COMMUNITY HEALTH NURSING

What is a community ?
- a group of people with common characteristics or interests living together within a
territory or geographical boundary
- place where people under usual conditions are found

What is community health ?

- part of paramedical and medical intervention/approach which is concerned
on the health of the whole population
- aims:
1. health promotion
2. disease prevention
3. management of factors affecting health

What is nursing ?
- assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness.

What is Community Health Nursing ?

“The utilization of the nursing process in the different levels of clientele-individuals,
families, population groups and communities,
concerned with the promotion of health, prevention of disease and disability and
rehabilitation.”
- Maglaya, et al
-
BASIC PRINCIPLES OF CHN

• COMMUNITY is the patient in CHN.

• FAMILY is the unit of care.
• The client is considered as an ACTIVE partner NOT PASSIVE recipient of
care.
• The goal of CHN is achieved through MULTI-SECTORAL EFFORTS.
• CHN is a part of health care system and the larger human services system.

HEALTH TEACHING is a primary responsibility of a CHN nurse

• CHN must be available to all regardless of race, creed and socioeconomic
status.
• The CHN Nurse makes use of available community health resources.
• There must be provision for periodic evaluation of CHN services.

Roles of the PUBLIC HEALTH NURSE

• CLINICIAN, who is a health care provider, taking care of the sick people at
home or in the RHU
• HEALTH EDUCATOR, who aims towards health promotion and illness
prevention through dissemination of correct information; educating people
• FACILITATOR, who establishes multi-sectoral linkages by referral system
• SUPERVISOR, who monitors and supervises the performance of midwives

FIVE FOLD MISSION OF CHN

1. Health promotion
2. Health protection
3. Health balance
4. Disease prevention
5. Social justice
COMMUNITY HEALTH NURSING PROCESS

A. Assessment
1. Initiate contact
2. Demonstrate caring attitude
3. Mutual trust and confidence
4. Collect data from all possible sources
5. Identify health problems

Categories:

Health deficit- occurs when there is a gap between actual and achievable
health status.
Health threats- conditions that promote disease or injury and prevent
people from realizing their health potential.
Foreseeable crisis- includes stressful occurrences such as death or
illnesses of a family member.
Health need- exists when there is a health problem that can be alleviated
with medical or social technology.
Health problem- is a situation in which there is a demonstrated health
need.

6. Assess coping ability.

7. Analyze and interpret data.

B. Planning
1. Prioritize needs.
2. Establish goals based on needs and capabilities .
3. Construct action and operational plan.
4. Develop evaluation parameters.

C. Implementation of Planned Care

1. Put plan into action
2. Coordinate care/ services
3. Utilize community resources
4. Delegate, supervise and monitor services provided
5. Document responses to nursing actions
D. Evaluation of care and services rendered
1. Monitor outcomes
2. Performance appraisal
3. Estimate cost benefit ratio
4. Assessment problems
5. Identify needed alterations
6. Revise plan as needed

MODERN CONCEPT OF HEALTH

- Refers to the optimum level of individuals, families and communities
FACTORS AFFECTING OLOF: BHHEPS
• Behavioral
• Heredity
• Health Care delivery system
• Environment
• Political
• Socio-economic
TEN DETERMINANTS OF HEALTH

1. Gender
2. Genetics
3. Education
4. Employment
5. Culture
6. Health services
7. Income
8. Personal behavior
9. Physical environment
10. Social support network

COMMUNITY HEALTH NURSING

GOAL: To raise the health of the citizenry.

Main activity: Health teaching (health promotion)

PHILOSOPHY: Worth and dignity of man.

DEPARTMENT OF HEALTH

VISION:

The DOH is the leader, staunch advocate and model in promoting Health for All in
the Philippines.

MISSION:

NEW- guarantee equitability, sustainability and quality of life for all Filipinos
especially for the poor and shall lead the quest for excellence in heath

OLD: ensure accessibility and quality of life, for all Filipinos especially the poor

GOAL: Health Sector Reform Agenda (HSRA)

Framework for implementation of HSRA: FOURmula ONE for Health

GOALS of FOURmula ONE for Health: (BEM)

1. Better health outcomes
2. Equitable health care financing
3. More responsive health systems

FOUR elements of the strategy:

• Health Care Financing
• Health regulation
• Health service delivery
• Good health governance

ROLES OF DOH (LEA)

1. Leadership in Health
2. Enabler and Capacity Builder
3. Administrator of specific services
PRIMARY HEALTH CARE

GOAL: Health for all Filipinos in the year 2000 and in the hands of the people in the
year 2020

MISSION: Strengthen health care delivery system

5 STAKEHOLDERS OF HEALTH

1. LGU
2. DOH
3. Philhealth Insurance Corporation
4. Communities
5. NGO’s

NURSING ROADMAP

- Originated 2007
- Transformation Program of Nursing Profession
- adopted from Public governance system (PGS), as instituted by Institute for
Solidarity in Asia (ISA)

June 5, 2008 - signing of the nursing roadmap by the COORDINATING BODY FOR
GOOD GOVERNANCE OF THE NURSING PROFESSION (CBGGNP) and
PHILIPPINE NURSNG ORGANIZATION (PNA)

Association of Deans of Philippine College of Nursing (ADPCN)- minor player

for nursing roadmap.

