familys ability to provide nursing care
to members
Enhance the familys capability to provide a
home environment conducive to health
maintenance
EVALUATION
Process of making judgments as the extent
objectives were met
ASSSESSMENT: Determine whether there are
changes in the health status
PLANNING: Determine if the interventions are
appropriate and adequate to achieve client
outcomes
IMPLEMENTATION: Specify what factors
created problems or barriers to care


CATEGORIES OF HEALTH PROBLEMS
HEALTH DEFICIT
A gap between actual and achievable health
status
Instances of failure in health maintenance
Possible precursors of health deficit:
History of repeated infections or
miscarriages
No regular health check-up
EXAMPLES
ILLNESS states, diagnosed or undiagnosed
Failure to thrive/develop
Disability
Transient (aphasia or temporary
paralysis after a CVA)
Permanent (leg amputation secondary
to diabetes, blindness from measles,
lameness from polio)
HEALTH THREAT
Conditions that are conducive to disease,
accident or failure to realize ones potential
EXAMPLES:
Family history of hereditary disease
Threat of cross infection
Accident hazards
Faulty eating habits
Poor environmental sanitation
Unhealthy lifestyle/personal habits
FORESEEABLE CRISIS
Anticipated periods of unusual demand on the
individual or family in terms of adjustment/family
resources
EXAMPLES:
Marriage
Pregnancy
Parenthood
Divorce or separation
Loss of job
Menopause
Death
CRITERIA FOR PRIORITIZING HEALTH PROBLEMS
NATURE OF THE PROBLEM categorized into
health deficit, health threat and foreseeable crisis
Health deficit 3
Health threat 2
Foreseeable crisis 1
MODIFIABILITY OF THE PROBLEM refers to the
probability of success in minimizing, alleviating or
totally eradicating the problem through intervention
Easily modifiable 2
Partially modifiable 1
Not modifiable 0
PREVENTIVE POTENTIAL refers to the nature and
magnitude of future problems that can be minimized
or totally prevented if intervention is done on the
problem under consideration
High 3
Moderate 2
Low 1
SALIENCE refers to the familys perception and
evaluation of the problem in terms of seriousness
and urgency of attention needed
A serious problem, immediate attention needed
2
A problem, but not needing immediate attention
1
Not a felt need / problem 0

ACTIVITIES OF THE COMMUNITY HEALTH NURSE
HOME VISIT
Made to a client or a responsible member of the
family
GOAL : provide necessary health care activities
and further attain an objective of the agency
A professional face-to-face contact made by a
nurse to the patient or the family
PURPOSE OF A HOME VISIT
Purpose or objective
Use all available information
Flexible and practical
First priority on recognized needs

FREQUENCY OF A HOME VISIT
Acceptance of the family
Ability to recognize own needs
Physical, psychological and educational needs
Other health agencies and health personnel involved
Policy of a given health agency
Evaluation of past services given to a family
PURPOSE OF A HOME VISIT
To give nursing care
To assess the living condition of the patient and his
family
To give health teachings regarding prevention and
control of diseases
To establish close relationship between health
agencies and the public
To make use of the inter-referral system
STEPS IN A HOME VISIT
1.Greet client and introduce self.
2. Explain purpose.
3. Inquire about health and welfare.
4. Place bag in a convenient place.
5. Wash hands and wear apron.
6. Perform physical assessment and nursing care
7. Give necessary health teaching.
8. Wash hands and close bag.
9. Record findings
10. Make appointment for clinic or home visit.
BAG TECHNIQUE
A tool using a public health bag done during a home
visit
The nurse can perform nursing procedures with ease
and deftness
Saving time and effort in view of rendering effective
nursing care
PRINCIPLES OF BAG TECHNIQUE
Use of bag technique should minimize, if not
totally prevent, the spread of infection
Should save time and effort in the performance
of nursing procedures
Should not overshadow concern for the patient
Show the effectiveness of total care given to
individual or family
SPECIAL CONSIDERATIONS
Should contain all necessary articles and
equipments
Bag and contents should be cleaned as often as
possible
Should be protected from contact with any
article in the home of the patient
Arrangement of the contents should be
convenient
Handwashing should be done frequently
When used in a communicable case, should be
thoroughly cleaned and disinfected before
keeping and re-using
CONTENTS OF THE PUBLIC HEALTH NURSE BAG
Thermometers in case (one oral and rectal)
syringes
Alcohol lamp
Zephiran solution
Benedicts solution
Tape measure
Hypodermic needles
Paper lining
Apron
Hand towel
Adhesive plaster
Soap in a soap dish
Paper bag
Surgical scissor
Bandage scissor
Curved forceps
Straight forceps
Sterile dressings
Cotton balls
Babys scale
Rubber gloves
Test tube
Test tube holder
Betadine
70% alcohol
Ophthalmic ointment
Hydrogen peroxide
Spirit of ammonia
Acetic acid

DENTAL HEALTH PROGRAM
VISION: A lifetime of oral health and no tooth decay for
the next generation
STRATEGIES
-Social mobilization
-Coordination and partnership with sectoral groups
-Networking
-Capacity building and work value formation
DIRECT SERVICES
-Dental Health Promotion and Advocacy
-Dental Preventive Program
-Dental Curative Program
-Oral Habilitation and Rehabilitation Program
SUPPORT SERVICES
-Dental Health Planning
-Training Program
-Dental Research Program
-Monitoring and Evaluation
SANG MILYONG SEPILYO
-Project for Social Mobilization
AIM:
- Emphasize the importance of oral health in relation to
total body health
- Increase public awareness on the prevention of
common dental diseases
-Solicit one million new toothbrushes from concerned
citizen
TRAINING OF BARANGAY DENTAL AUXILIARIES
- Provinces of Bohol, Albay and Lanao Del Norte
- Poor oral health due to lack of manpower, very high
dentist to population ratio and geographical location

