Chn review march 1 2011 complete - Presentation Transcript

1. COMMUNITY HEALTH NURSING ROMEO D. PIANSAY, JR., R.N., M.A.N. 2. o CHN ??? o Boring?? o Verbose?? o Confusing?? o Repetitive?? 3. 9 PRIMARY QUALITIES OF CHN 4. Promotion of OLOF thru health teaching and delivery of care 1 Primary GOAL 5. Health Teaching 2 Primary DUTY 6. 3 Health care for the ENTIRE community Primary PRINCIPLE 7. Health Promotion 4 Primary FOCUS 8. Nursing Process 5 Primary METHODOLOGY 9. Population-focused care (MASS BASED) 6 Primary TYPE of CARE DELIVERY 10. Recognized Needs of Clients 7 Primary BASIS 11. Family 8 Primary UNIT of SERVICE 12. 9 Primary CLIENT & SETTING Community 13. o Linguistic Origin o [L. communitas, fellowship] o [MOSBY] a group of species who reside in a designated geographic area and who share common interests or bonds o [STEDMAN] a group of persons united by some common feature or shared interest COMMUNITY
14. Qualities of a Healthy Community 4) Awareness community health status 5)

Independence people & leaders 6) Role Models parents & guardians 7) Active Concern health threats 8) Sustainability environment & needs 9) Accessibilty health services 1) Resources open & controlled 2) Empowerment active participation 3) People healthy citizenry 10) Politics mass-based & respected (REPAIR ASAP) 15. Classification of a Community 16. o Rural or Open lands o Agricultural / fishing o less dense o more spacious 1 17.

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Urban or the City non-agricultural dense & highly populated highly industrialized

2 18. Rurban or the Capitals - mixed type of rural & urban 3 19. COMPONENTS OF A COMMUNITY o THE CORE o People demographics, values & beliefs 20. B. 8 subsystems of the community 4) Economics livelihood projects 5) Recreation community activities 6) Fire and safety bldg. & house check 7) Politics & govt selection of leaders 8) Health health services & programs 1) Communication open all channels 2) Housing adequate shelter & security 3) Education health teachings, seminar (CHEER for public health) 21. APPROACHES TO COMMUNITY DEVELOPMENT o A. Welfare approach the immediate & spontaneous response to ameliorate poverty assumes that poverty is God-given poverty is destiny must accept fate just reward in heaven 22. o B. Modernization approach aka project development approach introduces lacking resources o C. Transformatory/participatory approach involves people empowerment & transformation of the poor assumes that poverty is not God-given poverty historical past existence of oppressive structures in society 23. o State of complete physical, mental and social well-being, not merely the absence of disease or infirmity o WORLD HEALTH ORGANIZATION o OLOF of individuals, families & communities being influenced by several factors in the eco-system o MODERN CONCEPT OF HEALTH o [NLPGN, CHN committee, 2000] HEALTH 24. ECO-SYSTEM FACTORS THAT AFFECT COMMUNITY HEALTH (OLOF) 25. o This factor pertains to the power and authority to regulate the environment o EXAMPLES:

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Safety Oppression People empowerment

POLITICAL 26. One component of this factor is the primary health care which is a partnership approach GOAL: effective provision of health services that are community-based and accessible COMPONENTS: Promotive, Preventive, Curative & Rehabilitative

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HEALTH CARE DELIVERY SYSTEM 27. COMPONENTS Culture Habits Ethnic customs EXAMPLES Smoking Intake of alcoholic drinks Substance abuse Lack of exercise

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BEHAVIORAL 28. COMPONENTS Employment Education Housing

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SOCIO ECONOMIC INFLUENCES 29. COMPONENTS Air Food Water waste Urban/rural noise Radiation Pollution

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ENVIRONMENTAL INFLUENCES 30. COMPONENTS Genetic endowment Defects Strengths Risks: Familial Ethnic Racial

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HEREDITY
31. 4) Environment air, food, water, noise 5) Behavior culture, habits, customs 6) Health

care delivery system promotive, preventive, curative, rehab 1) Political safety, oppression, govt. 2 ) Socio-economic employment, educ. 3) Heredity genetics, race, ancestry ECO-SYSTEM FACTORS THAT AFFECT CH Physician Sometimes Heals Everyone But Himself 32. o Public health as the science and art of preventing disease, prolonging life and efficiency to enable every citizen to realize his birthright of health and longevity. DEFINITIONS W I N S L O W 33. Public health is dedicated to the common attainment of the highest level of physical, mental and social well-being and longevity GOAL: contribute to the most effective total development and life of the individual and his society

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HANLON 34. Community health nursing is a learned practice discipline Ultimate goal : contribute to the promotion of clients optimum level of functioning Through teaching and delivery of care

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JACOBSON 35. CHN is a service rendered by a professional nurse with the community, groups, families and individuals GOAL: promotion of health, prevention of illness, care of the sick at home and rehabilitation

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FREEMAN 36. Philosophy of community health nursing is based on the worth and dignity of man

SHETLAND 37. 5 Core Business of Public Health o Disease control o Injury prevention o Health protection o Health public policy o Promotion of health and equitable health gain 38. MIND GAMES HOW MANY FACES CAN YOU SEE? 39. o [MOSBY] the practice in which a nurse assists the individual, sick or well, in the performance of those activities contributing to health or its recovery ( or to a peaceful death) o - adaptation from Virginia Henderson NURSING 40. PUBLIC HEALTH NURSING o Lillian Wald coined the term public o health nursing to denote a service o that was available to all people o PHN Public/govt agency o care of poor people o CHN -> nursing for the health of the o ENTIRE public/community, NOT ONLY for the o public who are poor o PHN & CHN have been used interchangeably in the Philippines by both foreign and local authors 41. o Public Health Nurses (PHNs) refer to nurses in the local /national health dept or public schools whether their official position title is Public Health Nurse or Nurse or School Nurse PHN ACCORDING TO NLPGN, 2005 42. PHN ACCORDING TO NLPGN, 2005 o Public Health Nursing refers to the practice of nursing in national and local govt health dept. and public schools. IT IS CHN PRACTICED IN THE PUBLIC SECTOR. 43. FIVE FOLD MISSION OF CHN / PHN: 4) Disease Prevention avoid consequences Primary prevention immunizations Secondary prevention screenings Tertiary

Prevention rehabilitation 5) Social Justice right to basics of life 1) Health Promotion lifestyles / choices 2) Health Protection alter community dses 3) Health Balance biopsychosocial homeo Holding Hands, Hugs, Dont Smack 44. 8 Millenium Devt Goals (2015) 4) Gender equality and women empowerment 5) Environmental sustainability 6) Universal primary education 7) Combat HIV/AIDS, malaria & other dses 8) Global partnership for development 1) Extreme poverty and hunger eradication 2) Maternal health improvement 3) Child mortality reduction Every Married Cool Guy Eyeballs Underage Cool Girls 45. o APIE over-all community health plan o Provide quality nursing services o Coordinate the health team, NGOs & govt. agencies o Researches relevant to PHN services o Continuing education & professional growth OBJECTIVES OF CHN: ALL PUBLIC COMFORT ROOMS CONTAMINATED 46. SPECIALIZED FIELDS OF CHN: COMMUNITY MENTAL HEALTH NURSING A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, community networks & the basic sciences FOCUS: mental health promotion 47. o OCCUPATIONAL HEALTH NURSING The application of nursing principles & procedures in conserving the health of workers in all occupations AIMS: Health promotion Prevention of diseases Risk reduction Safe workplace 48. o SCHOOL HEALTH NURSING Application of nursing theories & principles in the care of the school population COMPONENTS: School Health services Health instruction Healthful school living School-community linkage 49. LEADING AILMENTS/DEFECTS AMONG SCHOOL CHILDREN o Dental Caries o Intestinal Helminthiasis o Colds
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Pediculosis Upper respiratory tract infection 50. 1) Individual - Not the main client in CHN, but receives CHN care through the family Family - the basic unit of care Population group Community The ultimate patient is the COMMUNITY .

4 Levels of Clients / patients 51. 4 Major Functions of the Family o Physical Function o Economic Function o Reproductive Function o Socialization Function 52. KINDS OF FAMILY STRUCTURE o A) Traditional Family nuclear family Extended family o B) Alternate Family Structure Single-Parent Families Cohabitating families 53. The beginning family The early child-bearing family The family with pre-school children The family with school-age children The family with teen-agers The Family as Launching Center The middle-aged family The aging family Stages of Family Development 54. Infants & young children School age Adolescents Mothers Elderly Males *

VULNERABLE POPULATION GROUPS

55. CHN ROLES OF THE NURSE Facilitate & empower people 3) COLLABORATOR Coordinates community resources 1) CLINICIAN Focus on the health of individuals 2) COMMUNITY ORGANIZER 56. CHN ROLES OF THE NURSE Gives KSA, better informed choices a) INFORMATION provision of knowledge b) EDUCATION change thru KSA 4) COUNSELOR Listening, give feedback & support 5) EDUCATOR c) COMMUNICATION exchange of info 3 ASPECTS OF HEALTH TEACHING 57. CHN ROLES OF THE NURSE Shows examples of good behavior 8) CHANGE AGENT Influences & motivate others good behavior 6) RESEARCHER/STATISTICIAN/RECORDER Analyzes data to predict future phenomenon 7) ROLE MODEL 9) HEALTH ADVOCATE Aids people in asserting their rights; promotes self-care and self-determination 58. CHN ROLES OF THE NURSE providing nursing care skills in a home setting 10) CASE MANAGER oversees all aspects of care to facilitate delivery of cost-efficient care; to individualize and coordinate care 11) HOSPICE CARE 59. 7 FUNCTIONS OF PHN o Management function o Supervisory function o Nursing care function o Collaborating & coordinating function o Health promotion & education function o Training function o Research function 60. Sample Questions: o The community health nurse acting in a role of clinician would be more likely to: A) Work to articulate the special needs of a population such as homeless people B) Focus on reducing the incidence of disease in a population C) Address the spiritual needs of a group without performing any screening or treatment D) Coordinate the various components of care in different areas of the health system o Answer: B 61. o The CHN acting in the role of advocate would be o most likely to promote: Self-care & self-determination for the population Telling the people in a community that the medical experts know what is best for them. Smoking cessation That health care options should be pursued without the influence of friends or families o Answer: A 62. o Which of the following is not a role for the nurse o providing hospice or end-of-life care?

