CHNN312: Exam Week

18
BSN 3RD YEAR 1ST SEMESTER FINAL 2022
Bachelor of Science in Nursing 3YA
Professor: Adelynne Joie B. San Diego, RN, MAN
Final Topics: - BP recorded twice daily in morning & evening for several
• Non-communicable Disease Program days before a diagnosis of HPN. Measurements taken on
• Prevention and Control of Communicable Disease the first day are discarded. Two consecutive
• Trends in Public Health measurements are taken at least a minute apart and with
• Delivering Health Care to the Filipinos – Culture person seated. The average value of all the remaining
• Information Technology and Community Health measurements is taken to confirm a diagnosis of
• Nurse Entrepreneur hypertension
• Normal < 120 / 80
NON-COMMUNICABLE DISEASE PROGRAM • Prehypertension 120-139 / 80-89
- A medical condition that is both non- infectious and non- • HPN
transmissible - STAGE 1 140-159 / 90-99
- Also referred to as “chronic disease” – s/s longer than 6 - STAGE 2 160-179 / 100-109
months, interferes in way of living a normal life - STAGE 3 > 180 / 110
- “lifestyle -related diseases” - d/t common risk factors like Screening for Elevated Cholesterol
lifestyle that increases possibility • Involves taking blood samples to determine total serum
- Common LRNCD are cardiovascular, cerebrovascular, cholesterol, low density lipoprotein (LDL), & high-density
cancers, COPD & diabetes (DOH, 2005) lipoprotein (HDL)
- These diseases are considered as lifestyle related and is • Withhold food or drinks for at least 8 hours to ensure
mostly the result of unhealthy habits. Behavioral and accuracy of results in all adults aged 20 years or older.
modifiable risk factors like smoking, alcohol abuse, • A fasting lipoprotein profile should be obtained once every
consuming too much fat, salt and sugar and physical 5 years (NCEP, 2001)
inactivity • If test is done in non-fasting individual, the values for total
cholesterol and HDL cholesterol will be used.
Cardiovascular and Cerebrovascular Disease • Elevated LDL results in CVD
Cardiovascular • LDL Cholesterol, known as the bad cholesterol. It
- Referred as heart disease increases likelihood of plaque formation that can block
- A general term used to refer to disease that involve the blood flow in the arteries.
heart or blood vessels (arteries, capillaries and veins) • HDL or good cholesterol, clears excess LDL in the arteries.
Cerebrovascular Disease or Stroke • Total cholesterol is the sum total of all cholesterol
- a group of brain dysfunction related to disease of the (LDL/HDL and other cholesterol) at a given time (NCEP,
blood vessels supplying the brain. Most common cause is 2001).
the atherosclerosis and hypertension. • High total cholesterol or High LDL increases risk of
Hypertension or High Blood Pressure developing CVD.
- defined as systolic blood pressure equal to or above • The higher HDL, the better the health of individual
140mm Hg or a diastolic blood pressure equal to or above Classification of LDL, Total Cholesterol and HDL
90 mmHg Cholesterol (mg/dL)
Atherosclerosis 1) LDL Cholesterol
- A disease of blood vessels characterized by the deposition
• < 100 Optimal
of fats and cholesterol within the walls of the artery (WHO,
• 100- 129 Above Normal
2011).
• 130-159 Borderline
- Uncontrolled atherosclerosis and HPN leads to heart
• 160-189 High
attack, stroke, kidney damage and a host of complications
- Risk factors: Age, genetics, unhealthy diet, smoking, • > 190 Very High
sedentary lifestyle & alcohol consumption 2) Total Cholesterol
Screening • < 200 Desirable
- The identification of an unrecognized disease by the • 200-239 Borderline
application of test, examination & other procedures that • > 240 High
can be applied rapidly to help identify an individual’s 3) HDL Cholesterol
chances of becoming ill (WHO, 2011) • < 40 Low
- Screening of HPN is by monitoring of blood pressure • > 60 High
- Use reliable aneroid devices such as
sphygmomanometers calibrated every 6 months.

J.A.K.E 1 of 26
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
Cancer
- Based on estimated cancer cases by site / gender in 2010
- Leading cause of cancer
• women – breast, lung, liver, corpus, uteri
colon/rectum
• men – lung, liver, colon/rectum, prostate, stomach o
both sexes – breast, lung, liver, colon/rectum,
cervix/uteri
- Malignant Neoplasm is a group of various diseases
involving unregulated cell growth (Newton, 2009). Cells
divide, grow uncontrollably forming malignant tumors and
invade parts of body.