SENTRONG SIGLA MOVEMENT
- Joint effort of the DOH and LGUs
AIM:
- Promote availability of quality health services
- Make these services accessible to every Filipino
MAIN COMPONENT : certification recognition
programs
OBJECTIVES : foster better and more effective
collaboration
4 PILLARS OF SSM
Quality Assurance Pillar
Grants and Technical Assistance Pillar
Health Promotion Pillar
Award Pillar
QUALITY ASSURANCE PILLAR
- Responsible for setting the standards and requirements
for SSM
GRANTS AND TECHNICAL ASSISTANCE PILLAR
- Financial assistance to assist LGUs
- Access to a pool of experts
HEALTH PROMOTION PILLAR
- Promotion of the concept of health as a personal
responsibility
- Awareness and demand
AWARD PILLAR
- Responsible for certification and recognition programs
PRIORITY HEALTH PROGRAMS
Expanded Program on Immunization
Disease Surveillance
Control of Acute Respiratory Infections
Control of Diarrheal Diseases
Micronutrient supplementation
Family Planning Program
Sexually Transmitted Disease
Environmental Health and Sanitation Program
Cancer Control Program

STANDARD REQUIREMENTS
Building
Equipment
Supplies
Training
Pharmaceuticals
EXPECTED RESULTS OF SSM
Individuals will be empowered to:
Adopt healthy lifestyle
Improve health seeking behavior
Promote well-being
Demand for quality health services
Institutions
Develop policies
Develop quality services for health providers
Develop system for surveillance/merits
Advocates for laws

HEALTH CARE SERVICES FOR OLDER PERSONS
DEMOGRAPHIC AND HEALTH PROFILE OF OLDER
PERSONS
1. Living arrangement of older persons
Grandchildren
2. Leading cause of morbidity among 50 years and
above
Influenza
3. Leading causes of mortality among the 60 years and
above
Diseases of the heart
4. Leading causes of illness/accident/injury that affect
the ADL of older persons
Respiratory problems
5. Common health problems / conditions presented by
older persons
Difficulty walking
CHARACTERISTICS OF OLDER PERSONS
- Housebound due tophysical and sensory disabilities
and mental impairments
- Financially disadvantaged
- Have the tendency to underreport their illness
- Vulnerability to adverse drug reactions due to
changes in the immune system
HEALTH CARE SERVICES FOR OLDER PERSONS
GOAL: A Longer Disability Free Life
GUIDELINES IN PROVIDING HEALTH CARE
SERVICES FOR OLDER PERSONS
Rights of older persons
Traditions, beliefs and values as well as health
practices
Holistic care for older persons: developmental tasks
Care for older persons is multi-disciplinary
RA 7432 SENIOR CITIZENS ACT
- 20% discount from all establishments relative to
transportation services, hotels and similar lodging
establishments, restaurants and recreation centers and
purchase of medicines
- 20% discount on admission fee charges in theaters,
cinema houses and concert halls, circuses, carnivals,
and other similar places of culture, leisure and
amusement
RA 7876 SENIOR CITIZENS CENTER ACT OF THE
PHILIPPINES
- Establishment of center with recreational, educational,
health and social programs and facilities designed for
the full enjoyment and benefit of the senior citizens in the
city or municipality
OSTEOPOROSIS PREVENTION
OSTEOPOROSIS
- A disease that weakens the bones, making it more
fragile and likely to break
- Silent disease
- Considered a major health and economic problem
- Not an inevitable part of aging
- Risk of fracture: female, increase is seen after
menopause while male, increase is seen after age 70
RISK FACTORS FOR OSTEOPOROSIS
Smoking
Alcoholism
Immobilization
Menopause
Asian or Caucasian race
Peak bone mass (PBM) reached in the second to fourth
decade
DIAGNOSIS: Measurement of bone density by the Dual
Energy X-ray Absorptionmetry (DEXA) machine
PREVENTION
- Exercise as walking, cycling, tennis, aerobics, jogging
and badminton
- Regular intake of calcium rich foods and supplements
- Regular medical check-up
REPRODUCTIVE HEALTH PROGRAM
VISION: Reproductive health practice as a way of life for
every man and woman throughout life
GOALS:
1. To achieve healthy sexual development and
maturation
2. To achieve their reproductive intention
3. To avoid illness/diseases, injuries related to sexuality
and reproduction
4. To receive appropriate counseling and care of RH
problems
GOALS
Every pregnancy should be intended
Every birth should be healthy
Every sex act should be free from coercion and
infection
Achieve a desired family size
REPRODUCTIVE HEALTH CONCEPTS
A married couple has the capability to
reproduce/procreate
RH is the exercise of reproductive right with
responsibility
RH includes sexual health for the purpose of
enhancement of life and personal relations
RH assures access to information on sexuality
to achieve sexual enjoyment
STRATEGIES
Increase and improve the use of more effective
or modern contraceptive methods
RH care provision should be focused on
adolescent, men, unmarried and other
displaced people with RH problems
Strengthen outreach activities and the referral
system
PRACTICES TO MAINTAIN SEXUAL HEALTH
BREAST SELF-EXAM
MAMMOGRAPHY
TESTICULAR SELF-EXAM
DIGITAL RECTAL EXAMINATION
INTERNATIONAL AND LOCAL FRAMEWORK
INTERNATIONAL FRAMEWORK
Focus: womens health
Ultimate Goal: Quality of Life
LOCAL FRAMEWORK
Focus: Reproductive health status in terms of its
elements
Address both men and women
FACTORS/DETERMINANTS OF REPRODUCTIVE
HEALTH
1. Socio-economic condition
Education
Employment
Poverty
Nutrition
Living condition/environment
Family environment
2. Status of women
Women destined to bear and raise children
Not a primary decision-maker
3. Social and Gender Issues
Husbands provide guidance to wives
Restricted social participation, limited mobility,
lack of resource for health care
4. Biological, Cultural and Psychosocial factors
Knowledge of reproductive organ and functions
Norms, practices of RH
MENTAL HEALTH PROGRAM
MENTAL HEALTH
- State of well-being where a person can realize his or
her own abilities to cope with the normal stresses of life
and work productively
MENTAL ILL-HEALTH
- A disturbance in a persons thoughts, feelings and
behavior
- Affected by a persons interaction with others, ones
environment and even ones self-esteem
MENTAL DISORDER
- A medically diagnosable illness
- Results in significant impairment of ones cognitive,
affective or relational abilities
- Equivalent to mental illness
MENTAL HYGIENE
- Science which deals with measures employed to
promote mental health, reduce incidence of mental
illness through prevention and early treatment
PSYCHIATRIC NURSING
- Concerned with:
- Promotion of mental health
- Prevention of mental disorders
-Nursing care of patients during mental illness and
rehabilitation
FOUR FACETS OF MENTAL ILLNESS AS A PUBLIC
HEALTH BURDEN
DEFINED BURDEN
- Burden currently affecting persons with mental
disorders
- Measured in terms of prevalence
- Other indicators include : quality of life indicators and
disability adjusted life years (DALY)
UNDEFINED BURDEN
- Portion of the burden relating to the impact of mental
health problems to persons other than the individual
directly affected
- Repercussions felt heavily by families and communities
both in human and economic loss
HIDDEN BURDEN
- Refers to stigma and violations of human rights
- STIGMA mark of shame, disgrace or disapproval that
results in a person being shunned or rejected by others
FUTURE BURDEN
- Burden in the future
- Resulting from aging of the population, increasing
social problems and unrest inherited from the existing
burden
PSYCHOSOCIAL CONCERNS ACROSS VARIOUS
STAGES OF LIFE
1. Important milestone during the preschool age
Development of conscience
2. During the school age, what plays a big role in
facilitating the childs well-being and healthy social and
emotional growth?
Education
3. During what stage does consolidation of personality
formation and development of morals occur?
Adolescence
4. What is a very important mental health concern during
the adult period?
Workplace-related stress
MENTAL HEALTH PROGRAMS
GOALS
Promotion of mental health
Decrease health-related effects of stressful
lifestyle
Reduction of prevalence of mental ill health and
disorders in the Philippines
NATIONAL OBJECTIVES
Health status
Risk reduction
Services and programs
MENTAL HEALTH PROMOTION
Promotion of mental health among families
and the community
Utilize opportunities to extend the general
knowledge on mental hygiene
Help people understand basic emotional
needs
Teach parents the importance of providing
emotional support to children during critical
periods
MENTAL ILLNESS PREVENTION AND CONTROL
Recognize mental health hazards and stress
situations
Recognize pathological deviations from
normal
Be aware of potential causes of breakdown
Help the family to understand and accept the
patients health status and behavior
Impart information and guidance about the
treatment scheme of the patients
REHABILITATION FOR MENTAL ILLNESS
Initiate patient participation in occupational
activities
Encourage patient to partake in activities of
civic organizations
Advise the family about the importance of
regular follow-up at the clinic
Make regular home visit
HERBAL MEDICINES
LAGUNDI
SKIN DISEASES
HEADACHE
ASTHMA, COUGH, FEVER /AROMATIC BATH
RHEUMATISM, SPRAIN, INSECT BITE
ECZEMA
DYSENTERY

