Professional Documents
Culture Documents
COMMUNITY HEALTH NURSING REVIEW (Edited)
COMMUNITY HEALTH NURSING REVIEW (Edited)
COMMUNITY HEALTH NURSING REVIEW (Edited)
NURSING
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
(Mark 10:45)
Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be served
But to serve and to give His life as a ransom for
many.
COVERAGE FOR LOCAL
BOARD EXAM : CHN
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
1. Family-based Nursing
Services(Family Health Nursing
Process)
2. Population Group-based Nursing
Services
3. Community-based Nursing
Services/Community Health Nursing
Process
4. Community Organizing
5. Public Health Programs
I. Research and Quality
Improvement
2. SECONDARY
3. TERTIARY
Types of Clientele
1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
Lack of motivation
Attitude
Resistance to change
people
Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community
and the health agencies in the provision
of quality of life.
Providing linkages between the
government and the non-government
organization and people’s organization.
6. Recognition of interrelationship between the
health and development
HEALTH
is not merely the absence of disease. Neither it is only a
state of physical and mental well-being. Health being a
social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved quality of
life for all. Development is multi-dimensional. It has a
political, social, cultural, institutional and environmental
dimensions(Gonzales 1994). Therefore, it is measured by
the ability of people to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or governance,
support system provided by the Government,
networking and developing secondary
leaders.
8. DECENTRALIZATION
MAJOR STRATEGIES OF PRIMARY
HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND
SUSTAINED NATIONAL EFFORTS.
Attaining Health for all Filipino will require expanding
participation in health and health related programs whether
as service provider or beneficiary. Empowerment to
parents, families and communities to make decisions of
their health is really the desired outcome.
Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED HEALTH CARE
seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
8. Guava 1. Cleaning For wound cleaning, use
wounds decoction for washing the
2. Mouth wash wound 2 times a day
for mouth For tooth decay and
warm.
oApply the warm decoction on the
decoction as needed.
ELEMENTS OF PRIMARY HEALTH
CARE:
Education For Health
Is one of the potent methodologies for
information dissemination. It promotes
the partnership of both the family
members and health workers in the
promotion of health as well as prevention
of illness.
Locally Endemic Disease
Control
The control of endemic disease focuses
on the prevention of its occurrence to
reduce morbidity rate. Example
Malaria Control and Schistosomiasis
Control
Expanded Program on Immunization
This program exists to control the
occurrence of preventable illnesses
especially of children below 6 years old.
Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
preventable disease are given for free
by the government and ongoing
program of the DOH
Maternal and Child Health and
Family Planning
The mother and child are the most delicate
members of the community. So the
protection of the mother and child to
illness and other risks would ensure good
health for the community. The goal of
Family Planning includes spacing of
children and responsible parenthood.
Environmental Sanitation and
Promotion of Safe Water Supply
Environmental Sanitation is defined as the
study of all factors in the man’s 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
man’s environment. Water is necessary for the
maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic
promotion of health.
Nutrition and Promotion of Adequate
Food Supply
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.
Treatment of Communicable Diseases
and Common Illness
The diseases spread through direct contact
pose a great risk to those who can be infected.
Tuberculosis is one of the communicable
diseases continuously occupies the top ten causes
of death. Most communicable diseases are also
preventable. The Government focuses on the
prevention, control and treatment of these
illnesses.
Supply of Essential Drugs
This focuses on the information campaign
on the utilization and acquisition of drugs.
