1.

CD control program
Communicable diseases
National Tuberculosis Control
Program key policies
Case finding direct Sputum
Microscopy and X-ray
examination of TB symptomatics
who are negative after 2 or more
sputum exams
Treatment shall be given free
and on an ambulatory basis,
except those with acute
complications and emergencies
Direct Observed Treatment Short
Course comprehensive strategy
to detect and cure TB patients.
Category and Treatment Regimen
Category 1- new TB patients whose sputum is
positive; seriously ill patients with severe forms
of smear-negative PTB with extensive
parenchymal involvement (moderately- or faradvanced)
and extra-pulmonary TB (meningitis,
pleurisy, etc.)
Category 2-previously-treated patients with
relapses or failures.
Category 3 new TB patients whose sputum is
smear-negative for 3 times and chest x-ray
result of PTB minimal
Category 1new TB patients whose sputum is positive;
seriously ill patients with severe forms of smearnegative
PTB with extensive parenchymal
involvement (moderately- or far- advanced) and
extra-pulmonary TB (meningitis, pleurisy, etc.)
Intensive Phase (given daily for the first 2 months)Rifampicin + Isioniazid + pyrazinamide + ethambutol.
If sputum result becomes negative after 2 months,
maintenance phase starts. But if sputum is still positive
in 2 months, all drugs are discontinued from 2-3 days
and a sputum specimen is examined for culture and drug
sensitivity. The patient resumes taking the 4 drugs for
another month and then another smear exam is done at
the end of the 3rd month.
Maintenance Phase (after 3rd month, regardless of the
result of the sputum exam)-INH + rifampicin daily
Category 2-previously-treated patients with relapses or
failures.
Intensive Phase (daily for 3 months, month 1,2 & 3)Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+
rifampicin pyrazinamide+ ethambutol on the 3rd month.
If sputum is still positive after 3 months, the intensive
phase is continued for 1 more month and then another
sputum exam is done. If still positive after 4 months,
intensive phase is continued for the next 5 months.
Maintenance Phase (daily for 5 months, month 4,5,6,7,&
8)-Isionazid+ rifampicin+ ethambutol
Category 3 new TB patients whose sputum is smearnegative
for 3 times and chest x-ray result of PTB
minimal
Intensive Phase (daily for 2 months) Isioniazid
+ rifampicin + pyrazinamide
Maintenance Phase (daily for the next 2 months)
- Isioniazid + rifampicin
Stop TB ; Do it with DOTS
Advocacy is a planned and continuous effort to
inform people about issue and instigate change.
Advocacy usually takes place over an extended
period of time and includes a variety of
strategies to communicate a specific message.

TB is the number one infectious killer in the

world.
One TB suspect can infect another 10 healthy
persons
Leprosy Control Program
WHO Classification basis of multi-drug therapy
Paucibacillary/PB noninfectious
types. 6-9 months of
treatment.
Multibacillary/MB infectious
types. 24-30 months of
treatment.
Multi-drug therapy use of 2 or more drugs
renders patients non-infectious a week after
starting treatment
Patients w/ single skin lesion and
a negative slit skin smear are
treated w/ a single dose of ROM
regimen
For PB leprosy casesRifampicin+Dapsone on Day 1
then Dapsone from Day 2-28. 6
blister packs taken monthly
within a max. period of 9 mos.
All patients who have complied w/ MDT are
considered cured and no longer regarded as a
case of leprosy, even if some sequelae of leprosy
remain.
Responsibilities of the nurse
Prevention health education,
healthful living through proper
nutrition, adequate rest, sleep
and good personal hygiene;
Casefinding
Management and treatment
prevention of secondary injuries,
handling of utensils; special
shoes w/ padded soles;
importance of sustained therapy,
correct dosage, effects of drugs
and the need for medical checkup
from time to time; mental &
emotional support
Rehabilitation-makes patients
capable, active and selfrespecting
member of society.
Control of Schistosomiasis a tropical disease caused by
a blood fluke, Schistosoma Japonicum ; transmitted by a
tiny snail Oncomelania quadrasi
Preventive measures health education
regarding mode of transmission and methods of
protection; proper disposal of feces and urine;
improvement of irrigation and agriculture
practices
Control of patient, contacts and the immediate
environment
Specific treatment- Praziquantel drug of choice
Programs on Filariasis, Malaria and Dengue Hemorrhagic
Fever
Filariasis- a chronic prasitic infection caused by
a nematode, Wuchereria bancrofti. Young and
adult worms live in the lymphatic vessels and
nodes, while the micro filariae are in the blood;
transmitted through bites from an infected
female mosquito, Aedes poecilius, that bites at
night.
Treatment: Diethylcarbamazine
citrate or Hetrazan
Elephantiasis and Hydrocoele
are handled through surgery,

prevention and supportive care

Malaria infection caused by the bite of the female
Anopheles mosquito ,
Chemoprophylaxis Chloroquine taken
at weekly intervals, starting from 1-2
weeks before entering the endemic area.
Anti-malarial drugs sulfadoxine,
quiinine sulfate, tetracycline, quinidine
Insecticide treatment of mosquito nets,
house spraying, stream seeding and
clearing, sustainable preventive and
vector control meas
Dengue H-fever
4 oclock habit
Programs on Measles. Chickenpox,
Mumps, Diphtheria, Pertusis, Tetanus
focused on health information
campaigns and intensive immunization
of children in barangays.
Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and
Paragonimiasis in communities where eating of fresh or
inadequately cooked crab is a practice
Management:
1. Deworming
2. Health Education re:
Good personal hygiene
Use of footwear
Washing fruits and vegetables
well
Use of sanitary toilets
Sanitary disposal of garbage
Boiling drinking water at least 23 min. from boiling point or
chlorination
Prevention and Control on Leptospirosis/ Weils Disease/
Mud fever/Flood fever/ Spirochetal Jaundice thru contact with
the skin/ open wound with water or moist soil contaminated
with urine of infected rat
And Rabies
Mgt. of Rabies
Wash wound with soap and water, betadine or
alcohol may be applied
If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows
rabies, kill then bring head for lab. Exam &
consult doctor.
Active immunization body develops Ab against
rabies up to 3 yrs.
Passive I giving Ab to persons with head and
neck bites, multiple single deep bites,
contamination of mucous membranes or thin
covering of the eyes, lips or mouth to provide
immediate protection
RPO immunization of pets at 3 mos. of age and
yearly thereafter
Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most
serious type cause of severe cx. Eg. Massive
liver damage and hepatocarcinoma
- 4 Cs in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
2. Community Needs Assessment/ Community Diagnosis
Community Diagnosis

A process by which the nurse collects data about

the community in order to identify factors which
may influence the deaths and illnesses of the
population
to formulate a community health nursing
diagnosis and develop and implement community
health nursing interventions and strategies
Done to come up with a profile of local health
situation
Will serve as a basis of health programs and
services to be delivered to the community
Starts with determining the health status of the
community
2 Types of Community Diagnosis
1. Comprehensive Community Diagnosis
aims to obtain general information about
the community
2. Problem-Oriented Community Diagnosis
type of assessment responds to a
particular need
ELEMENTS OF
COMPREHENSIVE COMMUNITY DIAGNOSIS
1. DEMOGRAPHIC VARIABLES
i. Total population & Geographical
distribution including Urban-Rural index
& Population Density
ii. Age & Sex composition
iii. Selected vital indicators e.q. Growth
rate, CBR, CDR & Life expectancy rate
iv. Patterns of migration
v. Population projection
Note:
Population groups that need special
attentions:
Indigenous people
Socially dislocated groups as a
result of disasters, calamities &
development programs
2. Socio-economic & Cultural variables
i. Social indicators
Communication network
Transportation system
Educational level
Housing conditions
ii. Economic indicators
Poverty level income
Employment rate
Types of industry present in the
community
Occupation common in the community
iii. Environmental indicators
Physical/geographical/topographical
characteristics
Water supply
Waste disposal
Air, Water and Land pollution
iv. Cultural factors
Variables that may break up people into
groups within the community e.q.
Ethnicity
Social class
Language
Religion
Race
Political orientation