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Providing resources for caregivers to prevent burnout Ensuring that the client is given every reasonable chance to extend life and is encouraged not to give up too easily Working as part of a multidisciplinary team to meet clients needs. Promoting & coordinating palliative care Answer: B

63. 64. Philippine Herbal Medicine 65. T.A.M.A. OF 1997 o REPUBLIC ACT NO. 8423 o (TRADITIONAL & ALTERNATIVE MEDICINE ACT) o Created PITAHC (Phil. Institute of Traditional & Alternative Health Care) o - scientific research & development of traditional & alternative health care system that have impact on public health care. 66. Phil. Institute of Traditional & Alternative Health Care (PITAHC) o BACKGROUND: o Administrative Order No. 12 (1992)- Traditional Medicine Program, through former Health Secretary / Senator Juan M. Flavier o This special program was tasked to promote and advocate traditional medicine nationwide. 67. o Vision o "Traditional and alternative health care in the hands of the people" o Mission o "PITAHC upholds the right of every Filipino for better health through the provision of safe, effective and affordable traditional and alternative health care products, services and technologies." 68. Products of PITAHC 69. Handling Tips on Medicinal Plants / Herbs o If possible, buy herbs that are grown organically - without pesticides. o Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall. o Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts. 70. Tips on Preparation for Intake of Herbal Medicines: o Use only half the dosage prescribed for fresh parts like leaves when using dried parts. o Do not use stainless steel utensils when boiling decoctions. Only use earthen, enameled, glass or alike utensils. o As a rule of thumb, when boiling leaves and other plant parts, do not cover the pot, and boil in low flame. 71. o Reminders: o One kind of plant for each type of s/s o No insecticides o Use clay pot and plant part advocated

Stop in case of untoward reactions; seek consultation if signs/symptoms not relieved after 2-3 doses 72. QUESTION o In preparing herbal medicines, which of the following is incorrect? o A) When boiling, cover the pot well to preserve the nutrients. o B) You must boil them in low flame. o C) One kind of plant for each type of symptom o D) Use a clay pots. o ANSWER: A 73. QUESTION o In the use of herbal medicine, one should remember to o a. use all parts of the plant in making decoction. o b. boil leaves sprayed with insecticide. o c. stop giving herbal medicine if allergy occurs. o d. continue giving decoction even if signs and symptoms persist. o ANSWER : C 74. QUESTION o Which of the following is a correct statement? o a) local plants and herbs in the Philippine backyard are all effective in treatment of ailments o b) since they are readily available at no cost, you may use 2 or more for kinds for faster cure o c) no side effects or untoward reactions o d) not recommended for everyone to use herbal medicines o ANSWER : D 75. QUESTION o The Traditional & Alternative Medicine Act of 1997 is also known as: o A) PD #8243 o B) RA # 8342 o C) PD # 8432 o D) RA # 8423 o ANSWER: D 76. 10 DOH herbal medicines ( AUNTY LABS B ) o A AMPALAYA o U ULASIMANG BATO o N NIYOG-NIYUGAN o T TSAANG GUBAT o Y YERBA BUENA o L LAGUNDI o A AKAPULKO o B BAWANG o S SAMBONG o B BAYABAS 77. Ten (10) Herbal Medicines in the Philippines Approved by the Department of Health (DOH)
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78. 1. Ampalaya (Mamordica charantia) - "bitter gourd" or "bitter melon" in English, - treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients. 79. 2. Ulasimang Bato (Peperomia pellucida) - also known as "pansit-pansitan" for arthritis and gout 80. 3. Niyog-niyogan (Quisqualis indica L.) - is a vine known as "Chinese honey suckle - for intestinal worms, particularly the Ascaris and Trichina 81. 4. Tsaang Gubat (Ehretia microphylla Lam.) - enhance intestinal motility - mouth wash (high fluoride content) 82. 5. Yerba Buena (Clinopodium douglasii) - commonly known as Peppermint - an analgesic to relieve body aches and pain 83. 6. Lagundi (Vitex negundo) - "5-leaved chaste tree - for the relief of cough & asthma 84. 7. Akapulko (Cassia alata) - also known as "bayabas-bayabasan" and "ringworm bush" in English - Antifungal: Tinea Flava, ringworms, athletes foot and scabies 85. 8. Bawang (Allium sativum) - popularly known as "garlic - reduces cholesterol in the blood - helps control blood pressure 86. 9. Sambong (Blumea balsamifera) - English name: Blumea camphora - A diuretic for excretion of urinary stones - anti-edema 87. 10. Bayabas (Psidium guajava) - "guava" in English an antiseptic - to disinfect wounds - mouth wash to treat tooth decay and gum infection 88. QUESTION a. lagundi. b. akapulko. c. niyog-niyogan. d. bawang. ANSWER: D Allium sativum is the scientific name of: 89. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: C A vine which acts as an anti-helminthic is 90. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: A The use of bawang is advocated in order to 91. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: A WHICH OF THE FF. IS MAINLY USED FOR THE RELIEF OF COUGH AND ASTHMA? 92. QUESTION A) Clinopodium douglasii B) Allium sativum C) Mamordica charantia D) Shigella bordetella ANSWER: C The scientific name of ampalaya is: 93. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: C Which of the ff is an indication for ampalaya? 94. Narra Pterocarpus indicus o NARRA o USES: o DIARRHEA o HEADACHE o PRICKLY HEAT 95. Lansones Lansium domesticum Correa o LANSONES o USES: o DIARRHEA o ABDOMINAL COLIC

FEVER 96. Mani Arachis hypogaea Linn. PEANUT o MANI o USES: o BLADDER INFECTIONS o OILS & LINIMENTS 97. Luya Zingiber officinale Rose. GINGER o LUYA o USES: o ANTISEPTIC o RHEUMATISM o SORE THROAT/ HOARSENESS o COUGH o HANGOVERS o HEADACHES 98. Makahiya Mimosa pudica Linn. BASHFUL MIMOSA, SENSITIVE PLANT o MAKAHIYA o USES: o ASTHMA o EXPECTORANT o SORE THROAT o WOUNDS 99. Makopa Syzygium malaccense MALAY APPLE, TERSANA ROSE APPLE o MAKOPA o USES: o DYSENTERY o AMENORRHEA 100. Oregano Coleus aromaticus Benth. o OREGANO o USES: o ASTHMA o CHRONIC COUGH o BRONCHITIS 101. Kauayan BAMBOO o KAWAYAN o USES: o INDUCE LOCHIA AFTER C.B. o ANTIHELMINTHIC o ANURIA 102. Mangga Mangifera indica o MANGGA o USES: o DIURETIC o ASTRINGENT o STOMATITIS
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Mangostan Garcinia mangostana MANGOSTEEN MANGOSTEEN USES: ABDOMINAL PAIN DIARRHEA DYSMENORRHEA Malunggay Moringa oleifera BEN OIL TREE MALUNGGAY USES: INTESTINAL PARASITISM CONSTIPATION WOUNDS & CUTS Niyog Cocos nucifera COCONUT NIYOG USES: DANDRUFF DRY SKIN SCABIES Okra Abelmoschus escuclentus Linn. Hibiscus esculentis Linn. OKRA USES: URINARY INFECTIONS SORE THROAT WOUNDS Mais Zea mays CORN MAIS USES: DIURETIC DYSURIA URINARY TRACT INFECTION QUESTION It is also known as BEAN OIL TREE. NARRA NIYOG MAKOPA MALUNGGAY ANSWER: D QUESTION WHICH OF THE FOLLOWING IS EFFECTIVE FOR DYSMENORRHEA? OREGANO OKRA MAIS MANGOSTEEN ANSWER: D QUESTION

It is also known as MALAY APPLE. LANSONES MANGA MAKOPA OREGANO ANSWER: C 111. QUESTION o WHICH OF THE FOLLOWING IS EFFECTIVE o FOR INDUCING LOCHIA AFTER CHILD BIRTH? o MAKAHIYA o KAUAYAN o NIYOG o MALUNGGAY o ANSWER: B 112. Talong Solanum melogena L. o TALONG o USES: o SORE THROAT o ABSCESS o CRACKED NIPPLES 113. Sibuyas Allium cepa L. True onion o SIBUYAS o USES: o STIMULANT o DIURETIC o EXPECTORANT 114. Patatas Solanum tuberosum o PATATAS o USES: o GENTLE LAXATIVE o GOUTY ARTHRITIS o HYPERTENSION 115. Sabila Aloe vera o SABILA o USES: o DANDRUFF o SCALDS AND BURNS o SPRAINS o BRUISES 116. Siling-labuyo Capsicum frutescens CHILE PEPPER, SPANISH PEPPER CAYENNE o SILING-LABUYO o USES: o ARTHRITIS / RHEUMATISM o DYSPEPSIA
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FLATULENCE Sampalok Tamarindus indica Linn. TAMARIND SAMPALOK USES: FEVER LAXATIVE ASTHMA Sampagita Jasminum sambac Linn. JASMINE SAMPAGUITA USES: FEVER COUGH DIARRHEA Tanglad Andropogon citratus Lemon Grass, Ginger grass TANGLAD USES: DIARRHEA FEVER Papaya Carica papaya MELON TREE PAPAYA USES: LAXATIVE ACNE STOMACH ACHE Saging Musa sapientum Linn. BANANA SAGING USES: COOL DRESSING THINNING HAIR HEADACHES Pito-Pito Pito-Pito is a blend of seven seeds or leaves of seven traditional herbal medicinal plants , usually prepared as a decoction It is used in a wide variety of applications: headaches, fever, cough, colds, migraine, asthma, abdominal pains, diarrhea, etc. Pito-Pito The ingredients vary according to availability and intended use. Seven (pito) is believed to be numerologically essential to the efficacy of the eventual formulation. 124. A traditional combination is seven leaves of: alagaw, banaba, bayabas, pandan,

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mangga, with half a teaspoon each of anis and cilantro boiled for 30 minutes, strained and drained. Pito-Pito In the urban and suburban areas, it has become part of alternative new-age menu as a herbal tea blend. Commercial tea preparations substitute one or two ingredients with other herbal medicinal components. QUESTION It is also known as MELON TREE. PATATAS NIYOG PAPAYA PIPINO ANSWER: C QUESTION WHICH OF THE FOLLOWING IS EFFECTIVE FOR CRACKED NIPPLES? SILING-LABUYO SABILA PANDAN TALONG ANSWER: D QUESTION It is also known scietifically as MUSA SAPIENTUM. SAGING PATOLA PATATAS TANGLAD ANSWER: A QUESTION WHICH OF THE FOLLOWING IS NOT PART OF PITO-PITO? BANABA BAYABAS AMPALAYA MANGGA ANSWER: C VITAL STATISTICS 132. POPULATION STRUCTURE POPULATION SEX RATIO = M / F x 100% ex: 12,349 M / 12,413 F x 100 = 99% ( for every 99 males, there are 100 females) 133. AGE STRUCTURE

