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1.

CD control program
TB is the number one infectious killer in the
Communicable diseases
National Tuberculosis Control world.
Program – key policies One TB suspect can infect another 10 healthy
Case finding – direct Sputum persons
Microscopy and X-ray Leprosy Control Program
examination of TB symptomatics WHO Classification – basis of multi-drug therapy
who are negative after 2 or more ▪ Paucibacillary/PB – noninfectious
sputum exams types. 6-9 months of
Treatment – shall be given free treatment.
and on an ambulatory basis, ▪ Multibacillary/MB – infectious
except those with acute types. 24-30 months of
complications and emergencies treatment.
Direct Observed Treatment Short Multi-drug therapy – use of 2 or more drugs
Course – comprehensive strategy renders patients non-infectious a week after
to detect and cure TB patients. starting treatment
Category and Treatment Regimen ▪ Patients w/ single skin lesion and
a negative slit skin smear are
Category 1- new TB patients whose sputum is treated w/ a single dose of ROM
positive; seriously ill patients with severe forms regimen
of smear-negative PTB with extensive ▪ For PB leprosy cases-
parenchymal involvement (moderately- or faradvanced) Rifampicin+Dapsone on Day 1
and extra-pulmonary TB (meningitis, then Dapsone from Day 2-28. 6
pleurisy, etc.) blister packs taken monthly
Category 2-previously-treated patients with within a max. period of 9 mos.
relapses or failures. All patients who have complied w/ MDT are
Category 3 – new TB patients whose sputum is considered cured and no longer regarded as a
case of leprosy, even if some sequelae of leprosy
smear-negative for 3 times and chest x-ray
remain.
result of PTB minimal
Category 1- Responsibilities of the nurse
▪ Prevention – health education,
new TB patients whose sputum is positive;
healthful living through proper
seriously ill patients with severe forms of smearnegative nutrition, adequate rest, sleep
PTB with extensive parenchymal and good personal hygiene;
involvement (moderately- or far- advanced) and ▪ Casefinding
extra-pulmonary TB (meningitis, pleurisy, etc.) ▪ Management and treatment –
Intensive Phase (given daily for the first 2 months)- prevention of secondary injuries,
Rifampicin + Isioniazid + pyrazinamide + ethambutol. handling of utensils; special
If sputum result becomes negative after 2 months, shoes w/ padded soles;
maintenance phase starts. But if sputum is still positive importance of sustained therapy,
in 2 months, all drugs are discontinued from 2-3 days correct dosage, effects of drugs
and a sputum specimen is examined for culture and drug and the need for medical checkup
sensitivity. The patient resumes taking the 4 drugs for from time to time; mental &
another month and then another smear exam is done at emotional support
the end of the 3rd month. ▪ Rehabilitation-makes patients
Maintenance Phase (after 3rd month, regardless of the
capable, active and selfrespecting
result of the sputum exam)-INH + rifampicin daily
member of society.
Category 2-previously-treated patients with relapses or
Control of Schistosomiasis – a tropical disease caused by
failures.
a blood fluke, Schistosoma Japonicum ; transmitted by a
Intensive Phase (daily for 3 months, month 1,2 & 3)-
tiny snail Oncomelania quadrasi
Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+ Preventive measures – health education
rifampicin pyrazinamide+ ethambutol on the 3rd month. regarding mode of transmission and methods of
If sputum is still positive after 3 months, the intensive protection; proper disposal of feces and urine;
phase is continued for 1 more month and then another improvement of irrigation and agriculture
sputum exam is done. If still positive after 4 months, practices
intensive phase is continued for the next 5 months. Control of patient, contacts and the immediate
Maintenance Phase (daily for 5 months, month 4,5,6,7,&
environment
8)-Isionazid+ rifampicin+ ethambutol
Category 3 – new TB patients whose sputum is smearnegative Specific treatment- Praziquantel – drug of choice
for 3 times and chest x-ray result of PTB Programs on Filariasis, Malaria and Dengue Hemorrhagic
minimal Fever
Intensive Phase (daily for 2 months) – Isioniazid Filariasis- a chronic prasitic infection caused by
+ rifampicin + pyrazinamide
a nematode, Wuchereria bancrofti. Young and
Maintenance Phase (daily for the next 2 months) adult worms live in the lymphatic vessels and
- Isioniazid + rifampicin nodes, while the micro filariae are in the blood;
Stop TB ; Do it with DOTS transmitted through bites from an infected
female mosquito, Aedes poecilius, that bites at
Advocacy is a planned and continuous effort to night.
inform people about issue and instigate change. ▪ Treatment: Diethylcarbamazine
Advocacy usually takes place over an extended citrate or Hetrazan
period of time and includes a variety of ▪ Elephantiasis and Hydrocoele
strategies to communicate a specific message. are handled through surgery,
prevention and supportive care A process by which the nurse collects data about
Malaria – infection caused by the bite of the female
the community in order to identify factors which
Anopheles mosquito ,
may influence the deaths and illnesses of the
Chemoprophylaxis – Chloroquine taken population
at weekly intervals, starting from 1-2 to formulate a community health nursing
weeks before entering the endemic area.
diagnosis and develop and implement community
Anti-malarial drugs – sulfadoxine, health nursing interventions and strategies
quiinine sulfate, tetracycline, quinidine Done to come up with a profile of local health
Insecticide treatment of mosquito nets, situation
house spraying, stream seeding and Will serve as a basis of health programs and
clearing, sustainable preventive and
services to be delivered to the community
vector control meas
Dengue H-fever Starts with determining the health status of the
4 o‘clock habit community
Programs on Measles. Chickenpox, 2 Types of Community Diagnosis
1. Comprehensive Community Diagnosis
Mumps, Diphtheria, Pertusis, Tetanus –
focused on health information aims to obtain general information about
campaigns and intensive immunization the community
of children in barangays. 2. Problem-Oriented Community Diagnosis
Prevention and Control Program on Parasitic type of assessment responds to a
Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and
particular need
Paragonimiasis in communities where eating of fresh or
ELEMENTS OF
inadequately cooked crab is a practice
COMPREHENSIVE COMMUNITY DIAGNOSIS
Management:
1. DEMOGRAPHIC VARIABLES
1. Deworming
i. Total population & Geographical
2. Health Education re:
distribution including Urban-Rural index
▪ Good personal hygiene
& Population Density
▪ Use of footwear ii. Age & Sex composition
▪ Washing fruits and vegetables iii. Selected vital indicators e.q. Growth
well rate, CBR, CDR & Life expectancy rate
▪ Use of sanitary toilets iv. Patterns of migration
▪ Sanitary disposal of garbage v. Population projection
▪ Boiling drinking water at least 2- Note:
3 min. from boiling point or
chlorination Population groups that need special
Prevention and Control on Leptospirosis/ Weil’s Disease/ attentions:
Mud fever/Flood fever/ Spirochetal Jaundice thru contact with ▪ Indigenous people
the skin/ open wound with water or moist soil contaminated ▪ Socially dislocated groups as a
with urine of infected rat result of disasters, calamities &
And Rabies development programs
2. Socio-economic & Cultural variables
Mgt. of Rabies
i. Social indicators
Wash wound with soap and water, betadine or
Communication network
alcohol may be applied
Transportation system
If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows Educational level
rabies, kill then bring head for lab. Exam & Housing conditions
consult doctor.
ii. Economic indicators
Active immunization – body develops Ab against
Poverty level income
rabies up to 3 yrs.
Passive I – giving Ab to persons with head and Employment rate
neck bites, multiple single deep bites, Types of industry present in the
contamination of mucous membranes or thin community
covering of the eyes, lips or mouth to provide Occupation common in the community
immediate protection
iii. Environmental indicators
RPO – immunization of pets at 3 mos. of age and
Physical/geographical/topographical
yearly thereafter
Prevention and Control on STIs characteristics
- Gonorrhea, Syphilis, HIV/AIDS, Water supply
Trichomoniasis,Chlamydia, Hep B ( the most Waste disposal
serious type ‗cause of severe cx. Eg. Massive
liver damage and hepatocarcinoma Air, Water and Land pollution
- 4 C‘s in the Syndromic Mgt iv. Cultural factors
- 1. Compliance
Variables that may break up people into
- 2. Counseling/ Education
- 3. Contact tracing to treat partner groups within the community e.q.