ULASIMANG BATO
URIC ACID EXCRETION
Boil leaves and drink three times a day
May be eaten as salad three times a day

BAWANG
Hypertension
Fried
Roasted
Soaked in vinegar for 30 minutes
Blanched in boiling water for 5 minutes
Toothache
Pound a small piece and apply to affected part

BAYABAS
DIARRHEA
WASHING OF WOUNDS
GARGLE FOR TOOTHACHE
Warm decoction boiled for 15 minutes at low fire

YERBA BUENA
Swollen gums
Pain/pruritus
Insect bites
Toothache
Menstrual/gas pains
Arthritis
Nausea/fainting
Diarrhea

SAMBONG
ANTI-EDEMA
DIURETIC
ANTI-UROLITHIASIS
Boil chopped leaves in a glass of water for 15 minutes

AKAPULKO
ANTI-FUNGAL
Fresh, matured leaves are pounded and applied to
affected part

NIYUG-NIYOGAN
ANTI-HELMINTHIC
Seeds are taken 2 hours after supper
Give 2-3 doses with one week interval
Contraindicated to children below four years old

TSAANG-GUBAT
STOMACHACHE
Boil chopped leaves
DIARRHEA
Boil chopped leaves in 2 glasses of water for 15 minutes

AMPALAYA
DIABETES MELLITUS
Chop leaves and boil in water for 15 minutes

REMINDERS ON THE USE OF HERBAL MEDICINES
Boil in low heat and remove cover
One kind of plant for each type of symptom
No insecticides
Use clay pot and plant part advocated
Stop in case of untoward reactions / Seek
consultation if signs and symptoms not relieved
after 2-3 doses