Cultural beliefs and practices that affect

health
Concepts about Health and Illness
3. Health & illness patterns
Leading cause of mortality
Leading cause of morbidity
Leading cause of infant mortality
Leading cause of maternal mortality
Leading cause of hospital admission
4. Health resources
Manpower resources
Material resources
5. Political/Leadership patterns
Reflects the action potential of the state
and its people to address the health
needs and problems of the community
Mirrors the sensitivity of the
government to the peoples struggle for
better lives
PROCESS OF COMMUNITY DIAGNOSIS
Consists of;
1. Collecting, organizing & synthesizing data
In order to identify the different factors
that may directly or indirectly influence
the health of the population
2. Analyzing & interpreting health data
Seek explanations for the occurrence of
health needs and problems of the
community
3. Formulation of Community Health Nursing
Diagnoses
Will become the bases for developing
and implementing community health
nursing interventions and strategies
STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS

1. DETERMINING THE OBJECTIVES the nurse

decides on the depth and scope of the data she
needs to gather.

2. DEFINING THE STUDY POPULATION the nurse

identifies the population group to be included in
the study.

3. DETERMINING THE DATA TO BE COLLECTED the

objectives will guide the nurse in identifying the
specific data she will collect, and will also decide
on the sources of these data.

4. COLLECTING THE DATA the nurse decides on

the specific methods depending on the type of
data to be generated.
Ocular survey, interview, and records
review,

Descriptive data

8. DATA PRESENTATION will depend largely on

the type of data obtained.
Descriptive- narrative reports
numerical data- table or graphs

9. DATA ANALYSIS aims to establish trends and

patterns in terms of health needs and problems
of the community.
10. Identifying Community Health Nursing Problems
a. Health Status Problems
Increased/decreased morbidity,
mortality fertility or reduced capability
for wellness
b. Health Resources Problems
Lack of or absence of manpower, money,
materials or institutions necessary to
solve health problems
c. Health Related Problems
Existence of social, economic,
environmental and political factors that
aggravate the illness-inducing situations
in the community
11. Priority-setting
a. Nature of the condition/problem presented
Classified as health status, health
resources or health related problems
b. Magnitude of the problem
Severity of the problem which can be
measured in terms of the proportion of
the population affected by the problem
c. Modifiability of the problem
Probability of reducing, controlling or
eradicating the problem
d. Preventive potential
Probability of controlling or reducing the
effects posed by the problem
e. Social concern
Perception of the population or the
community as they are affected by the
problem and their readiness to act on
the problem
PLANNING
WHAT IS PLANNING?
is a process that entails formulation of
steps to be undertaken in the future in
order to achieve a desired end.
Concepts of Planning:
Planning is futuristic.
Planning is change-oriented.

5. DEVELOPING THE INSTRUMENT instruments/tools

facilitate the nurses data-gathering activities.
Most common instruments :

Planning is a continuous and dynamic

process.

survey questionnaire

Planning is flexible.

interview guide

Planning is a systematic process.

observation checklist

6. ACTUAL DATA GATHERING the nurse supervises

the data collectors by checking the filled-up
instruments in terms of completeness, accuracy
and reliability of the information collected.

7. DATA COLLATION the nurse is now ready to put

THE PLANNING CYCLE:

1. Situational Analysis
gather health data
tabulate, analyze and interpret data

together all the information.

Numerical data

identify health problems

set priority

2. Goal and Objective Setting

define program goals and objectives
assign priorities among objectives
3. Strategy/Activity Setting
Design CHN Program
Ascertain resources
Analyze constraints and limitations
4. Evaluation
determines outcomes
specify criteria and standards
Application of Public Health Tools (discuss in separate
slide)
Three important tools
The health disciplines of

1. Demography
2. Vital statistics
3. Epidemiology
3. COMMUNITY ORGANIZING
A process whereby the community members
develop the capability to assess their health
needs and problems, plan and implement actions
to solve these problems, put up sustain
organizational structures which will support and
monitor implementation of health initiatives by
the people
maglaya
COMMUNITY ORGANIZING
Purpose:
Empowerment or building the capability
of people for future community action
Approaches to community development
a. Social changes
Building up social organizations
(relationships, structure and resources)
b. Change in ideology
Knowledge, beliefs and attitude
c. Change agents
Capacity to influence others by setting a
good example.
Principles of CO:
1. Welfare approach
People esp. the oppressed, exploited and
deprived sectors are most open to change, have
the capacity to change and are able to bring
about change. Hence , CO is based on the ff:
a. Power must reside in the people
b. Development. is from the people to the
people
c. People participation
2. Technological approach

5. Dissemination reassessment
1.Community analysis
The process of assessing and defining needs,
opportunities and resources involved in
initiating community health action .
Maybe referred to as community diagnosis,
community needs assessment, health education
planning and mapping
5 components of community analysis
1. Demographic, social and economic profile of the
community derived from secondary data.
2. Health risk profile (social, behavioural and
environmental risks)
Behavioural- dietary habits and other life
style concerns like alcohol, tobacco and
drugs
Social indicators- exposure to long term
unemployment, low education and
isolation.
3. Health/wellness out comes profile
(morbidity/mortality data)
4. Survey of current health promotion programs.
5. Studies conducted in certain target groups
Steps in community analysis
Steps in community analysis
i. Defining the community
1. Determining the geographic boundaries
of the target community
ii. Collecting data
iii. Assessing community capacity
1. Entails an evaluation of the driving
forces which may facilitate or impede
the advocated change
iv. Assessing community barriers
v. Assessing readiness to change
1. Community interest
2. Perception on the importance of the
problem
vi. Synthesis data and set priorities
1. Provide a community profile of the needs
and resources and will become the Basis
for designing prospective community
interventions for health promotion
2.Design and initiation
STEPS:

1. Establish a core planning group and select a

local organizer.
Requirements:
Select 5-8 member in charge for core
planning and management of the
program
With management skills, good listener
and conflict resolution skills.
2. Choose an organizational structure.
This activate the community
participation.
Types:

a. Leadership board council- existing local

must be based on the poorest sectors of society.

The solutions of problems commonly shared by
these sectors must be focused on collective
organizations, planning and action
3. Transformatory approah
should lead to self-reliant communities
Five stages

leaders working for a common cause

1. Community analysis
2. Design and initiation
3. Implementation
4. Program maintenance consolidation

d. Grass-roots- informal structures in the

b. Coalition- linking organizations and

groups to work on community issues.

c. lead or official agency- a single agency

takes the primary responsibility of a
liaison for health promotion activities in
the community.
community like the neighbourhood
residents.

e. Citizens panels- a group of citizens (510) emerge to form a partnership with

the government agency.

c. Establish an ongoing recruitment plan.

f. Networks and consortia- network

It should be expected that volunteers

may leave the organization.
This requires a built in mechanisms for
continuous recruitment and training of
new members.
d. Disseminate results.

develop because of a certain concerns

3. Identify, select and recruit organizational
members.
As much as possible different groups,
organizations sectors should be
represented.
Chosen representative have power for
the group they represents
4. Define the organization mission and goals.
This will specify the what, who, where,
when and extent of the organizational
objectives.
5. Clarify roles and responsibilities of people
involved in the organization.
This is done to establish a smooth
working relationship and avoid
overlapping of responsibilities.
6. Provide training and recognition.
Active involvement in planning and
management of programs may require
skills development training.
Recognition of the programs
accomplishment and individuals
contribution to the success of the
program and boost morale of the
members.
3.Implementation
-put the design plan into action.
a. Generate broad citizen participation
How?
Organizing task force, who, with
appropriate guidance can
provide the necessary support.
b. Develop a sequential work plan
Activities should be planned
sequentially. Often, times has to be
modified as events unfold. Community
members may have to constantly
monitor implementation steps.
c. Use comprehensive, integrated strategies
Generally the program utilize more than
one strategies that must complement
each other.
d. Integrate community values into the programs,
materials and messages.
The community language, values and
norms have to be incorporated into the
program.
4.Program maintenance consolidation
The program a this point has experienced some
degree of success and has weathered through
implementation problems, the organization and
program is gaining acceptance in the
community.
Maintenance:
a. Integrate intervention activities into community
networks
This can be affected through
implementation problems.
The organization and program is gaining
acceptance in the community.
b. Establish a positive organizational culture.
A positive environment is a critical
element in maintaining cooperation and
preventing fast turnover of members.
This is a result of good group process
based on trust, respect, and openness.