- Carcinogens are substances that cause some cells to
undergo genetic mutations
- Lifestyle- related factors are: cigarette smoking, unhealthy
diet, alcohol drinking, physical inactivity and overweight /
obesity
- Screening for Cancer; Early detection of warning signals
using CAUTION US of American Cancer Society
Cancer Warning Signals by American Cancer Society
/CAUTION US
Chronic Obstructive Pulmonary Disease
- COPD is a disease of the lungs in which airways narrow
over time.
- Includes: chronic asthma and emphysema
- Strong Risk Factor: Smoking. Second-hand smoke and
pollution also aggravate problem.
Diabetes
- A group of metabolic disease in which an individual has
high blood sugar because the pancreas does not produce
enough insulin or cells do not respond to the insulin
produced
- Insulin is a hormone that regulates blood sugar
- Hyperglycemia or high blood sugar is a common effect of
diabetes
- Current Guidelines of WHO (2005) for the diagnosis of
diabetes
• Fasting blood sugar (FBS) of >7.0mmol/l (120mg/dl)
• 2hour blood sugar test of >11.1 mmol/l (200mg/fl).
These tests predict the risk for premature mortality
(WHO,2005).
J.A.K.E 2 of 26
- Symptoms of Diabetes includes:
• Increased frequency and amount of urination
(polydipsia)
• Increased thirst (polydipsia
• Constant hunger (polyphagia)
• Weight loss, vision changes and fatigue.
- Complications: heart disease, neuropathies,
amputations and dental disease.
- Lifestyle related factors: unhealthy diet, overweight and
obesity
Risk Factors for Non-Communicable Disease
1) Physical Inactivity
- Defined as less than 5 times of 30 minutes of
moderate activity per week or less than 20 minutes of
vigorous activity per week or equivalent (WHO, 2011)
2) Cigarette Smoking
- Smoking cigarettes damages the lining of blood
vessels and lessens HDL cholesterol and oxygen in
the blood (WHO, 2013)
- Chemicals found in cigarettes are carcinogens
(National Cancer Institute, 2004)
- Cigarette smoking causes lung cancer of lungs,
mouth, pharynx, larynx, esophagus
3) Unhealthy Eating
- Obesogenic is known as unhealthy eating
- High dietary intakes of saturated fats, trans- fat
cholesterol and salt and low intakes of fruits and
vegetables and fish are linked to overweight and
obesity
4) Excessive Alcohol Drinking
- Ingestion of excessive alcohol may lead to metabolic
and physiological effects on all organ systems such
as: gastrointestinal and cardiovascular disturbances
- Alcohol may cause: malabsorption, inflammation of
the gastrointestinal tract, liver problems and cancer.
- Also linked with colon and rectal cancer. Linked to
development of cancer of breast, liver, esophagus,
mouth and larynx
- Cardiovascular disorders include dysrhythmias,
cardiomyopathy, HPN and Atherosclerosis
- Predict diabetes incidence by increasing blood
glucose in blood.
5) Viruses
- Oncoviruses are viruses that are capable of causing
cancer by breaking the normal cell’s DNA chain during
infection
- These are: Human Papilloma virus (HPV) linked in
cervical and vulvar cancer o Epstein Barr Virus linked
in Nasopharynx Cancer and Anal Cancer o Human T-
lymphotropic virus (HTLV-1) linked with non-Hodgkin
lymphoma o Hepatitis B virus (HBV) and Hepatitis C
(HCV) linked with liver cancer
6) Radiation
- Radiation is energy emitted and transferred through
matter and space.
- Two most common forms are: Ultraviolet radiation
(UV) and ionizing radiation
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• UV radiation – unfavorably affects genes and the
cell enzymes producing DNA mutation.
• Ionizing radiation – causes tissue and cell harm
by breaking the DNA molecule
- Solar radiation is the chief source of UV radiation and
the major cause of skin cancer
- Ionizing Radiation comprises S-rays, gamma rays and
particulate radiation from nuclear accidents,
occupational exposure and treatments
- Risk for growth depends on the following: type,
amount, length of exposure. Risk incline to be
cumulative
Prevention Of Noncommunicable Diseases
Promote physical activity and exercise
• Physical activity is defined as any bodily movement
produces by skeletal muscles that results in expenditure
of energy and includes occupational, leisure-time and
routine daily activities.
• Exercise is a subcategory of physical activity that is
planned, structured repetitive and aimed at improving or
maintaining physical fitness or health.