NUTRITION PROGRAM FOR FILIPINOS
GOAL:
Improve quality of life of Filipinos through
better nutrition, improved health and increased
productivity
MALNUTRITION
It is a pathological state resulting from a
relative or absolute deficiency or excess of one
or more essential nutrients
CAUSES OF MALNUTRITION
Non-breastfeeding or early weaning
Dependence on artificial feeding
Absence of or inadequate complementary
feeding
Lack of or inadequate skill in managing diarrhea
at home
MARASMUS
Muscle wasting due to starvation
Extreme malnutrition and emaciation
(especially among children) from inadequate
intake of food or malnutrition
Due to a diet with a deficiency in protein and
carbohydrates
More frequent in children younger than 5 years
Can occur across all age groups
Causes: infection, nutrition and socio-
economic factors
SIGNS AND SYMPTOMS
Old mans face
Shrunken wasted appearance
Extreme growth failure
Marked wasting of muscles and subcutaneous
fat
Apathy (children seem to let themselves die)
KWASHIORKOR
Diseases that occur when the first child is
displaced from the breast by another child
Due to a diet which is very low in protein
It is not starvation but is due to an imbalanced
diet
Common among toddlers, 1 to 3 years old
Occurs most commonly in:
Areas of famine
Limited food supply
Low levels of education
Inadequate knowledge of proper diet
SIGNS AND SYMPTOMS
Moon face
Facial edema
Protuberant belly
Growth failure
Irritability
Lethargy or apathy
Hair: changes from black to brown, or brown to
yellow, thinning and brittle
Dermatosis, dryness of skin and desquamation
INTERVENTIONS TO PREVENT OR CONTROL
MALNUTRITION
Regular complementary feeding of protein
powders
Appropriate home management for diarrhea
FOOD FORTIFICATION
Food Fortification Act of 2000
Mandatory fortification of staple food:
Flour (Iron and Vitamin A)
Cooking oil (Vitamin A)
Refined sugar (Vitamin A)
Rice (Iron)
Sangkap Pinoy Seal
Voluntary fortification of processed foods
COMMON NUTRITIONAL DISEASES
Vitamin A
Iron
Iodine
XEROPHTHALMIA
SIGNS AND SYMPTOMS:
Mild irritation of the eye
Foreign body sensation
Sensitivity to light
Difficulty seeing at night

Target Preparation Dose/duration
Women 15-45
years old
Iodized oil
capsule with
200 mg
iodine
1 capsule for 1
year
Children of
school age
Adult males
SCHEDULE Infants 6-11
months
Pre-
schoolers 12-
83 months
Give today 100,000 IU 200,000 IU
Give tomorrow 100,000 IU 200,000 IU
Give after two
weeks
100,000 IU 200,000 IU

IRON DEFICIENCY ANEMIA

EXPANDED PROGRAM ON IMMUNIZATION
This was launched in July 1976 by the Department of
Health in cooperation with the World Health Organization
and the UNICEF
OBJECTIVE:
To reduce the morbidity and mortality among infants and
children caused by the seven immunizable diseases
THE EPI TARGET DISEASES
MEASLES
TUBERCULOSIS
DIPHTHERIA
PERTUSSIS
POLIOMYELITIS
NEONATAL TETANUS
HEPATITIS B
LEGAL BASIS
PD No. 996 (September 16, 1976)
- Providing for compulsory basic immunization for infants
and children below eight years old
RA 7846 (December 30, 1994)
- An Act requiring for the compulsory immunization
against hepatitis B for infants and children below eight
years old
PRINCIPLES OF EPI
- Based on epidemiological situation
- Mass approach is utilized
- Immunization is a basic health service
ELEMENTS OF EPI
Target-setting
Information, education and communication
Cold chain logistics and management
Assessment and evaluation of the programs overall
performance
Surveillance, studies and research
GENERAL PRINCIPLES ON IMMUNIZATION
1. It is safe and immunologically effective to administer
EPI vaccines on the same day at different sites of the
body
2. Measles vaccine should be given as soon as the child
is 9 months old, regardless of whether other vaccines
will be given on that day
3. The vaccination schedule should not be restarted from
the beginning even if the interval between doses
exceeded the recommended interval by months or years
FALSE CONTRAINDICATIONS TO VACCINATION
Moderate fever
Malnutrition
Mild respiratory infection
Cough
Diarrhea
Vomiting
4. It is safe to have mild side effects after vaccination.
Local reaction, fever and systemic symptoms can result
as part of the normal immune response
5. Strictly follow the principle of never, ever
reconstituting the freeze dried vaccines in anything other
then the diluent supplied with them
6. Use one syringe, one needle per child during
vaccination.
FULLY IMMUNIZED CHILD
One dose of BCG
3 doses of OPV
3 doses of DPT
3 doses of Hepatitis B
One dose of Measles
Before the childs first birthday
EPI VACCINES AND ITS CHARACTERISTICS
PROPER STORAGE: store vaccines in refrigerators
Target Preparation Dose/duration
Children 1-5
years old
Syrup
containing
30 mg
elemental
iron / 5 ml
1 tbsp OD for 3
months
30 mg once a
week for 6
months
Children 6-11
years old who
are anemic
and
underweight
Syrup
containing
30 mg
elemental
iron / 5 ml
2 tbsp once a
day for 6 months
DURATION:
RHO 3 Given 6 months
MHO / PHO 2 Given 3 months
BHS / RHU 1 Given 1 month
ADMINISTRATION OF VACCINES
BCG VACCINE
Age
At birth
Dosage
0.05 cc
Route
Intradermal
Site
Right deltoid
BCG VACCINE
Age
School entrants
Dosage
0.1 cc
Route
Intradermal
Site
Left deltoid
Wheal
Soreness and inflammation
Abscess
Ulceration
Scar
KOCHS PHENOMENON
Acute inflammatory reaction
Appears within 2-4 days of vaccination
Not serious and disappears rapidly
COMPLICATIONS OF BCG VACCINATION
DEEP ABSCESS due to injecting the vaccine
too deeply
EXCESSIVE ULCERATION ulcer present for
more than 12 weeks and more than 10 mm in
diameter
GLANDULAR ENLARGEMENT glands
draining at injection site may enlarge
KELOID thickened protruding scar

7. Repeat BCG vaccination if the child does not
develop a scar after the 1
st
injection.
8. Live vaccines like BCG vaccine must not be given
to individuals who are immunosuppressed due to
malignant disease.