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Percentage of a specified age group in comparison to the total number of population EXAMPLE: total population = 50 specified age group=children 1 4 = 30 30 / 50 x 100 = 60% 134. DEPENDENCY RATIO Refers to the very young & old population FORMULA: Population (0-14) + (65 & above) / (15 64) x 100 135. EXAMPLE: Population 0 14 + 65 & above = 500 Population 15 64 y.o. = 500 500 / 500 x 100 = 100 (ratio 1:1) 136. MEASURES OF DISTRIBUTION DENSITY (D) shows the number of persons dwelling upon a unit area of land D = Population / area 137. EXAMPLE: land area = 20,000 square meters population = 1000 1,000 / 20, 000 sq. m = 0.05 sq. m THUS: for every 100 sq. m, there are 5 persons living on it 138. MEASURES OF MIGRATION MIGRATION CRUDE IN MIGRATION RATE (CMIR) no. of in migrants / population x 100 139. CRUDE OUT MIGRATION RATE (CMOR) no. of out migrants / population x 100 NET MIGRATION RATE CMIR CMOR = net migration rate 140. MEASURES OF POPULATION GROWTH RATE OF NATURAL INCREASE CBR CDR per 1000 population 141. AVERAGE ANNUAL PERCENTAGE INCREASE Pt / Po 1 / t x 100 Where: Pt population at a later date Po population at an earlier date t time interval between dates t & o

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142. EXAMPLE: Population in 1977 = 5,000 Population in 1972 = 1,000 5,000 / 1,000 1 / 5 x 100 = 80% 143. ZERO GROWTH RATE BIRTH RATE = DEATH RATE 144. RATIO A relative number expressing the magnitude of one occurrence or condition in relation to another 145. RATE Measures the probability of occurrence of some particular events A relation indicating the number of times a certain number of exposures to the risks of occurrence is present in a given period of time 146. MID-YEAR POPULATION Population of the area under study as of JULY 1 POPULATION AT RISK Population capable of acquiring the disease 148. FERTILITY / NATALITY RATES CRUDE BIRTH RATE Total live births in a calendar year / MP x 1,000 149. GEN. FERTILITY RATE Total live births in a calendar year / mid-year population of women of childbearing age (15 44) x 1,000 150. MORTALITY RATES A. CRUDE DEATH RATE Total deaths in a calendar year from all causes / MP x 1,000 CAUSE SPECIFIC DEATH RATE Deaths from a particular cause / MP x 100,000 151. PROPORTIONAL MORTALITY RATE Deaths from a particular cause / deaths from all causes x 100 SWAROOPS INDEX Deaths in persons 50 yrs & above / total no. of deaths x 100 = % (no. of persons who died at 50 yrs. & above) 152. CASE FATALITY RATE Deaths from a particular cause / no. of cases from the same cause x 100

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INFANT MORTALITY RATE Deaths in 1 year of age / total live births in same year x 1,000 153. NEONATAL MORTALITY RATE Deaths below 28 days of age / total no. of live births x 1,000 MATERNAL MORTALITY RATE Deaths from women directly due to pregnancy, labor or puerperium (90 days after delivery) / total no. of live births x 1,000 154. MORBIDITY RATES Measures the frequency of illness or disability For groups of allied illnesses within specific populations 155. GENERAL MORBIDITY RATE Total no. of sick persons / MP x 100,000 INCIDENCE RATE It answers how frequently the disease occur within a given period of time No. of new cases of a specified disease during a given time / population at risk in the area during that time x 100,000 156. ATTACK RATE A measure of incidence during outbreaks or epidemics No. of new cases of a disease in a time period / population at risk during that time x 100 157. PREVALENCE RATE Measure of the status of a particular disease within a given point or interval in time It answers what proportion of the population or group of persons are actually ill with the particular disease or are infected with a particular agent at a given point in time 158. no. of new and old cases of a certain diseases registered at a given time PR = ___________________________________ x 100 total number of person examined at same given time MIND GAMES - WHAT DO YOU SEE? COPAR COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH DEFINITIONS: a social development approach that aims to transform the apathetic , individualistic, and voiceless poor into dynamic, participatory and politically responsive community IMPORTANCE OF COPAR COPAR helps the community workers

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to generate community participation in development activities. COPAR prepares people/clients to eventually take over the management of a development program in the future. 163. COPAR maximizes community participation and involvement; community resources are mobilized for community services PRINCIPLES OF COPAR People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change, and are able to bring about change COPAR should be based on the interests of the poorest sectors of society COPAR should lead to a self-reliant community and society PROCESSES / METHODS USED PROGRESSIVE CYCLE OF ACTION-REFLECTION- ACTION begins with small, local and concrete issues identified by the people and the evaluation and reflection of and on the action taken by them 166. CONSCIOUSNESS-RAISING THROUGH EXPERIENTIAL LEARNING - placing an emphasis on learning that emerges from concrete action and which enriches succeeding action 167. C. PARTICIPATORY & MASS-BASED it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed 168. D. GROUP-CENTERED and NOT LEADER ORIENTED leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity. PHASES OF THE COPAR PROCESS 1. Pre-entry phase - is the initial phase of the organizing process where the community organizer looks for communities to serve or help - it is considered the simplest in terms of actual outputs, activities, and strategies and time spent for it 170. Activities include: designing a plan for community development, including all its activities and strategies for care/development designing criteria for the selection of site Methods for site selection: Coordination with community leaders Ocular observation Data collection

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Informal interviews actually selecting the site for community care 171. 2. ENTRY PHASE - called the social preparation phase - activities are the following: a) sensitization of the people on the critical events in their life b) motivating them to share their dreams and ideas on how to manage their concerns c) mobilizing them to take collective action 172. signals the actual entry of the community worker/organizer into the community. Guidelines for entry: courtesy call - recognize the role of local authorities by paying them visits to inform them of your presence & activities when in Rome, be a Roman appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of being role the model adopt a low-key profile 173. - look for potential leaders & core-group members Criteria for potential leaders: Mass based or from poor sector Directly engaged in production Respectable & trustworthy Charismatic Pro - active & change agent Conscientious & resourceful Effective communication skills 174. 3. Organization-building phase - entails the formation of more formal structures - It is at this phase where the organized leaders or groups are being given trainings ( OJT, formal or informal ) - wider participation & collective community action 175. 4. Sustenance and strengthening phase - occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. 176. - strategies used may include: a) education & training b) networking and linkaging c) conduct of mobilization on health and development concerns d) implementation of livelihood projects

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e) developing secondary leaders RECORDS & REPORTS Records refer to forms on which information pertaining the client is noted Reports refers to periodic summaries of services /activities of an organization/ unit or the analysis of certain phases of its work 178. Purposes of records and reports: a) measure service / program directed to the clients b) provide basis for future planning c) interpret the work to the public and other agencies d) aid in studying the conditions of the community e) contribute to client care 179. Sample Questions One of the primary tasks of the community health nurses during the pre-entry phase is the selection of the Barangay to become the initial site for their organizing efforts. The following are the steps in the selection of the project site by the team, except: Developing criteria for site selection Identifying potential barangays and choosing the final project village Identification of potential leaders Identification of the host family Answer: C (under entry phase) 180. 2. It is considered the simplest in terms of actual outputs, activities, and strategies and time spent for it. Organizing-building phase Pre-entry phase Sustenance phase Strengthening phase Answer: B 181. 3. For potential leaders to perform their roles effectively, they have to possess certain characteristics. Among these are the following, except: They must belong to the poor sector They must be respected members of the community Preferably informal leaders Formal leaders with many community responsibilities Answer: D (They do not have time to perform additional duties) 182. 4. This phase signals the start of community self-management of any development program. Pre-entry phase Integration phase

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183.
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186.
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187.
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190.
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Entry phase Organization-building phase Answer: D (a community organization facilitates in the participation in health and other development activities) APPLICATION OF COPAR IN COMMUNITY HEALTH CARE PROCESS 184. NURSING PROCESS A systematic, scientific, dynamic, on-going interpersonal process The nurses & the clients are viewed as a system, with each affecting the other & both being affected by the factors within the behavior 185. 4 STEPS IN CHN PROCESS: A ssessment P lanning I mplementation E valuation Community competence refers to the communitys ability to: - identify needs - achieve working consensus - agree and work together to meet goals COMMUNITY ASSESSMENT Process of examining the community strategies that improve health and quality of life for the community Systematic & continuous 188. Identifies specific deficiencies or guidance needed Estimates possible effects of the nursing interventions getting to know the community client - this includes: a) decide what data to be gathered b) plan the process of data gathering 189. DATA TO BE COLLECTED Demographic data Vital health statistics Community dynamics Education, socio-cultural, religious & occupational background Family dynamics Environment & patterns of coping THREE DIMENSIONS OF COMMUNITY ASSESMENT Status - information about morbidity and mortality, life expectancy, crime rates and education. Structure socioeconomic, age, gender, resources Process how the community operates and functions as a whole

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195.
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196.
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198.

191. Planning for a Program of Action a) determining objectives for care / action - identify what is to be done and what outcomes might be expected from the program/project/services implemented 192. Criteria for setting objectives: they should be realistically be achievable should be specifically stated should be flexible enough to allow for change should be closely related to the problems and needs identified and felt by the client should be closely coordinated with those of the entire health care team 193. b) select activities and methods / strategies for achieving the objectives a. home visits b. conferences / demonstrations c. health service delivery d. group discussion e. information dissemination 194. Factors in selecting activities: a. need / capabilities of the client b. identify target clientele c. review traditional activities and select only those not detrimental to health, life and limb d. bear in mind that a balanced program is far more effective than in those which are unbalanced or biased Program Implementation refers to the actual carrying out of the plan refers to the mobilization of resources to meet objectives must include active participation of the people Program Monitoring & Evaluation Monitoring is an internal project/intervention/ care activity concerned to assess whether resources are being used as intended and whether they are producing the intended outputs 197. Evaluation is a process that is designed to show the relationship between services rendered and the objectives or purposes of the service / unit / care provider not a record nor count of what was done but of what DIFFERENCE the doing made CATEGORIES OF HEALTH PROBLEMS 199.