• Physical fitness is a measure of a patient’s ability to
perform physical activities with vigor and alertness
without undue fatigue and with ample energy to enjoy
leisure-time pursuits and respond to emergencies. It
requires endurance, strength, flexibility, balance, speed,
reaction time and body composition (USDHHS, 2008)
• The Four Levels of Physical Activity: Inactive, low,
medium and high
Metabolic equivalents (METS) of each
Levels of activity
intensity
Walking slowly around home, store or
office, sitting using computer, working
at desk, using light hand tools, standing,
Low
performing light work such as making
Less than 150
bed, washing dishes, ironing, preparing
minutes / week)
food or doing store clerk tasks, doing
arts and crafts, playing cards
Light (<3.0 METs)
Medium
Walking briskly, cleaning, sweeping
(150 – 300
floors, vacuuming carpet, washing car,
minutes of
doing carpentry, playing badminton,
moderate
basketball, shooting, bicycling on flat
intensity / week or
surfaces, ballroom dancing, fishing,
75 – 150 minutes
playing tennis doubles, playing
of vigorous
noncompetitive volleyball
intensity physical
Moderate (3.0 – 6.0 METs)
activity)
Running. Hiking, jogging, shoveling
High sand, carting heavy loads, farming,
Activity of more digging ditches, participation in a
than 300 minutes basketball game, playing soccer, playing
of moderate tennis singles, playing competitive
intensity a week volleyball at the gym or beach Vigorous
(>8.0 METs)
J.A.K.E 3 of 26
Recommendation:
• Medium and high levels of regular physical activity.
• A range of 500 – 1,000 METs of moderate intensity 5-days
a week for 30 minutes or high-intensity activity 3 days a
week for 20 minutes (Haskell, 200&)
• Moderate intensity activity for 30 minutes for 5 days each
week levels of regular physical activity is recommended at
least 30 minutes daily. (Marshal,2009)
Benefits of Regular Physical Activity
• Children and Adolescent
- Improves cardiovascular fitness, increases bone
mass, enhances mental well-being, prevent
development of CVD & other chronic diseases
- Recommendation: 60 mins of moderate or vigorous
physical activity every day for adults and children
• In Adults
- Physical activity reduce risk for cardiovascular &
cerebrovascular disease, cancer and diabetes.
- Increases functional independence through improved
muscle mass, increased bone density & better
cardiovascular.
Warm Up and Cool Down
- To prevent potential risk. A gradual increasing of physical
activity is recommended
- Warm Up
• increase blood flow to the heart and skeletal muscle,
• enhance oxygenation of tissues
• increases flexibility of muscles.
• About 7 to 10 minutes of slow walking, arm circles,
leg exercises or wall push – ups then followed
simultaneously by moderate to vigorous physical
Activity
- Cooldown
• to eliminate lactic acid in the muscles
• maintain blood flow to & from the muscles
• takes About 5 to 10m ins of slow walking, jogging or
cycling
Factors to Consider by the Nurse in Designing Physical
Activity Program:
1) Based on interest, preference and readiness of individuals
2) Enjoyable and include variety of activities to encourage
participation
3) Encourage direct involvement of family members in
physical activities like sports & sports & other recreational
program
4) Physical environment like schools, neighborhood
workplace may also influence physical; activity behaviors
Promote Healthy Diet and Nutrition
- ABC of Good Nutrition (USDA, 2013)
1) AIM for physical fitness
2) BUILD healthy base of nutrition practices
3) CHOOSE foods sensibly
- Methods used in Assessing Healthy Weight
• Body Mass Index (BMI)
- Although does not reflect total fat distribution,
they are useful assessing overweight or obesity.
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
Reflects risk for diabetes, CVDs & some forms of
cancer.
- BMI is calculated as weight in kilograms divided
by body weight in meters squared (kg/m2)
• Weight Circumference (WC)
- WC- used to assess central fat distribution and
the degree of abdominal obesity
- A high WC is associated with increased risk for
diabetes, dyslipidemia, hypertension and CVD
(Chan 1994).
- WC Measurement in taken using a standard tape
measure. Accurate measurement is achieved by
measuring halfway between lowest rib and top of
the hipbone, in line with the belly button, in
standing position with relaxed abdominal
muscles taken at the end of normal expiration.
- Note WC is not the same with belt size.
International Classification of Overweight and Obesity for
Adults based on BMI
Disease Risk Standard for Developing NCDs based on BMI
and WC (WHO,2004)
Strategies to Promote Healthy Eating and Physical Activity:
1) Choose sensible portions of foods lower in fat. Watch
portion sizes.
2) Learn healthier ways to make favorite foods
J.A.K.E 4 of 26
3) Learn to recognize and control environmental cases that
make you want to eat
4) Have a healthy snack an hour before a social gathering
5) Engage in moderate intensity, physical activity for 30
minutes every day
6) Do not eat meals in front of the television
7) Keep records of your food intake and physical activity.
Weight yourself weekly
8) Pay attention to why you are eating.