Continuous feedback to the community

on results of activities enhances
visibility and acceptance of the
organization.
Dissemination of information is vital to
gain and maintain community support.
5. Dissemination-Reassessment
Continuous assessment is part of the monitoring
aspect in the management of the program
a. Update the community analysis.
Is there a change in leadership,
resources and participation?
This may necessitate reorganization and
new collaboration with other
organizations.
b. Assess effectiveness of interventions/programs.
Quantitative and qualitative methods of
evaluation can be used to determine
participation, support and behavior
change level of decision making and
other factors deemed important to the
program.
c. Chart future directories and modifications.
This may mean revision of goals and
objectives and development of new
strategies.
Revitalization of collaboration and
networking may be vital in support of
new ventures.
d. Summarize and disseminate results.
Some organization die because of the
lack of visibility.
Thus, a dissemination plan may be
helpful in diffusion of information to
further boost support to the
organizations endeavour.
The Health Resource Development Program
Community Health Organizing Utilizing COPAR
HRDP
Was developed and sponsored by the Philippine
Center for Population and Development (PCPD)
To make health services available and accessible
to depressed and underserved communities in
the Philippines
PCPD is a non-stock, non-profit institution, which
serves as a resource center assisting institutions
and agencies through programs and projects
geared toward the social human development of
rural and urban communities
Formerly known as The Population Center
Foundation
HISTORY OF HRDP
HRDP I
Trained the faculty, medical/nursing
students to provide health care services
to the far flung barrios because of lack
of man power for health services at the
same time that similar activities fulfilled
the curricular requirements of the

students for public health

The PCPD provides seed money for the
income generating projects
The CO uses his/her own strategy or
method in developing the community
Short-term service
HISTORY OF HRDP
HRDP II
The 2nd cycle uses the same strategy but
the program could not be sustained by
the schools or hospitals and the incomegenerating
projects eventually become
the hindrance to the goal of achieving
the health program because the people
tend to be more interested in the income
generated by the projects
Both HRDP I and HRDP II have brought
about some changes in the community
life of the people
Established basic health infrastructure;
basic health services were increased;
there were trained workers and
organized health groups to take care of
the needs of the community
HISTORY OF HRDP
HRDP III
PCPD refined the program and resulted
to what is now called HRDP III, which has
these unique features:
Comprehensive training of the
staff and faculty of the
participating agency in which the
community work was initiated
Periodic training program and
regular assistance to the
participating agency were
provided to strengthen the
health outreach program to
become community oriented
PHC as the approach with which
all nursing/medical students,
their CIs and indigenous health
workers are trained for
community health work and
around which all other project
inputs will revolve
HISTORY OF HRDP
Community organizing as the main
strategy to be employed in preparing the
communities to develop their community
health care systems and the
establishment of community health
organization to manage the community
health programs
Organizing work in the communities
were done in 3 phases
PAR as fascinating strategy for
maximum community involvement
through collective identification and
analysis of community health problems
and collective health action
Available funds to finance community
initiated projects
COPAR?
Since Management Leadership and
Jurisprudence are courses taught in the
classroom members of this group of students
were trained to manage and acts as leaders of
the different levels of the students who were
involved in COPAR

Principles of management were applied in

carrying out primary health care
The community members, CHWs and leaders
were empowered to manage their own health
projects
Conducted seminars and trainings as well as
health education and services needed by
community(exposure and immersion 6-8 weeks)
THE HRDP-COPAR PROCESS
1. PRE-ENTRY PHASE
2. ENTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4. COMMUNITY ORGANIZATION AND CAPABILITYBUILDING
PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING PHASE
1. Pre-Entry Phase
Preparation of the Institution
Train faculty and students in COPAR.
Formulate plans for institutionalizing COPAR.
Revise/enrich curriculum and immersion
program.
Coordinate participants of other departments.
Site Selection
Initial networking with local government.
Conduct preliminary special investigation.
Make long/short list of potential communities.
Do ocular survey of listed communities.
Criteria for Initial Site Selection
o Must have a population of 100-200 families.
o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the
same program.
Identifying Potential Barangay
o Do the same process as in selecting
municipality.
o Consult key informants and residents.
o Coordinate with local government and NGOs
for future activities.
Choosing Final Barangay
o Conduct informal interviews with community
residents and key informants.
o Determine the need of the program in the
community.
o Take note of political development.
o Develop community profiles for secondary
data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.
Identifying Host Family
o House is strategically located in the
community.
o Should not belong to the rich segment.

o Respected by both formal and informal

leaders.
o Neighbours are not hesitant to enter the
house.
o No member of the host family should be
moving out in the community.
2. Entry Phase
Guidelines for Entry
o Recognize the role of local authorities by
paying them visits to inform their presence and
activities.
o Her appearance, speech, behavior and lifestyle
should be in keeping with those of the
community residents without disregard of their
being role model.
o Avoid raising the consciousness of the
community residents; adopt a low-key profile.
Activities in the Entry Phase
Integration - establishing rapport with the
people in continuing effort to imbibe community
life.
living with the community
seek out to converse with people
where they usually congregate
lend a hand in household chores
avoid gambling and drinking
Deepening social investigation/community study
verification and enrichment of data collected
from initial survey
conduct baseline survey by students,
results relayed through community
assembly

children
Causes: environmental factors, maternal diseases or
genetic aberrations
2. Rheumatic Fever or Rheumatic Heart Disease:
Systematic inflammatory disease that may
develop as a delayed reaction to repeated and
an inadequately treated infection of the upper
respiratory tract by group A beta-hemolytic
streptococci.
3. Hypertension: Persistent elevation of the
arterial blood pressure.
4. primary or essential) ;frequent among females
but severe,malignant form is more common
among males
5. Ischemic Heart Disease/ Atherosclerosis:
Condition usually caused by the occlusion of the
coronary arteries by thrombus or clot formation.
higher among males than females for the latter
are protected by estrogen before menopause
PF: HPN, DM, Smoking
Minor RF: stress, strong family history, obesity
CVD
CVD
Primary Prevention: CVD
Primary Prevention thru health education is the
main focus of the program:
1. maintenance of ideal body wt.
2. diet - low fat
3. alcohol/smoking avoidance
4. Exercise
5. regular BP check up
2. Cancer Prevention and Early Detection
Any malignant tumor arising from the abnormal
and uncontrolled division of cells causing the
destruction in the surrounding tissues.
Common Cancer: Lung cancer, cervical cancer,
colon cancer, cancer of the mouth, breast
cancer, skin cancer, prostate cancer.
3rd leading cause of illness and death ( Phil.)

Leader Spotting Through Sociogram.