- 4. Condom use ▪ Ethnicity
- Hep B vaccination ▪ Social class
- Universal precautions ▪ Language
- Safe sex ▪ Religion
2. Community Needs Assessment/ Community Diagnosis ▪ Race
Community Diagnosis ▪ Political orientation
Cultural beliefs and practices that affect Descriptive data
health
Concepts about Health and Illness 8. DATA PRESENTATION – will depend largely on
the type of data obtained.
3. Health & illness patterns
Descriptive- narrative reports
Leading cause of mortality
Leading cause of morbidity numerical data- table or graphs
Leading cause of infant mortality 9. DATA ANALYSIS – aims to establish trends and
patterns in terms of health needs and problems
Leading cause of maternal mortality
of the community.
Leading cause of hospital admission 10. Identifying Community Health Nursing Problems
4. Health resources a. Health Status Problems
Manpower resources Increased/decreased morbidity,
mortality fertility or reduced capability
Material resources
for wellness
5. Political/Leadership patterns b. Health Resources Problems
Reflects the action potential of the state Lack of or absence of manpower, money,
and its people to address the health materials or institutions necessary to
needs and problems of the community solve health problems
Mirrors the sensitivity of the c. Health Related Problems
government to the people‘s struggle for Existence of social, economic,
better lives environmental and political factors that
PROCESS OF COMMUNITY DIAGNOSIS aggravate the illness-inducing situations
Consists of; in the community
1. Collecting, organizing & synthesizing data 11. Priority-setting
In order to identify the different factors a. Nature of the condition/problem presented
that may directly or indirectly influence Classified as health status, health
the health of the population resources or health related problems
2. Analyzing & interpreting health data b. Magnitude of the problem
Seek explanations for the occurrence of Severity of the problem which can be
health needs and problems of the measured in terms of the proportion of
community the population affected by the problem
3. Formulation of Community Health Nursing c. Modifiability of the problem
Diagnoses
Probability of reducing, controlling or
Will become the bases for developing
eradicating the problem
and implementing community health d. Preventive potential
nursing interventions and strategies
STEPS IN CONDUCTING COMMUNITY Probability of controlling or reducing the
DIAGNOSIS effects posed by the problem
e. Social concern
1. DETERMINING THE OBJECTIVES – the nurse
decides on the depth and scope of the data she Perception of the population or the
needs to gather. community as they are affected by the
2. DEFINING THE STUDY POPULATION – the nurse problem and their readiness to act on
identifies the population group to be included in the problem
the study. PLANNING
3. DETERMINING THE DATA TO BE COLLECTED – the WHAT IS PLANNING?
objectives will guide the nurse in identifying the
specific data she will collect, and will also decide is a process that entails formulation of
on the sources of these data. steps to be undertaken in the future in
4. COLLECTING THE DATA – the nurse decides on order to achieve a desired end.
the specific methods depending on the type of Concepts of Planning:
data to be generated.
Planning is futuristic.
Ocular survey, interview, and records
review, Planning is change-oriented.
5. DEVELOPING THE INSTRUMENT instruments/tools
facilitate the nurse‘s data-gathering activities. Planning is a continuous and dynamic
Most common instruments : process.
survey questionnaire Planning is flexible.

interview guide Planning is a systematic process.


observation checklist THE PLANNING CYCLE:
6. ACTUAL DATA GATHERING – the nurse supervises 1. Situational Analysis
the data collectors by checking the filled-up
instruments in terms of completeness, accuracy gather health data
and reliability of the information collected.
7. DATA COLLATION – the nurse is now ready to put tabulate, analyze and interpret data
together all the information.
identify health problems
Numerical data
set priority 5. Dissemination – reassessment
1.Community analysis
2. Goal and Objective Setting The process of assessing and defining needs,
define program goals and objectives opportunities and resources involved in
initiating community health action .
assign priorities among objectives Maybe referred to as community diagnosis,
3. Strategy/Activity Setting community needs assessment, health education
planning and mapping
Design CHN Program
5 components of community analysis
Ascertain resources 1. Demographic, social and economic profile of the
community derived from secondary data.
Analyze constraints and limitations
2. Health risk profile (social, behavioural and
4. Evaluation environmental risks)
determines outcomes Behavioural- dietary habits and other life
specify criteria and standards style concerns like alcohol, tobacco and
Application of Public Health Tools (discuss in separate drugs
slide) Social indicators- exposure to long term
Three important tools unemployment, low education and
The health disciplines of isolation.
3. Health/wellness out comes profile
1. Demography (morbidity/mortality data)
2. Vital statistics 4. Survey of current health promotion programs.
3. Epidemiology 5. Studies conducted in certain target groups
3. COMMUNITY ORGANIZING Steps in community analysis
A process whereby the community members Steps in community analysis
develop the capability to assess their health i. Defining the community
needs and problems, plan and implement actions 1. Determining the geographic boundaries
to solve these problems, put up sustain of the target community
organizational structures which will support and ii. Collecting data
monitor implementation of health initiatives by iii. Assessing community capacity
the people 1. Entails an evaluation of the driving
forces which may facilitate or impede
maglaya the advocated change
iv. Assessing community barriers
COMMUNITY ORGANIZING v. Assessing readiness to change
Purpose: 1. Community interest
2. Perception on the importance of the
Empowerment or building the capability problem
of people for future community action vi. Synthesis data and set priorities
Approaches to community development 1. Provide a community profile of the needs
a. Social changes and resources and will become the Basis
Building up social organizations for designing prospective community
interventions for health promotion
(relationships, structure and resources) 2.Design and initiation
b. Change in ideology STEPS:
Knowledge, beliefs and attitude 1. Establish a core planning group and select a
c. Change agents local organizer.
Capacity to influence others by setting a Requirements:
good example.
Principles of CO: Select 5-8 member in charge for core
1. Welfare approach planning and management of the
program
People esp. the oppressed, exploited and
deprived sectors are most open to change, have With management skills, good listener
the capacity to change and are able to bring and conflict resolution skills.
about change. Hence , CO is based on the ff: 2. Choose an organizational structure.
a. Power must reside in the people This activate the community
b. Development. is from the people to the participation.
people
c. People participation Types:
2. Technological approach a. Leadership board council- existing local
must be based on the poorest sectors of society. leaders working for a common cause
The solutions of problems commonly shared by b. Coalition- linking organizations and
these sectors must be focused on collective groups to work on community issues.
organizations, planning and action c. ―lead‖ or official agency- a single agency
3. Transformatory approah takes the primary responsibility of a
should lead to self-reliant communities liaison for health promotion activities in
Five stages the community.
1. Community analysis d. Grass-roots- informal structures in the
2. Design and initiation community like the neighbourhood
residents.
3. Implementation e. Citizens panels- a group of citizens (5-
4. Program maintenance – consolidation 10) emerge to form a partnership with
the government agency. c. Establish an ongoing recruitment plan.
f. Networks and consortia- network It should be expected that volunteers
develop because of a certain concerns may leave the organization.
3. Identify, select and recruit organizational
This requires a built in mechanisms for
members.
continuous recruitment and training of
As much as possible different groups, new members.
organizations sectors should be d. Disseminate results.
represented.
Continuous feedback to the community
Chosen representative have power for on results of activities enhances
the group they represents visibility and acceptance of the
4. Define the organization mission and goals. organization.
This will specify the what, who, where, Dissemination of information is vital to
when and extent of the organizational gain and maintain community support.
objectives. 5. Dissemination-Reassessment
5. Clarify roles and responsibilities of people
Continuous assessment is part of the monitoring
involved in the organization.
aspect in the management of the program
This is done to establish a smooth a. Update the community analysis.
working relationship and avoid
Is there a change in leadership,
overlapping of responsibilities.