VISION:
By 2030, the Philippines shall be the lead in promoting professional nursing in the
Asia Pacific Region.

MISSION: We, the Filipino nurses are committed to provide society with professional
nursing service through innovations in education and training, research and
management that will improve the well-being and quality of life

BALANCED SCOREBOARD

- implementation of nursing roadmap

- Developed by OHNAP for executing the Nursing Roadmap

4 BROAD PERSPECTIVES:
1. Learning and Growth
2. Internal processes
3. Customer perspectives
4. Financial perspectives

STRATEGIC OBJECTIVES
DSL GG

1. Dynamic leaders
2. Standards
3. Good governance
4. Linkages
5. Growth and Productivity
NATIONAL HEALTH PLAN

- The blueprint defining the country’s: PPST PROBLEMS, POLICY THRUSTS,

STRATEGIES and THRUSTS
- Caters from 1995-2020
- A long term directional plan for health.

GOAL: To enable the Filipino to achieve a level of health that is accessible.

OBJECTIVE: Equity- Achieve “ Health for all by year 2020”

PRIMARY HEALTH CARE- strategy of NHP

MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE

IN THE YEAR 2020”

“23 IN 1993”
• refers to the 23 programs, projects, activities of the DOH for the year 1993,
which marks the beginning of its journey towards DOH vision
“Health for more in ‘94”
• activities in 1994 focused on Cancer prevention, Reproductive health,
• Mental health and maintenance of a safe environment

“Health Focus in 1995”… “Think Health, Health Link”

In lieu of “Five in ‘95”, DOH characterized what a…
Healthy __________________ should be:

BARRIO► Residents actively participate in attaining good health; they are

• PARTNERS in health care
• Highlight Project: BOTIKA SA PASO CAMPAIGN
Goal : to maintain herbal plants in pots for family use

CITY
► The physical environment in the workplace, streets, and public places promotes
health, safety, order, and cleanliness through structural manpower support
• Health-related Strategies: Construction of well-maintained, income-generating
public toilets; designation of a “Pook-Sakayan, Pook-Babaan”

MARKET
► adequate water supply
► proper drainage
► well-maintained toilet facilities
► proper garbage and waste disposal is observed by vendors
► cleanliness maintained
► affordable quality foods
► has a well-organized and honest market system

HOSPITAL
► A “CENTER OF WELLNESS”
► Promotes preventive care
► provides clean and adequate resources, affordable and accessible
services
► Patient-centered
► Governed by competent health team members and personnel
SCHOOL
► Health instructions provided through classroom/extra-curricular activities
► Maintains adequate, basic health services to both pupils, teachers, and
other personnel
Sample School Initiative : Little Doctor Program
- outstanding students are chosen yearly on the bases of their healthy
conditions and lifestyles

STREET
► Well-maintained roads and public waiting areas
► Well-marked traffic signs and pedestrian crossing lane and visible street
names
► Clean and obstruction-free sidewalks
► With minimal traffic problems
► With adequate strict law enforcement

Project: Pook-Tawiran (Kapag ikaw ay nahuli, walang sisihan)

Goal : To promote and reorient people especially erring pedestrians on the use
of pedestrian crossings.

PRISON
► Physical Environment: clean, safe detention place with adequate facilities
► Psychosocial Environment: services address the mental, spiritual, physical, social
and economic needs of inmates; has an atmosphere that actively promotes
JUSTICE, PEACE, REHABILITATION and a HEALTHY LIFESTYLE

PRIMARY HEALTH CARE

• PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to

community health development. It is a strategy aimed to provide essential
health care that is:
• Community-based
• Accessible
• Part and parcel of the total socio-economic development effort of the nation
• Acceptable
• Sustainable at an affordable cost.

Framework
 People’s Empowerment and Partnership is the
Key Strategy to achieve the goal, “Health For all Filipinos by the year 2000 And
Health in the Hands of the People by the year 2020”

4 PILLARS OF PHC: (MAPS)

1. Multi-sectoral approach
2. Appropriate technology
3. Participation active
4. Support system available
3 LEVELS OF PREVENTION

PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL

Health Promotion and Prevention Prevention of Disability,etc
Illness ofComplications thru
Prevention EarlyDx and Tx
Provided at – When hospitalization When highlyspecialized
► Health care/RHU is deemed necessary and medical care is necessary
► Brgy. Health Stations referral is made to ► referrals are made to
►Main Health Center emergency (now hospitals and medical center such as PGH,
►Community Hospital and district), provincial or PHC, POC, National
Health Center regional or private Center for Mental Health, and other gov’t private
►Private and Semiprivate hospitals hospitals at the municipal level
agencies hospitals