Key persons - approached by most people
Opinion leader - approach by key persons
Isolates - never or hardly consulted
4.NCD prevention and control program
1. Prevention and Control of Cardiovascular
Diseases
2. Cancer Prevention and Early Detection
3. Natl Diabetes Prevention and Control Program
4. Prevention and Control of Kidney Disease
5. Program on Mental Health and Mental Disorders
6. Program on Drug Dependence/
Substance Abuse
7. Community-Based Rehabilitation Program
8. Program on the Elderly/Geriatric Nursing
Services
9. Programs on Blindness, Deafness and
Osteoporosis
1. Prevention and Control of Cardiovascular Diseases
heart 1st leading cause of death
blood vessels - 2nd
Types:
1. Congenital Heart Disease (CHD):
2. Rheumatic Fever or Rheumatic Heart Disease

3. Hypertension
4. primary or essential
5. Ischemic Heart Disease/ Atherosclerosis
1.Congenital Heart Disease (CHD): Result of the
abnormal development of the heart that exhibits
septal defect, patent ductus arteriosus, aortic and
pulmonary stenosis, and cyanosis; most prevalent in

Incidence can only be reduced thru prevention

and early detection
NINE WARNING SIGNS OF CANCER:
Change in blood bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Unexplained anemia
Sudden unexplained weight loss
Prevention & Early Detection
PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES
One third of all cancers are curable if
detected early and treated properly.
Three major forms of treatment of cancer:
Surgery
Radiation Therapy
Chemotherapy
3.Natl Diabetes Prevention and Control Program
Aim:
Controlling and assimilating healthy lifestyle in
the Filipino culture ( 2005-2010) thru IEC

Main Concern: modifiable risk factors( diet, body

wt., smoking, alcohol, stress, sedentary living,
birth wt. ,migration
4.Prevention and Control of Kidney Disease
Acute or Rapidly Progressive Renal Failure : A
sudden decline in renal function resulting from the
failure of the renal circulation or by glomerular or
tubular damage causing the accumulation of
substances that is normally eliminated in the urine in
the body fluids leading to disruption in homeostatic,
endocrine, and metabolic functions.
Acute Nephritis: A severe inflammation of the kidney
caused by infection, degenerative disease, or disease
of the blood vessels.
Chronic Renal Failure: A progressive deterioration of
renal function that ends as uremia and its
complications unless dialysis or kidney transplant is
performed.
Neprolithiasis: A disorder characterized by the
presence of calculi in the kidney.
Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into the
urine because of increased permeability of the
glomerular capillary membrane
Urinary Tract Infection: A disease caused by the
presence of pathogenic microorganisms in the
urinary tract with or without signs and
symptoms.
Renal Tubular Defects: An abnormal condition in
the reabsorption of selected materials back into
the blood and secretion, collection, and
conduction of urine.
Urinary Tract Obstruction: A condition wherein
the urine flow is blocked or clogged.
5. Program on Mental Health and Mental Disorders
6. Program on Drug Dependence/
Substance Abuse
7.Community-Based Rehabilitation Program
A creative application of the primary health care
approach in rehabilitation services, which
involves measures taken at the community level
to use and build on the resources of the
community with the community people,
including impaired, disabled and handicapped
persons as well.
Goal: To improve the quality of life and increase
productivity of disabled, handicapped persons.
Aim: To reduce the prevalence of disability
through prevention, early detection and
provision of rehabilitation services at the
community level.
8. Program on the Elderly/Geriatric Nursing
Services
7 humanitarian issues: family, health, income,
security, employment and labor, social welfare,
education, recreation, culltural activities and
housing
Leading causes of illness:elderly
Influenza, HPN, diarrhea,
bronchitis, TB, diseases. of the heart,
pneumonia, malaria,
malignant neoplasm, chickenpox
Leading causes of death:elderly
Diseases of heart and vascular system
Pneumonia, TB, CCOPD

Malignant neoplasms
Diabetes
Nephritis
Accidents
9.Programs on Blindness, Deafness and Osteoporosis
Cataract- main causes of blindness
VAD- main cause of childhood blindness; most
serious eye problem of Fil. children below 6 yrs.
old
Osteoporosis special problem in women,
highest bet. 5079 yrs. old, MENOPAUSE- main
cause
Prevention of NCD/Role of Nursing in Health Promotion
And Advocacy
Yosi Kadiri- anti smoking
Edi Exercise/Hataw-regular physical activity
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high
fiber diet
Mag HL exercise, no smoking, avoidance of
alcohol, healthy diet, iwas stress, watch wt.
Sentrong Sigla Movement ( SSM)
-a certification recognition program which develops and
promotes standards for health facilities
- Joint effort bet.:
1.DOH provides technical and financial assistance
packages for health care
2. LGUs direct implementers of health programs &
prime developers of health centers and hospitals
making services accessible to every Filipino
Pillars of SSM
1. Quality Assurance
2. Grant and Technical Assistance
3. Health Promotion
4. Awards
Expected Outcome: SSM
Empowered individuals adopting healthy
lifestyle, improved health-seeking behavior and
well-being & increased demand for quality
health services
Institutions will develop policies, provide quality
services , institute system for surveillance/
merits and advocate for laws
Programs: SSM
EPI
Disease Surveillance
CARI
CDD
Nutrition/ Micronutrient Supplementation*Food Fortification :
Rice iron; Oil and sugar Vit. A;
Flour-Vit. A & iron; Salt- iodine
Integrated Management of Childhood Illness
( IMCI)
Integrates management of most common
childhood problems ( diarrhea, pneumonia,
measles, malnutrition, DHF, malaria)
Involves family members and community in the
health care process for physical growth and
mental development & disease prevention
IV. The Public Health Nurse
Definition and terms:
Public Health Nursing
refers to the practice of nursing in local/national
health departments (which includes health

centers and rural health units) and schools.

It is a community health nursing practice in the
public sector
Public Health Nurses
Refers to the nurses in the local/national health
departments or public schools whether their
official position title is public health nurse or
nurse or school nurse
Leaders in providing quality health services to the
communities
First level of health workers to be
knowledgeable about new public health
technologies and methodologies
Usually the first ones to be trained to implement
new programs and apply new technologies
Qualifications
Must be professionally qualified and licensed to
practice in the arena of public health nursing
Consistent with the nursing law of 2002 (RA
9173)
7 Roles and Functions
1. Management function
Inherent in the practice of PHN
Organizes the nursing service of the
local health agency
Applications of 5 management Functions
POSDC in organizing the nursing
service and the local health agency.
2. Supervisory function
Supervisor of the midwives and other
health workers
3. Nursing care function

and
occupational health nursing
School nursing
A type of public health nursing that focuses on
the promotion of health and wellness of the
pupils/students, teaching and non teaching
personnel of the schools.
The primary role is to support the student
learning and ensure that educational potential is
not hampered by unmet health needs
Assist the students in making choices for a
healthy life style, reduce risk taking behaviour
and focus on issues such as prevention of drug
and substance abuse, teenage pregnancy,
STD,Malnutrition, CD and NCD
founded by: Lillian Wald (1902)
a member of the professional educational
employed to aid students in developing their full
health potential in health and education
HNC (health and Nutrition Center) of the DepEd
Mandated to safeguard the health and
nutritional well-being of the total school
population.
2 division
1. health
4 sections
Medical

Inherent function of the nurse

Dental

Based on the science of art and caring

Nursing

Caring for all levels of clientele toward

health promotion and disease prevention
4. Collaborating and coordinating function
Care coordinators for communities and
their members
Establishes linkages and collaborative
relationships with other health
professionals, government agencies,
private sectors, NGOs peoples
organizations to address health
problems
5. Health promotion and education function
Activities goes beyond health teachings
and health information campaigns
6. Training function
Initiates the formulation of staff
development and training programs for
midwives and other auxiliary workers
7. Research function
Participates in the conduct of research
and utilizes research findings in her
practice
Disease surveillance
Measure the magnitude of the
problem
Measure the effect of the control
program
Competencies and skills
1. Community health nursing process
2. Nursing procedures during clinic and home visits
3. Community organizing
4. Health promotion and education
5. Surveillance
6. Recording and reporting
7. epidemiology
IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING
School nursing