Healthy Diet Across All Age Group - Infants and children
• Caloric and nutritive intake -support growth and
development
• Encourage mother to do exclusive breastfeeding
• Breast Milk- prevents nutritional deficiencies
• First yr of life – Consumes 40% calories from fats
• Age 2- Recommendation: diet lower in total fat, saturated
fat, cholesterol – lessen risk of chronic disease in latter
years
• Family beliefs and practices – affects dietary habits &
eating behaviors
Healthy Diet Across All Age Group – Adolescent
• Dietary requirement based on pubertal devp & growth
• Body size, compositions, functions & physical abilities are
rapidly changing
• Recommendation is consume diet with more nutrients
than they have before
• Added intake of iron, calcium, vit D during onset of
menstruation in girls & increase physical activity on boys
• Recommendation: fat less than 30% of calories per day
with less animal fat cholesterol to less than 300 mg daily
• Challenges: peer influence, social media, fast food
establishment
Healthy Diet Across All Age Group - Adult and elderly
• Recommendation is low in saturated fat & cholesterol –
maintains desire body weight & lower risk of CVD.
• Changes in body size, body mass, basal metabolism rate,
& physical activity -alters nutritional reqt.
• Essential Components of Adult & Elderly diet – complex
carbohydrate, fiber for bowel elimination, reduce serum
cholesterol, reduced risk of colon cancer, improve
glucose response.
• Supplementation after consultation – due to reduced
appetite, difficulty in swallowing & chewing
Overweight and obesity
- results from imbalance in energy due to excessive intake
of calories with the number of calories burned.
- For Weight loss Program
• If overweight & obese - should consult first health
care provider
• If with BMI of 30 & above or between 25 to 30 with two
or more weight-related health problems or with waist
circumference of over35 inches for women or 40
inches in men even if BMI is less than 25 – qualifies for
weight loss program.
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022

• Ineffective: - Reduce exposure of individuals& population to major

o Radical changes in food consmption is not determinants of NCD while preventing emergence of
recommended due to dehydratoin, nutritional preventable common risk factors
deprivation, fainting & heart attack - Strengthen health care for people with NCD through
o Withhold food at night health sector reform and cost-effective intervention
• Recommended / Effective:
o Rude caloric intake, with attention to portion size National Policy on Strengthening the Prevention & Control
while maintaining vitamins, mineral, fiber of Chronic Lifestyle Related Non-Communicable Diseases
combined with regular physical activity tolose (Administrative Order-2011-0003)
weight 1) Environmental interventions (macroeconomic and
o 5 to 15% reduction in body weight over 6 months policy change)
reduces obesity- related risk - Governance
o Losing 0.5 to 2 lbs weight per week - Policy and legislation
o Include low-carbohydrate. Low-fat high-protein, - Creating supportive environment
high-fibers 2) Lifestyle interventions
o Replace high-caloric with fiber, fruits and - Behavioral interventions
vegetables - Health promotion
o Read nutrition facts on food labels - Information and education
• PHN must: - Improving the built environment
o assist in planning weight management program 3) Clinical intervention
o strategy is health education on benefits - Clinical preventive services
o behavior modification technique - Risk factors detection (screening) and control
o assist family with limited means in selecting low- - Acuta care
cost foods - Chronic care and rehabilitation
Promote Smoke-Free Environment - Palliative care
- CDC Guidelines for Treating Tobacco Use And 4) Advocacy
Dependence: 5) Research, surveillance and evaluation
• Ask – systematically identify all tobacco users at every 6) “whole-of-government” and “Whole-of-society-
visit. response”
• Advise – strongly all tobacco users to quit - Leadership
• Assess – determine willingness to make quit attempt - Multisectoral partnership
• Assist – aide the client in quitting - Community mobilization
7) Health sector response
• Arrange a follow up – ask client if they still smoke,
- Primary health care
compliment ex-smokers soon after the visit and just
- Chronic care management
before the original quit day
- Health systems strengthening
Stress Management
• Defined (Selye, 1936) as nonspecific response on the
Causation Pathway Model for Major Chronic Diseases
body to any demand on it.
1) Underlying determinants
• Managing Stress involves understanding person’s reaction
- Globalization
to stress
- Urbanization
• Aim of Managing Stress is focus on minimizing frequency
- Population aging
of stress-inducing situations, increasing resistance,
- Social determinants
avoiding physiologic arousal resulting from stress (Pender,
2) Common risk factors
2011).