TYPES OF PRIMARY HEALTH WORKERS

Village/Grassroots Health Workers Intermediate Level Health Personnel

of First-Line
Hospitals
EXAMPLE • Trained Community • General • Physicians with
Health worker; Medical specialty area
• health Auxiliary Practitioners • Nurses
volunteer; • Public Health • Dentists
• Traditional Birth Nurses
Attendant • Midwives

CHARACTERISTICS • Initial link, 1st contact • 1st source of • Establish

of the Community professional close contact
• Work in liaison w/ the health care with the village
local health service • Attend to health and
workers problems intermediate
• Provide elementary beyond the level health
curative preventive competence of workers to
health care measures village health promote the
Workers continuity of
• Provide support acre from
to hospital to
the frontline health community to
workers in terms of home
supervision, training, • Provide back-up
referral services and health services
supplies thru linkages for cases
with other sectors requiring
hospital or
diagnostic
facilities not
available in
health care.
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?

Acronym: ELEMENTS + DAM

• Education of prevailing Health Problems
• Locally-endemic Disease Prevention and Control
• Expanded Program of Immunization
• Maternal and Child Health and Family Planning
• Environmental Sanitation and Safe Water Supply
• Nutrition and Food Supply
• Treatment of Communicable & Non-communicable Diseases/ Conditions
• Supply and Proper use of Essential Drugs and Herbal Medicine
• Dental Health Promotion
• Access to and use of hospitals as Centers of Wellness
• Mental Health Promotion

MILLENIUM DEVELOPMENTAL GOALS

-Formulated in the year 2000 by the UN general assembly.

PEGCMMEG
• Poverty eradication(2015)
• Education
• Gender equality
• Child mortality to decrease
• Malaria/AIDS to combat
• Maternal health
• Environment sustainability
• Global partnership

Expanded Program on Immunization

Goal: morbidity and mortality reduction of immunizable diseases

• LEGAL BASIS- PD 996-Compulsary, Basic Immunization for children 8 years
old and below (0-8 y/o), thus covers 2 age groups - infants
WEDNESDAY- designated as IMMUNIZATION DAY
ELEMENTS OF EPI:
• Target setting
• Information, education and communication
• Cold chain logistic management
• Surveillance and evaluation

PRINCIPLES IN VACCINATING CHILDREN

• It is safe and immunologically effective to administer all EPI vaccines on the

same day at different sites of the body.
• The vaccination schedule should not be restarted from he beginning even if
the interval between doss exceeded the recommended intervals by months or
years.
• Giving doses of a vaccine at less than the recommended 4 weeks interval
may lessen the antibody response. Lengthening the interval between doses of
vaccine leads to higher antibody levels.
• No extra doses must be given to children/mother who missed a dose of
DPT/HB/OPV/TT. The vaccination must be continued as if no time had
elapsed between doses.
• It is safe and effective with mild side effects after vaccination. Local reaction,
fever and systemic symptoms can result as part of the normal immune
response.
• Use one syringe one needle per child during vaccination.
Schedule:

• At birth: BCG
• 1 ½ months: First doses of DPT, Hep B, OPV
• 2 ½ months: Second doses of DPT, Hep B, OPV
• 3 ½ months: Third doses of DPT, Hep B, OPV

Tetanus Toxoid:

• First Pregnancy: TT1- 5th to 6th mo of pregnancy, after 4 weeks TT2 (3 years
immunity)
• Second Pregnancy: TT3 (1st booster dose) – 5th to 6th (5 years immunity)
• Third Pregnancy: TT4 (2nd booster dose) – 5th to 6th (10 years immunity)
• Fourth Pregnancy: TT5 (3rd booster dose) – 5th to 6th (life-long long
immunity)

Administration:

• BCG: (infants) 0.05 ml intradermal

• (school entrants) 0.10 ml intradermal
• DPT: 0.5 ml intramuscular
• Hepa B: 0.5 ml intramuscular
• OPV: 2 drops per orem
• Measles: 0.5 ml subcutaneous
• Tetanus toxoid: 0.5 ml intramuscular

TARGET-SETTING

• involves the calculation of the eligible population. “Eligible population consists

of any group of people targeted for specific immunizations due to their
susceptibility to one or several of the EPI diseases.”