Health education
2. nutrition division
Objectives of School Nursing
Genera l: To promote and maintain the health of
the school populace by proving comprehensive
and quality nursing care.
6 Specific :
1. Provide quality nursing service to the school
population
2. Create awareness among children, personnel
and administrators on the importance of the
promotive and preventive aspects of health
through health education.
3. Encourage the provision of standard functional
facilities
4. Providing nursing personnel with opportunities
for continuing education and training.
5. Conduct and participate in researches related to
nursing care.
6. Establish/ strengthen linkages with government
and non-government organization/agencies
for school community health
work.
9 Duties and responsibilities of the school nurses
1. Health advocacy
2. Health and nutrition assessment including other
screening procedures such as vision and
hearing.
3. Supervision of the health and safety of the
school plant.
4. Treatment of common ailments and attending to
emergency cases.
5. Referrals and follow-up of pupils and personnel
6. Home visits
7. Community outreach
E.g.,:
attending community assemblies

 and organizing school

community health councils.
8. Recording and reporting of accomplishments
9. Monitoring and evaluation of programs and
projects.
Skills and competencies
1. Assessment and screening skills
2. Health counselling skills
3. Social mobilization skills
4. Good oral and written communication skills
5. Basic management skills
6. Life skills
16 function of the school nurse

1. School health and nutritional survey (from 1st

visit and Qyr)- for data and planning purposes
Survey of the ff:
current health situation

Training programs,
conferences/workshops for teachers,
pupils and parents
11. Organization of school-Community Health and
Nutrition Councils
Membership shall come from both school
and community
This attend to the health related
problems and concerns
12. Communicable disease control
In participation of both the teachers,
parents and students
Encourage the importance of
immunization for prevention
13. Establishment of Data Bank on School Health
and Nutrition Activities

and nutritional status

Treatment in the school clinic

Facilities

Record of the school visit

Health education activities

2. Putting up a school clinic (R.A. 124)
3. Health assessment (every year or with
epidemics)
Purpose:
detect the signs of illness and physical
defects for early correction.
Health habits
4. Standard vision testing for school children
(20/20)
a
Purpose:
Screen students with poor visual acuity
and indentify other ocular problems
Refer students with eye disease and
errors of refraction for further
examination and management.
5. Ear examination
Methods:
Observation
Examination by using penlight or
otoscope
Screening test (whisper test,
conversation voice test, ball pen click.)
6. Height and weight measurement and nutritional
status determination
Height and weight measurement is a procedure
for evaluating the tallness or the shortness and
the heaviness of a pupil.
DepEd
<10 years old=weight for age and height
for age
>10 years old= BMI
Appropriate school feeding programs with rice,
milk or fortified noodles are given to children
with below normal nutritional status for 120
feeding days
Deworming is a pre requite prior to feeding
Consent from parent is pre requisite prior to deworming
7. Medical referrals
8. Attendance to emergency cases

9. Student health counselling( for student who

manifest the physical and emotional symptoms)
(parents, teacher, and student)
10. Health and nutrition education activities

Health assessment report of the school

health personnel
Health and nutritional status of
pupils/students
Form 86 of teaching and non teaching
personnel
Teachers health profile
Records of attended emergency case
Inventory of clinic and equipment
supplies
Health and nutrition activities in school
Record of accomplishment of school
health services
Records of officers/ officials of the
School-Community Health Council and
their accomplishment
Action plan
14. School plant inspection for healthy environment
Others concerns: school site, area,
location, space and sanitation,
classroom and others rooms, school
clinics, water supplies, sanitation, school
canteen.
Inspect for the size, lighting, ventilation,
arrangement of seats.
15. Rapid Classroom Inspection( after holidays and
epidemics but not to exceed more than a month
except for cases of epidemics)
Procedure same as HA
Purpose:
Detect cases of CD
Note the correction that have been made
Note if the eyeglasses are correctly adjusted
Note the general cleanliness of the students
Note new ailments.
16. Home visitation
Indication:
Pupils whose parents are afraid of some
medical procedures
Pupils who get re-infected because of
home conditions
Pupils suffering from CD
Pupils who are absent frequently
because of sickness

Pupils who are malnourished.

Occupational health nursing
By American Association of Occupational Health
The special practice that provides for and
delivers health care services to workers and
worker populations.
The practice focuses on promotion, protection,
and restoration of workers health within the
context of a safe and health work environment.
Occupational health nursing is autonomous, and
occupational health nurses make independent
nursing judgments in providing occupational
health services.
The foundation of occupational health nursing
practice is research-based with an emphasis on
optimizing health, preventing illness and injury,
and reducing health hazards.
By PNA ANSAP, 1982
Is aimed at assisting workers in all occupations
to cope with actual and potential stresses in
relation to their work and work environment.
It is primarily geared at helping workers attain
and maintain optimum level of physical and
psychological functioning.
mission
To ensure so far as possible every working man
in the country is safe and in healthful working
conditions
Occupational Health Team
1. Occupational Health Nurses
2. Occupational physicians- focus on the
prevention, detection, and treatment of workrelated
diseases and injuries.
3. Industrial hygienists-recognize, evaluate, and
control toxic exposures and hazards in the work
environment.
4. Safety Hazards engineers- focus on the
prevention of occupational injuries and the maintenance
or creation of safe workplaces and safe work practices.
5. epidemiologists- study and describe the natural
history of occupational diseases and injuries in
population groups.
6. toxicologists- study and describe the toxic
properties of agents used in work application to which
workers may be exposed.
7. Industrial engineers- design the tools,
equipment, and machines used in manufacturing
and other work applications
8. Ergonomists- study design, and promote the
healthy interface of humans, their tools, and
their work.
9. Environmental engineers- concentrate on
environmental controls to limit environmental
pollution and achieve a healthy environment.
Function of Public Health Nurse as an Occupational
Health Nurse
1. Work with the occupational health team
to lead the sanitary hygiene of all industrial
establishment including hospitals to
determine their
compliance with the sanitation code and its
implementing rules and regulations
2. Recommends to Local Health Authority the issuance
of license/ business permits and suspensions or
revocation of the same for any violations of the
conditions upon which said licenses or permits had been
issued, pursuant to existing rules and regulation.
3. Coordinates with other governments agencies relative
to the implementation of the implementing rules and

regulations
4. Attends to complaints of all establishment in the area
of assignment related to industrial hygiene and
recommends appropriate measures for immediate
compliance.
5. Participate to provide, install and maintain in good
condition all control facilities and protective barriers for
potential and actual hazards.
6. Informs all affected workers regarding the nature
hazards and the reasons for the control measures and
protective equiptment.
7. Makes a periodic testing for physical examination of
the workers and other health examination related to
workers exposure to potential or actual hazards in the
work place
8. Provide control measures to reduce noise, dust,
health and other hazards.
9. Ensure strict compliance on the regular use and
proper maintenance of Personal Protective Equipment
(PPE)
10. Provide employees an occupational health services
and facilities
11. Refers or elevate to higher authority all unresolved
issues in relation to occupational and environmental;
health problems
12. Prepare and submit yearly reports to the local and
national Government
Application of Public Health Principles to Occupational
Health Nursing

