College of Nursing

Community Health Nursing

(Individual & Family)
Finals Module
st
1 Semester 2020-2021

Course : NCM 104

Course Title : Community Health Nursing (Individual and Family)
Course credits : 54 hours, Lecture
Contract hours/week: 6 hours/week

Course Description : This course deals with concepts, principles, theories and
techniques in the provision of basic care in terms of health promotion, disease prevention,
restoration and maintenance and rehabilitation at the individual and family level. It includes the
study of the Philippine Health Care Delivery System, national health situation and the global
context of public health. The learners are expected to provide safe, appropriate and holistic
nursing care to individual and family as clients in community setting utilizing the nursing
process.

Topic:
a) Control of Communicable Diseases
b) Environmental Health
c) Alternative Medicines

Learning Outcomes:
 At the end of the lesson, the student should be able to:
o Be familiar with the different communicable disease control programs of the
Department of Health.
o Identify ways on how to control communicable diseases in the community.

Activate Prior Knowledge

 Recall the different control programs implemented by the Department of Health
regarding Communicable diseases.
 Define the following terms:
o Host
o Agent
o Environment

Acquiring New Knowledge

Communicable Disease
 A communicable disease is one that is spread from one person to another through a
variety of ways that include: contact with blood and bodily fluids; breathing in an
airborne virus; or by being bitten by an insect.

Control of Communicable Diseases

1. National TB Program-Directly Observed Treatment, Short-course (NTP-DOTS)

 The National TB Control Program, organized in 1978 and operating within a

devolved health care delivery system, is one of the public health programs being
managed and coordinated by the Infectious Diseases for Prevention and Control
Division (IDPCD) of the Disease Prevention and Control Bureau (DPCB) of the
Department of Health (DOH)

Vision Long term Goal Medium Term Goal (2022)

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 (2035)

TB-free Philippines Reduce TB burden by Reduce TB burden by:

decreasing TB mortality
by 95% and TB
incidence by 90%
 Decreasing the number of
TB deaths by 50% from
22,000 to 11,000
 Decreasing TB incidence
rate by 15% from
554/100,000 to 470/100,000

Reduce catastrophic costs incurred by

TB-affected households from 35% to
0%.

At least 90% of patients are satisfied

with the services of the DOTS facilities

 Definition of Tuberculosis
o Tuberculosis (TB) is a disease caused by bacteria called
Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they
can also damage other parts of the body.

 Category and treatment management of TB

Treatment Regimen
Category Classification and Registration Group Continuation
Intensive Phase
Phase
I Pulmonary TB, new (whether 2 HRZE 4 HR
bacteriologically-confirmed or clinically
diagnosed)

Extrapulmonary TB, new (whether

bacteriologically-confirmed or clinically
diagnosed) except CNS/bones or joints
Ia Extrapulmonary TB, new (CNRC/bones or 2 HRZE 10 HR
joints)
II Pulmonary or extra-pulmonary, Previously 2 HRZE + 5 HRE
treated drug-susceptible TB (whether 1HRZE
bacteriologically-confirmed or clinically
diagnosed)
 Relapse
 Treatment after failure
 Treatment after lost to follow-up
(TALF)
 Previous treatment outcome unknown
 Other
IIa Extrapulmonary, Previously treated drug- 2 HRZES + 1 9 HRE
susceptible TB (whether bacteriologically HRZE
confirmed or clinically diagnosed – CNS/bones
or joints)
Standard Rifampicin-resistant TB or Multi-drug resistant  Individualized once DST
Regimen TB result is available
Drug-  Treatment duration for at
resistant least 18 months

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 (SRDR)
XDR-TB Extensively drug-resistant TB  Individualized based on
Regimen DST result and history of
previous treatment
 H – Isoniazid
 R – Rifampicin
 Z – Pyrazinamide
 E – Ethambutol
 S – Streptomycin

2. National Leprosy Control Program

 The National Leprosy Control Program (NLCP) is a multi-agency effort to control
Leprosy in the country with private and public partnership in achieving its goals to
lessen the burden of the disease and its mission to have a leprosy-free country.