VACCINE COMPUTATION:

I. Compute for the eligible population=

Total population x :
Infant/school age= 0.03
Pregnant woman= 0.035
Polio outbreak= 11.5
Measles outbreak= 14.5

II. Determine Annual Dose-doses required in a year for complete coverage

AD = EP x

BCG- 1
OPV-3
HB-3
MEASLES-1
TT-5

III. Determine Wastage Allowance

Wastage Dose = Annual Dose x % wastage allowance
AD X
BCG e, DPT/TT,OPV} 1.67
HB- 1.2
M-2
BCG I- 2.5
IV. COMPUTED ALLOWANCE=
Wastage allowance
# of recipients
All vaccines are 20 except BCG E, MEASLES= 10
OPV=25

V. OVERALL TOTAL= CA X 1.25

After rounding off, always add 1

COLD CHAIN

A system used to maintain the potency of a vaccine from that of manufacture to

the time it is given to child or pregnant woman.
Principles:
I. Storage
Storage of vaccine should not exceed:
• - 6 mos. @ the Regional Level
• - 3 mos. @ the Provincial Level/District Level
• - 1 mo. @ Main Health Centers (with refrigerators)
• - not more than 5 days @ Health Centers (using transport boxes)

Important points to remember:

Arranging of stored vaccine according to :
• Type
• Expiration date
• Duration of Storage
• # of times they have been brought out to the field

EPIDEMIOLOGY

- Backbone in the prevention of the disease.

- the study of occurrence and distribution of a disease as well as the distribution
and determinants of health states or events in a specified population
-
The EPIDEMIOLOGIC TRIANGLE:

Agent- the intrinsic property of microorganisms to survive and multiply in the

environment to produce disease
Host- (intrinsic factors)- influences exposure, susceptibility or response to agents
Environment- (extrinsic factors)- influences the existence of the agent, exposure,
or susceptibility to agent.

OUTLINE PLAN FOR EPIDEMIOLOGICAL INVESTIGATION

1. Establish fact of the presence of epidemic

• Verify diagnosis- do clinical and laboratory studies t confirm the data
2. Establish time and space relationship of the disease
• Are the cases limited to or concentrated in any particular geographical
subdivision of the affected community?
• Relation of cases by days of onset to onset of the first known cases- maybe
done by days, week or months.
3. Relations to characteristic of the group of community
• Relation of cases to age, group, sex, color, occupation, school attendance,
past immunization
• Relation to milk and food supply
• Relation of cases and known carriers if any
4. Correlation of all data obtained
• Summarize the data clearly with the aid of such tables and charts which are
necessary to give a clear picture of the situation
• Build up the case for the final conclusion carefully utilizing all the evidence
available.

STAGES OF A DISEASE: BACKBONE TO CONTROL A DISEASE

• Incubation period- exposure to an infection to the appearance of the first

symptom
• Prodromal period- from the appearance of the first symptom to the
appearance of a pathognomonic sign
• Stage of illness- a stage where the patient manifest most of the signs and
symptoms
• Convalescence- stage of recovery, and a gradual decrease of symptoms
manifested

Patterns of Disease Occurrence

• Epidemic-high incidence of new cases of a specific disease in excess of the

expected.
• Endemic- habitual presence of a disease.
• Sporadic- disease occurs every now and then.
• Pandemic- global occurrence of a disease

National Epidemic Sentinel System (NESS)

- hospital-based information system that monitors the occurrence of infectious
diseases with outbreak potential.

Why is there a need to investigate an outbreak?

1. Control and prevention measure
2. Severity and risks to others
3. Research opportunities
4. Public, political and legal concerns
5. Program consideration
6. training

VITAL STATISTICS

Refers to the systematic study of vita events such as births, illnesses, marriages,
divorce, separation and deaths.
RATE- the relationship between a vital event and those persons exposed to the
occurrence of the said event
RATIO- the relationship between two numerical quantities or measures of events
without taking particular consideration to the time or place.

USE OF VITAL STATTISTICS:

1. Indices of the health and illness status of the community
2. Serves as the bases for planning, implementing, monitoring and evaluating
community health nursing programs and services
SOURCES OF DATA:
1. Population census
2. Registration of vital data
3. Health survey
4. Studies and researches
CRUDE OR GENERAL RATES- refers to the total living population
SPECIFIC RATE- the relationship for a specific population class or group
CRUDE BIRTH RATE- natural growth or increase of a population
CBR- Total # of live births in a given calendar year
Estimated population as July 1 of same year x 1,000

CRUDE DEATH RATE

CDR- Total # of deaths in a given calendar year
Estimated population as July 1 of same year x 1,000

INFANT MORTALITY RATE- a good index of the general health condition of a

community.
IMR- Total # of death under 1 year of age registered in a given year
Total # of live births of the same calendar year x 1,000

MATERNAL MORTALITY RATE- an index of the obstetrical care needed and

received by women in a community
MMR- Total # of deaths from maternal causes registered in a given year
Total # of live births of the same calendar year x 1,000

FETAL DEATH RATE- measures pregnancy wastage

FDR- Total # of FETAL deaths registered in a given year
Total # of live births of the same calendar year x 1,000

NEONATAL DEATH RATE- an index of the effects of prenatal care and

obstetrical management of the newborn
NDR- Total # of deaths under 28 days of age registered in a given year
Total # of live births of the same calendar year x 1,000