ORAL POLIO VACCINE
Age
6 10 14 weeks
Dosage
2 gtts
Route
Per orem
Site
Mouth
Only vaccine with no side-effects
Instruct mother to keep the child on NPO for 30
minutes after OPV administration
If child spits it out, give another dose

HEPATITIS B VACCINE
Age
0-6-14 weeks
Dosage
0.5 cc
Route
Intramuscular
Site
Thigh
Side-effects: Soreness and inflammation
Management: Paracetamol RTC

DPT VACCINE
Age
6-10-14 weeks
Dosage
0.5 cc
Route
Intramuscular
Site
Thigh
Management: Paracetamol RTC
DPT 2 is contraindicated for a child who has had
convulsions within 3 days of the 1
st
DPT dose

9. Giving doses of a vaccine at less than the
recommended 4 weeks interval may lessen the
antibody levels
10. Lengthening the interval between doses of
vaccines leads to higher antibody levels
11. No extra doses must be given to children who
missed a dose of DPT/HB/OPV/TT. The vaccination
must be continued as if no time elapsed between
doses

MEASLES VACCINE
Age
9 months
Dosage
0.5 cc
Route
Subcutaneous
Site
Deltoid
Side-effects: Fever and mild rashes
Management: Paracetamol RTC (fever);
Diphenhydramine (rashes)

MATERNAL AND CHILD HEALTH PROGRAM
OVERALL ENCOMPASSING GOAL
Promotion and maintenance of optimal health of
women and their newborn
PHILOSOPHY
Pregnancy, labor and puerperium are part of the
total life cycle
Maternal and child nursing is family centered
HOME BASED MOTHERS RECORD
Used when rendering prenatal care
Guide in identification of risk factors and danger
signs in pregnancy
Aids in promoting appropriate measures in
pregnancy
PRENATAL CARE
- Important service that helps protect a mother and the
unborn child
- Chance for early detection of risk factors or diseases
that can cause maternal complications
1
st
visit: as early in pregnancy as possible
2
nd
visit: during 2
nd
trimester
3
rd
visit: during 3
rd
trimester
Every 2 weeks: after 8
th
month of pregnancy until
delivery
BASIC PRENATAL SERVICES
History taking
Physical examination
Treatment of diseases
Tetanus toxoid immunization
Iron supplementation
Health education
Laboratory examination
Oral/dental examination
STANDARD PRENATAL PHYSICAL EXAMINATION
- Weight, height and BP measurement
- Examination of eyes and palms for pallor
- Abdominal exam for fundic height, fetal position,
presentation and FHT
- Face,
- Neck exam for goiter
TETANUS TOXOID IMMUNIZATION
Mrs. Dela Cruz received the 1
st
booster dose on
November 20, 2004. When is the 2
nd
booster?
November 20, 2005
As a child, you have 3 doses of DPT. Now you
became pregnant. What do you need to
receive?
3 booster doses-only TT3, TT4 and TT5
If as a child, only 1 dose of DPT was given, is
there a definite immunity?
Theres no definite number of years of immunity.
If until 3 years she failed to receive the vaccine,
she has to start with the 1
st
dose
MALARIA INFESTED AREAS
Prophylaxis for pregnant
Chloroquine 150mg/tab
2 tablets per week for whole duration of
pregnancy
QUALIFICATIONS FOR HOME DELIVERY
Full term (9 months)
2
nd
to 4
th
delivery
Cephalic presentation
Pelvic adequacy
No premature rupture of membranes
Imminent delivery
CONTENTS OF THE HOME DELIVERY KIT
Sterilized scissors/razor blade
Sterile cord strings/cord clamps
2 pairs of forceps
2 sets of 2x 2 gauze
70% alcohol
Povidone iodine antiseptic
Soap and handbrush
Clean towel or piece of cloth
Flashlight
Sphygmomanometer
Stethoscope
Ophthalmic solution
RISK FACTORS FOR PREGNANCY
Age: under 18 and more than 35
Height: less than 4 feet (145 cm)
History of heart disease
2
nd
pregnancy
Previous normal delivery
Postpartum hemorrhage
Previous caesarian section
3 consecutive abortions
History of bronchial asthma
NURSING CARE AFTER DELIVERY
Each birth must be registered in the civil registry
The birth certificate should be filled out by the
attendant at birth
All newborns should be enrolled for Under Fives
and issued a Growth Monitoring Chart
POSTPARTUM VISIT FOR HOME DELIVERIES
1
st
visit: 1
st
week post partum, preferably
3-5 days
2
nd
visit: 6 weeks post partum
MOTHERS
Check for bleeding and infection
Check vital signs, breastfeeding practices
Postpartum counseling : birth spacing, cord
care, hygiene, breastfeeding, nutrition
NEWBORN
- Sucking reflex and breastfeeding practices
- Umbilical stump for bleeding and signs of
infection
- Pathologic jaundice and pallor

Immediate newborn care: silver nitrate 1 % or
tetracycline ointment
Eyes should be gently cleaned with cold boiled
water
Any abnormality should be reported to the
physician
The mother and birth attendant should
accompany the infant to the hospital
THE FAMILY PLANNING PROGRAM
Overall Goal: Provide universal access to family
planning information and services
Contribute to reduce:
Infant deaths
Neonatal deaths
Under-five deaths
Maternal deaths
FAMILY PLANNING METHODS
FEMALE STERILIZATION / BILATERAL TUBAL
LIGATION
ADVANTAGES
P ermanent
I ncreased sexual enjoyment
N o long term side effects / no effect on breastfeeding
S ex is not interfered
DISADVANTAGES
R eversal surgery is difficult, expensive and not
available
O perating room set-up required
L imitation in physical activities such as heavy work
and lifting
E ctopic pregnancy