Vision Mission Objectives

Leprosy-free To ensure the provision of
Philippines by the comprehensive, integrated
year 2022 quality leprosy services at
all levels of healthcare
 To further reduce the
disease burden and sustain
provision of high-quality
leprosy services for all
affected communities
ensuring that the principle of
equity and social justice are
followed
 To decrease by 50 % the
identified hyper endemic
cities and municipalities

 Definition of Leprosy
o Is a chronic disease of the skin and peripheral nerves caused by
Mycobacterium Leprae or Hansen’s bacillus.

 Management and treatment

o Paucibacillary (tuberculoid and interminate)
o Non-infectious types

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 o Multibacillary (Lepromatous and borderline)
Infectious types

3. Schistosomiasis Control Program

 Schistosomiasis is an acute and chronic disease caused by parasitic worms called
trematodes or blood flukes. It is endemic in the Philippines affecting 1,599 barangays
(villages), in 189 municipalities (towns) and 15 cities, in 28 endemic provinces, in 12
regions. The total population at risk is approximately 12 million with 2.5 million
individuals directly exposed to the disease. It is transmitted through contact with fresh
water infested with the cercarial schistosome of the parasite that penetrates human
skin. Given the magnitude of the problem of schistosomiasis in the country, the
Department of Health (DOH) strengthened the Schistosomiasis Control and
Elimination Program by adopting a multi- pronged multi-stakeholders’ approach and
fueling additional funding.

Vision Mission Objectives

Schistosomiasis Synchronized and Interruption of transmission of Schistosomiasis
Free Philippines harmonized public Infection by 2025.
and private 1. All high endemic barangays will reach the
stakeholders’ target of criteria for Morbidity/Infection Control
efforts in the (<5% prevalence of heavy intensity infection for

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 elimination of 5 years).
schistosomiasis in 2. All moderate endemic barangays will reach
the Philippines the target of criteria of Transmission Control
(Elimination as a Public Health Problem with
<1% prevalence of heavy intensity infection for
5 years).
3. All low endemic barangays will reach the
target criteria of Transmission Interruption (no
local infection in man and animals, no infection
in snail for 5 years).

 Management and treatment

4. Filariasis Control Program

 Filariasis is a major parasitic infection, which continues to be a public health problem
in the Philippines.  It was first discovered in the Philippines in 1907 by foreign
workers. It is the second leading cause of permanent and long-term disability. The
disease affects mostly the poorest municipalities in the country about 76% of the case
live in the 4th-6th class type of municipalities.

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 Vision Mission Objectives
Healthy and Elimination of  To sustain transmission
productive Filariasis as a public interruption in provinces through
individuals and health problem thru strengthening of surveillance
families for comprehensive  To intensify interventions and
Filariasis-Free approach and interrupt transmission in persistent
Philippines universal access to infection provinces
quality health  To strengthen Morbidity
services Management & Disability
Prevention (MMDP) activities and
services to alleviate suffering
among chronic patients
 To strengthen the health system
capacity to secure LF elimination
 Secure adequate investment from
governmental and non-
governmental sources to sustain all
program objective

 Management and treatment

o Surgery
 Lymphatic filariasis
 Large hydroceles and scrotal elephantiasis can be managed
with surgical excision. Correcting gross limb elephantiasis with
surgery is less successful and may necessitate multiple
procedures and skin grafting.
 Onchoceriasis
 Nodulectomey with local anesthetic is a common treatment to
reduce skin and eye complications.
o Diet and activity
 Fatty foods are restricted in individuals with proven chyluria that is
associated with lymphatic filariasis. Because of associated nutritional
deficiencies, diets should be high in protein.
 Individuals and chronic lymphatic filariasis are encouraged to mobilize
the affected limb and elevate it at night.

5. Malaria Control Program

 Malaria is a life-threatening disease caused by plasmodium parasites transmitted by
anopheles mosquito or rarely through blood transfusion and sharing of contaminated
needles causing acute febrile illness and symptoms in the form of fever, headache and
chills. Untreated, P. falciparum malaria may progress to severe illness and possibly,
death.