SPECIFIC DEATH RATE

SDR- Deaths in specific class or group registered in a given calendar year x
100,000
Estimated population as July 1 of same specified class or group of the sad
year
EXAMPLES: CSDR, ASDR, SSDR

CSDR- # of deaths from a specific cause registered in a given calendar year

Estimated population as July 1 of same year x 100,000

ASDR- # of deaths in particular age group registered in a given calendar year

Estimated population as July 1 of same year x 100,000

SSDR- # of deaths in certain sex registered in a given calendar year

Estimated population as July 1 of same year x 100,000

ATTACK RATE- a more accurate measure of the risk of exposure

AR- # of persons acquiring a disease
# of exposed to same disease in same year x 100

INCIDENCE RATE- measures the frequency of occurrence of the phenomenon

during a given period of time
IR- # of new cases of particular disease during a specified period of time
Estimated population as of July 1 of the same year x 100,000
PREVALENCE RATE
PR- # of new and old cases of a certain disease during a specified period of
time
Total # of persons examined at same given time x 100

CASE FATALITY RATIO- index of a killing power of a disease

CFR- # of registered deaths from a specific disease for a given year
# of registered cases from same specific disease in same year x 100

FIELD HEALTH SERVICE INFORMATION SYSYTEM (FHSIS)

A recording system that may give a picture about the accomplished indicators at the
brgy. Community, district, provincial, regional and national levels.

COMPONENTS:
1. Family Treatment record- the fundamental building block
- the form or piece of paper upon which recorded the presenting symptoms or
complaints of the patient
2. Target client list
- to plan and carry out patient care and service delivery
- to report services delivered
2. Tally/ Reporting forms- only mechanism through which date are routinely
transmitted from one facility to another.

Reports are submitted directly to the PROVINCIAL HEALTH OFFICE.

TALLY/REPORTING FORMS
FHIS/ E- deaths
E-1- notification of death form
E-2- Maternal death form
E-3- Perinatal Death form

FHSIS/M- monthly
M-1- Monthly Field Health service Activity report
M-2- Monthly natality report
M-3- Monthly Mortality report
M-4- Monthly laboratory report
M-5- Monthly Dental report
M-6- Family Planning Subsidized Surgical Procedure Report
M-7- Monthly Social Hygiene Clinic Activity Report

FHSIS/Q- Quarterly
Q-1- Quarterly Field Health Service Activity Report
Q-2- Quarterly Dental Facility Inspection Report
Q3- Quarterly Environmental Health Activities
Q-4- Quarterly Reports of Malaria Control Activities
Q-5- Drugs And Supplies Quarterly Status Report
Q-6- Laboratory Supplies Quarterly Status Report

DISEASES UNDER SURVELLANCE (NESS):

Laboratory diagnosed:
1. Cholera
2. Hepatitis A
3. Hepatitis B
4. Malaria
5. Typhoid fever
Clinically diagnosed:
1. DHF
2. Diphtheria
3. Measles
4. Meningococcal disease
5. Neonatal tetanus
6. Non neonatal tetanus
7. Pertussis
8. Rabies
9. Leptospirosis
10. Poliomyelitis

Under Surveillance system:

1. Poliomyelitis
2. Measles
3. Maternal and neonatal tetanus
4. Paralytic shellfish poisoning
5. Fireworks and related injury
6. HIV/AIDS

COMMUNITY DIAGNOSIS
-A process in which the PHN
and the community are
identifying community problems
that will serve as basis in
formulating community
programs
-It is derived and will be the
bases for developing and
implementing CHN intervention
and strategies.
COMMUNITY
COMMUNITY ORGANIZING
ORGANIZING PARTICIPATORY ACTION
RESEARCH
- To bring about social - A PROCESS of enhancing
and behavioral community participation and
changes, social development to prepare people to
organizations, ideology become the manager of their own
and change agents are community in the future.
needed.
- Often termed as
EMPOWERMENT of
building the capability of
people for future
community action.

COPAR
Pre entry phase:
Selection of Site
1. Underserved community
2. Lack of health services in the community
3. Poor health status
4. Relative peace and order
5. Acceptable by the community
6. No health related organizations/programs conducted in the place to prevent
duplication and competition

Entry phase
1. Organize core group criteria
2. Educate the people
3. Collect the data
4. Involve the people in the prioritization of identified needs and problems
Organization and Building phase
1. Community organization
2. Election of officers

Sustenance and strengthening phase

Phase out
 COMMUNITY ORGANIZING
PARTICIPATORY ACTION COMMUNITY ORGANIZING ACTIVITIES
RESEARCH
I. Pre- entry Community Analysis/ 1. Area selection
Diagnosis/ Mapping 2. Contact persons
3. Courtesy calls
4. Introduction of self
5. Leaders meet
6. Agenda setting
II. Entry phase Design and Initiation 1. Family hosting
2. Core group formation
III. Organization and Building Implementation
phase
IV. Sustenance and Program maintenance- Commitment
strengthening phase Consolidation Organization

V. Phase out Dissemination/ How can I leave the people ?

Reassessment When to leave the people?