6. Provide training and recognition. resources and participation?
Active involvement in planning and This may necessitate reorganization and
management of programs may require new collaboration with other
skills development training. organizations.
b. Assess effectiveness of interventions/programs.
Recognition of the programs Quantitative and qualitative methods of
accomplishment and individuals evaluation can be used to determine
contribution to the success of the participation, support and behavior
program and boost morale of the change level of decision making and
members. other factors deemed important to the
3.Implementation program.
-put the design plan into action. c. Chart future directories and modifications.
a. Generate broad citizen participation This may mean revision of goals and
How? objectives and development of new
▪ Organizing task force, who, with strategies.
appropriate guidance can Revitalization of collaboration and
provide the necessary support.
networking may be vital in support of
b. Develop a sequential work plan
new ventures.
Activities should be planned d. Summarize and disseminate results.
sequentially. Often, times has to be Some organization die because of the
modified as events unfold. Community
lack of visibility.
members may have to constantly
monitor implementation steps. Thus, a dissemination plan may be
c. Use comprehensive, integrated strategies
helpful in diffusion of information to
Generally the program utilize more than further boost support to the
one strategies that must complement organization‘s endeavour.
each other. The Health Resource Development Program
d. Integrate community values into the programs,
materials and messages. Community Health Organizing Utilizing COPAR
The community language, values and HRDP
norms have to be incorporated into the Was developed and sponsored by the Philippine
program.
4.Program maintenance – consolidation Center for Population and Development (PCPD)
The program a this point has experienced some To make health services available and accessible
degree of success and has weathered through to depressed and underserved communities in
implementation problems, the organization and the Philippines
program is gaining acceptance in the PCPD is a non-stock, non-profit institution, which
community. serves as a resource center assisting institutions
Maintenance: and agencies through programs and projects
a. Integrate intervention activities into community geared toward the social human development of
networks rural and urban communities
This can be affected through Formerly known as The Population Center
implementation problems. Foundation
The organization and program is gaining HISTORY OF HRDP
acceptance in the community. HRDP I
b. Establish a positive organizational culture. Trained the faculty, medical/nursing
A positive environment is a critical students to provide health care services
element in maintaining cooperation and to the far flung barrios because of lack
preventing fast turnover of members. of man power for health services at the
This is a result of good group process same time that similar activities fulfilled
based on trust, respect, and openness. the curricular requirements of the
students for public health Principles of management were applied in
The PCPD provides seed money for the carrying out primary health care
income generating projects The community members, CHW‘s and leaders
The CO uses his/her own strategy or were empowered to manage their own health
method in developing the community projects
Short-term service Conducted seminars and trainings as well as
HISTORY OF HRDP health education and services needed by
HRDP II community(exposure and immersion 6-8 weeks)
THE HRDP-COPAR PROCESS
The 2nd cycle uses the same strategy but 1. PRE-ENTRY PHASE
2. ENTRY PHASE
the program could not be sustained by 3. COMMUNITY STUDY/DIAGNOSIS
the schools or hospitals and the incomegenerating PHASE/RESEARCH PHASE
projects eventually become 4. COMMUNITY ORGANIZATION AND CAPABILITYBUILDING
the hindrance to the goal of achieving PHASE
the health program because the people 5. COMMUNITY ACTION PHASE
tend to be more interested in the income 6. SUSTENANCE AND STRENGTHENING PHASE
generated by the projects 1. Pre-Entry Phase
Both HRDP I and HRDP II have brought
about some changes in the community Preparation of the Institution
life of the people Train faculty and students in COPAR.
Established basic health infrastructure;
Formulate plans for institutionalizing COPAR.
basic health services were increased;
there were trained workers and Revise/enrich curriculum and immersion
organized health groups to take care of program.
the needs of the community Coordinate participants of other departments.
HISTORY OF HRDP
HRDP III Site Selection
PCPD refined the program and resulted Initial networking with local government.
to what is now called HRDP III, which has Conduct preliminary special investigation.
these unique features:
▪ Comprehensive training of the Make long/short list of potential communities.
staff and faculty of the Do ocular survey of listed communities.
participating agency in which the
community work was initiated Criteria for Initial Site Selection
▪ Periodic training program and
regular assistance to the o Must have a population of 100-200 families.
participating agency were o Economically depressed.
provided to strengthen the
health outreach program to o No strong resistance from the community.
become community oriented o No serious peace and order problem.
▪ PHC as the approach with which
all nursing/medical students, o No similar group or organization holding the
their CI‘s and indigenous health same program.
workers are trained for
community health work and Identifying Potential Barangay
around which all other project o Do the same process as in selecting
inputs will revolve
municipality.
HISTORY OF HRDP
o Consult key informants and residents.
Community organizing as the main
strategy to be employed in preparing the o Coordinate with local government and NGOs
communities to develop their community for future activities.
health care systems and the
establishment of community health Choosing Final Barangay
organization to manage the community o Conduct informal interviews with community
health programs
residents and key informants.
Organizing work in the communities
o Determine the need of the program in the
were done in 3 phases
community.
PAR as fascinating strategy for
o Take note of political development.
maximum community involvement
through collective identification and o Develop community profiles for secondary
analysis of community health problems data.
and collective health action
o Develop survey tools.
Available funds to finance community
o Pay courtesy call to community leaders.
initiated projects
COPAR? o Choose foster families based on guidelines.
Since Management Leadership and
Identifying Host Family
Jurisprudence are courses taught in the
classroom members of this group of students o House is strategically located in the
were trained to manage and acts as leaders of community.
the different levels of the students who were
o Should not belong to the rich segment.
involved in COPAR
o Respected by both formal and informal children
Causes: environmental factors, maternal diseases or
leaders.
genetic aberrations
o Neighbours are not hesitant to enter the 2. Rheumatic Fever or Rheumatic Heart Disease:
house. Systematic inflammatory disease that may
o No member of the host family should be develop as a delayed reaction to repeated and
an inadequately treated infection of the upper
moving out in the community.
respiratory tract by group A beta-hemolytic
2. Entry Phase
streptococci.
Guidelines for Entry 3. Hypertension: Persistent elevation of the
arterial blood pressure.
o Recognize the role of local authorities by 4. primary or essential) ;frequent among females
paying them visits to inform their presence and but severe,malignant form is more common
activities. among males
5. Ischemic Heart Disease/ Atherosclerosis:
o Her appearance, speech, behavior and lifestyle
Condition usually caused by the occlusion of the
should be in keeping with those of the coronary arteries by thrombus or clot formation.
community residents without disregard of their
being role model. higher among males than females for the latter
are protected by estrogen before menopause
o Avoid raising the consciousness of the
community residents; adopt a low-key profile. PF: HPN, DM, Smoking
Minor RF: stress, strong family history, obesity
Activities in the Entry Phase
CVD
Integration - establishing rapport with the
people in continuing effort to imbibe community CVD
life. Primary Prevention: CVD
§ living with the community Primary Prevention thru health education is the
main focus of the program:
§ seek out to converse with people 1. maintenance of ideal body wt.
where they usually congregate 2. diet - low fat
3. alcohol/smoking avoidance
§ lend a hand in household chores 4. Exercise
5. regular BP check up
§ avoid gambling and drinking 2. Cancer Prevention and Early Detection
Any malignant tumor arising from the abnormal
Deepening social investigation/community study
and uncontrolled division of cells causing the
verification and enrichment of data collected
destruction in the surrounding tissues.
from initial survey
Common Cancer: Lung cancer, cervical cancer,
conduct baseline survey by students, colon cancer, cancer of the mouth, breast
results relayed through community cancer, skin cancer, prostate cancer.
assembly
3rd leading cause of illness and death ( Phil.)
Leader Spotting Through Sociogram.