- Tobacco use
• Alternative Medicine for Stress Management & Prevention - Unhealthy diet
of Stress: Biofeedback meditation, breathing relaxation, - Physical inactivity
exercise and massage - Harmful use of alcohol
- Air pollution
Noncommunicable Disease Prevention and Control - Age and heredity (non-modifiable)
Program 3) Intermediate risk factors
• Goal - Raised blood sugar
- Reduce the toil of morbidity, disability and premature - Raised blood pressure
deaths due to chronic, noncommunicable lifestyle - Abnormal blood lipids
related disease - Overweight/ obesity
• Objectives - Abnormal lung function
- Analyze the social, economic, political and behavioral 4) Diseases
determinants of NCD - Cardiovascular
- Cancer
J.A.K.E 5 of 26
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
- Diabetes
- Chronic respiratory disease
Areas For Intervention using Comprehensive Approach
Effect Change At Three Levels:
1) Environment Interventions such as policy and regulatory
interventions seek to create a supportive environment for
healthier choices. They address the multiple
environmental determinants brought about, for example,
by globalization and urbanization that give rise to the
development of unhealthy lifestyles. Environmental
interventions shall aim at providing and encouraging
healthy choices for all to be implemented in three (3)
major health promotion settings: community, school and
workplace
2) Lifestyle Interventions address the common risk factors
and intermediate risk factors by providing population-
based lifestyle interventions (for example, information and
education and behavioral interventions for those who are
already at risk).
3) Clinical Interventions, palliation and rehabilitation
address the capacity of the health system to treat and
manage diseases through screening, risk factor
modification, clinical management, palliation and
rehabilitation.
Additional actions in the following areas:
- advocacy; research, surveillance, monitoring and
evaluation; networking and coalition building across all
sectors of the movement and society, and health system
strengthening through primary health care to make it more
responsive to chronic care.
- Primary level health facilities such as rural health centers
and primary hospitals shall :
• provide appropriate services particularly on early
detection and screening and primary prevention.
• Community participation shall also be enhanced to
strengthen awareness on prevention and control of
lifestyle-related diseases and
• provide a supportive environment conducive for
behavior change towards healthy lifestyle.
- Balance between "healthy choices" and "healthy
environments" because it recognizes that supportive
environments are needed to empower healthy choices. It
redistributes responsibility across whole society, govt,
health sector, private sector, NGO, communities, families
& individuals all sharing accountability to promote healthy
lifestyles and quality care for LRNCD
Terminologies
• Healthy lifestyle - refers to having regular healthy diet,
regular and adequate physical activity, and non-use of
tobacco and alcohol.
• MDG Max - refers to the country's commitment to fight
poverty by including the prevention and control of Non-
Communicable Diseases as one of the Millennium
Development Goals..
J.A.K.E 6 of 26
• Healthy diet - refers to balance of food intake which: (1)
achieves energy balance and a healthy weight; (2) limits
energy intake from total fats and shift fat consumption
away from saturated fats to unsaturated fats and towards
the elimination of trans-fatty acids; (3) increase
consumption of fruits and vegetables, and legumes,
whole grains and nuts; (4) limit the intake of free sugars;
and (5) limit salt (sodium) consumption from all sources.
PREVENTION AND CONTROL OF COMMUNICABLE DISEASE
- Communicable disease means an illness caused by an
infectious agent or its toxins that occurs through the direct
or indirect transmission of the infectious agent or its
products from an infected individual or via an animal,
vector or the inanimate environment to a susceptible
animal or human host.
Malaria
- Malaria is a serious and sometimes fatal disease caused
by a parasite that commonly infects a certain type of
mosquito which feeds on humans.
- Although malaria can be a deadly disease, illness and
death from malaria can usually be prevented.
- Cause
• Protozoan parasite called Plasmodium
• In the Philippines, there are four main species of
malaria-causing Plasmodium: P. falciparum, P. vivax,
P. malariae, and P. ovale.
• Infection with P. knowlesi has also been identified in
the province of Palawan in 2010.)
- Mode of Transmission
• Transmitted through the bite of an infected female
Anopheles sp. mosquito, which usually bites during
nighttime
- Signs and Symptoms
• Chills
• High-grade fever
• Severe headache
• Vomiting
- Treatment
• Uncomplicated P. falciparum
o First-Line: Artemether-Lumefantrine + Primaquine
o Second-Line: Quinine Sulfate + Doxycycline/
Tetracycline/ Clindamycin
• Complicated P. falciparum: Quinine Dihydrochloride
Infusion + Doxycycline/ Tetracycline/Clindamycin
• Plasmodium vivax or Plasmodium ovale: Chloroquine
+ Primaquine
• Plasmodium malariae: Chloroquine + Primaquine
- Prevention and Control
• Use long lasting insecticidal mosquito nets, especially
during nighttime.
• Wear long sleeved clothing and pants.
• Use mosquito repellants/coils and screens on doors
and windows.
• Clear hanging branches of trees along streams.
• Have blood examined if have the signs and symptoms
of malaria.