A. Community Assessment :
Identify the demographic data on
disease trends including
morbidity and mortality
statistics,
and social environmental
conditions
that will provide
pertinent information for
the establishment of
priorities in planning and
implementing
occupational health
programs
B. Worker Assessment:
Assessment of the workforce to
determine populations at risk for
occupationally related injury or illness.
Types of Classification:
Age, sex, race, type of work, the
presence or absence of disability.
C. Application of Epidemiology
To determine relationship of work and
injury or illness
Methods use:
Toxicology, pathology, ergonomics
D. Team Approach
Collaboration with occupational health
team for the development of
comprehensive occupational health
program
Industrial hygienist, epidemiologist,
medical technologist, toxicologist, safety
engineer, ergonomist, physician,
occupational health nurse, occupational
health therapist
E. Program Planning and Implementation
Goal: promotion of wellness and prevention of
illness and injury among workers.
Application:
Primary prevention
A program to ensure the health of
prospective employees/ workers includes

a history and physical examination to

assess level of wellness. Maintenance of
that level is provided through
appropriate job placement.
Secondary Prevention
Applied once the health problems is not
meet by primary prevention
methods:
Early detection and treatment of both
work-and non-work related health
problems
Tertiary prevention:
Rehabilitation toward workers disabled
by occupational and non occupational
problems
Methods:
Evaluation of current status
Enhancement of employability,
and appropriate job placement of
employees
Services:
Physical occupational and speech
therapy
Vocational training
Chronic pain clinics
Remedial reading
Mathematics program
F. Referral to Community Resources
G. Program Evaluation
Assessment of program to determine
benefits in terms of decreasing loss of
productivity related to employee health
problems is carried out.
Issues In Occupational Health Nursing
A. Physical Hazard
Are agents within the work environment
that may cause tissue damage or other
physical harm.
Radiation, extreme temperature, noise,
electric and magnetic field, lasers,
microwaves, and vibration.
Acute: acoustic trauma from excessive noise,
heat stress or stroke, skin rashes, eye injuries
from infrared radiation, skin burns, cuts or
contusions.
Chronic: NIHL, multiple myeloma and
leukaemia's from exposure to ionizing radiation,
teratogenic or genetics effects induced by
certain types of radiation.
B. Chemical Hazards:
Various forms of either synthetic or naturally
occurring chemicals in the work environment
may be potentially toxic or irritating to the body
system through inhalation, skin absorption,
ingestion, or accidental injection.
Mists, vapors, aerosols, gases, medications,
particulate matters (dusts and fumes), solvents,
metals, oil synthetic textiles, pesticides,
explosives, and pharmaceuticals. Specifically,
health care workers are exposed to chemical
hazards such as anaesthetic gases,
chemotherapeutic and antineoplastic agents,
tissue fixative reagents, disinfectant and
detergents, sterilizing agents, solvents, latex
and mercury.
Acute: respiratory irritation due to smoke,

poisoning from accidental ingestion, metal-fume

fever, chemical burns, contact dermatitis and
other dermatoses
Chronic: cancers (mesothelioma, bronchogenic
and GI carcinomas); pleural diseases;
occupational asthma; hypersensitivity
pneumonitis, birth defects and neurological
disorders.
mesothelioma
C. Biological Hazards:
Biological agents such as viruses, bacteria,
fungi, mold, or parasites may cause infection
disease via direct contact with infected
individuals/ animals, contaminated body fluids,
or contaminated objects, surfaces
Workers in certain occupations ( health care,
biological research and animal handling) have a
high incidence of infectious diseases.
Acute: self limiting infections such as colds and
influenzas, measles, skin and parasitic
infections.
Chronic: TB, chronic Hepa B, HIV and AIDS
D. Mechanical Hazards
Mechanical agents may cause stress on the
musculoskeletal or other body systems
Hazards include inadequate work-station and
tool design, frequent repetition of a limited
movement, repeated awkward movements with
hand-held tools, local vibrations.
Acute: neck strain and other muscular fatigue
from forceful exertion or awkward positioning,
and visual; fatigue.
Chronic: Raynaud's syndrome from use of
vibrating power tools, carpal tunnel syndrome
Raynaud's syndrome
E. Psychosocial Hazards:
Often related to trauma to the nature of the job,
the job content, the organizational structure and
culture, insufficient training and education
regarding job requirements, and the physical
condition in the work place, leadership and
management styles.
Interpersonal conflict, unsafe working
conditions, overtime, sexual harassment, racial
inequality, role conflict, shift work, limited
autonomy, poorly defines expectations and work
instructions, and absent or limited reward.
Acute: increased HR, increased BP, sleep
disturbances, fatigue, depression,
substance abuse, worksite violence.
Chronic: HPN, alcoholism, CAD, mental
illness, GI
f.Occupational injury- is any injury, such as cut, fracture,
sprain, or amputation that results from a single incident
in the work environment.
g.Occupational illness- is any abnormal condition or
disorder, other than one resulting from a occupational
injury, caused by exposure to environmental factors
associated with employment.
School Nursing
Health assessment
METHODS USED:
a. Interview
b. Nutritional Assessment height and weight
measurements
c. Vision Acuity Test/ Hearing Test
d. IPPA
e. V/S
f. Appraisal of the General and Physical and Mental

Condition
g. Recording
PREPARATION:
a. Well, lighted, ventilated, screened room or a
corner of the classroom
b. 2 or 3 chairs according to need
c. Waste basket
d. Hand washing facilities
e. Tongue dep., penlight
f. Step/ sphygmo
g. Forms/ records
PROCEDURES OF HEALTH ASSESSMENT
1. Nx conduct a classroom lecture to educate the
pupils on what to do during the Health
Assessment.
2. 3-5 children at a time should be waiting for the
assessment
3. Wash hand by the start of health assessment
4. Assess the children one by one
5. Inspection:
a. From head to foot
b. Skin diseases
c. Signs of abnormal condition
d. Stet should be use across the heart/ lung
assessment
e. Findings should be recorded during the
assessment
STEPS
a. ARMS, HANDS, AND FINGER NAILS:
Ask the child to roll their sleeves
Extend their arms
Show hands one side first, then the
other
Spread their finger
b. EYES
Ask the child to pull his lower lid using
his index finger and ask him to look up
c. TEETH
Ask the child to open is mouth and say
ah to show his throat
d. NOSE
Ask the child to place his 2nd finger on
the tip of the nose and pull up his nose
and extend his head backward
e. EARS
Ask the child to push back his hair
behind his ear and pull the outer ear up,
slightly backward/ and then forward.
f. NECK and CHEST
Examine the neck
Chest/ back should be auscultated
g. HAIR
Ask the pupil to run his fingers through
his hair several times
Ask to show the nape by the pulling the
hair up.
h. FEET/LEG
Ask the girl to pull up her dress
The boy his trousers to their knees
Or you can observe while they
performed marching
i. GENERAL APPEARANCE
IMPORTANT REMINDERS IN HA:
1. If the health personnel is of the opposite sex,
performed the procedure in the presence of the
same sex.
2. The result should be discuss to the teacher
3. If
4. Refer cases that cannot be handle stat

5. Inform parents if the findings

COMMUNITY ORGANIZING PARTICIPATORY ACTION
RESEARCH (COPAR)
Importance of COPAR
COPAR is an important tool for community development and
people empowerment as this helps the community workers to
generate community participation in development activities.
COPAR prepares people/clients to eventually take over the
management of a development program(s) in the future. COPAR
maximizes community participation and involvement;
community resources are mobilized for community services.
Principles of COPAR
1. 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.
2. COPAR should be based on the interest of the
poorest sector of society.
3. COPAR should lead to a self-reliant community and
society.
Phases of the COPAR Process
1. Pre-Entry Phase
Preparation of the Institution
o Train faculty and students in COPAR.
o Formulate plans for institutionalizing
COPAR.
o Revise/enrich curriculum and immersion
program.
o Coordinate participants of other
departments.
Site Selection
o Initial networking with local government.
o Conduct preliminary special investigation.
o Make long/short list of potential
communities.
o Do ocular survey of listed communities.
Criteria for Initial Site Selection
o Must have a population of 100-200 families.
o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the
same program.
Identifying Potential Municipalities
o Make long/short list.
Identifying Potential Barangay
o Do the same process as in selecting
municipality.
o Consult key informants and residents.
o Coordinate with local government and NGOs
for future activities.
Choosing Final Barangay
o Conduct informal interviews with
community residents and key informants.
o Determine the need of the program in the
community.
o Take note of political development.
o Develop community profiles for secondary
data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.
Identifying Host Family
o House is strategically located in the
community.
o Should not belong to the rich segment.
o Respected by both formal and informal
leaders.
o Neighbours are not hesitant to enter the
house.
o No member of the host family should be
moving out in the community.
2. Entry Phase
Guidelines for Entry
o Recognize the role of local authorities by
paying them visits to inform their presence
and activities.
o Her appearance, speech, behavior and
lifestyle should be in keeping with those of