Incidence can only be reduced thru prevention
Key persons - approached by most people
and early detection
Opinion leader - approach by key persons NINE WARNING SIGNS OF CANCER:
Isolates - never or hardly consulted Change in blood bowel or bladder habits
4.NCD prevention and control program A sore that does not heal
1. Prevention and Control of Cardiovascular
Diseases Unusual bleeding or discharge
2. Cancer Prevention and Early Detection Thickening or lump in breast or elsewhere
3. Nat‘l Diabetes Prevention and Control Program
4. Prevention and Control of Kidney Disease Indigestion or difficulty in swallowing
5. Program on Mental Health and Mental Disorders Obvious change in wart or mole
6. Program on Drug Dependence/
Substance Abuse Nagging cough or hoarseness
7. Community-Based Rehabilitation Program Unexplained anemia
8. Program on the Elderly/Geriatric Nursing
Services Sudden unexplained weight loss
9. Programs on Blindness, Deafness and Prevention & Early Detection
Osteoporosis PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES
1. Prevention and Control of Cardiovascular Diseases One third of all cancers are curable if
heart – 1st leading cause of death detected early and treated properly.
Three major forms of treatment of cancer:
blood vessels - 2nd Surgery
Types:
1. Congenital Heart Disease (CHD): Radiation Therapy
2. Rheumatic Fever or Rheumatic Heart Disease
3. Hypertension Chemotherapy
4. primary or essential 3.Nat‘l Diabetes Prevention and Control Program
5. Ischemic Heart Disease/ Atherosclerosis
1.Congenital Heart Disease (CHD): Result of the Aim:
abnormal development of the heart that exhibits Controlling and assimilating healthy lifestyle in
septal defect, patent ductus arteriosus, aortic and the Filipino culture ( 2005-2010) thru IEC
pulmonary stenosis, and cyanosis; most prevalent in
Main Concern: modifiable risk factors( diet, body Malignant neoplasms
wt., smoking, alcohol, stress, sedentary living, Diabetes
birth wt. ,migration
4.Prevention and Control of Kidney Disease Nephritis

Acute or Rapidly Progressive Renal Failure : A Accidents


9.Programs on Blindness, Deafness and Osteoporosis
sudden decline in renal function resulting from the
failure of the renal circulation or by glomerular or Cataract- main causes of blindness
tubular damage causing the accumulation of VAD- main cause of childhood blindness; most
substances that is normally eliminated in the urine in
serious eye problem of Fil. children below 6 yrs.
the body fluids leading to disruption in homeostatic,
old
endocrine, and metabolic functions.
Osteoporosis special problem in women,
Acute Nephritis: A severe inflammation of the kidney highest bet. 50—79 yrs. old, MENOPAUSE- main
caused by infection, degenerative disease, or disease cause
of the blood vessels. Prevention of NCD/Role of Nursing in Health Promotion
Chronic Renal Failure: A progressive deterioration of And Advocacy
renal function that ends as uremia and its Yosi Kadiri- anti smoking
complications unless dialysis or kidney transplant is Edi Exercise/Hataw-regular physical activity
performed.
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high
Neprolithiasis: A disorder characterized by the
fiber diet
presence of calculi in the kidney.
Mag HL – exercise, no smoking, avoidance of
Nephrotic Syndrome: A clinical disorder of
alcohol, healthy diet, iwas stress, watch wt.
excessive leakage of plasma proteins into the Sentrong Sigla Movement ( SSM)
urine because of increased permeability of the -a certification recognition program which develops and
glomerular capillary membrane promotes standards for health facilities
Urinary Tract Infection: A disease caused by the - Joint effort bet.:
presence of pathogenic microorganisms in the 1.DOH – provides technical and financial assistance
urinary tract with or without signs and packages for health care
symptoms. 2. LGUs – direct implementers of health programs &
prime developers of health centers and hospitals
Renal Tubular Defects: An abnormal condition in
making services accessible to every Filipino
the reabsorption of selected materials back into
the blood and secretion, collection, and Pillars of SSM
conduction of urine. 1. Quality Assurance
2. Grant and Technical Assistance
Urinary Tract Obstruction: A condition wherein
3. Health Promotion
the urine flow is blocked or clogged. 4. Awards
5. Program on Mental Health and Mental Disorders
6. Program on Drug Dependence/ Expected Outcome: SSM
Substance Abuse Empowered individuals adopting healthy
7.Community-Based Rehabilitation Program lifestyle, improved health-seeking behavior and
A creative application of the primary health care well-being & increased demand for quality
approach in rehabilitation services, which health services
involves measures taken at the community level Institutions will develop policies, provide quality
to use and build on the resources of the services , institute system for surveillance/
community with the community people, merits and advocate for laws
including impaired, disabled and handicapped
persons as well. Programs: SSM
Goal: To improve the quality of life and increase EPI
productivity of disabled, handicapped persons. Disease Surveillance
Aim: To reduce the prevalence of disability CARI
through prevention, early detection and
provision of rehabilitation services at the CDD
community level. Nutrition/ Micronutrient Supplementation-
8. Program on the Elderly/Geriatric Nursing
*Food Fortification :
Services
Rice –iron; Oil and sugar – Vit. A;
7 humanitarian issues: family, health, income, Flour-Vit. A & iron; Salt- iodine
security, employment and labor, social welfare,
education, recreation, culltural activities and Integrated Management of Childhood Illness
housing ( IMCI)
Leading causes of illness:elderly Integrates management of most common
Influenza, HPN, diarrhea, childhood problems ( diarrhea, pneumonia,
bronchitis, TB, diseases. of the heart, measles, malnutrition, DHF, malaria)
Involves family members and community in the
pneumonia, malaria,
health care process for physical growth and
malignant neoplasm, chickenpox mental development & disease prevention
Leading causes of death:elderly IV. The Public Health Nurse
Diseases of heart and vascular system Definition and terms:
Public Health Nursing
Pneumonia, TB, CCOPD refers to the practice of nursing in local/national
health departments (which includes health
centers and rural health units) and schools. and
It is a community health nursing practice in the occupational health nursing
public sector School nursing
Public Health Nurses A type of public health nursing that focuses on
Refers to the nurses in the local/national health
the promotion of health and wellness of the
departments or public schools whether their
pupils/students, teaching and non teaching
official position title is public health nurse or
personnel of the schools.
nurse or school nurse
Leaders in providing quality health services to the The primary role is to support the student
communities
First level of health workers to be learning and ensure that educational potential is
knowledgeable about new public health not hampered by unmet health needs
technologies and methodologies Assist the students in making choices for a
Usually the first ones to be trained to implement healthy life style, reduce risk taking behaviour
new programs and apply new technologies and focus on issues such as prevention of drug
Qualifications and substance abuse, teenage pregnancy,
Must be professionally qualified and licensed to STD,Malnutrition, CD and NCD
practice in the arena of public health nursing
Consistent with the nursing law of 2002 (RA founded by: Lillian Wald (1902)
9173)
7 Roles and Functions a member of the professional educational
1. Management function employed to aid students in developing their full
Inherent in the practice of PHN health potential in health and education
Organizes the nursing service of the HNC (health and Nutrition Center) of the DepEd
local health agency Mandated to safeguard the health and
Applications of 5 management Functions nutritional well-being of the total school
―POSDC‖ in organizing the nursing population.
service and the local health agency. 2 division
2. Supervisory function 1. health
Supervisor of the midwives and other 4 sections
health workers
3. Nursing care function Medical
Inherent function of the nurse Dental
Based on the science of art and caring Nursing
Caring for all levels of clientele toward Health education
health promotion and disease prevention 2. nutrition division
4. Collaborating and coordinating function Objectives of School Nursing
Care coordinators for communities and Genera l: To promote and maintain the health of
their members the school populace by proving comprehensive
Establishes linkages and collaborative and quality nursing care.
relationships with other health
professionals, government agencies, 6 Specific :
private sectors, NGO‘s people‘s 1. Provide quality nursing service to the school
organizations to address health population
problems 2. Create awareness among children, personnel
5. Health promotion and education function and administrators on the importance of the
Activities goes beyond health teachings promotive and preventive aspects of health
through health education.
and health information campaigns 3. Encourage the provision of standard functional
6. Training function facilities
Initiates the formulation of staff 4. Providing nursing personnel with opportunities
development and training programs for for continuing education and training.
midwives and other auxiliary workers 5. Conduct and participate in researches related to
7. Research function nursing care.
Participates in the conduct of research 6. Establish/ strengthen linkages with government
and non-government organization/agencies
and utilizes research findings in her
▪ for school community health
practice
work.