Vision Mission Objectives

A Malaria–Free Further accelerate 1 (Universal Access) – To ensure universal
Philippines by malaria control and access to reliable diagnosis, highly effective
2030 transition towards and appropriate treatment and preventive
elimination measures
2 (Governance and Human Resources) – To
strengthen governance and human resources
capacity at all levels to manage and
implement malaria interventions

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 3 (Health Financing) – To secure government
and non-government financing to sustain
malaria control and elimination efforts at all
levels
4 (Health Information and Regulation) – To
ensure quality malaria services, timely
detection of infection and immediate
response, and information and evidence to
guide malaria elimination

 Management and treatment

6. Rabies Control Program

 Rabies is a human infection that occurs after a transdermal bite or scratch by an
infected animal, like dogs and cats. It can be transmitted when infectious material,
usually saliva, comes into direct contact with a victim’s fresh skin lesions.

Vision Mission Objectives

To declare To eliminate human rabies To eliminate rabies as a public health
Philippines Rabies- by the year 2020 problem with absences of indigenous
Free by year 2022 cases for human and animal

 Management
o Provision of Post Exposure Prophylaxis to all rabies exposures/animal bite
victim (provided by RA 9482)
o ABTC/ABC certification as quality PEP providers-PhilHealth Package
o Provision of Pre- Exposure Prophylaxis (PrEP) to high risk individuals and
school children in high incidence area- Provided by RA 1984.
o Strengthened IEC campaign on:
 Responsible Pet Ownership (RPO)

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  RA 9482 known as the “The Anti Rabies Act of 2007” and enactment
of and strict implementation of local rabies control ordinances.
 Early and proper management of animal bites.
 In coordination with DA-BAI: promotion of dog vaccination, dog
population control and control of stray animals.
o Advocacy Campaign:
 Rabies awareness and advocacy campaign that focuses on pet owners,
animal bite victims
o Training of Medical Doctors and Registered Nurses of ABTCs  on the
guidelines on the management of animal bite victims- A requirement for
ABTC certification as providers of quality PEP services and PHIC
accreditation:
 Training course offered only to government and privately owned bite
centers.
 MHOS. CHOs, PHNs and resident’s physicians not functioning as
ABTC are not invited to attend the training
o Disease free zone – Joint DOH-DA evaluation and declaration of Rabies-free
islands (as provided for in the DOH disease free zone initiative and the Joint
DOH-DA AO).
o Integration of rabies program in elementary curriculum- almost 50% of animal
bite victims are <15 years old
o Post-mortem review – death review will be performed jointly by both human
health workers from the provinces/cities and hospitals with cases of human
rabies by. This aims to review the diagnostic history, clinical aspect, and
outcome of the patient, status of biting animal and location of biting incidence
of human death cases due to rabies to be able to call for an action on how to
have a zero incidence of rabies.
o Support to Department of Agriculture on Dog Vaccination

7. Dengue Control Program

 Dengue is the fastest spreading vector-borne disease in the world endemic in 100
countries.
o Dengue has four serotypes (DENV1, DENV2, DENV3, DENV4)
o First infection with one of the four serotypes usually is non-severe or
asymptomatic, while second infection with one of other serotypes may cause
severe dengue.
o Dengue has no treatment but the disease can be early managed.
o The five-year average cases of dengue are 185,008; five-year average deaths
are 732; and five-year average Case Fatality Rate is 0.39 (2012-2016 data).

Vision Mission Objectives

A dengue free Ensure healthy lives and To reduce dengue morbidity by at least
Philippines promote well-being for all 25% by 2022
at all ages
Goal: To reduce the burden of dengue
disease

 Dengue Case Classification and Level of Severity

o Dengue illness is categorized according to level of severity as dengue without
warning signs, dengue with warning signs and severe dengue.
o Dengue without warning warnings can be further classified according to signs
and symptoms and laboratory tests as suspect dengue, probable dengue and
confirmed dengue.

o Dengue without warning signs

 Suspect dengue

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  a previously well individual with acute febrile illness of 1-
7 days’ duration plus two of the following: headache, body
malaise, retro-orbital pain, myalgia, arthralgia, anorexia,
nausea, vomiting, diarrhea, flushed skin, rash (petechial,
Hermann’s sign)