the community residents without disregard of

their being role model.
o Avoid raising the consciousness of the
community residents; adopt a low-key profile.
Activities in the Entry Phase
o Integration - establishing rapport with the
people in continuing effort to imbibe
community life.
living with the community
seek out to converse with people where
they usually congregate
lend a hand in household chores
avoid gambling and drinking
o Deepening social investigation/community
study verification and enrichment of data
collected from initial survey
conduct baseline survey by students,
results relayed through community assembly
Leader Spotting Through Sociogram.
Key persons - approached by most people
Opinion leader - approach by key persons
Isolates - never or hardly consulted
3. Organization-building Phase
Entails the formation of more formal structure and the inclusion
of more formal procedure of planning, implementing, and
evaluating community-wise activities. It is at this phase where
the organized leaders or groups are being given training
(formal, informal, OJT) to develop their style in managing their
own concerns/programs.
Key Activities
o Community Health Organization (CHO)
preparation of legal requirements
guidelines in the organization of
the CHO by the core group
election of officers
o Research Team Committee
o Planning Committee
o Health Committee Organization
o Others
o Formation of by-laws by the CHO
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. At this point, the
different committees setup in the organization-building phase
is already expected to be functioning by way of planning,
implementing and evaluating their own programs, with the
overall guidance from the community-wide organization.
Key Activities
o Training of CHO for monitoring and
implementing of community health program.
o Identification of secondary leaders.
o Linkaging and networking.
o Conduct of mobilization on health and
development concerns.
o Implementation of livelihood projects.
MATERNAL HEALTH PROGRAM
Tasked:
to reduce MMR by three quarters by
2015 to achieve ( millennium
Development Goal) MDG
Maternal Mortality Rate (2003)
CAUSE
Other Complications related to pregnancy occurring in
the course of labor, delivery and puerperium

1. Hypertension complicating pregnancy, childbirth

and puerperium (25%)

2. Postpartum hemorrhage (20.3%)

3. Pregnancy with abortive outcome (9%)
4. Hemorrhage related to pregnancy

Strategic thrusts for 2005-2010

1. Launch and implement Basic Emergency and
Obstetric Care (BEMOC) strategy in coordination
with DOH
Entails establishment of facilities that
provide emergency obstetric care for
every 125,000 population and which are
located strategically
2. Improve quality of prenatal and postnatal care
Pregnant women should have at least
four (4) prenatal visit
3. Reduce womens exposure to health risks
Institutionalization of responsible
parenthood
4. Stakeholders must advocate for health
Resource generation and allocation for
health services
Essential Health Service Packages
A. Antenatal Registration

B. Tetanus Toxoid Immunization

C. Micronutrient Supplementation
D. Treatment of Diseases and Other Conditions
E. Clean and Safe delivery
F. Recommended Schedule for Post Partum Care
Visits

G. Importance of BF
1. Antenatal Registration
2. Tetanus Toxoid Immunization
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
3. Micronutrient Supplementation
4. Treatment of Diseases and Other Conditions
Types:
1. Difficulty of breathing/ obstruction of airway
2. Unconsciousness
3. Post partum bleeding
4. Intestinal parasite infection
5. malaria
1.Difficulty of breathing/ obstruction of airway
What to do?
Clear the airway
Place in her best position
Refer woman to hospital with EmOC
capabilities.
Do not give anything PO
2. Unconsciousness
What to do?
Keep on her back arms at the side.
Tilt head backwards (unless trauma is
suspected)
Lift chin to open airway
Clear secretions from throat.
Give IVF to prevent or correct shock.
Monitor BP and SOB every 15
Monitor fluid given. If DOB and puffiness
develops, stop the infusion.
Monitor UO
Do not give:
ORS for both unconscious or with
convulsions
IVF if not trained to do so.
3. Post partum bleeding
What to do?:
Massage uterine and expel clots.
If bleeding persist:

 Place cupped palmed on uterine

fundus and feel for state of
contraction
Massage fundus in a circular
motion
Apply bimanual uterine
compression if mem treatment
done and postpartum bleeding
still persist.
Give ergometrine 0.2mg IM and
another dose after 15
Do not give:
Mem to woman with eclampsia, preeclampsia
or HPN
4. Intestinal parasite infection
What to do?
Give mebendazole 500mg tab. Single
dose anytime from 4-9mos. Of pregnancy
if none was given in the past 6 mos.
Do not give:
Mebendazole in the 1st 1-3mos. Of
pregnancy
This might cause congenital
problem in the baby
5. Malaria
What to do?
Give sulfadoxin-pyrimethamine to
woman from malaria endemic areas who
are in 1st or 2nd pregnancy
500mg-25mg tab., 3 tabs. At the
beginning of 2nd to 3rd tri semesters not
less than one month interval.
E. Clean and Safe delivery
Presence of skilled birth attendant
Purpose
to ensure hygiene during labor and
delivery.
Provide non-traumatic delivery
recognize complications
Referred those complicated deliveries to
high level of care
Steps to follow during labor, childbirth and immediate
postpartum
Please refer accordingly
1. Do a quick check upon admission for emergency
signs:
Unconscious/convulsion
Vaginal bleeding
Severe abdominal pain
Looks very ill
Severe headache with visual disturbance
Severe breathing difficulty
Fever
Sever vomiting
2. Make the woman comfortable
Establish rapport with the client by greeting and
interviewing to make her comfortable
3. Assess the woman in labor
- to determine the status during labor
LMP
Number of pregnancy
Start of labor pains
Age/height

Danger signs of pregnancy

Taking the history through interview will help
determine the clients condition during delivery
of baby
4. Determine the stage of labor
Uterine contractions
Bulging vulva
Leaking amniotic fluid
Vaginal bleeding
IE
5. Decide if the woman can safely deliver
By assessing the condition of the client
and not finding any indication that could
harm the delivery of the baby
6. Give supportive care throughout labor.
Purpose:
To deliver clean, safe and free from
fatigue
1. Encourage to take a bath at the onset of labor
2. Encourage to drink but not eat as this may
interfere surgery in case needed
3. Encourage to empty bladder and bowels to
facilitate delivery of the baby. Remind to empty
the bladder every 2 hours.

4. Encourage to do breathing technique to help

energy in pushing out the vagina. Panting can
be done by breathing with open mouth with 2
short breaths followed by long breaths. This
prevent pushing at the end of the 1st stage
7. Monitor and manage the different stage of labour
-watch out for any danger signs
1. First stage: not in active labor
Cervix: 3cms
Contraction: weak
Frequency: < 2 to 10
What to do?
Check Q 1hr. for emergency signs,
frequency and duration of contractions
and FHT.
Check Q 4hrs. For fever, pulse, BP and
cervical dilatation.
Record time of ROM and color of
amniotic fluid
Assess progress of labor
Refer STAT to hospital with
complete facilities for the ff
condition:
If after 8hrs,
contractions are
stronger and more
frequent but not
progress in cervical
dilatation, with or
without membranes
ruptured
It is false labor if after 8hrs there is no
increase in contractions, membranes are
not ruptured and no progress in cervical
dilatation.
Not to do:
IE more frequently than Q 4hrs.
First stage: active labor
4cms cervical dilatation
What to do?
Check Q30 for emergency signs
Check Q4hrs. For fever, pulse, BP and

cervical dilatation
Record time of ROM and color of
amniotic fluid
Record finding in partographs/patient
record.
Not to do:
Do not allow woman to push unless
delivery is imminent. It will just exhaust
the woman
Do not give medication to speed of
labor. It may cause trauma to mother
and the baby
Second stage:
Cervix: 10 cms. or bulging thin perineum
and head visible
What to do:
Check Q 5 for perineum thinning and
bulging, visible descend of the had
during contraction, emergency signs,
FHR and mood and behavior
Continue recording in the partograph.
Not to do:
Do not apply fundal pressure to help
deliver the baby
Third stage:
Between birth of the baby and delivery
of the placenta
What to do:
Deliver the placenta
Check the completeness of placenta and
membranes
Not to do:
Do not squeeze or massage the abdomen
to deliver the placenta
8. Monitor closely within 1hr. After delivery and
give supportive care.
9. Continue care after 1hr. Postpartum. Keep watch
closely for at least 2hrs.
10. Educate and counsel on FP and provide FP
method if available and decision was made by a
woman.
11. Informs, teach and counsel the woman on
important MCH messages:
Birth registration

suffering from diarrheal diseases.