MALE STERILIZATION / VASECTOMY
ADVANTAGES
P ermanent, safe, simple and easy to perform
E ffective 3 months after the procedure
N o effect on the male hormonal function, sexual ability
and ejaculation
DISADVANTAGES
R eversibility is difficult and expensive
U ncomfortable due to slight pain and swelling
B leeding may result in hematoma
PILL
INJECTABLES
- Contain synthetic hormone, progestin which
suppresses ovulation, thickens cervical mucus, making it
difficult for sperm to pass through and changes uterine
lining
ADVANTAGES
R eversible, rapid return to fertility
O varian and endometrial cancer have lower risk
M enstrual cycle becomes regular
E asy to use and convenient
S afe as proven through extensive studies
DISADVANTAGES
S ide effects: nausea, dizziness or breast tenderness
O ffers no protection against sexually transmitted
infections
C an suppress lactation
O ften not used correctly and consistently

MALE CONDOM
ADVANTAGES
S afe and has no hormonal effect
E asily accessible
E ncourages male participation in family planning
P rotects against microorganisms causing STIs /HIV
DISADVANTAGES
R equires a mans cooperation for its use
A llergy for people who are sensitive to latex or
lubricant
I nterrupts the sexual act
D ecrease sensation, making sex less enjoyable

LACTATIONAL AMENORRHEA METHOD (LAM)
Temporary introductory postpartum method of
postponing pregnancy based on physiological
infertility experienced by breastfeeding women

ADVANTAGES
U niversally available to all postpartum breastfeeding
women
DISADVANTAGES
C onsidered as an introductory, short-term FP method
E ffective only for a maximum of 6 months postpartum
F ull or nearly full breastfeeding may be difficult to
maintain for up to 6 months

CERVICAL MUCUS METHOD / BILLINGS METHOD
ADVANTAGES
C an be used by any woman of the reproductive age
DISADVANTAGES
C annot be used by women with unusual disease or
condition that results in extraordinary vaginal discharge
that makes observation difficult

BASAL BODY TEMPERATURE
ADVANTAGES
E ffective, safe, inexpensive, no side-effects
DISADVANTAGES
I naccurate temperature readings can cause failure in
using BBT

SYMPOTHERMAL METHOD
ADVANTAGES
S - afe, inexpensive
C an be used by any woman
A cceptable to couples
DISADVANTAGES
C an become unreliable for women with abnormal
cervical secretions, inaccurate temperature reading

MISCONCEPTIONS ABOUT FAMILY PLANNING
METHODS
Some family planning methods causes abortion
Using contraceptives will render couples sterile
Using contraceptive methods will result to loss of
sexual desire
ENVIRONMENTAL HEALTH AND SANITATION
ENVIRONMENTAL HEALTH
- Branch of public health that deals with the study of
preventing illnesses by managing the environment and
changing peoples behavior to reduce exposure to
biological and non-biological agents of disease and
injury
ENVIRONMENTAL SANITATION
- The study of all factors in mans physical environment,
which may exercise a deleterious effect on his health,
well-being and survival
IMPORTANCE OF ENVIRONMENTAL SANITATION
It promotes health
It prevents disease transmission
It eliminates breeding places of insects and
rodents that carry the germs
ENVIRONMENTAL SANITATION
Water Supply Sanitation
Solid Waste Management
Food Sanitation
Insect and Vermin Control
Excreta and Sewerage Disposal
Housing and Public Places Sanitation
Environmental Protection
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
OFFICE (EOHO)
Under the National Center for Disease
Prevention and Control Program of the DOH
Responsible for the promotion of healthy
environmental conditions and prevention of
environmental related diseases through
appropriate sanitation strategies
STRATEGIES
Water quality surveillance
Evaluation of food establishments
Proper solid and liquid waste management
Sanitation of public places
Sanitation management of disaster areas
Diarrheal diseases: ranked first in the leading
causes of morbidity among the general population
SANITATION-RELATED DISEASES
Tuberculosis
Intestinal parasitism
Schistosomiasis
Malaria
Dengue
Filariasis

Approved types of water supply facility
LEVEL 1 POINT SOURCE
- Protected well/spring with an outlet without
distribution system
- Serves around 15 to 25 households
- Should not be more than 250 meters from its
farthest user
- Yield or discharge from 40 to 140 liters per
minute
LEVEL 2 COMMUNAL FAUCET SYSTEM / STAND
POSTS
- Composed of a source, a reservoir, a piped
distribution network and communal faucets
- Located not more than 25 meters from farthest
house
- Average of 100 households, with one faucet per
4 to 6 household
LEVEL 3 WATERWORKS SYSTEM / INDIVIDUAL
HOUSE CONNECTIONS
- A system with a source, a reservoir, a piped
distribution network and household taps
- Suited for densely populated urban areas
UNAPPROVED TYPES OF WATER SUPPLY
Open dug wells
Unimproved springs
Wells that need priming
DISINFECTION OF WATER SUPPLY SOURCES ARE
REQUIRED ON THE FOLLOWING:
Newly constructed water supply facilities
Water supply facility that has been
repaired/improved
Water supply sources found to be positive
bacteriologically by laboratory analysis
Container disinfection of drinking water collected
from a water facility that is subject to
recontamination like open dug wells,
unimproved springs and surface water
METHOD OF WATER DISINFECTION
Boiling: minimum of 3 minutes to maximum of 10
minutes, average 5 minutes
Sterilization: 30 minutes after water starts to boil
Filtration: use of filter paper or cotton cloth to
separate solid particle from liquid water
Coagulation/Flocculation: uses aluminum crystal that
collects or absorbs particles from the liquid part and
becomes slimy
Chlorination: use 100% pure concentrated chlorine
Flouridation: adding flouride to prevent dental caries
and whitens enamel of teeth
SAFETY OF DRINKING WATER
- Rural Sanitary Inspector: permit for deep well
construction
- Secretary of Health (or his representative):
certification of potability of an existing water
source
- Sanitary Engineer: examination of drinking water
APPROVED TYPES OF TOILET FACILITY
LEVEL 1
Non water carriage toilet facility
Ex. Pit latrines, reed odorless earth closet
Toilets requiring small amt of water
Ex. Pour flush, aqua privies
LEVEL 2
Water-sealed
Flush type
Septic vault/Tank disposal
LEVEL 3
Water carriage types of toilet facilities
Connected to septic tanks
Connected to sewerage system or treatment
plants