Disease surveillance 9 Duties and responsibilities of the school nurses
▪ Measure the magnitude of the 1. Health advocacy
problem 2. Health and nutrition assessment including other
▪ Measure the effect of the control screening procedures such as vision and
program hearing.
Competencies and skills 3. Supervision of the health and safety of the
1. Community health nursing process school plant.
2. Nursing procedures during clinic and home visits 4. Treatment of common ailments and attending to
3. Community organizing emergency cases.
4. Health promotion and education 5. Referrals and follow-up of pupils and personnel
5. Surveillance 6. Home visits
6. Recording and reporting 7. Community outreach
7. epidemiology E.g.,:
IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING ▪ attending community assemblies
School nursing
▪ and organizing school Training programs,
community health councils. conferences/workshops for teachers,
8. Recording and reporting of accomplishments pupils and parents
9. Monitoring and evaluation of programs and 11. Organization of school-Community Health and
projects. Nutrition Councils
Skills and competencies
1. Assessment and screening skills Membership shall come from both school
2. Health counselling skills and community
3. Social mobilization skills This attend to the health related
4. Good oral and written communication skills problems and concerns
5. Basic management skills 12. Communicable disease control
6. Life skills
16 function of the school nurse In participation of both the teachers,
1. School health and nutritional survey (from 1st parents and students
visit and Qyr)- for data and planning purposes Encourage the importance of
Survey of the ff: immunization for prevention
13. Establishment of Data Bank on School Health
current health situation and Nutrition Activities
and nutritional status Treatment in the school clinic
Facilities Record of the school visit
Health education activities Health assessment report of the school
2. Putting up a school clinic (R.A. 124) health personnel
3. Health assessment (every year or with Health and nutritional status of
epidemics)
pupils/students
Purpose:
Form 86 of teaching and non teaching
detect the signs of illness and physical personnel
defects for early correction. Teachers health profile
Health habits
Records of attended emergency case
4. Standard vision testing for school children
(20/20) Inventory of clinic and equipment
a supplies
Purpose: Health and nutrition activities in school
Screen students with poor visual acuity Record of accomplishment of school
and indentify other ocular problems health services
Refer students with eye disease and Records of officers/ officials of the
errors of refraction for further School-Community Health Council and
examination and management. their accomplishment
5. Ear examination Action plan
Methods: 14. School plant inspection for healthy environment
Observation Others concerns: school site, area,
Examination by using penlight or location, space and sanitation,
classroom and others rooms, school
otoscope
clinics, water supplies, sanitation, school
Screening test (whisper test, canteen.
conversation voice test, ball pen click.) Inspect for the size, lighting, ventilation,
6. Height and weight measurement and nutritional
arrangement of seats.
status determination
15. Rapid Classroom Inspection( after holidays and
Height and weight measurement is a procedure epidemics but not to exceed more than a month
except for cases of epidemics)
for evaluating the tallness or the shortness and
the heaviness of a pupil. Procedure same as HA
DepEd Purpose:
Detect cases of CD
<10 years old=weight for age and height
for age Note the correction that have been made
>10 years old= BMI Note if the eyeglasses are correctly adjusted
Appropriate school feeding programs with rice, Note the general cleanliness of the students
milk or fortified noodles are given to children Note new ailments.
with below normal nutritional status for 120
16. Home visitation
feeding days
Indication:
Deworming is a pre requite prior to feeding
Pupils whose parents are afraid of some
Consent from parent is pre requisite prior to deworming medical procedures
7. Medical referrals Pupils who get re-infected because of
8. Attendance to emergency cases
home conditions
9. Student health counselling( for student who Pupils suffering from CD
manifest the physical and emotional symptoms)
(parents, teacher, and student) Pupils who are absent frequently
10. Health and nutrition education activities because of sickness
Pupils who are malnourished. regulations
4. Attends to complaints of all establishment in the area
•Occupational health nursing
of assignment related to industrial hygiene and
By American Association of Occupational Health recommends appropriate measures for immediate
compliance.
• The special practice that provides for and 5. Participate to provide, install and maintain in good
delivers health care services to workers and condition all control facilities and protective barriers for
worker populations. potential and actual hazards.
The practice focuses on promotion, protection, 6. Informs all affected workers regarding the nature
hazards and the reasons for the control measures and
and restoration of workers’ health within the protective equiptment.
context of a safe and health work environment. 7. Makes a periodic testing for physical examination of
Occupational health nursing is autonomous, and the workers and other health examination related to
occupational health nurses make independent workers exposure to potential or actual hazards in the
nursing judgments in providing occupational work place
health services. 8. Provide control measures to reduce noise, dust,
health and other hazards.
The foundation of occupational health nursing 9. Ensure strict compliance on the regular use and
practice is research-based with an emphasis on proper maintenance of Personal Protective Equipment
optimizing health, preventing illness and injury, (PPE)
and reducing health hazards. 10. Provide employees an occupational health services
and facilities
By PNA – ANSAP, 1982
11. Refers or elevate to higher authority all unresolved
issues in relation to occupational and environmental;
•Is aimed at assisting workers in all occupations
health problems
to cope with actual and potential stresses in 12. Prepare and submit yearly reports to the local and
relation to their work and work environment. national Government
Application of Public Health Principles to Occupational
It is primarily geared at helping workers attain
Health Nursing
and maintain optimum level of physical and A. Community Assessment :
psychological functioning.
mission Identify the demographic data on
To ensure so far as possible every working man ▪ disease trends including
in the country is safe and in healthful working morbidity and mortality
conditions statistics,
Occupational Health Team ▪ and social environmental
1. Occupational Health Nurses conditions
2. Occupational physicians- focus on the ▪ that will provide
prevention, detection, and treatment of workrelated pertinent information for
diseases and injuries. the establishment of
3. Industrial hygienists-recognize, evaluate, and priorities in planning and
control toxic exposures and hazards in the work implementing
environment. occupational health
4. Safety Hazards engineers- focus on the programs
prevention of occupational injuries and the maintenance B. Worker Assessment:
or creation of safe workplaces and safe work practices. Assessment of the workforce to
5. epidemiologists- study and describe the natural determine populations at risk for
history of occupational diseases and injuries in occupationally related injury or illness.
population groups. Types of Classification:
6. toxicologists- study and describe the toxic
properties of agents used in work application to which Age, sex, race, type of work, the
workers may be exposed. presence or absence of disability.
7. Industrial engineers- design the tools, C. Application of Epidemiology
equipment, and machines used in manufacturing To determine relationship of work and
and other work applications injury or illness
8. Ergonomists- study design, and promote the
healthy interface of humans, their tools, and Methods use:
their work. Toxicology, pathology, ergonomics
9. Environmental engineers- concentrate on D. Team Approach
environmental controls to limit environmental
pollution and achieve a healthy environment. Collaboration with occupational health
Function of Public Health Nurse as an Occupational team for the development of
Health Nurse comprehensive occupational health
1. Work with the occupational health team program
to lead the sanitary hygiene of all industrial Industrial hygienist, epidemiologist,
establishment including hospitals to medical technologist, toxicologist, safety
determine their engineer, ergonomist, physician,
occupational health nurse, occupational
compliance with the sanitation code and its health therapist
implementing rules and regulations E. Program Planning and Implementation
2. Recommends to Local Health Authority the issuance Goal: promotion of wellness and prevention of
of license/ business permits and suspensions or illness and injury among workers.
revocation of the same for any violations of the Application:
conditions upon which said licenses or permits had been Primary prevention
issued, pursuant to existing rules and regulation. A program to ensure the health of
3. Coordinates with other governments agencies relative prospective employees/ workers includes
to the implementation of the implementing rules and
a history and physical examination to poisoning from accidental ingestion, metal-fume
assess level of wellness. Maintenance of fever, chemical burns, contact dermatitis and
that level is provided through other dermatoses
appropriate job placement. Chronic: cancers (mesothelioma, bronchogenic
Secondary Prevention
and GI carcinomas); pleural diseases;
Applied once the health problems is not occupational asthma; hypersensitivity
meet by primary prevention pneumonitis, birth defects and neurological
methods: disorders.
mesothelioma
Early detection and treatment of both
C. Biological Hazards:
work-and non-work related health
problems Biological agents such as viruses, bacteria,
Tertiary prevention: fungi, mold, or parasites may cause infection
Rehabilitation toward workers disabled disease via direct contact with infected
individuals/ animals, contaminated body fluids,
by occupational and non occupational
or contaminated objects, surfaces
problems
Workers in certain occupations ( health care,
Methods:
biological research and animal handling) have a
Evaluation of current status high incidence of infectious diseases.