In response to this campaign, the
GENERIC ACT of the Philippines is
enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
FAMILY HEALTH NURSING
- that level of CHN practice directed to the
FAMILY as the unit of care with HEALTH as
the goal and NURSING as the medium,
channel or provider of care
Family Case Load
- the no. and kind of families a nurse handles
at any given time
- variable for cases are added or dropped based
on the need for nursing care and supervision
Types of Families
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
Types of Families
8. Single adult living alone
9. Cohabiting/ Living –in
10. No- kin
11. Compound
12. Gay
14. Commune
Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest –retirement)
8. Period from retirement to Death of both spouses
HEALTH TASKS OF THE
FAMILY( Freeman, 1981)
1. recognizing interruptions of health or development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled and
dependent member of the family
5. maintaining a home environment conducive to
good health and personal development
6. maintaining a reciprocal relationship with the
community and health institutions
Family Nursing Problem
Arises when the family cannot effectively
perform its health tasks
Nurse’s Roles in Family Health
Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR
FAMILY NURSING PRACTICE
Family structure, Characteristics, and
Dynamics
2. Members of the household and relationship to
the head of the family
3. Demographic data – age, sex, civil status,
position in the family
4. Place of residence of each member – whether
living with the family or elsewhere
4. Type of family structure – e.g. matriarchal
or patriarchal, nuclear or extended
2. Dominant family members in terms of
decision-making, especially in matters of
health care
3. General family relationship/dynamics –
presence of any readily observable conflict
between members; characteristics
communication patterns among members
Socio-economic and Cultural
Characteristics
2. Income and Expenses
Occupation, place of work and income of
each working members
Adequacy to meet basic necessities
Who makes decisions about money and how
it is spent
3. Educational attainment of each other
4. Ethnic background and religious
affiliation
1. Significant Others – role(s)
they play in family’s life
2. Relationship of the family to
larger community – Nature and
extent of participation of the
family in community activities
Home and Environment
2. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of vectors of
diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply – source, ownership, portability
Toilet facility – type, ownership, sanitary condition
Drainage system – type, sanitary condition
1. Kind of neighborhood, e.g.
congested, slum, etc.
2. Social and health facilities
available
3. Communication and
transportation facilities
available
Health Status of each Family Member
2. Medical and nursing history indicating current
or past significant illnesses or beliefs and
practices conducive to health illness
3. Nutritional assessment
Anthropometric data: Measures of nutritional status
of children, weight, height, mid-upper arm
circumference: Risk assessment measures of
obesity: body mass index, waist circumference,
waist hip ratio
Dietary history specifying quality and quantity of
food/nutrient intake per day
Eating/ feeding habits/ practices
3. Developmental assessments of infants, toddlers,
and preschoolers – e.g., Metro Manila
4. Risk factor assessment indicating presence of
major and contributing modifiable risk factors
for specific lifestyles, cigarette smoking,
elevated blood lipids, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking
and other substance abuse
5. Physical assessment indicating
presence of illness state/s
6. Results of laboratory/
diagnostic and other screening
procedures supportive of
assessment findings
Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.
Examples include:
3. Immunization status of family members
4. Healthy lifestyle practices. Specify.
5. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate footwear
in parasite-infested areas;
relaxation and other stress management activities
6. Use of promotive-preventive health services
A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
FIRST-LEVEL ASSESSMENT
Presence of Wellness Condition – stated as Potential
or Readiness- a clinical or nursing judgment about a
client in transition from a specific level of wellness
or capability to a higher level. Wellness potential is
a nursing judgment on wellness state or condition
based on client’s performance, current competencies
or clinical data but no explicit expression of client
desire. Readiness for enhanced wellness state is a
nursing judgment on wellness state or condition
based on client’s current competencies or
performance, clinical data explicit expression of
desire to achieve a higher level of state or function in
specific area on health promotion and maintenance.
Examples of these are the following:
1. Potential for Enhanced Capability for:
Healthy lifestyle – e.g. nutrition/diet, exercise/
activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being – process of a client’s
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
Others,
1. Readiness for Enhanced Capability for:
Healthy Lifestyle
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being
Others,
I. Presence of Health Threats –
conditions that are conducive to
disease, accident or failure top
realize one’s health potential.
Examples of these are the following:
3. Family history of hereditary
condition, e.g. diabetes
4. Threat of cross infection from a
communicable disease case
1. Family size beyond what family
resources can adequately provide
2. Accidental hazards
Broken stairs
Sharp objects, poison, and
medicines improperly kept
Fire hazards
1. Faulty nutritional habits or
feeding practices.