d. Reduces the infants exposure to infection.
BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION
TRAINING
Breastfeeding practices has been proved to be very
beneficial to both mother and baby thus the creation of
the following laws support the full implementation of
this program:
A. Executive Order 51
B. Republic Act 7600
C. The Rooming-In and Breastfeeding Act
of 1992
A. EO 51 THE MILK CODE protection and promotion of
breastfeeding 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. )
B. RA 7600 THE ROOMING IN and BREASTFEEDING ACT
of 1992
=An act providing incentives to government and private
health institutions promoting and practicing rooming-in
and breast-feeding.
=Provision for human milk bank.
=Information, education and re-education drive
=Sanction and Regulation
BABY
Provides Antibodies
Contains Lactoferin (binds with Iron)
Leukocytes
Contains Bifidus factor-promotes growth of the
Lactobacillus-inhibits the growth of pathogenic
bacilli
For the Mother
e. Reduces a womans risk of excessive blood loss
after birth
f. Provides a natural method of delaying
pregnancies.
g. Reduces the risk of ovarian and breast cancers
and osteoporosis.
For the Family and Community
h. Conserves funds that otherwise would be spent
on breast milk substitute, supplies and fuel to
prepare them.
i. Saves medical costs to families and
governments by preventing illnesses and by
providing immediate postpartum contraception.
POSITIONS IN BF THE BABY:

Importance of BF
Newborn Screening for babies delivered
in RHU or at home within 48hrs up to 2
weeks after birth.
Scheduled when to return for
consultation for postpartum visit

F. Recommended Schedule for Post Partum Care

Visits
G. Importance of BF
BREASTFEEDING
Breast milk is best for babies up to 2
years old. Exclusive breastfeeding is recommended for
the first six months of life. At about six months, give
carefully selected nutritious foods as supplements.
Breastfeeding provides physical and
psychological benefits for children and mothers as well
as economic benefits for families and societies.
BENEFITS :
For infants
a. Provides a nutritional complete food for the
young infant.
b. Strengthens the infants immune system,
preventing many infections.
c. Safely rehydrates and provides essential
nutrients to a sick child, especially to those

1. Cradle Hold = head and neck are supported

2. Football Hold
3. Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
Environmental Health Program
Environmental Sanitation and Promotion of Safe
Water Supply
Environmental Sanitation is defined as the study of all
factors in the mans environment, which exercise or may
exercise deleterious effect on his well-being and

survival.
-Water is a basic need for life and one factor in
mans environment. Water is necessary for the
maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic
promotion of health.
-One basic need of the family is food. And if
food is properly prepared then one may be assured
healthy family. There are many food resources found in
the communities but because of faulty preparation and
lack of knowledge regarding proper food planning,
Malnutrition is one of the problems that we have in the
country.
HEALTH AND SANITATION
-Environmental Sanitation is still a health
problem in the country.
-Diarrheal diseases ranked second in the
leading causes of morbidity among the general
population.
-Other sanitation related diseases :
tuberculosis, intestinal parasitism, schistossomiasis,
malaria, infectious hepatitis, filariasis and dengue
hemorrhagic fever
DOH thru Environmental Health Services (EHS)unit is
authorized to act on all issues and concernsin
environment and health including the
verycomprehensive Sanitation Code of the Philippines
(PD 856, 1978).
WATER SUPPLY SANITATION PROGRAM
EHS sets policies on:
Approved types of water facilities
Unapproved type of water facility
Access to safe and potable drinking water
Water quality and monitoring surveillance
Waterworks/Water system and well construction
Approved type of water facilities
Level 1 (Point Source)- a protected well or a developed
spring with an outlet but without a distribution system
indicated for rural areas;
serves 15-25 households; its outreach is not
more than 250 m from the farthest user
yields 40-140 L/ min
Level II ( Communal Faucet or Stand Posts)
With a source, reservoir, piped distribution
network and communal faucets
Located at not more than 25 m from the farthest
house
Delivers 40-80 L of water per capital per day to
an average of 100 households
Fit for rural areas where houses are densely
clustered
Level III ( Individual House Connections or Waterworks
System)
With a source, reservoir, piped distributor
network and household taps
Fit for densely populated urban communities
Requires minimum treatment or disinfection
ENVIRONMENTAL SANITATION
- the study of all factors in mans
physical environment, which may exercise a deleterious
effect on his health, well-being and survival.
Includes:
1.1 Water sanitation
1.2 Food sanitation
1.3 Refuse and garbage disposal
1.4 Excreta disposal
1.5 Insect vector and rodent control
1.6 Housing
1.7 Air pollution

1.8 Noise
1.9 Radiological Protection
1.10 Institutional sanitation
1.11 Stream pollution
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
EHS sets policies on:
Approved types of toilet facilities :
LEVEL II on site toilet facilities of the water carriage
type with water-sealed and flush type with septic
vault/tank disposal.
LEVEL III water carriage types of toilet facilities
connected to septic tanks and/or to sewerage system to
treatment plant.
FOOD SANITATION PROGRAM
-sets policy and practical programs to prevent
and control food-borne diseases to alleviate the living
conditions of the population
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and other
wastes from hospital which combine them with the
municipal or domestic wastes pose health hazards to the
people.
Hospitals shall dispose their hazardous wastes thru
incinerators or disinfectants to prevent transmission of
nosocomial diseases
PROGRAM ON HEALTH RISK MINIMIZATION DUE TO
ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to health
(depletion of the stratosphere ozone layer which
increases ultraviolet radiation, climate change and other
conditions)
NURSING RESPONSIBILITIES AND ACTIVITIES
Health Education IEC by conducting community
assemblies and bench conferences.
The Occupational Health Nurse, School Health
Nurse and other Nursing staff shall impart the
need for an effective and efficient environmental
sanitation in their places of work and in school.
Actively participate in the training component of
the service like in Food Handlers Class, and
attend training/workshops related to
environmental health.
Assist in the deworming activities for the school
children and targeted groups.
Effectively and efficiently coordinate
programs/projects/activities with other
government and non-government agencies.
Act as an advocate or facilitator to families in
the community in matters of
program/projects/activities on environmental
health in coordination with other members of
Rural Health Unit (RHU) especially the Rural
Sanitary Inspectors.
Actively participate in environmental sanitation
campaigns and projects in the community. Ex.
Sanitary toilet campaign drive for proper
garbage disposal, beautification of home
garden, parks drainage and other projects.
Be a role model for others in the community to
emulate terms of cleanliness in the home and
surrounding.
There was a man who saw a scorpion floundering
around in the water.
He decided to save it by stretching out his finger
but the scorpion stung him.
The man still tried to get the scorpion out of the
water but the scorpion stung him again.
Another man nearby told him to stop saving the

scorpion but the man said, Its the nature of

the scorpion to sting. Its my nature to love, why
should I give up my nature to love just because
its the nature of the scorpion to sting?
Dont give up loving, dont give up your
goodness even if people around you sting
THE END
See u next sem.