WHEN?
• Change in attitude
• Objectives meet
• Resources maximized

HOW?
• Pull out intervention
• Institutionalization
• Consultancy services

10 MEDICINAL PLANTS: LUBBY SANTA

Lagundi Sambong
Ulasimang-Bato Ampalaya
Bawang Niyog-niyogan
Bayabas Tsaang gubat
Yerba-buena Akapulko

RA 8423: utilization of medicinal plants as alternative for high cost medications.

Policies:

1. The indications/uses of plants

2. The part of the plant to be used
3. Preparation of
a. Decoction e. oils
b. Poultice f. ointment
c. Infusion g. tincture
d. Syrup h. Elixir
HERBAL MEDICINES

COMMON NAME SCIENTIFIC NAME INDICATIONS

S- skin diseases
A-aromatic bath
Lagundi Vitex negundo R- rheumatism
A- asthma, body aches
H- headache, cough

Ulasimang bato Peperonia pellucida Gouty arthritis

Bawang Allium sativum Hypertension, toothache

Bayabas Psidium guava Mouthwash, wound wash, diarrhea

SARAH + menstrual pains, insect
Yerba Buena Mentha cordifolia
bites, headaches, body pans
S- skin diseases
A-aromatic bath
Lagundi Vitex negundo R- rheumatism
A- asthma, body aches
H- headache, cough

Ulasimang bato Peperonia pellucida Gouty arthritis

Bawang Allium sativum Hypertension, toothache

Bayabas Psidium guava Mouthwash, wound wash, diarrhea

SARAH + menstrual pains, insect

Yerba Buena Mentha cordifolia
bites, headaches, body pans

CHN PROCEDURES
CLINIC VISIT
I. Admission/Registration
II. Waiting time
III. Triaging
a. IMCI
b. Control of diarrheal diseases
IV. Clinical evaluation
a. Evaluate the c/c,hx, P.E
b. Evidenced based practice/medicine
c. Illness, treatment and prevention
V. Laboratory test and other DX examinations
a. Benedict´s test
b. Heat and acetic acid test
VI. Referral-2-way referral system
VII. Prescription and Dispensing
VIII. Health education
HEAT AND ACETIC ACID TEST

- Place 3-5 m of urine + 6-8 drops of heat + acetic acid solution then pre heat in
bunsen burner
- Observe for precipitation or cloudiness
- Cloudy- + for protein (PIH)

BENEDICT’S TEST – determination of glucose content

- Pour 3-5 ml of benedict’s solution + 6-8 drops of urine
- Heat for 3 minutes in a bunsen burner

RESULT:
Blue- negative
Green- trace (+1)-normal for pregnant woman
Yellow- +2
Orange- +3
Red-+4

HOME VISIT- a nurse –family contact which allows the health worker to asssess the
home and family situations in order to provide the necessary nursing care and health
related activities

PUROSES OF A HOME VISIT:

1. Give nursing care to the sick, postpartum mother and her newborn
2. Assess the living condition of the patient and his family and the health
practices
3. Give health teaching regarding the prevention and control of disease
4. Establish close relationship between agencies and the public for the
promotion of health
5. Make use of the inter-referral system and to promote the utilization of
community services

PRINCIPLES OF A HOME VISIT

• Must have a purpose or objective.

• Must use all available information about the patient and his family
• Must give priority to the essential needs of the family
• The planning and delivery must involve the individual and his family.
• Must be flexible

IMPORTANT POINTS TO REMEMBER: 4 C’s + H

1. Contains all the necessary articles, supplies and equipment to answer

emergency needs
2. Cleaned very often, supplies replaced and ready for use anytime.
3. Consider the bag and its contents clean and sterile, while articles belonging to
the patient as dirty and contaminated.
4. Collection of article should be convenient to the user, to facilitate efficiency
and avoid confusion, proper arrangement must be maintained.
5. Handwashing is done as frequently as situation for, helps minimizing and
avoiding contamination of the bag and its contents.
STEPS IN CONDUCTING HOME VISIT

I. Greet
II. Purpose
III. Health inquiry
IV. Bag placement
V. Physical examination
VI. Health teaching
VII. Record
VIII. Appointment

BAG TECHNIQUE

PHN BAG- essential and indispensable equipment of a PHN

PRINCIPLES OF BAG TECHNIQUE:
1. Minimize, if not prevent the spread of any infections.
2. Saves time and effort in the performance of nursing procedure.
3. Show the effectiveness of total care of the individual and the family.
4. Variety of ways should be performed depending on the agency’s policy.