Inadequate food intake both in
quality & quantity
Excessive intake of certain
nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
1. Stress-provoking factors –
Strained marital relationship
Strained parent-sibling
relationship
Interpersonal conflicts between
family members
Care-giving burden
1. Poor home condition-
Inadequate living space Unsanitary waste
Lack of food storage disposal
facilities Improper
Polluted water supply drainage system
Presence of breeding Poor ventilation
sites of vectors of Noise pollution
disease Air pollution
Improper garbage
1. Unsanitary food handling and preparation
2. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
1. Inherent personal characteristics – e.g.
poor impulse control
2. Health history which induce the
occurrence of a health deficit, e.g.
previous history of difficult labor
3. Inappropriate role assumption – e.g. child
assuming mother's role, father not
assuming his role
4. Lack of immunization/ inadequate
immunization status specially of children
1. Family disunity –
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
2. Other
I. Presence of Health Deficits – instances
of failure in health maintenance.
Examples include:
3. Illness states, regardless of whether it is
diagnosed or by medical practitioner
4. Failure to thrive/ develop according to
normal rate
5. Disability – whether congenital or
arising from illness; temporary
I. Presence of stress Points/ Foreseeable Crisis
Situations – anticipated periods of unusual demand of
the individual or family in terms of family resources.
Examples of these include:
Marriage 9. Menopause
Pregnancy 10. Loss of job
Parenthood 11. Hospitalization of a
Additional member family member
Abortion 12. Death of a manner
Entrance at school 13. Resettlement in a
Adolescence new community
Divorce 14. illegitimacy
Second Level Assessment
Focus on determining family’s capacity to perform the
health tasks
Statements on family health nursing problem:
c. Inability to recognize the presence of the condition or
problem
d. Inability to make decisions with respect to taking
appropriate health action
e. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the family
f. Inability to provide a home environment conducive to health
maintenance or personal development
g. Failure to utilize community resources for health care
Scale for Ranking Health Conditions
and Problems according to priorities
Criteria:
b. Nature of the condition or problem presented
( wellness state, health deficit, health threat, forseeable
crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not immediate,
not perceived as a problem)
COMMUNITY HEALTH CARE
PROCESS
Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health of the
community people
Evaluation
Purpose : To determine the effectiveness of health care programs
NURSING PROCEDURES
CLINIC VISIT
- process of checking the client’s health condition
in a medical clinic
HOME VISIT
OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
ELEMENTS OF EPI:
TARGET SETTING
COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
maintained under proper environmental
condition until the time of administration.
IEC
Assessment and evaluation of Over-all
performance of the program
Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Number Minimum Reason
Age of 1st of Doses Interval
Dose Between
Doses
BCG Birth or 1 BCG is given
(Bacillus at the earliest
anytime possible age
Calmette after protects against
Guerin)
birth the possibility
of TB infection
School from the other
entrants family
members
2. DPT 6 weeks 4 weeks An early start with
(Diphtheria 3 DPT reduces the
Pertusis
Tetanus)
chance of severe
pertussis
A. NO DEHYDRATION
Condition – well, alert
Eyes – normal
Tears – present
Eyes – sunken
Tears – absent
15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed, give
100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful every 1-2
min.
5. If the child vomits, wait for 10 min, then continue giving
ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS , give plain
water or breast milk, Resume ORS when puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be used
for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition – lethargic or unconscious; floppy
Eyes – very sunken and dry
Tears – absent
Mouth and tongue – very dry
Thirst- drinks poorly or not able to drink
Skin pinch – goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM
3. Increase breastfeeding
Severe undernutrition
TTT.
Refer urgently to hospital
ASSESSMENT OF RESPIRATORY
INFECTION
ASK THE MOTHER:
2. How old is the child?
3. Is the child coughing? For how long?
4. Age 2 months up to 5 years: Is the child able
to drink?
Age less than 2 months: Has the young infant
stopped feeding well?
6. Has the child had fever? For how long?
7. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.
Age0 Fast Breathing
Less than 2 months 60/minute or more
2 months – 12 months 50/minute or more
12 months – 5 years 40/minute or more
TREATMENT
1.Cotrimoxazole,Amoxycillin,or Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION – pus draining from the
ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the ear dry
by wicking.