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A gap between actual and achievable health status Instances of failure in health maintenance Possible precursors of health deficit: History of repeated infections or miscarriages No regular health check-up

HEALTH DEFICIT 200. EXAMPLES ILLNESS states, diagnosed or undiagnosed Failure to thrive/develop Disability Transient (aphasia or temporary paralysis after a CVA) Permanent (leg amputation secondary to diabetes, blindness from measles, lameness from polio) 201. Conditions that are conducive to disease, accident or failure to realize ones potential EXAMPLES: Family history of hereditary disease Threat of cross infection Accident hazards Faulty eating habits Poor environmental sanitation Unhealthy lifestyle/personal habits

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HEALTH THREAT 202. Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources EXAMPLES: Marriage Pregnancy Parenthood Divorce or separation Loss of job Menopause Death

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FORESEEABLE CRISIS 203. NATURE OF THE PROBLEM categorized into health deficit, health threat and foreseeable crisis

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Health deficit 3 Health threat 2 Foreseeable crisis 1

PRIORITIZING HEALTH PROBLEMS 204. MODIFIABILITY OF THE PROBLEM refers to the probability of success in minimizing, alleviating or totally eradicating the problem through intervention Easily modifiable 2 Partially modifiable 1 Not modifiable 0 205. PREVENTIVE POTENTIAL refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration High 3 Moderate 2 Low 1 206. SALIENCE refers to the familys perception and evaluation of the problem in terms of seriousness and urgency of attention needed A serious problem, immediate attention needed 2 A problem, but not needing immediate attention 1 Not a felt need / problem 0 NURSING PROCEDURES 208. ____ Take clinical history ___ Write findings on client records ___ Perform physical assessment ___ Greet and make client at ease ___ Do laboratory examinations ___ Take temperature, blood pressure, height and weight

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207.
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PRE-CONSULTATION CONFERENCE 1 2 3 4 5 6 209. ___ Inform physician of relevant findings gathered in pre-conference ___ Observe confidentiality of examination results ___ Ensure privacy, safety and comfort of patient throughout procedure ___ Work with the physician during the examination ___ Assist client before, during and after examination by physician

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MEDICAL EXAMINATION 1 2 3 4 5 210.

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___ Counseling ___ Seek information regarding health status of other family members ___ Explain and reinforce physicians orders and advises ___ Teach patient measures to promote and maintain health as proper diet, exercise and personal hygiene ___ Carry out physicians orders as giving medication or injection

NURSING INTERVENTION 1 2 3 4 5 211. ____ Make appointment for next clinic/home visit ____ Refer patient to other health worker/agency ____ Explain findings and needed care or intervention

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POST-CONSULTATION CONFERENCE 1 2 3 212.

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ACIVITIES OF THE COMMUNITY HEALTH NURSE 213. Made to a client or a responsible member of the family GOAL : provide necessary health care activities and further attain an objective of the agency A professional face-to-face contact made by a nurse to the patient or the family

HOMEVISIT 214.
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PHASES OF A HOME VISIT PREPARATORY PHASE Review existing records or referral data Notifies family of intention Introduce self and explains purpose HOME VISIT PHASE Actual visit to the patient Assessment, planning, and health teaching POST-VISIT PHASE Records data in the chart Plan for next visit Referral to other health professionals STEPS IN A HOME VISIT 1.Greet client and introduce self. 2. Explain purpose. 3. Inquire about health and welfare. 4. Place bag in a convenient place. 5. Wash hands and wear apron. 6. Perform physical assessment & nursing care. 7. Give necessary health teaching. 8. Wash hands and close bag.

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9. Record findings. 10. Make appointment for clinic or home visit. 217. A tool using a public health bag done during a home visit The nurse can perform nursing procedures with ease and deftness Saving time and effort in view of rendering effective nursing care

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BAGTECHNIQUE 218. Use of bag technique should minimize, if not totally prevent, the spread of infection Should save time and effort in the performance of nursing procedures Should not overshadow concern for the patient Show the effectiveness of total care given to individual or family

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PRINCIPLES OF BAG TECHNIQUE 219. Should contain all necessary articles and equipments Bag and contents should be cleaned as often as possible Should be protected from contact with any article in the home of the patient Arrangement of the contents should be convenient Handwashing should be done frequently When used in a communicable case, should be thoroughly cleaned and disinfected before keeping and re-using

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SPECIAL CONSIDERATIONS 220. thermometers in case (1 oral & 1 rectal) syringes alcohol lamp sputum cup medicine dropper zephiran solution benedict solution tape measure hypodermic needles

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CONTENTS OF THE PHN BAG 221. 222.

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Essential health care made universally acceptable to individuals and families in the community By means acceptable to them and through their full participation At a cost that the community and country can afford at every stage of development

PRIMARYHEALTHCARE 223. GOAL : Health for all Filipinos and Health in the Hands of the People by the year 2020 MISSION : To strengthen the health care system wherein people will manage their own health care CONCEPT : partnership and empowerment of the people LEGAL BASIS: Letter of Instruction 949 President Ferdinand Marcos October 19, 1979 224. First International Conference on Primary Health care Alma Ata, USSR September 6-12, 1978 Sponsored by the World Health Organization and UNICEF ELEMENTS/COMPONENTS of PHC Education for Health Locally Endemic Disease Control Expanded Program on Immunization Maternal and Child Health Essential Drugs and Elderly Care Nutrition Treatment of CD and Non-CD Sanitation: Water & Environment

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225.
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ELEMENTS 226. Framework for meeting the goal of primary health care Calls for active and continuing partnership among the communities, private and government agencies in health development

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ORGANIZATIONALSTRATEGY 227.
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LEVELS OF HEALTH CARE SERVICES PRIMARY Barangay Health Station Private Practitioners

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Community Hospitals Rural Health Unit SECONDARY Emergency/District Hospitals Provincial/City Hospitals LEVELS OF HEALTH CARE SERVICES TERTIARY Regional Medical Centers and Training Hospitals National Medical Centers Teaching and Training Hospital 229. VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs) - Trained community health workers - Health auxiliary volunteer - Traditional birth attendant or healer INTERMEDIATE LEVEL HEALTH WORKERS - General medical practitioner - Public health nurse - Rural sanitary inspector - Midwives

TWO LEVELS OF PHC WORKERS 230. DOH PROGRAMS 231. ental health program steoporosis prevention ealth education & community organizing rimary health care eproductive health lder persons health service uidelines for good nutrition espiratory Infection Control lternative health care aternal and child care entrong Sigla Movement

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DOH PROGRAMS 232. DENTAL HEALTH PROGRAM 233. VISION: A lifetime of oral health & no tooth decay for the next generation STRATEGIES Social mobilization

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Coordination and partnership with sectoral groups Networking Capacity building and work value formation

DENTAL HEALTH PROGRAM 234. Project for Social Mobilization AIM: Emphasize the importance of oral health in relation to total body health Increase public awareness on the prevention of common dental diseases Solicit one million new toothbrushes from concerned citizens

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"Sang Milyong Sepilyo" 235.

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238.
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EXPANDED PROGRAM ON IMMUNIZATION (EPI) 236. EXPANDED PROGRAM ON IMMUNIZATION A program implemented under PD no. 996 signed on September 16, 1976 which provides for compulsory basic immunization for infants & children below 8 years old ELEMENTS OF EPI (SACIT) Surveillance, studies & research Assessment & evaluation of the programs overall performance Cold chain logistic management Information, Education & Communication Target setting Principles & Legal Basis Based on EPIDEMIOLOGICAL SITUATION Mass Approach basic health service (it is integrated into the health system) P.D. 996 compulsory basic immunization for infants and children below 8 years old R.A. 7846 compulsory Hep B immunization for infants and children below 8 years old 239. 2 IMPORTANT GOALS OF THE PROGRAM: To reduce the morbidity & mortality rates of the 7 EPI diseases To reduce the incidence of neonatal tetanus by providing pregnant women with TT immunization 240. APRIL 6, 1986 PP no. 6 enjoin all govt. as well as NGOs to achieve the goal of immunizing every Filipino against the 6 EPI diseases: Poliomyelitis Measles Diptheria

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241.
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248.
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Pertussis Tetanus Tuberculosis Hepatitis B added recently The seven target EPI Diseases 1) Tuberculosis A specific, chronic, infectious disease caused by Mycobacterium tuberculosis, characterized by the formation of tubercles in the tissues. 242. 2) Diphtheria An acute, specific, highly infectious, epidemic and endemic disease caused by Corynebacterium diphtheria; transmitted by direct and indirect contact and carrier. 243. 3) Pertussis Whooping cough. A highly communicable infectious disease of children with paroxysms of coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic whoop. 244. 4) Tetanus An acute infectious disease induced by the toxin of Clostridium tetani, an anaerobic organism growing at the site of injury to body tissue. Is characterized by painful muscular contractions, chiefly of the face and neck, hence the appellation lockjaw. 245. 5) Poliomyelitis Inflammation of the grey matter of the spinal cord; an acute epidemic viral disease most commonly affecting children; marked by fever, headache, sore throat, stiff neck, gastrointestinal symptoms. 246. 6) Measles Rubeola. An acute, highly contagious, febrile, exanthematous viral disease; spread by droplets; characterized by fever, blotchy rash, and catarrhal inflammation of the mucous membranes; associated with high rate of complications. 247. 7) Hepatitis B May be transmitted by contaminated needles, blood mucous membranes (sexual intercourse), or ingestion of contaminated food; characterized by increase in aspartate transaminase and alanine transaminase level and increased bilirubin in the blood. Fully immunized Child (Revised in 1996) A child who has received the following vaccines 1 BCG, 3 DPT, 3 OPV, 3 Hep B, 1 MV At the right intervals Before reaching 12 months of age

249. Dosage, route & site of administration Deltoid region, upper arm Intramuscular 0.5 ml TT Outer part of the upper arm Subcutaneous 0.5 ml Measles Upper outer portion thigh Deep IM 0.5 ml DPT Upper outer portion thigh Intramuscular 0.5 ml Hep B Mouth Oral 2 drops OPV Deltoid region right arm Intradermal Infants 0.05 ml BCG Site of Adm. Route of Adm. Dose Vaccine 250. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason BCG Birth, anytime after birth 1 - BCG given early protects infants against TB meningitis infection from family members 251. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason OPV 6 weeks 3 4 weeks When given early increases extent of protection against polio 252. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Minimum Interval Bet. Doses Reason Hep B w/in 24 hrs of birth 3 6 weeks from 1 st dose to 2 nd dose, and; 8 weeks interval from 2 nd dose to 3 rd dose - Early start reduces chance of infection & becoming a carrier - Eliminate HB before 2012 ( a western regional goal) 253. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason DPT 6 weeks 3 4 weeks Early start reduces chance of severe pertussis 254. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason Measles 9 months 1 o At least 85% of measles cases can be prevented by immunizing at this age o - Eliminate measles by 2008 255. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 1 As early as possible during pregnancy 256. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 2 At least 4 weeks after TT 1 80 % Infants protected from neonatal tetanus, 3 years protection for the mother against tetanus 257. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 3 At least 6 months after TT 2 95% Infants protected from neonatal tetanus, 5 years protection for the mother against tetanus 258. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 4 At least 1 year after TT 3 99% Infants protected from neonatal tetanus, 10 years protection for the mother against tetanus 259. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 5 At least 1 year after TT 4 99% Infants protected from neonatal tetanus, lifetime protection for the mother against tetanus 260. o QUESTION: o If a woman received 3 doses of DPT during infancy, what will be her current TT immunization schedule? o A) TT1, previous 3 DPT doses not significant o B) TT2, 3 doses of DPT equals TT1 o C) TT3, 3 doses of DPT considered TT1 & TT2 o D) TT4, 3 doses of DPT equals 3 TT shots o ANSWER: C