PROCEDURE

1. Bag placement- L arm flexed @ 45°; not too close; not too far
R arm- long, non folding black umbrella
2. Ask for basin of H2O or glass of water
3. Open/ secure towel/ get soap
4. Handwashing
5. Apron in- right side out
6. Articles out
7. Close CHN bag
8. Physical examination
9. Hand washing and clean articles
10. Articles in
11. Apron out- clean side out
12. Close CHN bag
13. RECORD
14. Setting up next schedule

THERMOMETER TECHNIQUE

Procedure:
1 cotton ball- dry
3 cotton ball- soap-soaked
3 cotton ball- water- soaked
1 cotton ball- alcohol- final disinfection
1 cotton ball- dry

Oral- 2-3 min

Rectal- 1 min
Axilla- 5-8 min
ISOLATION TECHNIQUE IN THE HOME

CONSIDERATIONS:
1. Articles used by the patient should not be mixed with the articles used by
other family members.
2. Frequent hand washing and airing of beddings and other articles and
disinfection of the room are imperative. Abundant use of soap, water, sunlight
and some chemical disinfectants is necessary.
3. The one caring for the sick should be provided with a gown that should be
used only within the room.
4. Al discharges from the nose and throat of a communicable disease pt should
be carefully discarded.
5. Articles soiled with discharges should be boiled for 30 minutes before
washing.

MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAMS

Water Supply Sanitation Program

3 Types of Approved Water Supply and Facilities:
• Level I-Point Source
• Level II-Communal faucet system or stand posts
• Level III-Waterworks system or individual house connections

Proper Excreta and Sewage Disposal System

3 Types of Approved Toilet Facilities:

Level 1 Level 2 Level 3

Non-water carriage toilet On site toilet facilities of Water carriage types of
facility: the water carriage type toilet facilities connected to
- Pit latrines with water sealed and septic tanks an/or to
- Reed Odorless Earth flushed type with septic sewerage system to
Closet vault/tank disposal treatment plant.
- Bored-hole facilities
- Compost
- Ventilated improved pit
Toilets requiring small
amount of water to wash
waste into receiving
space
- Pour flush
- Aqua privies
FOOD SANITATION PROGRAM

4 RIGHTS IN FOOD SAFETY:

1. Right Source
• Always buy fresh meat, fish, fruits and vegetables.
• Always look at the expiry date.
• Use water only from clean and safe sources
2. Right Preparation
• Avoid contact between raw foods and cooked foods.
• Always buy pasteurized milk and fruit juices.
• Wash vegetables well if to be eaten raw such as lettuce, cucumber, tomatoes
and carrots.
3. Right Cooking
• Cook food thoroughly and ensure that the temperature on all parts of the food
should reach 70 degrees centigrade
• Eat cooked food immediately.
4. Right Storage
• All cooked foods should be left at room temperature for NOT more then TWO
HOURS to prevent multiplication of bacteria.
• Store cooked foods carefully. Be sure to use tightly sealed containers for
storing food.
RULE IN FOOD SAFETY: When in doubt, throw it out!

HOSPITAL WASTE MANAGEMENT PROGRAM

• A Hospital Waste management program shall be prepared and implemented

as a requirement for renewal /registration of licenses by hospitals.
• Training of all hospital personnel involved in waste management shall be an
essential part of hospital training program.

OTHER PRIORITY HEALTH PROGRAMS

SENTRONG SIGLA MOVEMENT

-Quality assurance program

GOAL: To make DOH and LGU active partners in providing quality health services.
Key strategies:
1. Certificate Recognition Program= CRP
2. Continuous Quality Improvement=CQI

SENTRONG SIGLA MOVEMENT:

Goal: Better quality of life, quality health
Objective: Better and more effective collaboration between DOH and LGUs
DOH: Provider of technical and financial assistance packages for health care
including regulation
LGU: Prime developers of heath systems and direst implementers of health
programs

PILLARS OF SSM: QATH

• Quality assurance
• Award
• Technical and grants assistance
• Health promotion
What are the agencies that can apply for SSM?
This program is intended for RHU’s and Health Centers and not the hospitals.
PU B LIC HEALTH PROGRAMS

• Maternal Care Program

• Strategies:
A. Provision of Regular and Quality Maternal Care Services
 regular and quality pre-natal care
• hx-taking, utilization of HBMR (Home-Based Mother’s Record)
• as a guide in the identification of risk factors
• PE: weight, height, BP-taking
• Perform head-to-toe assessment, abdominal exam
• Tetanus Toxoid Immunization
• Fe supplementation: given from 5th mo. of pregnancy to two months
postpartum (100-120 mg orally/day for 210 days)
• Laboratory exam:
1. Heat-acetic acid test.
2. Benedict’s test
• Oral/Dental exam

