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Communityhealthnursing 120519074242 Phpapp01 PDF
Communityhealthnursing 120519074242 Phpapp01 PDF
What is a community?
a group of people with common
characteristics or interests living together
within a territory or geographical
boundary
place where people under usual
conditions are found
What is health?
Health-illness continuum
High-level wellness
Agent-host-environment
Health belief
Evolutionary-based
Health promotion
WHO definition
What is community health?
Clinician, who is a health care provider, taking care of the sick people
at home or in the RHU
Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people
Facilitator, who establishes multi-sectoral linkages by referral system
Supervisor, who monitors and supervises the performance of
midwives
TARGET POPULATION (IFC) ARE:
1. I ndividual
2. F amily
3. C ommunity
3 Elements considered in CHN:
3 Elements of Communication:
Message
Sender
Receiver
PUBLIC HEALTH WORKERS (PHW)
PHWs: are members of the health team who are
professionals namely
Medical Officer (MO)-Physician
Public Health Nurse (PHN)-Registered Nurse
Rural Health Midwife (RHM)-Registered Midwife-
Dentist
Nutritionist
Medical Technologist
Pharmacist
Rural Sanitary Inspector (RSI)-must be a sanitary engineer
5 MAJOR FUNCTIONS:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of
labor and proper coordination of operations among the
government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of
services regarded as public health goods
4. Plan and establish arrangements for the public health systems to
achieve economies of scale
5. Maintain a medium of regulations and standards to protect
consumers and guide providers
To guarantee EQUITABLE,
SUSTAINABLE and QUALITY
health for all Filipinos,
especially the poor and to
lead the quest for
excellence in health
Principles to attain the vision of DOH
Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate
4 CONTRIBUTIONS OF PHC TO DOH &
ECONOMY:
Co-Trimoxazole:
its a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
Has a bacteriostatic action that stops/inhibits multiplication
of bacteria
For GUT, GIT & URTI (TMP combined with SMX)
Sulfamethoxazole (SMX)
Has bactericidal action that kills bacteria
For GUT, GIT, URTI & Skin Infections
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Amoxicillin/Ampicillin
An antibacterial drug that comes from the Penicillin
family
Effect is generally bacteriostatic (when source of
infection is bacterial)
These 2 drugs provide the least sensitivity reaction
(rashes & GI) and the adverse effect of other antibiotics
is anaphylactic shock
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Paracetamol
Has an analgesic & anti-pyretic effect
Oresol:
a management for diarrhea to prevent dehydration
under the Control of Diarrheal Diseases (CDD)
Program
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Nifedipine:
An anti-hypertensive drug
According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive
C. HERBAL PLANTS
Know indications
Know parts of plants with therapeutic value: roots,
fruits, leaves
Know official procedure/preparation
Procedures/Preparations:
Decoction
Gather leaves & wash thoroughly, place in a
container the washed leaves & add water
Let it boil without cover to vaporize/steam to
release toxic substance & undesirable taste
Use extracts for washing
PROCEDURES/PREPARATIONS:
Poultice
Done by pounding or chewing leaves used by
herbolaryo
Example: Akapulko leaves-when pounded, it releases
extracts coming out from the leaves contains enzyme
(serves as anti-inflammatory) then apply on affected
skin or spewed it over skin
For treatment of skin diseases
PROCEDURES/PREPARATIONS:
Infusion
The report of nurse at the RHU/MHC are the Annual Form 1 which is the report
on vital statistics: demographic, environmental, natality and mortality.
Annual Form 2 is the report that lists all diseases and their occurrence in the
municipality/city. The report is broken down by age and sex.
Annual Form 3 is the report of all deaths occurred in the municipality/city. The
report is also broken down by age and sex.
FLOW OF REPORT
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF
TOOLS SUBMISION
BHS Midwife - ITR Monthly Form Monthly Every 2nd week of the
- TCL (M1 & M2) succeeding month
- ST
A-BHS Form Annually Every 2nd week of
January
Trust building
Knowing your client
Adjusting to the situation and environment
RESPECT
II. ASSESSMENT
Data Gathering: tools or instruments used during
survey:
Interview
Observation
Questionnaires-mostly patronized & used in CHN
Records & Reports available
Statistical Approaches:
1. Central Tendencies: 3 Ms
Mean=average
Median=range (Highest Lowest Score)
Mode=frequency of occurrence of a variable, used if
theres too many variable occur
2. Standard Deviation: used if there are too many
variables available to be treated which is seldom
used in CHN
Catego
Catego
Catego
Catego
2
Polygon-connecting the results
Histograph-2 or more variables & appear adjacent to
each other
TYPOLOGY OF NURSING PROBLEMS
1.Preparatory
2.Organizing
3.Mobilizing
4.Educating
5.Collaborating
6.Phase Out
1. PREPARATORY PHASE
A. Area of Selection
It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
Old Criteria it must be a virgin
community=meaning no agency has gone there.