Paracetamol maybe given for pain or high fever.
ear.
Maternal and Child Health Nursing
Philosophy
Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
MCN is FAMILY CENTERED- the father
is as important as the mother
Goals
To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear
healthy children
As early as possible
TT1 during pregnancy 80%
TT2 At least 4 80% Infants born to the
weeks later mother will be
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
At least 6 Infants born to the mother
TT3 months later 90% will be protected
from neonatal
tetanus.
Gives 5 years protection
for the mother.
TT4 At least 1 99% Gives 10
year later protection
for the
mother
TT5 At least 1 year 99% Gives lifetime
later protection for
the mother.
All infants
born to that
mother
will be
protected.
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
Components of Prenatal Visits
History – taking
Determination of obstetrical score- G, P,
TPAL,AOG,EDD
U/A for Proteinuria, glycosuria and infxtn
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for pallor
Abdominal exam - fundic ht, Leopold’s
maneuver and FHT
Exam of breasts, face, hands and feet for edema and
neck for thyroid enlargement
Health teachings- nutrition, personal hygiene,
common complaints
Tetanus toxoid immunization
Iron supplementation – from 5th mo. of pregnancy -
2 mos. Postpartum
In goiter endemic areas – iodized capsule once a
year
In malaria infested areas- prophylactic Chloroquine
( 150 mg/tab ) 2 tabs/ wk for the whole duration of
pregnancy
UNDER FIVE CLINIC
MOTHER
• Oxytocin help the uterus contracts
• Uterine involution
• Reduce incidence of Breast Cancer
• Promote Maternal-Infant Bonding
• Form of Family planning Method (Lactational
Amenorrhea)
BABY
• Provides Antibodies
• Contains Lactoferin (binds with Iron)
• Leukocytes
• Contains Bifidus factor-promotes
growth of the Lactobacillus-inhibits the
growth of pathogenic bacilli
POSITIONS IN BF THE BABY:
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
GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week long
delivery of a package of health services to children between
the ages of 0-59 months old with the purpose of reducing
morbidity and mortality among under fives through the
promotion of positive Filipino values for proper child
growth and development.
Headache ( severe)
blindness)
Severe leg pain ( calf or thigh )
Weakness
Rapid pulse
Vomiting
Dizziness
Amenorrhea
WARNING SIGNS
Vasectomy
Fever
Scrotal blood clots or excessive swelling
Nutrition
Goal
To improve the nutritional status,
productivity and quality of life of
the population thru adoption of
desirable dietary practices and
healthy lifestyle
Objectives
Increase food and dietary energy
(later stage)
bitot’s spot (foamy soapsuds-like spots on
prescribed
VAD is most common in children suffering
from PEM and other infectious diseases.
Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not
fortified with Vitamin A.
• Common among preschoolers and infants
( FNRI)
SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO
INFANTS PRESCHOOLERS AND MOTHERS
Schedule Infants(6-11 Preschoolers Post Partum
mos) (12-83 mos) Mother
Dosage
Children 0-59 months Iodine capsules (200mg)
( in endemic areas) potassium iodate in oil
orally once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
1.1 Weight is a very important indicator of a person’s
nutritional status. It is measured in relation to either
AGE or HEIGHT. Normally, a well-nourished child
gains weight as she/he grows older.
1.2 On the other hand, a malnourished child either
decreases in weight or maintains his/her previous weight.
1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms of
the different forms of nutritional deficiencies.
IMPORTANT:
1.1Weigh the child in minimal clothing, with no
shoes, clogs or slippers on; and hands and
pockets free of objects.
1.2The same type of scale should be used for
subsequent weighing.
1.3Observe the proper maintenance of the
weighing scale.
1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD
TOGETHER WITH THE PARENTS TO THE
HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD
REGULARLY AND MONITOR HIS/HER
WEIGHT.
< ADVISE PARENTS AND THE WHOLE
COMMUNITY ABOUT BETTER NUTRITION
AND PROPER FEEDING ESPECIALLY OF
INFANTS, CHILDREN AND SICK PERSONS.