 Probable dengue
 a suspect dengue case plus laboratory test: Dengue NS1
antigen test and at least CBC (leukopenia with or without
thrombocytopenia) or dengue IgM antibody test (optional) 

 Confirmed dengue
 a suspect or probable dengue case with positive result of viral
culture and/or Polymerase Chain Reaction
(PCR) and/or Nucleic Acid Amplification Test- Loop Mediated
Amplification Assay (NAAT-LAMP) and/ or Plaque Reduction
Neutralization Test (PRNT)

o Dengue with warning signs

 a previously well person with acute febrile illness of 1-7 days plus any
of the following: abdominal pain or tenderness, persistent vomiting,
clinical signs of fluid accumulation (ascites), mucosal bleeding,
lethargy or restlessness, liver enlargement, increase in haematocrit
and/or decreasing platelet count 

o Severe dengue
 severe plasma leakage leading to
 shock (DSS)
 fluid accumulation with respiratory distress
 severe bleeding
 as evaluated by clinician
 severe organ impairment
 Liver: AST or ALT ≥ 1000
 CNS: e.g. seizures, impaired consciousness
 Heart: and other organs (i.e. myocarditis, renal failure)

o Phases of Dengue
 Febrile Phase
 Usually last 2-7 days
 Mild haemorrhagic manifestations like petechiae and mucosal
membrane bleeding (e.g nose and gums) may be seen.
 Monitoring of warning signs is crucial to recognize its
progression to critical phase.

 Critical Phase
 Phase when patient can either improve or deteriorate.
 Defervescence occurs between 3 to 7 days of
illness. Defervescence is known as the period in which the
body temperature (fever) drops to almost normal (between 37.5
to 38°C).
 Those who will improve after defervescence will be
categorized as Dengue without Warning Signs, while those
who will deteriorate will manifest warning signs and will be
categorized as Dengue with Warning Signs or some may
progress to Severe Dengue.

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  When warning signs occurs, severe dengue may follow near
the time of defervescence which usually happens between 24 to
48 hours.

 Recovery Phase
 Happens in the next 48 to 72 hours in which the body fluids go
back to normal.
 Patients’ general well-being improves.
 Some patients may have classical rash of “isles of white in the
sea of red”.
 The White Blood Cell (WBC) usually starts to rise soon after
defervescence but the normalization of platelet counts typically
happens later than that of WBC. 

o Management (based on patient type)

 Group A- patients who may be sent home
 These are patients who are able to:
o Tolerate adequate volumes of oral fluids
o Pass urine every 6 hours
o Do not have any of the warning signs particularly when
the fever subsides
o Have stable hematocrit
 Group B- patient who should be referred for in-hospital management
 Patients shall be referred immediately to in-hospital
management if they have the following conditions:
o Warning signs
o Without warning signs but with co-existing conditions
that may make dengue or its management more
complicated ( such as pregnancy, infancy, old age,
obesity, diabetes mellitus, hypertension, heart failure,
renal failure, chronic haemolytic diseases such as
sickle- cell disease and autoimmune diseases, etc.)
o Social circumstances such as living alone or living far
from health facility or without a reliable means of
transportation.
o The referring facility has no capability to manage
dengue with warning signs and/or severe dengue
 Group C- patient with severe dengue.requiring emergency treatment
and urgent referral
 These are patients with severe dengue who require emergency
treatment and urgent referral because they are in the critical
phase of the disease and have the following:
o Severe plasma leakage leading to dengue shock and/or
fluid accumulation with respiratory distress;
o Severe hemorrhages;
o Severe organ impairment (hepatic damage, renal
impairment, cardiomyopathy, encephalopathy or
encephalitis)
 Patients in Group C shall be immediately referred and admitted
in the hospital within 24 hours

8. Sexually-Transmitted Infections and AIDS Control Program

 Objective:

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 o Reduce the transmission of AIDS and STI among the Most at Risk Population
and General Population and mitigate its impact at the individual, family, and
community level.
 Mission
o To reduce the occurrence of STI’s through disease surveillance, case and
outbreak investigation, screening, preventive therapy, outreach, diagnosis,
case management, and education. The Department of Public Health mandates
reporting of 5 STI’s; syphilis, gonorrhea, chlamydia, neonatal herpes, and
cancroid. Surveillance activities are conducted on the 3 most common STI’s;
syphilis, gonorrhea, and chlamydia, all of which can be cured with proper
treatment.
o To control the person-to-person spread of sexually transmitted infections.