Discard point of OPV using the VVM Constant Temperature, Day and Night Length of Time VVM Reaches Discard Point At room temperature + 25 C 8 days At room temperature + 20 C 20 days At room temperature + 4 C 180 days At room temperature - 20 C Over 2 years 262. Proper stocking of Vaccines (refrigerator) o Neatly arrange the vaccines (segregated by type) o Domestic refrigerator o - freezer compartment -OPV, AMV o - body - BCG, DPT, Hep B, TT, Diluent o Modified refrigerator o - freezer compartment - ice packs o - Body Top - OPV, AMV Middle - BCG, DPT, Hep B, TT, Diluent Lower - Bottles/ ice packs with water 263. How to Maintain Cold Chain o Stocking of Vaccines in the Transport Box Vaccine Carrier o Make sure you have enough ice packs o transport box 24 pcs o Vaccine carrier 4 pcs o Place OPV, AMV in contact with frozen ice packs o Wrap DPT, Hep B, TT with paper o Place BCG in between AMV, OPV and wrapped vaccines 264. What to do with Opened vials of Vaccines? o I. Continue to use opened vials in the subsequent sessions if all these conditions are met: Expiry date has not passed Vaccines are stored appropriately (+2 to +8 C) Sterile procedures have been fully observed Opened vial has not been contaminated 265. o NOTE: o Discard opened BCG and MV after 6 hours of reconstitution. o Opened vials of DPT, Hep B, TT can still be used for 4 weeks provided condition 1-4 in the previous slide are met. 266. o II. Discard an opened vial immediately if any of the following conditions apply: o Sterile procedures have not been fully observed o + Suspicion of contamination of the opened vial o + Visible evidence of contamination (e.g. change in appearance or presence of floating particles) 267. o If the label has come off, or o If the VVM has reached discard point the inner square matches, or is darker than the circle
261.

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269.
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Reconstituted vaccines (BCG, AMV) after 6 hours of reconstitution 268. What is reconstitution? To restore to the original state by adding water; To build up again by putting back together the original pieces. What is a diluent? An inert substance that dilutes the strength of a solution or mixture. What is thermal shock? It is the process of damage to the vaccine resulting from the use of diluent that is at too high a temperature (above +8C). It results in the death of some or all of the essential live organisms in the vaccine.

270. 271. How to read a vaccine vial monitor The inner square is lighter than the outer circle. If the expiry date has not passed, USE the vaccine. As time passes the inner square is still lighter than the outer circle. If the expiry date has not passed, USE the vaccine. Discard point: the colour of the inner square matches that of the outer circle. DO NOT USE the vaccine. Beyond the discard point: inner square is darker than the outer circle. DO NOT USE the vaccine. 272. POINTS to REMEMBER: o Only diluent supplied by the manufacturer, specific for the vaccine, should be used. No other diluent may be used. o Distilled water for injection should NOT be used as a vaccine diluent. 273. o Oral vaccine diluents should never be injected. o To ensure the correct quantities are available, diluents must be shipped and distributed together with the vaccine vials that it will be used to reconstitute. 274. During the Reconstitution process: o Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. o A sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single vial or ampoule of freeze dried vaccine. o Special care must be taken in opening ampules to avoid loss of the dry vaccine. 275. Vaccinators and store keepers should always: o Include diluents in stock control and ensure adequate supplies. o Check that the vaccines have been supplied with the right diluent. If any error is noted, the vaccine should not be used and the supervisor must be notified immeditely. o Use only the diluent that is indicated for each type of vaccine and manufacturer. 276. Ensure the volume of diluent used is correct so that the proper number of doses per vial is obtained. Ensure that no other medication or substance which might be confused with the vaccine or its diluent is stored in the refrigerator of the immunization centre.

Reconstituted vaccine should be kept on ice to preserve its potency (by maintaining the maximum possible number of live organisms in each dose). 277. A sterile needle and sterile syringe must be used for each separate dose of reconstituted vaccine drawn from the vial. The reconstituted vaccine must be kept cool and any remaining liquid must be discarded after 6 hours. 278. Sizes of syringe and Needle to use During Vaccination DPT, MV and TT - use 23 ml syringe with 25 or 30 mm 23 or 25 gauge needle BCG - use 1 ml tuberculin syringe with 10 mm 26 gauge needle In mixing vaccines - use 5 or 10 ml syringe with 18 gauge needle 279. Proper ways of handling syringes and needles o Disposal of used syringes and needles o Immediately after use Do not recap the needle Place them in a safety collector box o Disposal options Burn in pit, bury Collect and incinerate 280. o Absolute Contraindications to Immunization: o BCG to a baby born from a mother with AIDS o DPT2 and DPT3 to a child who develops convulsion within 3 days of giving DPT o Infants and children with active neurologic disease o Relative contraindication o Any illness which warrants admission to the hospital. 281. "first expiry and first out" (FEFO) o A "first expiry and first out" (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to expiring. o Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the cold chain. 282. MIND GAMES WHAT ARE INSIDE THE BOTTLE? 283. o Implementing guidelines on Hepatitis B Immunization for Infants 284. o Rationale hepatitis B is the major health problem in the Philippines 10-12 % of the total population are chronically infected No affordable and effective drug treatment are currently available 90% of chronic carriers of infection acquire their infection at birth or in early childhood 285. Objectives o General:

To improve effectiveness of management in the provision of 3 doses of routine Hepatitis B vaccine among infants including a birth dose. o Specific: o To provide new guidelines & procedures for Hepatitis B vaccination for infants at all types of health facilities. o To provide instructions for administration of birth dose Hepatitis B vaccine accdg to the settings where the birth takes place. 286. New Schedule of Hep. B, DPT & OPV Note: Hep B1 was 6 weeks (old DOH book ); now AT BIRTH (p. 149 new DOH book) Age Hep B DPT OPV At Birth (within 24 hours) Hep B 1 6 weeks Hep B 2 DPT 1 OPV 1 10 weeks DPT 2 OPV 2 14 weeks Hep B 3 DPT 3 OPV 3 287. o Type of Vaccine o - Recombinant or genetically engineered vaccine using HBsAg (10mg dose) o - Synthesized in yeast or mammalion cells into which HBsAg gene has been inserted. o Formulation o - Monovalent Hepatitis B vaccine/ univalent o Protects only against Hepatitis B o Single antigen formulation o Used for birth dose o - Combination vaccines (multivalent) o Protects against Hepatitis B & other dse o (DPT-Hep B, DPT-Hep B +HiB, Hib-Hep B) o Combination with other vaccine o Used for subsequent doses 288. o Dosage o Standard pediatric dose is 0.5 ml o Sites of administration o - Recommended series of 3 doses of hepatitis B vaccine shall be given intramuscularly only in the anterolateral thigh muscle . o - Hepatitis B vaccine o Shouldnt be given in the buttocks o Risk of injury to the sciatic nerve o Shouldnt be given intradermal o It doesnt produce adequate antibody response to children o Shouldnt be mixed in the same syringe with other vaccine 289. o Vaccine storage and handling Hep B vaccine o Stored in refrigerators provided solely for vaccine storage at +2 to +8 C o Transported properly in once-packed containers with cold chain monitors or thermometer o Should never be frozen or allowed to come into direct contact with ice because it will be inactivated and will no longer be potent. o Shake test used to determine if the vaccine has been damaged by freezing.
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290. Indication and Contraindication No contraindication for the administration of Hep B vaccine to a newborn within 24 hours of birth. Used to protect against Hepatitis B virus. Vaccine side effects and adverse Reaction Hep B vaccine is one of the safest vaccines. Mild reaction include: Soreness & fever at the injection site Serious reaction: Anaphylaxis risk for anaphylaxis is estimated at 1/600,000 doses 291. Administration of Hep B vaccine birth dose While 2nd dose and 3rd dose of Hep b vaccine shall be administered along with 1st and 3rd dose of DPT and OPV, administration of the 1st dose within 24 hour of birth. Hospitals and lying-in Clinics A) No mother/child should be discharged from the hospital without providing the birth dose of Hepatitis b vaccine to the newborn. B) Provision of birth dose of Hep B vaccine as part of the standing order for the routine care of medically stable infants weighing equal to or more than 2000 grams at birth. 292. Health centers & Barangay Health Stations All infants attended at birth by midwives from the health center/BHS shall be given the monovalent Hepatitis B vaccine within 24 hours after birth . 293. Birth taking place outside health facilities attended by traditional birth attendants or other non-trained providers A) TBA or mother should be advised to inform the nearest health facility either by phone or by personal visit for the provision of the Hep B and BCG B) Or bring the newborn to the health facility for vaccination C) Or the midwife will give immunization during house visit within 7 days after delivery 294. Calculation of Hepatitis B Vaccine Needs (Steps for Calculating Hep B requirement) 1) Identify the important data for computation: Eligible Population (EP) of infants EP= Total Population (TP) x 3% Wastage Multiplier : 1.2 National: Reserve stock :25% Reserve stock multiplier: 1.25 Region/ province/city: Reserve stock: 12.5%

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Reserve Stock Multiplier : 1.125 Municipality Reserve Stock: 12.5% Reserve Stock multiplier: 1.1 295. 2) Formula Hep B requirements of National/Provincial/city level =EPx no. of doses x wastage multiplier x reserve stock multiplier Hep B requirements of lower level = EP x no. of doses x wastage multiplier x reserve stock multiplier 296. SEATWORK: Given: Province A with a total population of 2,000,000 for 2006.Compute for the annual requirements for hepatitis B Compute for the eligible population infants for Province A Calculate for the annual needs (in doses) for Province A Calculate for annual needs (in vials) for Province A. 297. Sample Computation Given: Province A with a total population of 2,000,000 for 2006.Compute for the annual requirements for hepatitis B Compute for the eligible population infants for Province A 2,000,000 x 0.03 = 60,000 infants Calculate for the annual needs (in doses) for Province A 60,000 x 3 doses x 1.2 x 1.125= 243,000 doses Calculate for annual needs (in vials) for Province A. 243,000 doses / 10 doses per vial = 24,300 vials 298. QUESTION: 1) It refers to a protein which can stimulate the production of antibodies and react specifically with those antibodies. A) glycoprotein B) vaccines C) toxoids D) antigen ANSWER: D 299. QUESTION: It is a class of specific protein substances in the blood that destroy or render inactive certain foreign substances, particularly bacteria. A) antigen B) anti-toxin C) toxoids D) antibody ANSWER: D