This is a dangerous situation thats why RA 7305:
Magna Carta for Public Workers was provided-a PHN
is to receive a hazard pay of 20-25% of monthly
salary
1. PREPARATORY PHASE
C. Integration/Immersion
Immersion is imbibing the life situation/
condition of the community by living, eating &
sleeping with the family to be able to
understand their situation
It requires 2 Qualities of PHN:
Empathy
Sympathy (Integration)
1. PREPARATORY PHASE
Health Resource(s):
5 Ms-Manpower/Man, money, machinery, material & methods
(+) available facilities-Hospital/Clinic, mode of transportation,
market, school & movie houses for recreation
PRIORITIZATION OF COMMUNITY PROBLEMS
NATURE
Health Status (HS) 3
Health Resource(s) 2
Health Related 1
Mobilization
- let the members of the community do the work.
PHN should only SUPERVISE
4. HEALTH EDUCATION
6. PHASE OUT
EPIDEMIOLOGY
is the pattern of occurrences & distribution of diseases, defects &
deaths
2 Population in Distribution
Patterns Susceptible Immune
(at risk to develop, acquire (those that did not
or experience the disease) experience the disease,
usually individuals develop
resistance against the
disease)
Epidemic 80% (more than 50%) 20%
Endemic 50% 50%
Sporadic 20% 80%
Pandemic ----- -----
EPIDEMIC
Greater than 50% of populations are susceptible or less immune
individual
Greater % of the population is affected by the occurring disease
Assessment
Nursing Care
Treatment
Health Education
Referral (if care fails)
PRIORITIES (IN THE CARE): TO PREVENT CROSS
CONTAMINATION
1. Newborn
2. Post partum
3. Pregnant mothers
4. Morbid cases
The families need the assistance of the health center thats why
home visit was done to the family
The person who makes the home visit is rendering services on
behalf of the health center
PHASES OF HOME VISIT:
1. Planning
Starts at the health center
Makes a study on the status of the family
Statement of the problem
Formation of objective
2. Socialization first activity is to establish rapport
& to gain the trust of the family
PHASES OF HOME VISIT:
3. Activity
Intervention/Professional Phase
Opportunity to provide or extend health services
Standard Role of the Nurse: Independent, Dependent and
Interdependent
To be effective, come in complete uniform (also bring a long
umbrella with pointed end which serve as protection)
4. Summarization - ability to put into record & report
(orally) about the outcome of the activity
PUBLIC HEALTH BAG:
Cleaning
The inner part of the bag should be clean & sterile
Should be done every after home visit
Never endorse the bag
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:
Contamination
The less one opens the bag, the lesser
chance of contamination
In general, the bag is open 3x:
Putting out materials for hand washing
Putting out materials used for nursing
care
Returning all what have been used
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:
C ase Finding
H ealth Education
E nvironmental Sanitation
S nail Eradication
CASE FINDING:
6 Aspects or Thing to Know
Disease: Schistosomiasis
Other name: Bilhariasis or Snail Fever
Causative agent: Schistosoma-a blood fluke (parasite)
3 Types of Species:
Schistosoma japonicum-endemic in the Philippines &
affecting Indonesia, China, Japan, Korea Vector: Oncomelania
quadrasi
Schistosoma mansoni
Schistosoma haematobium
Laboratory Procedures to rule out Schistosomiasis:
Blood Examination: eosinophil level indicates parasitism
Fecalysis: Kato Katz (plain stool exam that uses a special
apparatus resembling a feeding bottle sterilizer)
Procedure:
Collect specimen
Have the test tube undergo centrifugation for 20
minutes
Get specimen from precipitate & swab it on glass slide
Observe it on microscope
Signs & Symptoms
GOALS:
A. Safe Pregnancy
Right age to be pregnant=20-35 years old,
not less than 20 & not more than 35
Right interval of pregnancy=once in 2 or 3
years
Home Base Mothers Record (HBMR): the
record used for care of mothers in CHN
Laboratory Examinations:
Benedicts Test: test for sugar in the urine; test for diabetes
Heat test tube with 5 cc of Benedicts Solution (blue) in the
burner then add 3-5 gtts of urine (amber yellow) then heat again.