Environmental Health
 Study of all factors in man’s physical environment, which may exercise a deleterious
effect on his health well-being and survival

1. Water supply sanitation

o Approved type of water supply facilities
o Level I (Point Source)
 A protected well or a developed spring with an outlet but without
distribution system, generally adaptable for rural areas where the house is
thinly scattered.
o Level II (Communal Faucet System or Stand-Posts)
 A system composed of a source a reservoir, a piped distribution network
and communal faucet.
o Level III (Waterworks System or Individual House Connections)
 A system with a source, a reservoir, a piped distributor network and
household taps.

2. Proper excreta disposal

o Approved types of toilet facilities
o Level I
 Non-water carriage toilet facility
 No water is necessary to wash the waste into the receiving space
 Toilet facilities requiring small amount of water to wash the waste into the
receiving space
o Level II
 On site toilet facilities of the water carriage type with water-sealed and
flush type with septic tank/vault disposal facilities.
o Level III
 Water carriage types of toilet facilities connected to septic tanks and/or to
sewerage system to treatment plant.

3. Solid waste management

o The Philippines has endeavored to improve its management of solid waste
through the passage of RA 9003 or the Ecological Solid Waste Management Act
that provides for a systematic, comprehensive and ecological waste management
program to ensure the protection of public health and the environment.  It
mandates the bureau to provide secretariat support to the National Solid Waste
Management Commission in the implementation of the solid waste management
plans and prescribes policies to achieve the objectives of the National Ecology
Center that is in charge of information dissemination, consultation, education and
training of various local government units on ecological waste management.

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 o The collecting, treating, and disposing of solid material that is discarded because
it has served its purpose or is no longer useful

4. Vector control
o Vector control is any method to limit or eradicate the mammals, birds, insects or
other arthropods (here collectively called "vectors") which transmit disease
pathogens. The most frequent type of vector control is mosquito control using a
variety of strategies.

5. Food sanitation
o Four Rights of Food Safety
1. Right source
 Meat, fish, fruits and vegetables used as main ingredients should
always be fresh and clean.
 For processed and canned foods, it is necessary to check the
expiration date and should be free from dents, bulges,
deformation, broken seals and improper seams as these may
provide bacteria the way to get into the can or packages.
 For the source of water, when in doubt as to whether it is clean or
not, boil it for 2 minutes before using.

2. Right preparation
 Utensils and wares to be used should be washed and should also be
kept clean after using.
 Contact between raw food and cooked should be avoided.
 Wash vegetables thoroughly.
 Sweep kitchen floors to remove food droppings and prevent the
harbor of rats and insects especially after the preparation process.

3. Right cooking
 Wash hands before and after cooking and eating.
 Food should be cooked thoroughly with all parts of the food to
reach 70oC when being cooked.
 Eat food immediately after cooking to get the best taste.

4. Right storage
 All cooked foods should be left at room temperature for not more
than two hours to prevent multiplication of bacteria.
 Be sure to store food under hot conditions (at least or above 60oC)
or in cold conditions (below or equal to 10oC).