Enhancement of employability, Acute: self limiting infections such as colds and
and appropriate job placement of influenzas, measles, skin and parasitic
infections.
employees
Chronic: TB, chronic Hepa B, HIV and AIDS
Services:
D. Mechanical Hazards
Physical occupational and speech
Mechanical agents may cause stress on the
therapy
musculoskeletal or other body systems
Vocational training
Hazards include inadequate work-station and
Chronic pain clinics tool design, frequent repetition of a limited
Remedial reading movement, repeated awkward movements with
hand-held tools, local vibrations.
Mathematics program Acute: neck strain and other muscular fatigue
F. Referral to Community Resources from forceful exertion or awkward positioning,
G. Program Evaluation and visual; fatigue.
Assessment of program to determine Chronic: Raynaud's syndrome from use of
benefits in terms of decreasing loss of vibrating power tools, carpal tunnel syndrome
productivity related to employee health
problems is carried out. Raynaud's syndrome
Issues In Occupational Health Nursing E. Psychosocial Hazards:
A. Physical Hazard Often related to trauma to the nature of the job,
Are agents within the work environment the job content, the organizational structure and
that may cause tissue damage or other culture, insufficient training and education
physical harm. regarding job requirements, and the physical
Radiation, extreme temperature, noise, condition in the work place, leadership and
management styles.
electric and magnetic field, lasers,
microwaves, and vibration. Interpersonal conflict, unsafe working
Acute: acoustic trauma from excessive noise, conditions, overtime, sexual harassment, racial
inequality, role conflict, shift work, limited
heat stress or stroke, skin rashes, eye injuries autonomy, poorly defines expectations and work
from infrared radiation, skin burns, cuts or instructions, and absent or limited reward.
contusions.
Acute: increased HR, increased BP, sleep
Chronic: NIHL, multiple myeloma and
disturbances, fatigue, depression,
leukaemia's from exposure to ionizing radiation, substance abuse, worksite violence.
teratogenic or genetics effects induced by
certain types of radiation. Chronic: HPN, alcoholism, CAD, mental
B. Chemical Hazards: illness, GI
Various forms of either synthetic or naturally f.Occupational injury- is any injury, such as cut, fracture,
sprain, or amputation that results from a single incident
occurring chemicals in the work environment in the work environment.
may be potentially toxic or irritating to the body g.Occupational illness- is any abnormal condition or
system through inhalation, skin absorption, disorder, other than one resulting from a occupational
ingestion, or accidental injection. injury, caused by exposure to environmental factors
Mists, vapors, aerosols, gases, medications, associated with employment.
particulate matters (dusts and fumes), solvents, School Nursing
metals, oil synthetic textiles, pesticides,
explosives, and pharmaceuticals. Specifically, Health assessment
health care workers are exposed to chemical METHODS USED:
hazards such as anaesthetic gases, a. Interview
chemotherapeutic and antineoplastic agents, b. Nutritional Assessment – height and weight
tissue fixative reagents, disinfectant and measurements
detergents, sterilizing agents, solvents, latex c. Vision Acuity Test/ Hearing Test
and mercury. d. IPPA
Acute: respiratory irritation due to smoke, e. V/S
f. Appraisal of the General and Physical and Mental
Condition 5. Inform parents if the findings
g. Recording COMMUNITY ORGANIZING PARTICIPATORY ACTION
PREPARATION: RESEARCH (COPAR)
a. Well, lighted, ventilated, screened room or a Importance of COPAR
corner of the classroom COPAR is an important tool for community development and
b. 2 or 3 chairs according to need people empowerment as this helps the community workers to
c. Waste basket generate community participation in development activities.
d. Hand washing facilities COPAR prepares people/clients to eventually take over the
e. Tongue dep., penlight management of a development program(s) in the future. COPAR
f. Step/ sphygmo maximizes community participation and involvement;
g. Forms/ records community resources are mobilized for community services.
PROCEDURES OF HEALTH ASSESSMENT Principles of COPAR
1. Nx conduct a classroom lecture to educate the 1. People, especially the most oppressed, exploited
pupils on what to do during the Health and deprived sectors are open to change, have the capacity to
Assessment. change, and are able to bring about change.
2. 3-5 children at a time should be waiting for the 2. COPAR should be based on the interest of the
assessment poorest sector of society.
3. Wash hand by the start of health assessment 3. COPAR should lead to a self-reliant community and
4. Assess the children one by one society.
5. Inspection: Phases of the COPAR Process
a. From head to foot 1. Pre-Entry Phase
b. Skin diseases Preparation of the Institution
c. Signs of abnormal condition o Train faculty and students in COPAR.
d. Stet should be use across the heart/ lung o Formulate plans for institutionalizing
assessment COPAR.
e. Findings should be recorded during the o Revise/enrich curriculum and immersion
assessment program.
STEPS o Coordinate participants of other
a. ARMS, HANDS, AND FINGER NAILS: departments.
Ask the child to roll their sleeves Site Selection
o Initial networking with local government.
Extend their arms o Conduct preliminary special investigation.
Show hands one side first, then the o Make long/short list of potential
communities.
other
o Do ocular survey of listed communities.
Spread their finger Criteria for Initial Site Selection
b. EYES o Must have a population of 100-200 families.
Ask the child to pull his lower lid using o Economically depressed.
o No strong resistance from the community.
his index finger and ask him to look up
o No serious peace and order problem.
c. TEETH o No similar group or organization holding the
Ask the child to open is mouth and say same program.
―ah‖ to show his throat Identifying Potential Municipalities
d. NOSE o Make long/short list.
Identifying Potential Barangay
Ask the child to place his 2nd finger on o Do the same process as in selecting
the tip of the nose and pull up his nose municipality.
and extend his head backward o Consult key informants and residents.
e. EARS o Coordinate with local government and NGOs
for future activities.
Ask the child to push back his hair
Choosing Final Barangay
behind his ear and pull the outer ear up, o Conduct informal interviews with
slightly backward/ and then forward. community residents and key informants.
f. NECK and CHEST o Determine the need of the program in the
Examine the neck community.
o Take note of political development.
Chest/ back should be auscultated
o Develop community profiles for secondary
g. HAIR data.
Ask the pupil to run his fingers through o Develop survey tools.
his hair several times o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.
Ask to show the nape by the pulling the
Identifying Host Family
hair up. o House is strategically located in the
h. FEET/LEG community.
Ask the girl to pull up her dress o Should not belong to the rich segment.
o Respected by both formal and informal
The boy his trousers to their knees
leaders.
Or you can observe while they o Neighbours are not hesitant to enter the
performed marching house.
i. GENERAL APPEARANCE o No member of the host family should be
IMPORTANT REMINDERS IN HA: moving out in the community.