FOOD SANITATION PROGRAM
Inspection/approval of all food sources,
containers, transport vehicles
Compliance to sanitary permit requirements for
all food establishments
Provision of updated health certificate for food
handlers, cook and cook helpers
Monitoring for the presence of:
Intestinal parasites
Amoeba
Typhoid fever
Cholera
Dysentery
Destruction or banning of food unfit for human
consumption
Training of food handlers and operators on food
sanitation
Food establishments
Class A Excellent
Class B Very satisfactory
Class C - Satisfactory
FOUR RIGHTS IN FOOD SAFETY
Right source
Right preparation
Right cooking
Right storage
Rule in food safety: When in doubt, throw it
out!
ENVIRONMENTAL LAWS
PD 856: SANITATION CODE OF THE PHILIPPINES
- Provides for the control of all factors in mans
environment that affect health including quality of water,
food, milk, control of insects, animal carriers
RA 8749: CLEAN AIR ACT OF 1999
- Comprehensive air pollution management and control
- Smoke emission standards for vehicles
- Banning of smoking
RA 9003: ECOLOGICAL SOLID WASTE
MANAGEMENT ACT OF 2000
- Waste diversion through composting and recycling
RA 9275: CLEAN WATER ACT OF 2004
- Waste water treatment facilities that will clean water
before releasing into rivers and seas

EPIDEMIOLOGY, DEMOGRAPHY AND VITAL
STATISTICS
- Study of the occurrence and distribution of health
conditions such as disease, death, deformities or
disabilities on the population
- Study of the spread of disease in a group of individuals
as in public health
- Backbone of the prevention of disease

PRESENTATION OF DATA AFTER
EPIDEMIOLOGICAL INVESTIGATION
BAR GRAPH for comparisons
PIE CHART show breakdown
SCATTERED DIAGRAM for correlation
LINE GRAPH show trend data

ECOLOGIC TRIAD
AGENT any element, substance or force, either
animate or inanimate, the presence or absence of which
may serve as stimulus to initiate or perpetuate a disease
process
HOST any organism that harbors and provides
nourishment for another organism
ENVIRONMENT sum total of all external conditions
and influences that affect the life and development of an
organism

DISEASE DISTRIBUTION
EPIDEMIC situation when there is a marked upward
fluctuation in disease incidence
ENDEMIC implies the habitual presence of disease in
a given geographic location accounting for the low
number of both immune and susceptibles
SPORADIC when disease occurs every now and then
affecting only a small number of people relative to the
total population
PANDEMIC worldwide, international, universal, global
in occurrence
National epidemic sentinel surveillance system
(NESSS)
- Hospital based information system that monitors the
occurrence of infectious diseases with outbreak potential
Diseases under Surveillance
Typhoid fever
Malaria
Cholera
Dengue Hemorrhagic fever
Meningococcal disease
Rabies

DEMOGRAPHY
- science which deals with the study of the human
populations size, composition and distribution in space

CENSUS
- Official and periodic enumeration of the population
DE JURE METHOD people are assigned to the place
where they usually live
DE FACTO METHOD assigned to the place where
they are physically present

SAMPLE SURVEY
- Demographic information is collected from a sample of
a given population

REGISTRATION SYSTEMS
- Vital events in the community: birth, death, separation
- LOCAL CIVIL REGISTRAR Municipal Treasurer or
Municipal health officer

POPULATION COMPOSITION
SEX RATIO
- Number of males for every 100 females in the
population
Number of males x 100
Number of females

DEPENDENCY RATIO
- Number of economically dependent with the
economically productive group
Economically dependent: 0-14 and 65 years and above
Economically productive: 15 to 64 years old
Economically dependent x 100
Economically productive

POPULATION DISTRIBUTION
POPULATION DENSITY
- Determine how congested a place and implications on
adequacy of health services
Number of people living in an area
Total land area

CROWDING INDEX
- Describes the ease by which a communicable disease
will be transmitted from one host to another susceptible
host
Number of persons living in a household
Number of rooms used for sleeping

DEMOGRAPHIC PROFILE
Average life expectancy: 68.6 years
Dependency ratio: 79
249 people for every square kilometer of
Philippine territory
Metro Manila highest population density
CAR lowest population density

VITAL STATISTICS
- Systematic study of vital events such as birth, illnesses,
marriages and death
- Application of statistical methods and techniques in the
study of vital facts

INFANT MORTALITY RATE
Total number of death under 1 year of age registered in
a given calendar year
Total number of registered live births of same calendar
year

MATERNAL MORTALITY RATE
Total number of deaths from maternal causes registered
for a given year
Total number of registered live births of same calendar
year

FETAL DEATH RATE
Total number of fetal deaths registered in a given
calendar year
Total number of registered live births of same calendar
year

NEONATAL DEATH RATE
Number of deaths under 28 days of age registered in a
given calendar year
Total number of registered live births of same calendar
year

TUBERCULOSIS
- Highly infectious chronic disease caused by the
tubercle bacilli
- Primarily a respiratory disease
- Can also affect other organs of the body
- Common among malnourished individuals living in
crowded areas
- Often occurs in children in the form of primary complex