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Follow advice of health workers on how to take anti-
malaria drugs
- Policies and Laws for Malaria
• 2014: AO 2014-0004: PhilMIS : Reporting and
Recording of malaria cases
• 2013: AO 2013-0023 “Guidelines on Establishment of
Collaborating Centers”
• 2013: AO 2013-0007 “Guidelines on Establishment of
Elimination Hub”
• 2012: AO 2012-0026 “Guidelines in the Conduct of
Border Operation”
• 2009: AO 2009-0001 “Revised Policy and Guidelines
on the Diagnosis and Treatment of
• 2009:AO 2009-0024 “Reconstitution of the Country
Coordinating Mechanism in Support of the Global
Fund to Fight Against AIDS, Tuberculosis and Malaria
Grants in the Philippines”
• Department Circular No. 167 s. 1987: Semi-vertical
Malaria programme1991: RA 7160 “Local Government
Code”
• EO 119: change in the bureaucracy of the Philippine
government – revising the system of the Department
of Health (1986)
• “Malaria Eradication” to “Malaria control in 1983
• EO 851, ordered the decentralization and integration
of malaria control in “the general health services”
(1982)
• Cut-off from the support of USAID and WHO (1973)
• Republic Act 4832: Malaria Eradication Law; an act
creating the malaria eradication service and providing
funds for the duration of the campaign. (1966)
Filariasis
- Filariasis is commonly known as “elephantiasis.”
- Cause: Parasitic worms known as filarial nematode
(Bancroftian or Brugian filariasis)
- Mode of Transmission: Parasitic worms transmitted to
humans through the bite of an infected mosquito
- Signs and Symptoms
• Pain and swelling of the breast, vagina, scrotum, legs,
and arms
• Fever
• Cough
• Chills
• Wheezing
- Treatment
• Selective treatment with DEC (Diethylcarbamazine
Citrate) is given to people with clinical manifestations
of the disease.
• Mass treatment of the people living in established
endemic areas is carried out.
• Medicines (DEC and albendazole) are given once a
year to 2 years and above age.
• Mass Drug Administration (MDA)- Every July Of The
Year
J.A.K.E 7 of 26
- Prevention
• Wear long-sleeved shirt and long pants when working
in farms or areas where filariasis is endemic.
• Sleep under a mosquito net or use mosquito repellant
- Policies and Laws Related to Filariasis
• Administrative Order No. 24s.1998: Elimination of the
disease
• Executive Order No. 369, 2004: Filariasis Mass
Treatment Month
• “November as Filariasis Mass Treatment Month “
• World Health Assembly No. 50.29: Filariasis
Elimination as public health problem
• Formula One for Health: Disease-Free Zones
• KP Roadmap 2014-2016
• Sustainable Development Goal No. 3: Good Health
and Well being
• Philippine Health Development Agenda: Disease for
Elimination
Sexually Transmitted Infections (STIS)
- Sexually transmitted infections (STIs) are infections that
are spread primarily from person-to person during sex.
- Cause: Bacteria, viruses, and parasites
- Some of the most common infections are listed below:
• Gonorrhoea (caused by Neisseria gonorrhoeae)
• Chlamydial infections (caused by Chlamydia
trachomatis)
• Syphilis (caused by Treponema pallidum )
• Chancroid (caused by Haemophilus ducreyi)
• Granuloma inguinale or donovanosis (caused by
Klebsiella granulomatis, previously known as
Calymmatobacterium granulomatis)
• AIDS (caused by Human Immunodeficiency Virus or
HIV)
• Genital herpes (caused by Herpes simplex virus type
2)
• Genital warts and cervical cancer in women (caused
by human papillomavirus)
• Hepatitis (caused by Hepatitis B virus); chronic cases
may lead to cancer of the Liver
• Inflammation in the brain, the eye, and the bowel
(caused by cytomegalovirus)
• Vaginal trichomoniasis (caused by Trichomonas
vaginalis)
• Vaginal yeast infection or vulvovaginitis in women and
inflammation of penis and foreskin or balano-posthitis
in men (caused by Candida albicans)
- Mode of Transmission
• Spreads primarily through person-to-person sexual
contact (There are more than 30 different sexually
transmissible bacteria, viruses, and parasites.
• Several, in particular HIV and syphilis, can also be
transmitted from mother to child during pregnancy
and childbirth, and through blood products and tissue
transfer.)
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
- Signs and Symptoms
• Symptoms vary and some STIs exist without
symptoms.
• Soreness
• Unusual lumps or sores,
• Itching
• Pain when urinating
• Unusual discharge from the genitals
Rabies
- Rabies is a deadly viral infection that is mainly spread by
infected animals.
- 100% fatal though 100% preventable
- Public health problem because
• it is one of the most acutely fatal infection and
• it is responsible for the death of 200-300 Filipinos
annually.