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300. QUESTION: Which of the following is NOT an element of EPI? A) Information, Education & Communication B) Surveillance, studies & research C) Target setting D) Vaccine safety ANSWER: D 301. QUESTION: The law which requires compulsory basic immunization for infants and children below 8 years old. A) R.A.7846 B) P.D. 996 C) R.A. 8746 D) P.D. 966 ANSWER: B 302. QUESTION: Which of the following does not belong to the 7 target EPI diseases? A) diphtheria B) tuberculosis C) diabetes D) tetanus ANSWER: C 303. QUESTION: It is a highly communicable infectious disease of children with paroxysms of coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic whoop. A) emphysema B) pertussis C) tuberculosis D) bronchial asthma ANSWER: B 304. QUESTION: Which of the following is a fully immunized child? A) a 7 month old child who has received 1 MV, 1 BCG, 1 Hep B, 3 DPT and 3 OPV B) an 18 month old child who had just completed his 1 BCG, 1 Hep B, 1MV, 3 DPT and 3 OPV C) a 1 yr old child who had just completed his 1 BCG, 1MV, 3 Hep B, 3 DPT and 3 OPV D) none of the above

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ANSWER: C 305. QUESTION: When is the recommended schedule for Hep B2? A) within 24 hours B) together with DPT1 C) together with DPT2 D) 14 weeks ANSWER: B 306. QUESTION: Hepatitis B vaccine should not be given in the buttocks because of: A) gluteal muscle irritation and pain B) inadequate antibody production response to children in that area C) risk of hematoma formation D) potential injury to the sciatic nerve ANSWER: D 307. QUESTION: Which of the following is an inappropriate nursing intervention about Hepatitis B vaccine? A) Shouldnt be given intradermal B) Should be given in the anterolateral thigh muscle C) Should do shake test to determine if the vaccine has been damaged by heat D) Shouldnt be frozen to preserve its potency ANSWER: C 308. QUESTION: Which of the following is appropriate? A) No mother/child should be discharged from the hospital without providing the mother the required Hepatitis b vaccine. B) Provision of birth dose of Hepatitis B vaccine to infants weighing equal to or more than 1000 grams at birth. C) Infants attended at birth by midwives shall be given the combination Hepatitis B vaccine within 24 hours after birth. D) If birth is attended by TBA outside regular health facilities, the midwife will give immunization during house visit within 7 days after delivery ANSWER: D 309. QUESTION: It assure that all vaccines are utilized before its expiry date ? A) vaccine vial monitoring B) FEFO system C) cold chain management D) ECCD monitoring

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ANSWER: B 310. QUESTION: Which of the following is an example of relative contraindication to immunization? A) Melena, a newborn baby of a mother with AIDS, about to be given BCG B) Shigella, a eurasian child who develops convulsion within 3 days of giving DPT, & is due to receive DPT2 C) Bordatella , a 6 wk infant-relative of the nurse, who has active neurologic disease D) Rubella, a 14 wk infant, admitted to the hospital due to fever and chills. ANSWER: D 311. QUESTION: Which of the following follows the standard protocol on immunization? A) Open a vial of vaccine even if only one eligible child or pregnant woman is present for immunization. B) Distribute health information materials on family planning C) Conduct health education among mothers with high risk infants only D) Use one sterile needle & one syringe for each type of vaccine for all patients. ANSWER: A 312. QUESTION: It means t o restore to the original state by adding water or to build up again by putting back together the original pieces. A) dilution B) reconstitution C) discard point D) cold chain ANSWER: B 313. QUESTION: During administration of DPT, MV and TT, what syringe size is appropriate ? A) 1 ml syringe B) 5 ml syringe C) 2-3 ml syringe D) none of the above ANSWER: C 314. QUESTION: When injecting BCG to your inafnts, which of the following needle sizes is most appropriate? A) 26 gauge needle B) 23 gauge needle C) 19 gauge needle

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D) 18 gauge needle ANSWER: A 315. QUESTION: Upon inspection of the vaccine vial monitor, you noticed that the inner square is darker than the outer circle. Which of the following is correct? A) it has reached the discard point, do not use B) it is already expired, do not use C) it is already beyond discard point, do not use D) it is already expired, do not use if already opened ANSWER: C 316. QUESTION: In storing OPV, which of the following is appropriate? A) middle portion of the body of a modified refrigerator B) lower body of a domestic refrigerator C) freezer compartment of both the domestic or modified refrigerator D) top body of a modified refrigerator ANSWER: D 317. QUESTION: In storing diluents, which of the following is appropriate? A) middle portion of the body of a modified refrigerator B) lower body of a domestic refrigerator C) freezer compartment of both the domestic or modified refrigerator D) top body of a modified refrigerator ANSWER: A 318. QUESTION: In storing AMV, which of the following is appropriate? A) middle portion of the body of a modified refrigerator B) lower body of a domestic refrigerator C) freezer compartment of both the domestic or modified refrigerator D) top body of a modified refrigerator ANSWER: D 319. Sample Computation Problem Given: Tagbilaran city, with a total population of 1,000,000 for 2007.Compute for the annual requirements for hepatitis B Compute for the eligible population (infants) Calculate for the annual needs (in doses) Calculate for annual needs (in vials) 320. Problem Solution

Given: Tagbilaran city with a total population of 1,000,000 for 2007.Compute for the annual requirements for hepatitis B o Compute for the eligible population (infants) o 1,000,000 x 0.03 o = 30,000 infants o Calculate for the annual needs (in doses) o 30,000 x 3 doses x 1.2 (WM) x 1.125 (RSM) o = 121,500 doses o Calculate for annual needs (in vials) o 121,500 doses / 10 doses per vial o = 12,150 vials 321. Supply the missing diagram: The inner square is lighter than the outer circle. If the expiry date has not passed, USE the vaccine. As time passes the inner square is still lighter than the outer circle. If the expiry date has not passed, USE the vaccine. Discard point: the colour of the inner square matches that of the outer circle. DO NOT USE the vaccine. Beyond the discard point: inner square is darker than the outer circle. DO NOT USE the vaccine. 322. Supply the missing blanks: New Schedule of Hep. B, DPT & OPV AGE HEP B DPT none Birth (within 24 hours) Hep B1 Hep B3 Hep B2 6 weeks 10 weeks 14 weeks DPT 1 DPT2 DPT3 OPV1 OPV2 OPV3 OPV none none 323. 324. MATERNAL CARE PROGRAM & FAMILY PLANNING 325. WHAT IS MATERNAL & CHILD HEALTH NURSING? Mother & child relation-ship to one another & of the entire family 326. o GOALS: o To ensure that every expectant & nursing mother maintains good health o Learns the art of child care o Has a normal delivery & bears healthy children 327. ESSENTIAL HEALTH SERVICE PACKAGES o Antenatal registration o Tetanus toxoid immunization o Micronutrient supplementation o Treatment of diseases & other conditions o Clean and safe delivery o Support to Breastfeeding o Family planning counselling 328. o Attendants must be aware of the early signs, symptoms and complications. They should follow the 3 CLEANS: o CLEAN Hands o CLEAN Surface o CLEAN Cord 329. o Situations wherein trained hilots are allowed to attend to home deliveries: o A) Time of delivery
o

 no licensed health personnel trained on maternal care, is available B) Area of domicile of pregnant mother o there is no licensed health personnel trained on maternal care 330. BREASTFEEDING o MILK PRODUCTION HORMONES: o PROLACTIN Milk secreting hormone MILK SECRETION REFLEX Secreted at the base of the anterior pituitary gland Delays ovulation & protect against subsequent pregnancy Sensory stimulation through sucking 331. o OXYTOCIN For milk letdown MILK EJECTION REFLEX HELP REFLEX Site of baby Sound of babys voice Sensory impulses from nipples Anxiety, pain or doubts STOP reflex 332. o LEGAL MILESTONES: o EO 51 MILK CODE OF THE PHILIPPINES o - protection and promotion of breastfeeding o - to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) 333. o POSITIONS IN BF THE BABY: o 1. Cradle Hold - head & neck are supported o 2. Football Hold o 3. Side Lying Position 334. A ANTIBODIES PRESENT S STOOL INOFFENSIVE(GOLDEN YELLOW) T TEMPERATURE ALWAYS IDEAL F FRESH MILK NEVER GOES OFF E EMOTIONALLY BONDING E EASY ONCE ESTABLISHED B BEST FOR BABIES R REDUCE INCIDENCE OF ALLERGENS E ECONOMICAL D DIGESTED EASILY I N G IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED 335. o RA 7600 o THE ROOMINGIN & BREASTFEEDING ACT of 1992 o - An act providing incentives to government and private health institutions promoting and practicing rooming-in & breastfeeding. o - Provision for human milk bank. o - Information, education and re-education drive
o o

336.
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340.
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- Sanction and Regulation FOOD FORTIFICATION PROGRAM 337. Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning. 338. Example: The use of FIDEL salt F ortification for I odine D eficiency EL imination 339. REPUBLIC ACT NO. 8976 Philippine Food Fortification Act of 2000 a) Voluntary Food Fortification - Sangkap Pinoy Seal Program (SPSP) a strategy to encourage food manufacturers to fortify processed foods or food products with essential nutrients at levels approved by the DOH. The fundamental concept of the program is to authorize food manufacturers to use the DOH seal of acceptance for processed foods or food products, after these products passed a set of defined criteria. The seal is a guide used by consumers in selecting nutritious foods. b) Mandatory Food Fortification The fortification of staple foods: Rice with iron; Wheat flour with vitamin A and Iron; Refined sugar with vitamin A; Cooking oil with vitamin A; and Other staple foods with nutrients as may later be required by the NNC. RA 832 Rice Enrichment Law All milled rice has to be enriched with premix Rice Governments nutrition program RA 8172 FIDEL Salt SANGKAP PINOY or micronutrients are vitamins and minerals required by the body in very small quantities. These are essential in maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children. vitamin A, iron and iodine, which cannot be synthesized by the human body, and therefore must be provided through the diet. 341. MARASMUS Protein & energy malnutrition Usually less than 1 year old when malnutrition started

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Very thin Very poor weight gain 342. Old mans face Enlarged abdomen Prominent ribs Loose & wrinkled skin Anxious Always hungry 343. KWASHIORKOR Disease of the older child (1-3 y.o.) Very thin Fails to grow Light-colored weak hair Moon-shaped, unhappy face 344. Enlarged abdomen Muscle wasting Swollen lower & upper extremities Apathetic 345. Skin sores & skin peeling dark spots on the skin Does not want to eat 346. TREATMENT: Food is the only cure Increase: CHON & energy concentration of food prepared Frequency of feeding Variety of food offered 347. IRON-DEFICIENCY ANEMIA Causes: Low intake of iron-rich food Blood loss Poor absorption of iron Increased demands 348. VITAMIN A DEFICIENCY Causes: Low intake of vitamin A rich food Low intake of oil & protein Illness like measles, diarrhea & pneumonia Consequences:

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Blindness Low resistance to infection

350. 351. 352. 353. 354. 355.

349. IODINE DEFICIENCY Causes Low intake of iodine Consequences FETUS Abortion Congenital abnormalities Stillbirth Review is Over ... Have a nice day ! Good Bye ! Good Luck and God Bless you !