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  Reheat stored food before eating to at least 70oC.
Alternative Medicines
1. Herbal plants
Medicinal Plants approved by DOH
Herbal Plant
1. Akapulko (Cassia alat)
2. Amplaya (Momordica
charantia)
3. Bawang (Allium satibum)
4. Bayabas (Psidium guajava)
5. Lagundi (Vitex negundo)
6. Niyog-niyogan (Quisqualis
Indica L)
7. Sambong (Blumea
balsamifera)
8. Tsaang Gubat (Ehretia
microphylla Lam”
9. Ulasimang Bato/Pansit-
pansitan (Peperomia
pellucida)
10. Yerba Buena (Clinopodium
douglasii)
2. Acupuncture
o Acupuncture is an ancient Chinese medicine-based approach to treating a variety
of conditions by triggering specific points on the skin with needles.
3. Acupressure
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Use
 Medicinal plant called “ringworm bush or
shrub”
 Used to treat tinea infections, insect bites,
ringworms, eczema, scabies and itchiness
 “Bitter melon” or Bitter gourd”
 Found to be effective in the treatment of
diabetes, hemorrhoids, coughs, burns and
scalds, and being studied for anti-cancer
studies
 Used to treat infection with antibacterial, anti-
inflammatory, anti-cancer and anti-
hypertensive properties
 Widely used to reduce cholesterol level in the
blood
 Used as anti-septic, anti-inflammatory. Anti-
spasmodic, antioxidant hepatoprotective, anti-
allergy, anti-microbial, anti-plasmodial, anti-
cough, anti-diabetic and antigenotoxic in
folkloric medicine
 Known as “5-leaved chaste tree”
 Used to treat cough, colds and fever
 Used as a relief for asthma and pharyngitis,
rheumatism, dyspepsia, boils and diarrhea
 Vine knoown as “Chines honey suckle”
 Used to eliminate intestinal parasites
 Known as “Ngai camphor or Blumea
camphor”
 Used to treat kidney stones, wounds and cuts,
rheumatism, anti-diarrhea, anti-spasms, colds
and coughs and hypertension
 Known as “wild Tea”
 Taken as tea to treat skin allergies including
eczema, scabies and itchiness wounds in child
birth
 Known for its effectivity in treating arthritis
and gout
 Known as “Peppermint”
 Used as analgesic to relive body aches and
pain due to rheumatism and gout.
 also used to treat cough, colds and insect bites.
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 o Acupressure is an alternative medicine technique similar in principle to
acupuncture. It is based on the concept of life energy which flows through
"meridians" in the body. In treatment, physical pressure is applied to acupuncture
points with the aim of clearing blockages in these meridians.

4. Massage
o Massage therapy is used to help manage a health condition or enhance wellness. It
involves manipulating the soft tissues of the body. Massage has been practiced in
most cultures, both Eastern and Western, throughout human history, and was one
of the earliest tools that people used to try to relieve pain.

Massage stroke Description

Effleurage This type of massage stroke is a long gliding stroke. Pressure is
exerted in the direction of the nervous and lymphatic flow. The
return stroke should be extremely light and gentle, and hands must
be flexible and under perfect control so that the entire palmar
surface will be in contact and mould to the area being massaged.
Petrissage This type of massage stroke is often described as one in which the
practitioner is kneading, rolling, wringing, and lifting the soft
tissue being worked on. This is a compression and lifting the
tissues away from the underlying structures (bone)whereby
pressure is firmly applied and relaxed. The movement is also
termed kneading. The degree of pressure exerted must be reduced
on less muscular areas. Performed with one or both hands.
Tapotement This type of massage stroke is a percussive stroke in which the
hand action is rhythmically applied to an area being worked on in
order to stimulates nerves, muscles, and circulation. These include
pinching, hacking, cupping, beating and pounding. They consist of
striking tissue, both hand alternatively, the wrists are kept loose
and mobile so that the movements are light, springy and
stimulating.

References:

Gaje, V. M. Four Rights in Food Safety. http://archives.pia.gov.ph/?m=12.

National Tuberculosis TB Control Program: Department of Health website.

https://www.doh.gov.ph/national-tuberculosis-control-program.

Rabies Prevention and Control Program: Department of Health website. Rabies Prevention and
Control Program | Department of Health website. https://www.doh.gov.ph/national-
rabies-prevention-and-control-program.

Philippine Traditional and Alternative Medicine. Kilusang Bagong Lipunan. (2016).

https://kbl.org.ph/philippine-traditional-and-alternative-medicine/.

Schistosomiasis Control Program: Department of Health website. Schistosomiasis Control

Program | Department of Health website. (2018, October 26).
https://www.doh.gov.ph/schistosomiasis-control-program.

Type of Stroke in Massage. Study.com. https://study.com/academy/lesson/types-of-strokes-in-

massage-therapy.html.

http://www.ntp.doh.gov.ph/downloads/issuances/aopdf/ao2006-0026.pdf

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http://www.ntp.doh.gov.ph/aboutNTP.php

Prepared by:
NCM 104/CHN (Theory) Lecturers

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