1. If the health personnel is of the opposite sex, 2. Entry Phase
performed the procedure in the presence of the Guidelines for Entry
same sex. o Recognize the role of local authorities by
2. The result should be discuss to the teacher paying them visits to inform their presence
3. If and activities.
4. Refer cases that cannot be handle stat o Her appearance, speech, behavior and
lifestyle should be in keeping with those of
the community residents without disregard of Strategic thrusts for 2005-2010
their being role model. 1. Launch and implement Basic Emergency and
o Avoid raising the consciousness of the Obstetric Care (BEMOC) strategy in coordination
community residents; adopt a low-key profile. with DOH
Activities in the Entry Phase Entails establishment of facilities that
o Integration - establishing rapport with the
provide emergency obstetric care for
people in continuing effort to imbibe
every 125,000 population and which are
community life.
located strategically
living with the community 2. Improve quality of prenatal and postnatal care
seek out to converse with people where Pregnant women should have at least
they usually congregate four (4) prenatal visit
lend a hand in household chores 3. Reduce women‘s exposure to health risks
Institutionalization of responsible
avoid gambling and drinking
parenthood
o Deepening social investigation/community
4. Stakeholders must advocate for health
study verification and enrichment of data
collected from initial survey Resource generation and allocation for
conduct baseline survey by students, health services
Essential Health Service Packages
results relayed through community assembly
A. Antenatal Registration
Leader Spotting Through Sociogram.
Key persons - approached by most people B. Tetanus Toxoid Immunization
Opinion leader - approach by key persons C. Micronutrient Supplementation
Isolates - never or hardly consulted D. Treatment of Diseases and Other Conditions
3. Organization-building Phase E. Clean and Safe delivery
Entails the formation of more formal structure and the inclusion F. Recommended Schedule for Post Partum Care
of more formal procedure of planning, implementing, and Visits
evaluating community-wise activities. It is at this phase where
the organized leaders or groups are being given training
G. Importance of BF
(formal, informal, OJT) to develop their style in managing their 1. Antenatal Registration
own concerns/programs. 2. Tetanus Toxoid Immunization
Key Activities Dose:0.5ml
o Community Health Organization (CHO) Route: Intramuscularly
preparation of legal requirements Site: Right or Left Deltoid/Buttocks
3. Micronutrient Supplementation
guidelines in the organization of 4. Treatment of Diseases and Other Conditions
the CHO by the core group Types:
election of officers 1. Difficulty of breathing/ obstruction of airway
o Research Team Committee 2. Unconsciousness
3. Post partum bleeding
o Planning Committee
o Health Committee Organization 4. Intestinal parasite infection
o Others 5. malaria
o Formation of by-laws by the CHO 1.Difficulty of breathing/ obstruction of airway
4. Sustenance and Strengthening Phase What to do?
Occurs when the community organization has already been Clear the airway
established and the community members are already actively Place in her best position
participating in community-wide undertakings. At this point, the
different committee’s setup in the organization-building phase Refer woman to hospital with EmOC
is already expected to be functioning by way of planning, capabilities.
implementing and evaluating their own programs, with the Do not give anything PO
overall guidance from the community-wide organization. 2. Unconsciousness
Key Activities What to do?
o Training of CHO for monitoring and Keep on her back arms at the side.
implementing of community health program.
o Identification of secondary leaders. Tilt head backwards (unless trauma is
o Linkaging and networking. suspected)
o Conduct of mobilization on health and
Lift chin to open airway
development concerns.
o Implementation of livelihood projects. Clear secretions from throat.

MATERNAL HEALTH PROGRAM Give IVF to prevent or correct shock.

Tasked: Monitor BP and SOB every 15‘


Monitor fluid given. If DOB and puffiness
to reduce MMR by three quarters by develops, stop the infusion.
2015 to achieve ( millennium Monitor UO
Development Goal) MDG
Do not give:
Maternal Mortality Rate (2003)
CAUSE ORS for both unconscious or with
Other Complications related to pregnancy occurring in convulsions
the course of labor, delivery and puerperium IVF if not trained to do so.
1. Hypertension complicating pregnancy, childbirth 3. Post partum bleeding
and puerperium (25%) What to do?:
2. Postpartum hemorrhage (20.3%) Massage uterine and expel clots.
3. Pregnancy with abortive outcome (9%) If bleeding persist:
4. Hemorrhage related to pregnancy
▪ Place cupped palmed on uterine Danger signs of pregnancy
fundus and feel for state of
contraction Taking the history through interview will help
▪ Massage fundus in a circular determine the client‘s condition during delivery
motion of baby
▪ Apply bimanual uterine 4. Determine the stage of labor
compression if mem treatment Uterine contractions
done and postpartum bleeding
Bulging vulva
still persist.
▪ Give ergometrine 0.2mg IM and Leaking amniotic fluid
another dose after 15‘ Vaginal bleeding
Do not give:
Mem to woman with eclampsia, preeclampsia IE
or HPN 5. Decide if the woman can safely deliver
4. Intestinal parasite infection By assessing the condition of the client
What to do? and not finding any indication that could
Give mebendazole 500mg tab. Single harm the delivery of the baby
dose anytime from 4-9mos. Of pregnancy 6. Give supportive care throughout labor.
if none was given in the past 6 mos. Purpose:
Do not give: To deliver clean, safe and free from
Mebendazole in the 1st 1-3mos. Of fatigue
1. Encourage to take a bath at the onset of labor
pregnancy
2. Encourage to drink but not eat as this may
▪ This might cause congenital interfere surgery in case needed
problem in the baby 3. Encourage to empty bladder and bowels to
5. Malaria facilitate delivery of the baby. Remind to empty
What to do? the bladder every 2 hours.
Give sulfadoxin-pyrimethamine to 4. Encourage to do breathing technique to help
woman from malaria endemic areas who energy in pushing out the vagina. Panting can
are in 1st or 2nd pregnancy be done by breathing with open mouth with 2
short breaths followed by long breaths. This
500mg-25mg tab., 3 tabs. At the prevent pushing at the end of the 1st stage
beginning of 2nd to 3rd tri semesters not 7. Monitor and manage the different stage of labour
less than one month interval. -watch out for any danger signs
E. Clean and Safe delivery 1. First stage: not in active labor
Presence of skilled birth attendant Cervix: 3cms

Purpose Contraction: weak

to ensure hygiene during labor and Frequency: < 2 to 10‘


delivery. What to do?
Provide non-traumatic delivery Check Q 1hr. for emergency signs,
frequency and duration of contractions
recognize complications and FHT.
Referred those complicated deliveries to Check Q 4hrs. For fever, pulse, BP and
high level of care cervical dilatation.
Steps to follow during labor, childbirth and immediate Record time of ROM and color of
postpartum
amniotic fluid
Please refer accordingly
Assess progress of labor
1. Do a quick check upon admission for emergency
signs: ▪ Refer STAT to hospital with
complete facilities for the ff
Unconscious/convulsion condition:
Vaginal bleeding ▪ If after 8hrs,
contractions are
Severe abdominal pain
stronger and more
Looks very ill frequent but not
progress in cervical
Severe headache with visual disturbance
dilatation, with or
Severe breathing difficulty without membranes
ruptured
Fever
It is false labor if after 8hrs there is no
Sever vomiting
increase in contractions, membranes are
2. Make the woman comfortable not ruptured and no progress in cervical
Establish rapport with the client by greeting and dilatation.
interviewing to make her comfortable Not to do:
3. Assess the woman in labor IE more frequently than Q 4hrs.
- to determine the status during labor First stage: active labor
LMP 4cms cervical dilatation
Number of pregnancy What to do?
Start of labor pains Check Q30‘ for emergency signs

Age/height Check Q4hrs. For fever, pulse, BP and


cervical dilatation suffering from diarrheal diseases.
Record time of ROM and color of d. Reduces the infant‘s exposure to infection.
BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION
amniotic fluid
TRAINING
Record finding in partographs/patient Breastfeeding practices has been proved to be very
record. beneficial to both mother and baby thus the creation of
Not to do: the following laws support the full implementation of
Do not allow woman to push unless this program:
A. Executive Order 51
delivery is imminent. It will just exhaust
B. Republic Act 7600
the woman
C. The Rooming-In and Breastfeeding Act
Do not give medication to speed of of 1992
labor. It may cause trauma to mother A. EO 51 THE MILK CODE – protection and promotion of
and the baby breastfeeding to ensure the safe and adequate nutrition
Second stage: of infants through regulation of marketing of infant
Cervix: 10 cms. or bulging thin perineum foods and related products. (e.g. breast milk
substitutes, infant formulas, feeding bottles, teats etc. )
and head visible B. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT
What to do: of 1992
Check Q 5‘ for perineum thinning and =An act providing incentives to government and private
bulging, visible descend of the had health institutions promoting and practicing rooming-in
during contraction, emergency signs, and breast-feeding.