COMMUNITY HEALTH NURSING ROMEO D. PIANSAY, JR., R.N., M.A.N. National Voluntary Blood Service Program (NVBSP) 356. o The project is the development and implementation of the computer-based Drug Test Operations and Management Information System (DTOMIS). 357. The Doctors to the Barrios Program is the deployment of doctors as Rural Health Physicians to doctorless municipalities, usually hard to reach, economically underdeveloped areas 358. Four Rights in Food Safety o Rule in Food Safety: o When in doubt, throw it out! o Right Source: o Always buy fresh meat, fish, fruits & vegetables. o Always look for the expiry dates of processed foods and avoid buying the expired ones. o Avoid buying canned foods with dents, bulges, deformation , broken seals and improperly seams. o Use water only from clean and safe sources . o When in doubt of the water source, boil water for 2 minutes . 359. o Right Preparation: o Avoid contact between raw foods and cooked foods . o Always buy pasteurized milk and fruit juices. o Wash vegetables well if to be eaten raw such as lettuce, cucumber, tomatoes & carrots. o Always wash hands and kitchen utensils before and after preparing food. o Sweep kitchen floors to remove food droppings and prevent the harbor of rats & insects. 360. o Right Cooking:

 Cook food thoroughly. Temperature on all parts of the food should reach 70 degrees centigrade. o Eat cooked food immediately . o Wash hands thoroughly before and after eating . 361. o Right Storage: o All cooked foods should be left at room temperature for NOT more than two hours to prevent multiplication of bacteria. o Store cooked foods carefully. Be sure to use tightly sealed containers for storing food. o Be sure to store food under hot conditions (at least or above 60 degrees centigrade ) or in cold conditions (below or equal to 10 degrees centigrade ). This is vital if you plan to store food for more than four to five hours. 362. o Foods for infants should not be stored at all. It should always be freshly prepared . o Do not overburden the refrigerator by filling it with too large quantities of warm food. o Reheat stored food before eating. Food should be reheated to at least 70 degrees centigrade . 363. FOUR mula ONE for Health Framework for Implementation 364. Goals Better health outcomes More responsive health systems Equitable health care financing 365. Elements Health Financing Health Regulation Health Service Delivery Good Governance 366. o The goal of this reform area is to foster greater, better and sustained investments in health. The Philippine Health Insurance Corporation through the National Health Insurance Program and the Department of Health through sectorwide policy support will lead this component jointly.
o

Health Financing 367. The goal is to ensure the quality and affordability of health goods and services.

Health Regulation 368. The goal is to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services.

Health Service Delivery 369. The goal is to enhance health system performance at the national and local levels.

Good Governance 370. Key Feature National Health Insurance Program (NHIP) The main lever to effect changes and outcomes in each of the four implementation components. 371. o The NHIP reduces the financial burden placed on Filipinos by health care costs. Health Financing 372. The NHIPs role in accreditation and payments based on quality acts as a driver for improved performance in the health sector.

Health Regulation 373. The NHIP demands fair compensation for the costs of care directed at providing essential goods and services in health.

Health Service Delivery 374. The NHIP is a prudent purchaser of health care thereby influencing the health care market and related institutions.

Good Governance 375.

o

377.
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378.
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376. Sentrong Sigla Movement is a joint effort of the Department of Health and the LGUs It aims at promoting availability of quality health services in health centers and hospitals and at making these services accessible to every Filipino Its main component is the certification and recognition program that develops and promotes standards for health facilities Contract Distribution System A new distribution system for DOH procured core essential drugs (CED). Its goal is to ensure that available stocks are distributed in a timely fashion to health facilities in proportion to health facilities actual use of and requirements for the drugs. PHILIPPINE MEDICAL TOURISM Medical tourism is a term that has risen from the rapid growth of an industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing, and fully experiencing the attractions of the countries that they are visiting. 379. Republic Act No. 9211

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TOBACCO REGULATION ACT OF 2003 . . REPUBLIC ACT NO. 9211 . AN ACT REGULATING THE PACKAGING, USE, SALE DISTRIBUTION AND ADVERTISEMENTS OF TOBACCO PRODUCTS AND FOR OTHER PURPOSES. 382. What is TB Network? It is the official communication handle of the National Tuberculosis Control Program or NTP that will stand for DOHs re-energized fight against TB. It is a product of DOHs collaboration with the LGUs, PhilCAT, and Philhealth. It is a special group dedicated to help/ take care of TB symptomatics and TB patients. Initially, it comprises regular health workers in the RHUs, MHOs and PHOs. Eventually, it will include everyone in the community who wish to help in the administration and financing of D.O.T.S.; family and relatives of TB symptomatics / patients, church, church organizations, civic organizations, NGOs, schools, companies/corporations. 383. Contract Distribution System A new distribution system for DOH procured core essential drugs (CED). Its goal is to ensure that available stocks are distributed in a timely fashion to health facilities in proportion to health facilities actual use of and requirements for the drugs. Healthy City A Healthy City is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all functions of life and in developing their maximum potential (WHO,1994). Health Sector Reform Agenda (HSRA) It describes the major strategies, organizational and policy changes and public investments needed to improve the way health care is delivered, regulated and financed. Blood Donation Program > legal basis - RA 7719 ("Blood Services Act of 1994) 387. The main objectives are: > to promote and encourage voluntary blood donation by the citizenry > to instill public consciousness of the principle that blood donation is a humanitarian act;

380. 381.
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384.
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385.
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386.
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o o

388.
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> to provide, adequate, safe, affordable and equitable distribution of supply of blood and blood products; > to mobilize the community for voluntary and non-profit collection of blood GMA 50 The primary goal of the project is to ensure that affordable, high quality, safe and effective drugs and medicines are always available, especially to the poor. Breastfeeding TSEK ( Tama, Sapat at Eksklusibo) campaign Goiter Awareness Week Proclamation No. 1188 declares every fourth week of January as Goiter Awareness Week Iwas Goiter ni Mommy, Lusog Isip ni Baby theme of 5th GAW on Jan. 23-29, 2011 focus on informing pregnant & lactating women on the benefits of using iodized salt & dangers of iodine deficiency disorders 392. ental health program steoporosis prevention ealth education & community organizing rimary health care eproductive health lder persons health service uidelines for good nutrition espiratory Infection Control lternative health care aternal and child care entrong Sigla Movement

389. 390. 391.

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DOH PROGRAMS 393.

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Health Programs - Adolescent and Youth Health and Development Program - Botika Ng Barangay - Breastfeeding Program / Mother and Baby Friendly Hospital Initiative - Blood Donation Program - Cancer Control Program - Child Health - Diabetes Mellitus Prevention Program - Dengue Control Program - Dental Health Program - Doctors to the Barrios (DttB) Program - Emerging Disease Control Program - Environmental Health - Expanded Program on Immunization - Family Planning - Food and Waterborne Diseases Prevention and Control Program

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- Food Fortification Program - FOURmula One - Garantisadong Pambata - GMA 50 / Parallel Drug Importation (PDI) - Human Resource Health Network - Healthy Lifestyle Program - Health Sector Development Program - Knock-Out Tigdas - Leprosy Control Program - Malaria Control Program - Measles Elimination Campaign (Ligtas Tigdas) - National Cardiovascular Disease Prevention and Control Program - National Filariasis Elimination Program - National Mental Health Program - Natural Family Planning - Newborn Screening - Nutrition - Occupational Health Program - Health Development Program for Older Persons (Elderly Health) - Pinoy MD - Persons with Disabilities Program - Pnuemonia and Other Acute Respiratory Infections (ARI's) - Prevention of Blindness Program - Rabies Control Program - Safe Motherhood and Women's Health - Schistosomiasis Control Program - Smoking Cessation Program - Soil Transmitted Helmenthiasis - TB Control Program - Unang Yakap

Botika Ng Barangay (BnB) 394.

o o

395.

Botika Ng Barangay (BnB) refers to a drug outlet managed by a legitimate community organization (CO/nongovernment organization (NGO) and/or the Local Government Unit (LGU) specifically licensed by the Bureau of Food and Drugs (BFAD) to sell, distribute, offer for sale and/or make available low-priced generic home remedies, over-thecounter (OTC) drugs and two (2) selected, publicly-known prescription antibiotic drugs (i.e. Amoxicillin and Cotrimoxazole) aims to promote equity in health by ensuring the availability and accessibility of affordable, safe and effective, quality, essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas Adolescent and Youth Health and Development Program (AYHDP)

The program is an expanded version of Adolescent Reproductive Health (ARH) element of Reproductive Health which aims to integrate adolescent and youth health services into the health delivery systems. o Mission: Ensure that all adolescent and youth have access to quality health care services in an adolescent and youth friendly environment. 396. Promotion of Breastfeeding program / Mother and Baby Friendly Hospital Initiative (MBFHI) o Realizing optimal maternal and child health nutrition is the ultimate concern o the main strategy is to transform all hospitals with maternity and newborn services into facilities which fully protect, promote and support breastfeeding and rooming-in practices o exclusive breastfeeding in the first four (4) to six (6) months after birth is encouraged as well as enforcement of legal mandates. o RA 7600 (The Rooming-In and Breastfeeding Act of 1992) o Executive Order 51 of 1986 (The Milk Code) 397. Philippine Cancer Control Program o integrated approach utilizing primary, secondary and tertiary prevention in different regions of the country at both hospital and community levels. o Six lead cancers (lung, breast, liver, cervix, oral cavity, colon and rectum) 398. CHILD 21 o is a strategic framework (a document) for planning programs and interventions that promote and safeguard the rights of Filipino children o Children's Health 2025 a subdocument of CHILD 21 o ultimate goal to achieve good health for all Filipino children by the year 2025 399. Dengue Control Program o community-based prevention and control in endemic areas o Major strategy is advocacy and promotion, particularly the Four Oclock Habit which was adopted by most LGUs. This is a nationwide, continuous and concerted effort to eliminate the breeding places of Aedes aegypti. 400. FOOD FORTIFICATION PROGRAM ROMEO D. PIANSAY, JR., R.N., M.A.N. - CHN REVIEW 2008 401. o Fortification o is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning.
o

ROMEO D. PIANSAY, JR., R.N., M.A.N. - CHN REVIEW 2008 402. Example: The use of FIDEL salt F ortification for I odine D eficiency EL imination

o o o o o o

ROMEO D. PIANSAY, JR., R.N., M.A.N. - CHN REVIEW 2008 403. REPUBLIC ACT NO. 8976 Philippine Food Fortification Act of 2000 a) Voluntary Food Fortification - Sangkap Pinoy Seal Program (SPSP) RA 832 Rice Enrichment Law All milled rice has to be enriched with premix Rice Governments nutrition program RA 8172 FIDEL Salt