SIGNS AND SYMPTOMS
Cough of two weeks or more
Fever (low grade, afternoon)
Chest or back pain not referable to any
musculoskeletal disorders
Hemoptysis or recurrent blood-streaked sputum
Significant weight loss
Other s/sx: sweating, fatigue, body malaise and
shortness of breath

Infectious agent
Mycobacterium tuberculosis
Mycobacterium africanum
Mode of Transmission
Airborne droplet: coughing, singing or
sneezing
Direct invasion through mucous
membranes or breaks in the skin

DIAGNOSTIC TESTS FOR TUBERCULOSIS
MANTOUX TEST
Screening test
Positive: indicates exposure
PPD
ID
5 mm
10 mm
>10 mm to 15 mm
Result: after 48-72 hours
SPUTUM EXAM
Confirmatory exam for TB
Early morning specimen
15 ml required
Rinse mouth
Sterile container
Sputum AFB
Oral hygiene after
CHEST X-RAY
Determines severity of the lesions
Pregnancy
Lead shield
Inhale deeply and hold breath
Remove metals from chest
SUSCEPTIBILITY AND RESISTANCE
- The most hazardous period for development of clinical
disease is the first 6 to 12 months after exposure to the
bacilli.
- The risk of developing disease is highest in children
under three years old.
- The susceptibility to disease is markedly increased in
those with HIV infection or other forms of
immunosuppression, underweight, diabetes and
substance abusers.

NATIONAL TUBERCULOSIS CONTROL PROGRAM
GENERAL OBJECTIVE:
To control tuberculosis which is a public
health problem
SPECIFIC OBJECTIVES:
To vaccinate with BCG the eligible population
under EPI
To identify at least 45% the prevalence of
infectious cases annually
To treat effectively and adequately all sputum
positive cases
DIRECT OBSERVED TREATMENT SHORT COURSE
(DOTS)
Comprehensive strategy which is being used by
primary health services around the world to
detect and cure TB patients
Liberation of the treatment of PTB wherein
treatment is domiciliary (home setting)
KEY POLICIES
Direct Sputum Smear Microscopy (DSSM)
primary diagnostic tool in NTP case finding
All TB symptomatics asked to undergo DSSM
for diagnosis before start of treatment
HEMOPTYSIS only contraindication for
sputum collection
No TB diagnosis shall be made based on results
of X-ray examination or PPD skin test
TWO FORMULATIONS OF ANTI-TB DRUGS
Fixed-dose combination (FDCs)
Two or more first-line anti-TB drugs are
combined in one tablet
Single drug formulation (SDF)
Each drug is prepared individually
INH, ethambutol and pyrazinamide:
tablet form
Rifampicin: capsule form
LEPROSY TODAY
At the beginning of 2003, the number of leprosy patients
in the world was around 534,000, as reported by 110
countries. About 620 000 new

According to the World Health Organization,
approximately 4,277 cases of leprosy are registered in
the Philippines. *

Nearly 80,000 Filipinos have been cured with Multi Drug
Therapy (MDT) since it was implemented last 1989.

Definition
A chronic systemic infection characterized by
progressive cutaneous lesions
Etiologic Agent
Mycobacterium leprae
Incubation Period
5 months-8 years
Mode of transmission
Contact
Droplet

Slit Skin Smear (SSS)
Done when clinical diagnosis is doubtful
Main objective: prevent misclassification
and wrong treatment
EARLY SIGNS AND SYMPTOMS OF LEPROSY
Change in skin color (reddish or white)
Absence of sensation on the skin lesion
Loss of sweating and hair growth on the
lesion

LATE SIGNS AND SYMPTOMS OF LEPROSY
Loss of eyebrows (madarosis)
Inability to close eyelids (lagophthalmos)
Clawing, Contractures, Chronic ulcers
Enlargement of male breast (gynecomastia)
Sinking of the nosebridge

MANAGEMENT/TREATMENT OF LEPROSY
Ambulatory chemotherapy through the use of multi-drug
therapy
Domiciliary treatment as embodied in RA 4073 which
advocates home treatment
MULTI-DRUG THERAPY (MDT) use of 2 or more
drugs for the treatment of leprosy. It is proven effective
cure for leprosy and renders patients non-infectious one
week after starting treatment
DAPSONE: drug of choice for monotherapy
Multidrug Therapy for adults

TREATMENT COMPLETION
A patient on PB regimen should take
6 blister packs within 9 months.
A patient on MB regimen should take
12 blister packs within 18 months.
At the end of this duration, the patient should be
considered as
Treatment Completed (TC).

TREATMENT COMPLETION
A Leprosy patient who has completed treatment should
no longer be regarded as a case of leprosy, even if
some effects of leprosy remain (e.g. ulcers, deformities)
Patient with special needs
PREGNANCY
the standard regimens are considered safe to both the
mother & child and therefore should be continued during
pregnancy



TUBERCULOSIS
since Rifampicin doses for Tuberculosis are larger than
for leprosy MDT regimen, remove the Rifampicin
capsules from the MDT blister packs for the duration of
the TB therapy & give the Clofazimine & Dapsone
together with the TB regimen. When the TB treatment is
completed, resume the prescribed MDT regimen.

Monitoring progress
Clinical progress is assessed during the monthly clinic
visit of the patient to collect the blister pack. During the
visit, the health worker concerned (MHO/PHN/RHM)
should note & record the following:

- Changes in the character of the lesion (Color,
extent, etc)
- Pain in the eyes, changes in the color of the
sclera & conjunctiva
- New disabilities or progression of previous
disabilities
- Nerve damage in the form of:
- Nerve pain, loss of sensation
& loss muscle strength
- painless wounds, or blisters, or an area of
insensitivity
- difficulty in performing simple tasks like holding
a pen, buttoning a shirt, or weaknesses or loss
of skill

RELAPSE
is the recurrence of Leprosy after successful completion
of treatment
characterized by the occurrence of new lesion
very rare & confirmed by a laboratory