► Pre-natal counseling
► Provision of safe, delivery care
• all birth attendants shall ensure clean and safe deliveries at home or at the
faciltiies (RHUs/hospitals)
• at-risk pregnancies and mothers must be immediately referred to the nearest
institution
• untrained TBA’s who actively practice must be identified, trained and
supervised by a personnel of the nearest BHS/RHU trained on maternal care.
► Provision of quality postpartum care
• Proper schedule of follow-up must be followed:
• 1st postpartum visit for home deliveries must be done within 2 4 hours after
delivery
• -2nd, done at least 1 week after delivery
• -3rd, done 2- 4 weeks thereafter
• Attendants must be aware of the early signs, symptoms and
complications. They should follow the 3 CLEANS:
CLEAN HAND S
CLEAN Surface
CLEAN Cor d

3 FACTORS CONTRIBUTING TO PREGNANCY RELATED ILLNESS AND

DEATH AMONG MOTHERS AND INFANTS
1. too early pregnancy
2. pregnancy before age 20 or after age 35
3. pregnancy after the 4th baby

NUTRITION PROGRAM

Goal: The improvement of the nutritional status and quality of life of the population
through the adoption of desirable dietary practices and healthy lifestyle.
• Villavieja et. al. Rice is the main source of protein among Filipinos
• WATER- most essential of all nutrients

FILIPINO PYRAMID

Fats= 1 serving (eat sparingly)

Proteins= 2-4 servings (need some )
Fruits= 2-3 servings
Vegetables =3-5 servings
Carbohydrates=6-11 servings (eat more)
Fluid= 8-12 servings (drink a lot)

Programs and projects:

• Micronutrient Supplementation
- To address the health and nutritional needs of infants and children and
improve their growth and survival.
• Food Fortification
-Voluntary fortification of processed foods through the “Sangkap Pinoy seal.”

FAMILY PLANNING PROGRAM

Methods of Family Planning:

I. Spacing
A. Hormonal
• Oral Contraceptives
• Injectables
• Inplants
B. Barrier
• IUD
• Condom
• Diaphragm, Cervical cap
C. Biologic - Lactation-Amenorrhea Method
D. Natural - Basal Body Temperature (BBT)
• Sympto-thermal
• Cervical Mucus

ORAL CONTRACEPTIVES

• first 21 pills have a combination of synthetic estrogen and progesterone

hormones
• last 7 pills of a 28-day pack have no hormones and are called spacer pills
• Pill stops ovulation, preventing the ovaries from releasing eggs
• thickens cervical mucus, making it harder for sperm to enter the uterus

• first 21 pills have a combination of synthetic estrogen and progesterone

hormones
• last 7 pills of a 28-day pack have no hormones and are called spacer pills
• Pill stops ovulation, preventing the ovaries from releasing eggs
• thickens cervical mucus, making it harder for sperm to enter the uterus

Missed Pills: Late Start

1 day late starting the next package: Take 2 pills as soon as you remember and one
pill each day after. Use a backup form of birth control for two weeks.
2 days late starting the next package: Take 2 pills per day for 2 days, then continue
as usual. Use a backup form of birth control for two weeks.
3 or more days late starting the next package: Call the clinic for instructions.
CONTRACEPTIVE INPLANTS

• soft capsules, about 1½ inch long, under the skin in a woman’s upper, inner
arm
• prevents pregnancy by thickening the cervical mucus so that sperm can’t get
into the uterus and by stopping ovulation
• Effective contraception for three years.
• doesn't interfere with fertility once it's removed

DEPO-PROVERA: AN INJECTABLE CONTRACEPTIVE

• drug very similar to progesterone, a hormone normally produced by the

ovaries every month as part of the menstrual cycle
• prevents pregnancy for up to 3 months with each injection ("shot").
• given as 1 shot in the buttock or upper arm
• first shot should be given within 5 days after the beginning of a normal
menstrual period, and shots should be repeated every 3 months.
• good for 2 years unless no other form of birth control is right for you.

INTRAUTERINE DEVICE (IUD)

• a small object that is inserted through the cervix and placed in the uterus to
prevent pregnancy
• can last 1-10 years
• usually inserted during a menstrual period when the cervix is slightly open and
pregnancy is least likely
• recommended that women check their IUD after each period

CERVICAL CAP (FEMCAP)

• A silicone cup inserted into the vagina to prevent pregnancy

• It is recommended that spermicide be added to increase the effectiveness of
this method.
• Lasts for up to two years
• acts by blocking the entrance to the uterus; spermicide acts by killing and
immobilizing the sperm, preventing it from fertilizing the egg.
II. Permanent (surgical/irreversible)
A. Tubal Ligation - done in women; a 15 min. surgical procedure in which the
fallopian tubes are tied and cut to prevent passage of sperms
B. Vasectomy - done in men, was deferens is tied and cut to block passage of
sperm

MENTAL HEALTH PROGRAMS

4 FACETS OF MENTAL HEALTH:

DEFINED BURDEN- burden currently affecting persons with mental disorders

UNDEFINED BURDEN- burden relating to the impact of mental health problems to
persons other than the individual directly affected.
HIDDEN BURDEN- the stigma and violations of human rights.
FUTURE BURDEN- burden in the future resulting from the aging of the population.