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ROMEO D. PIANSAY, JR., R.N., M.A.N. - CHN REVIEW 2008 404.

o o

405.
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406.
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o o o o o

SANGKAP PINOY or micronutrients are vitamins and minerals required by the body in very small quantities. These are essential in maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children. vitamin A, iron and iodine, which cannot be synthesized by the human body, and therefore must be provided through the diet. Emerging Disease Control Program Emerging infectious diseases are newly identified and previously unknown infections which cause public health problems either locally or internationally. These include diseases whose incidence in humans has increased within the past two decades or threatens to increase in the near future. Environmental Health Environmental Health is concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury. It is concerned primarily with effects of the environment to the health of the people. Program strategies and activities are focused on environmental sanitation, environmental health impact assessment and occupational health through interagency collaboration. An Inter-Agency COmmittee on Environmental Health was created by virute of E.O. 489 to facilitate and improve coordination among concerned agencies. It provides the venue for technical collaboration, effective monitoring and communication, resource mobilization, policy review and development. The Committee has five sectoral task forces on water, solid waste, air, toxic and chemical substances and occupational health. Vision: Health Settings for All Filipinos Mission: Provide leadership in ensuring health settings Goals:

407.
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408.
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Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion and mitigation of hazards and risks in the environment and worksplaces. Expanded Program on Immunization Children need not die young if they receive complete and timely immunization. Children who are not fully immunized are more susceptible to common childhood diseases. The Expanded Program on Immunization is one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of six (6) immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles) Special campaigns have been undertaken to improve further program implementation, notably the National Immunization Days (NID), Knock Out Polio (KOP) and Garantisadong Pambata (GP) since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and improved surveillance system. Family Planning A national mandated priority public health program to attain the country's national health development: a health intervention program and an important tool for the improvement of the health and welfare of mothers, children and other members of the family. It also provides information and services for the couples of reproductive age to plan their family according to their beliefs and circumstances through legally and medically acceptable family planning methods. The program is anchored on the following basic principles. * Responsible Parenthood which means that each family has the right and duty to determine the desired number of children they might have and when they might have them. And beyond responsible parenthood is Responsible Parenting which is the proper ubringing and education of chidren so that they grow up to be upright, productive and civic-minded citizens. * Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is NOT a FP method: * Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It enables women to recover their health improves women's potential to be more productive and to realize their personal aspirations and allows more time to care for children and spouse/husband, and; * Informed Choice that is upholding and ensuring the rights of couples to determin the number and spacing of their children according to their life's aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children's and their own lives. E. Intended Audience: Men and women of reproductive age (15-49) years old) including adolescents F. Area of Coverage: Nationwide G. Mandate: EO 119 and EO 102 H. Vision:

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Empowered men and women living healthy, productive and fulfilling lives and exercising the right to regulate their own fertility through legally and acceptable family planning services. I. Mission The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the availability of FP information and services to men and women who need them. J. Program Goals: To provide universal access to FP information, education and services whenever and wherever these are needed. K. Objectives General: To help couples, individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health. Specifically, by the end of 2004: Reduce * MMR from 172 deaths 100,000 LB in 1998 to less than 100 deaths/100,000 LB * IMR from 35.3 deaths/1000 livebirths in 1998 to less than 30 deaths/1000 live births * TFR from 3.7 children per woman in 1998 to 2.7 chidren per woman Increase: * Contraceptive Prevalence Rate from 45.6% in 1998 to 57% * Proportion of modern FP methods use from 28>2% to 50.5% L. Key Result Areas 1. Policy, guidelines and plans formulation 2. Standard setting 3. Technical assistance to CHDs/LGUs and other partner agencies 4. Advocacy, social mobilization 5. Information, education and counselling 6. Capability building for trainers of CHDs/LGUs 7. Logistics management 8. Monitoring and evaluation 9. Research and development M. Strategies I. Frontline participation of DOH-retained hospitals II. Family Planning for the urban and rural poor III. Demand Generation through Community-Based Management Information System IV. Mainstreaming Natural Family Planning in the public and NGO health facilities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM VI. Contraceptive Interdependence Initiative N. Major Activities I. Frontline participation of DOH-retained hospitals

o o o o o o o o o o o o o o o o o o o o o o o o o o o o

o o o

* Establishment of FP Itinerant team by each hospital to respond to the unmet needs for permanent FP methods and to bring the FP services nearer to our urban and rural poor communities * FP services as part of medical and surgical missions of the hospital * Provide budget to support operations of the itenerant teams inclduing the drugs and medical supplies needed for voluntary surgical sterilization (VS) services * Partnership with LGU hospitals which serve as the VS site II. Family Planning for the urban and rural poor * Expanded role of Volunteer Health Workers (VHWs) in FP provision * Partnership of itenerant team and LGU hospitals * Provision of FP services III. Demand Generation through Community-Based Management Information System * Identification and masterlisting of potential FP clients and users in need of PF services (permanent or temporary methods) * Segmentation of potential clients and users as to what method is preferred or used by clients IV. Mainstreaming Natural Family Planning in the public and NGO health facilities * Orientation of CHD staff and creation of Regional NFP Management Committee * Diacon with stakeholders * Information, Education and counseling activities * Advocacy and social mobilization efforts * Production of NFP IEC materials * Monitoring and evaluation activities V. Strengthening FP in the regions with high unmet need for FP: CAR, CHD 5, 8, NCR, ARMM * Field of itinerant teams by retained hospitals to provide VS services nearer to the community * Installation of COmmunity Based Management Information System * Provision of augmentation funds for CBMIS activities VI. Contraceptive Interdependence Initiative * Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and FP Itenerant Teams * Expansion of Philhealth benefit package to include pills, injectables and IUD * SOcial Marketing of contraceptives and FP services by the partner NGOs * National Funding/Subsidy VIII. Development /Updating of FP CLinical Standards IX. Formulation of FP related policies/guidelines. E.g. Creation of VS Outreach team by retained hospitals and its operationalization, GUidelines on the Provision of VS services, etc. X. Production and reproduction of FP advocacy and IEC materials XI. Provision of logistics support such as FP commodities and VS drugs and medical supplies O. Other Partners

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409.
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1. Funding Agencies * United States Agency for International Development (USAID) * United Nations Funds for Population Activities (UNFPA) * Management Sciences for Health (MSH) * Engender Health * The Futures Group 2. NGOs * Reachout foundation * DKT * Philippine Federation for Natual Family Planning (PFNFP) * John Snow Inc. - Well Family Clinic * Phlippine Legislators Committee on Population Development (PLPCD) * Remedios Foundation * Family Planning Organization of the Philippines (FPOP) * Institute of Maternal and CHild HEalth (IMCH) * Integrated Maternal and CHild Care Services and Development, Inc. * Friendly Care Foundation, Inc. * Institute of Reproductive Health 3. Other GOs * Commission on Population * DILG * DOLE * LGUs Food and Waterborne Diseases Prevention and Control Program Food and Waterborne Diseases ( FWBDs ) are among the most common causes of diarrhea. In the Philippines, diarrheal diseases for the past 20 years is the number one cause of morbidity and mortality incidence rate is as high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 population. From 1993 to 2002, FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/foodborne diseases were the most common outbreaks investigated by the Department of Health. Also, outbreaks from FWBDs can be very passive and catastrophic. Since most of these diseases have no specific treatment modalities, the best approach to limit economic losses due to FWBDs is prevention through health education and strict food and water sanitation. The Food and Waterborne Disease Prevention and Control Program (FWBDPCP) established in 1997 but became fully operational in year 2000 with the provision of a budget amounting to PHP551,000.00. The program focuses on cholera, typhoid fever, hepatitis A and other foodborne emerging diseases (e.g. Paragonimiasis ). Other diseases acquired through contaminated food and water not addressesd by other services fall under the program. National Drug Policy - Pharmaceutical Management Unit 50 Mission: A team of dedicated, committed, competent & dynamic health & health-related professionals, that endeavors to formulate national policies, processes & design strategies through participatory/ multisectoral coordination & knowledge

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412.
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413.
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414.
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415.
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management that shall ensure availability & accessibility of safe, efficacious & quality essential drugs. 411. Vision: Providing quality health care through improved access and rational use by the Filipino people of safe, effective, quality and affordable drugs to all, especially the poor. Goal: Attain universal (at least 85%) regular access to essential medicines by 2015. Half-Priced Medicines Program related terms - GMA 50 / Pharma 50 / a program that would reduce the cost of medicines commonly bought by the poor to half of their regular prices and make them available nationwide through a distribution network as determined by the Department of Health The primary goal of the project is to ensure that affordable, high quality, safe and effective drugs and medicines are always available, especially to the poor. Pharma 50 unit, an ad-hoc unit which is currently named as the National Drug Policy-Pharmaceutical Management Unit (NDP-PMU 50) Botika ng Barangay (BnB) Among the programs initiated were the Botika ng Barangay (BnB), DOH botikas and the Parallel Drug Importation (PDI). These were created to implement stopgap measures to the emanating issues. Other existing programs that are continuously implemented are the Generics Advocacy, Philippine National Drug Formulary (PNDF) and Essential Drug Price Monitoring System (EDPMS). The establishment of the BnBs in the communities, including the insurgent areas, ensures accessibility of low-priced generic over-the-counter (OTC) drugs and five (5) prescription drugs as recommended by the National Formulary Committee (NFC). Other community drug outlets include Botika Binhi (funded by the members of the Peso for Health with counterpart from the local government unit), Health Plus (funded by the GTZ), Botika sa Parokya (funded by the Office of the President) and the Botika ng Bayan (BNB) under PITC/PITC Pharma Inc. At present, about 11,934 BnB outlets have been established in the country. Parallel Drug Importation (PDI) The Parallel Drug Importation was created to address the urgent need to make available quality low-priced medicines to the public immediately. This refers to the importation of similarly branded drug products that are cheaper in other countries to be distributed to the local market. Currently, there are forty-five (45) essential drugs being imported in the country and sold through 72 DOH Retained Hospitals and 3 local government units (LGUs). A revolving fund system was established to assure continuity of this program. Generics Advocacy aims to educate the public and health professionals with the end in view of changing the publics perception on generics that locally produced generic drugs are of good quality and more affordable, as well as affecting the prescribing and dispensing behaviors of health professionals Philippine National Drug Formulary

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an integral component of the Philippine National Drug Policy (PNDP) aiming at making available and accessible essential drugs of proven efficacy, safety and quality at affordable cost. It is a major strategy in the promotion of rational drug use that provides list of essential drugs deliberated by the National Formulary Committee (NFC) Electronic Drug Price Monitoring System a system and procedure for the data collection on prices of selected essential drugs P100 Project aims to provide packages of drug regimen worth 100 pesos or lower, with 100% safety, quality, and efficacy that will soon be available in 100 hospitals (DOH and LGU)

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