Observe for the change in color:
Blue : (-) sugar in urine
Green : trace of sugar in urine +1 +
Yellow : traces of sugar in urine +2 ++
Orange : more traces of sugar in urine +3 +++
Brick Red : surely diabetic +4 ++++
Laboratory Examinations:
Acetic Acid Test: test for albumin in urine; test for
Pregnancy Induced HPN
Collect urine in test tube, heat it in burner then add
3-5 gtts of acetic solution (clear white). Observe for
change in color:
If it remains clear: (-) CHON or albumin in urine
If it turns cloudy: (+) CHON=proteinuria
POLICIES:
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all Curricular Program:
LOI 47 DECS states that Family Planning is to be integrated in all
school curricular programs, either baccalaureates or non-
baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other
agencies which can either be:
Intrasectoral
Intersectoral-Local or International (WHO, Unicef, USAID,
Japhiego)
METHODOLOGIES:
Biological
A. Basal Body Temperature (BBT)
Get the temperature early morning before waking up
which should be monitored daily at the same time
There should be a sudden drop of temperature between
0.3-0.6C followed by an increase of temperature by
0.3-0.6C which means that the woman is fertile
B. Sympto-thermal
C. Cervical Mucus Test
Billings Method by Dr. Billing
Spinnbarkheit (came from a German word Spinner which means
to play with the cervical mucus with the finger) or Wet & Dry
Method:
Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &
adhesive
D. Calendar (Rhythm)
Deleted already since 1998 because its not recommended for
irregular cycle of menstruation
Menstrual cycle should be regular; obtain 4-6 months cycle
E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding &
Rooming In Law
DOH organized Maternal & Child Family Health Institute (MCFHI)
with the following members:
All government hospitals
Private hospitals (volunteer)
Normal involution (uterus goes back to normal) of the uterus:
after 45 days or 5-6 weeks or 1 months if not breastfeeding
Frozen breast milk is to be put out of the freezer 2 hours before
feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months)
Left over milk should be discarded & should not be re-preserved
or re-frozen because it is already contaminated
METHODOLOGIES:
Temporary
A. Chemical
Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
inhibits ovulation
Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women amenorrheic;
1991, DMPA was found to be causing cancer of the cervix
1994, DMPA is given IM 4x a year every 3 months (90 days interval)
Implants: Norplant-it inhibits ovulation effective for 5 years
but seldom advocated for use because it is usually
expensive; the client buys the device (consists of 5
capsules) & have it implanted at the health center by
minor surgical incision in:
upper inner arm because it is nearest to the brain
external oblique
thigh
gluteal muscles
B. Mechanical:
IUD
Up to 10 years protection
Cervical cap & Diaphragm
Prevent the sperm to pass the cervix
Works better with spermicide
Wore 30 minutes before coitus and keep up to 6
hours after coitus
Condom
Most effective way to prevent STDs / STIs
METHODOLOGIES:
C. Behavioral
Abstinence
Withdrawal
D. Permanent
Vasectomy (reversible)-since year 2000 in the
Philippines
BLT
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of
malnutrition
A. Anthropometric Measurement: study of measurements of
human dimensions
Age for Weight-if weight is not appropriate with the age:
Stunting: growth retardation
Wasting: connotes malnutrition
Age for Height-if height is not appropriate with the age:
Stunting
Weight for Height
Rule Male Female
Every height of 5 110 lbs. 105 lbs.
ft.
Every increment + 6 +5
of an inch above
5 ft. ADD
Every decrement - 6 -5
of an inch below
5 ft. SUBTRACT
Skin Folds Test-pinch the external oblique muscle (bilbil)
with your palm
Normal: 1 inch
Overweight: > 1 inch
Middle Upper Arm Circumference (MUAC)-used in children
below 5 years old by measuring the middle upper arm with a
tape measure
Normal: 13 cms. & above
Malnutrition: <13 cms
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
B. Biochemical Method
Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u.
Pre-schoolers (12-83 months) : 200,000 i.u.
Post partum : 200,000 i.u.
Kwashiorkor-protein deficiency
Marasmus-carbohydrate deficiency (energy
giving food)
Kwashiorkor Marasmus
Etiology Disease experienced by an elder Muscle wasting
child upon the birth of a new baby
Potable
Free from any particles that might
cause illness to an individual
Ways to make Water Potable:
Level I
Point Source
Level III
Waterworks system or individual house
connections
A system with a source, a reservoir, a piped
distributor network and household taps that is
suited for densely populated urban areas.
2. PROPER EXCRETA AND SEWAGE DISPOSAL
SYSTEM
3 TYPES OF APPROVED TOILET FACILITIES
Level 1
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost
Level 2
Level 3
Dead animals like dead dogs, cats, rats, pigs, and chickens that
are killed by cars and trucks on streets and public highways.
They include small and large animals that died from disease.
Household
Burial
Deposited in 1m x 1m deep pits covered with
soil, located 25 m. away from water supply
Open burning
o Animal feeding
o Composting
o Grinding and disposal sewer
WAYS OF DISPOSAL
Community
Sanitary landfill or controlled tipping
Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet
Incineration
Ecological Solid Waste Management: RA 9003- the use of
incinerator approved in 2000 but was implemented in 2003
because of lack of funding to purchase
4. FOOD SANITATION PROGRAM
POLICIES:
Food establishment are subject to inspection
(approved of all food sources containers and
transport vehicles)
Comply with sanitary permit requirement
Comply with updated health certificates for food
handlers, helpers, cooks
All ambulant vendors must submit a health
certificate to determine present of intestinal parasite
and bacterial infection
3 POINTS OF CONTAMINATION