NUTRITIONAL GUIDELINES
2. Eat a variety of food everyday.
3. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods while
continuing breastfeeding.
4. Maintain children’s normal growth through proper
diet and monitor their growth regularly.
5. Consume fish, lean meat, poultry or dried beans.
6. Eat more vegetables, fruits, and root crops.
7. Eat foods cooked in edible/cooking oil daily.
Consume milk, milk products or other calcium-
rich foods such as small fish and dark green leafy
vegetables everyday. Use iodized salt, but avoid
excessive intake of salty foods.
Use iodized salt, avoid excessive intake of salty
foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise
regularly, do not smoke, avoid drinking alcoholic
beverages.
AIMS AND RATIONALE OF EACH OF
THE GUIDELINES
birth of children
Right to exercise satisfying sex life
Factors/ determinants of RH
Socioeconomic conditions – education,
employment, poverty, nutrition, living
condition/ environment, family environment
Status of women – equal right in education and
Complications
Prevention and Treatment of Reproductive
Sexual Health
Elements
Breast and Reproductive Tract Cancers and
other Gynecological Conditions
Men’s Reproductive Health
Sexual Disorders
Selected Concepts
RH is the exercise of reproductive right with
responsibility
It means safe pregnancy and delivery, the right of
access to appropriate health information and services
It includes protection from unwanted pregnancy by
having access to safe and acceptable methods of family
planning of their choice
It includes protection from harmful reproductive
practices and violence
It ensure sexual health for the purpose of enhancement
of life and personal relations and assures access to
information on sexuality to achieve sexual enjoyment
Goal
To achieve healthy sexual development
and maturation
To achieve their reproductive intention
care of RH problems
Strategies
Increase and improve the use of more effective or
modern contraceptive methods
Provision of care, treatment and rehabilitation for
RH
RH care provision should be focused on adolescents,
men and unmarried and other displaced people with
RH problems
Strengthen outreach activities and referral system
Prevent specific RH problems through information
dissemination and counseling of clients
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 concerns
in environment and health including the very
comprehensive Sanitation Code of the Philippines
(PD 856, 1978).
WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
Approved types of water facilities
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 man’s
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
LEVEL I
◙ Non-water carriage toilet facility – no water
necessary to wash the waste into receiving space e.g.pit
latrines, reed odorless earth closet.
◙ Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
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
obesity
CVD
PERIOD OF LIFE TYPE OF CVD PREVALENCE
Unexplained anemia
Sudden unexplained weight loss
Prevention & Early Detection
CA type Prevention Detection
Lung No smoking None
Uterine Monogamy Pap’s smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber diet Regular medical
Rectum Low fat intake check-up after 40
yrs of age
Fecal occult
blood test
DRE
Sigmoidoscopy
Radiation Therapy
Chemotherapy
3. Nat’l 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
CARI
CDD
*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
IMCI: Case Mgt. Process
1. Assessing the child or young infant- History
taking, PE
2. Classifying the Illness- severity of illness
3. Identifying ttt.- classification chart
4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to carry out
ttt.
5. Counseling the mother- child feeding,foods and
fluids to give & when to bring the child back to the
health center
6. Giving of follow-up care
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
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 cases- Rifampicin+Dapsone on Day 1 then
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
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 o’clock 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
1. SERVICE
2. EDUCATION
3. ENVIRONMENT
Mission of School Health Program:
Psychologist/ Counselor
Teacher
Nutritionist
Nurse
Social Workers
Maintenance Personnel
Targets in SHN
Family
Students
Teachers
Supportive Personnel
Community
School Health Nurse’s Roles:
EDUCATOR
CONSULTANT /RESEARCHER
STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
HEALTH SCREENER
HEALTH CARE PROVIDER
Common Health Concerns of Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders- pimples/acne,
fungal infections, allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
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, “It’s the nature of the
scorpion to sting. It’s my nature to love, why
should I give up my nature to love just because
it’s the nature of the scorpion to sting?”
Don’t give up