FHR and mood and behavior =Provision for human milk bank.
Continue recording in the partograph. =Information, education and re-education drive
=Sanction and Regulation
Not to do: BABY
Do not apply fundal pressure to help Provides Antibodies
deliver the baby
Third stage: Contains Lactoferin (binds with Iron)
Between birth of the baby and delivery Leukocytes
of the placenta Contains Bifidus factor-promotes growth of the
What to do: Lactobacillus-inhibits the growth of pathogenic
Deliver the placenta bacilli
Check the completeness of placenta and For the Mother
membranes e. Reduces a woman‘s risk of excessive blood loss
Not to do: after birth
Do not squeeze or massage the abdomen f. Provides a natural method of delaying
pregnancies.
to deliver the placenta g. Reduces the risk of ovarian and breast cancers
8. Monitor closely within 1hr. After delivery and and osteoporosis.
give supportive care.
9. Continue care after 1hr. Postpartum. Keep watch For the Family and Community
closely for at least 2hrs. h. Conserves funds that otherwise would be spent
10. Educate and counsel on FP and provide FP on breast milk substitute, supplies and fuel to
method if available and decision was made by a prepare them.
woman. i. Saves medical costs to families and
11. Informs, teach and counsel the woman on governments by preventing illnesses and by
important MCH messages: providing immediate postpartum contraception.
Birth registration POSITIONS IN BF THE BABY:
Importance of BF
1. Cradle Hold = head and neck are supported
Newborn Screening for babies delivered
in RHU or at home within 48hrs up to 2 2. Football Hold
weeks after birth.
Scheduled when to return for 3. Side Lying Position
consultation for postpartum visit BEST FOR BABIES
F. Recommended Schedule for Post Partum Care REDUCE INCIDENCE OF ALLERGENS
Visits ECONOMICAL
G. Importance of BF ANTIBODIES PRESENT
BREASTFEEDING STOOL INOFFENSIVE (GOLDEN YELLOW)
Breast milk is best for babies up to 2 EMPERATURE ALWAYS IDEAL
years old. Exclusive breastfeeding is recommended for FRESH MILK NEVER GOES OFF
the first six months of life. At about six months, give EMOTIONALLY BONDING
carefully selected nutritious foods as supplements. EASY ONCE ESTABLISHED
Breastfeeding provides physical and DIGESTED EASILY
psychological benefits for children and mothers as well IMMEDIATELY AVAILABLE
as economic benefits for families and societies. NUTRITIONALLY OPTIMAL
BENEFITS : GASTROENTERITIS GREATLY REDUCED
For infants Environmental Health Program
a. Provides a nutritional complete food for the
young infant. Environmental Sanitation and Promotion of Safe
b. Strengthens the infant‘s immune system, Water Supply
preventing many infections. Environmental Sanitation is defined as the study of all
c. Safely rehydrates and provides essential factors in the man‘s environment, which exercise or may
nutrients to a sick child, especially to those exercise deleterious effect on his well-being and
survival. 1.8 Noise
-Water is a basic need for life and one factor in 1.9 Radiological Protection
man‘s environment. Water is necessary for the 1.10 Institutional sanitation
maintenance of healthy lifestyle. 1.11 Stream pollution
Safe Water and Sanitation is necessary for basic PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
promotion of health. EHS sets policies on:
-One basic need of the family is food. And if Approved types of toilet facilities :
food is properly prepared then one may be assured LEVEL II – on site toilet facilities of the water carriage
healthy family. There are many food resources found in type with water-sealed and flush type with septic
the communities but because of faulty preparation and vault/tank disposal.
lack of knowledge regarding proper food planning, LEVEL III – water carriage types of toilet facilities
Malnutrition is one of the problems that we have in the connected to septic tanks and/or to sewerage system to
country. treatment plant.
HEALTH AND SANITATION FOOD SANITATION PROGRAM
-Environmental Sanitation is still a health -sets policy and practical programs to prevent
problem in the country. and control food-borne diseases to alleviate the living
-Diarrheal diseases ranked second in the conditions of the population
leading causes of morbidity among the general HOSPITAL WASTE MANAGEMENT PROGRAM
population. Disposal of infectious, pathological and other
-Other sanitation related diseases : wastes from hospital which combine them with the
tuberculosis, intestinal parasitism, schistossomiasis, municipal or domestic wastes pose health hazards to the
malaria, infectious hepatitis, filariasis and dengue people.
hemorrhagic fever Hospitals shall dispose their hazardous wastes thru
DOH thru’ Environmental Health Services (EHS)unit is incinerators or disinfectants to prevent transmission of
authorized to act on all issues and concernsin nosocomial diseases
environment and health including the PROGRAM ON HEALTH RISK MINIMIZATION DUE TO
verycomprehensive Sanitation Code of the Philippines ENVIRONMENTAL POLLUTION
(PD 856, 1978). Foci:
WATER SUPPLY SANITATION PROGRAM 1. Prevention of serious environmental hazards
EHS sets policies on: resulting from urban growth and industrialization
Approved types of water facilities 2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to health
Unapproved type of water facility (depletion of the stratosphere ozone layer which
Access to safe and potable drinking water increases ultraviolet radiation, climate change and other
conditions)
Water quality and monitoring surveillance NURSING RESPONSIBILITIES AND ACTIVITIES
Waterworks/Water system and well construction Health Education – IEC by conducting community
Approved type of water facilities assemblies and bench conferences.
Level 1 (Point Source)- a protected well or a developed The Occupational Health Nurse, School Health
spring with an outlet but without a distribution system
Nurse and other Nursing staff shall impart the
indicated for rural areas; need for an effective and efficient environmental
serves 15-25 households; its outreach is not sanitation in their places of work and in school.
more than 250 m from the farthest user Actively participate in the training component of
yields 40-140 L/ min the service like in Food Handler‘s Class, and
attend training/workshops related to
Level II ( Communal Faucet or Stand Posts) environmental health.
Assist in the deworming activities for the school
With a source, reservoir, piped distribution
children and targeted groups.
network and communal faucets
Effectively and efficiently coordinate
Located at not more than 25 m from the farthest
programs/projects/activities with other
house government and non-government agencies.
Delivers 40-80 L of water per capital per day to Act as an advocate or facilitator to families in
an average of 100 households the community in matters of
Fit for rural areas where houses are densely program/projects/activities on environmental
clustered health in coordination with other members of
Level III ( Individual House Connections or Waterworks Rural Health Unit (RHU) especially the Rural
System) Sanitary Inspectors.
With a source, reservoir, piped distributor Actively participate in environmental sanitation
network and household taps campaigns and projects in the community. Ex.
Sanitary toilet campaign drive for proper
Fit for densely populated urban communities
garbage disposal, beautification of home
Requires minimum treatment or disinfection garden, parks drainage and other projects.
ENVIRONMENTAL SANITATION Be a role model for others in the community to
- the study of all factors in man‘s emulate terms of cleanliness in the home and
physical environment, which may exercise a deleterious surrounding.
effect on his health, well-being and survival.
Includes: There was a man who saw a scorpion floundering
1.1 Water sanitation around in the water.
1.2 Food sanitation He decided to save it by stretching out his finger
1.3 Refuse and garbage disposal but the scorpion stung him.
1.4 Excreta disposal
1.5 Insect vector and rodent control The man still tried to get the scorpion out of the
1.6 Housing water but the scorpion stung him again.
1.7 Air pollution Another man nearby told him to stop saving the
scorpion but the man said, ―It‘s the nature of
the scorpion to sting. It‘s my nature to love, why
should I give up my nature to love just because
it‘s the nature of the scorpion to sting?‖
Don‘t give up loving, don‘t give up your
goodness even if people around you sting…
THE END
See u next sem.

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