- Cause: Rabies virus
- Mode of Transmission
• Close contact with infected saliva (rabies virus)
• transdermal bite or scratch by an infected animal, like
dogs and cats
• when infectious material, usually saliva, comes into
direct contact with a victim’s fresh skin lesions
though in very rare cases through inhalation of virus-
containing spray or through organ transplants
- Signs and Symptoms
• Headache and fever
• Pain or numbness of bite site
• Delirium and paralysis
• Muscle spasms
• Hydrophobia and aerophobia
- Treatment (When Bitten by a Dog)
• Wash the wound immediately with soap and running
water.
• Consult immediately even while observing the dog
• Observe the dog for 14 days and consult your
physician if any of the following occurs:
- Dog becomes wild and runs aimlessly.
- Dog drools (saliva).
- Dog bites any moving or non-moving object.
- Dog does not eat or drink.
- Dog dies within observation period.
• If dog cannot be observed (stray dog), or if suspected
to be rabid, consult your physician immediately or go
to the nearest Animal Bite Treatment Center in your
area.
- Prevention and Control
• Be a responsible pet owner.
• Have your pet dog immunized by a veterinarian
against rabies at 3 months old and every year
thereafter.
• Never allow pet dog to roam PEP) -anti-rabies
prophylaxis administered after an exposure (such as
bite, scratch, lick, etc.) from potentially rabid animals.
• Pre-Exposure Prophylaxis (PrEP) –vaccination given to
individuals who are at high risk of getting rabies.
J.A.K.E 8 of 26
- Health Promotion
• Celebration of Rabies Awareness Month under
Executive Order No. 84, March is Rabies Awareness
Month
• Celebration of World Rabies Day - September 28 has
been declared as World Rabies Day.
• Development of IEC Materials -All agencies involved
in the implementation of the program are encouraged
to conceptualize, produce/reproduce and distribute
IEC materials and collaterals.
• Massive Health Information Campaign using tri-media
• Integration of Rabies Program into the School
Curriculum - The integration of the program into the
curriculum is a collaborative effort of DOH and DepEd
to educate school children who are the most
vulnerable to animal bites.
• Dog Vaccination – This is the most effective measure
to control canine rabies.
• The Department of Agriculture – Bureau of Animal
Industry takes the lead in mass dog vaccination
campaigns and provision of animal rabies vaccine.
• Dog Population Management – This includes stray dog
management through impounding, field control and
disposal, surgical and non-surgical sterilization and
habitat control.
• Central Database System The Philippine Animal
Health Information System (PhilAHIS) was established
to provide data on dog registration, vaccination and
reports of canine rabies maintained by the
Department of Agriculture.
• Responsible Pet Ownership – The program adopts the
strategy of promoting Responsible Pet Ownership to
prevent spread of rabies.
• The public is advised to bring their pet dogs for anti-
rabies vaccination when they reach 3 months of age
and yearly thereafter, provide proper nutrition,
exercise and shelter to their pet dogs and not to allow
their pet dogs to roam around to prevent contact with
infected animals.
Leptospirosis
- Leptospirosis is a bacterial infection transmitted by many
animals, such as rodents and other vermin.
- Waste products (e.g., urine and feces) of an infected
animal, especially rats, contaminate the soil, water, and
vegetation.
- Cause: Leptospira spirochetes bacteria
- Mode of Transmission
• Ingesting contaminated food or water or
• when broken skin or open wounds and mucous
membrane (eyes, nose, sinuses, mouth) come in
contact with contaminated water (usually flood water)
or soil
• Incubation period of bacteria is 7-10 days.
- Signs and Symptoms
• Fever
• Non-specific symptoms of muscle pain, headache
• Calf-muscle pain and reddish eyes in some cases
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Severe cases resulting in liver involvement, kidney
failure, or brain involvement (Thus some cases may
have yellowish body discoloration, dark-colored urine
and light stools, low urine output, severe headache.)
- Treatment
• Take antibiotics duly prescribed by a physician.
• Early recognition and treatment within 2 days of
illness prevents complications of leptospirosis, so
early consultation is advised.
- Prevention and Control
• Avoid swimming or wading in potentially
contaminated water or flood water.
• Use proper protection, like boots and gloves, when
work requires exposure to contaminated water.
• Drain potentially contaminated water when possible.
• Control rodents in the household by using rat traps or
rat poison and maintaining cleanliness in the house.
Leprosy
- Leprosy is a chronic, mildly communicable disease that
mainly affects the skin, the peripheral nerves, the eyes,
and mucosa of the upper respiratory tract.
- Cause: Mycobacterium leprae bacillus
- Mode of Transmission: Transmitted via droplets, from
the nose and mouth, during close and frequent contacts
with untreated cases
- Signs and Symptoms: 3 Cardinal Signs of Leprosy
1) Skin patch with loss of sensation – The skin lesion can
be single or multiple, usually less pigmented than the
surrounding normal skin. Sometimes the lesion is
reddish or copper-colored.
2) Enlarged peripheral Nerve – A thickened nerve is often
accompanied by other signs as a result of damage to
the nerve. These may be loss of sensation in the skin
and weakness of muscles supplied by the affected
nerve.
3) Positive slit-skin smear – In a small proportion of
cases, rod-shaped, red-stained leprosy bacilli, which
are diagnostic of the disease, may be seen in the
smears taken from the affected skin when examined
under a microscope after appropriate staining.
- Skin smears are also used to diagnose leprosy.
- Classification Based on Skin Smears,
• Patients showing negative smears at all sites are
grouped as PAUCIBACILLARY LEPROSY (PB), while
those showing positive smears at any site are grouped
as having
• MULTIBACILLARY LEPROSY (MB).
- Clinical System of Classification
• for the purpose of treatment includes the use of
number of skin lesions and nerves involved as the
basis for grouping leprosy patients into multibacillary
(MB) and paucibacillary (PB) leprosy.
- Treatment: Multidrug therapy (MDT) treatment
• Combination of rifampicin, clofazimine, and dapsone
for Multibacillary (MB) leprosy
J.A.K.E 9 of 26
• Combination of Rifampicin and dapsone for
Paucibacillary (PB) leprosy patients
• Treatment of leprosy with only one antileprosy drug
will always result in development of drug resistance to
that drug.
- Prevention and Control
• Treat all leprosy cases to prevent spread of infection.
• Avoid direct contact with untreated patients
(especially young children).
• Practice personal hygiene.
• Maintain body resistance by healthful living.
• Practice good nutrition.
• Have enough rest and exercise.
• Keep environment clean.
Tuberculosis
- Tuberculosis is an infectious disease that primarily affects
the lungs and this condition is known as pulmonary
tuberculosis.
- A patient with both pulmonary and extrapulmonary
tuberculosis should be classified as a case of pulmonary
TB
- Other parts of the body may also be affected by
tuberculosis; this is known as extrapulmonary
tuberculosis. It may affect the bones, meninges, joints,
genito-urinary tract, intestines, liver, kidneys, and the
heart.
- Cause: Mycobacterium tuberculosis or tubercle bacilli
- Mode of Transmission: Inhalation of bacteria released
from air droplets when a person with TB coughs or
sneezes (Generally, the bacteria will be killed in 5 minutes
after direct exposure to sunlight but these bacteria can
survive for up to 1 year in a dark, moist, and poorly
ventilated area.)
- Signs and Symptoms: Cardinal signs and symptoms that
are lasting for ≥2 weeks:
• cough
• unexplained fever
• unexplained weight loss
• night sweats.
• If any of the above signs/symptoms are present for at
least two weeks, identify as a presumptive TB.
• Other s/s: Chest or back pain not referable to other
diseases, Blood-streaked sputum or hemoptysis
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Record demographic data and contact information of
patient in a registrer of consults
1) Ask all patients consulting the health facility, if
they have the following any TB cardinal assigns
and symptoms lasting for > 2 weeks
2) If yes, identify patient as a presumptive TB.
3) Those who do not have any of the cardinal
signs/symptoms above or experienced it for less
than two weeks, offer chest X-ray screening if one
has not been conducted in the past year
• All patients with chest X-ray findings suggestive of TB
should be identified as presumptive TB.
• Physician may decide whether to consider the patient
a presumptive TB case, If chest X-ray is not available
and these high-risk patients have signs and symptoms
lasting less than two weeks.
- If resources are limited: An option is to prioritize those
with TB risk factors as primary clients for chest X-ray
screening. Risk factors include:
• contacts of TB patients;
• those ever treated for TB (i.e. with history of previous
TB treatment);
• people living with HIV (PLHIV);
• elderly (> 60 years old);
• diabetics;
• smokers;
• health-care workers;
• urban and rural poor (indigents); and
• those with other immune-suppressive medical
conditions (silicosis, solid organ transplant,
connective tissue or autoimmune disorder, end-stage
renal disease, chronic corticosteroid use, alcohol or
substance abuse, chemotherapy or other forms of
medical treatment for cancer).
Presumptive Pulmonary Tuberculosis
- refers to any person having: i) two weeks or longer of any
of
- the following – cough, unexplained fever, unexplained
weight
- loss, night sweats; or ii) chest X-ray finding suggestive of
TB.
- Other policies for a Systematic Screening are as
follows:
• Systematic screening for TB in all health facilities.
• Symptom screening using 4 cardinal s/s -primary
screening tool in health facilities among all consults
including for immunization, maternal health and child
health. Accompanying persons will also be screened
by asking for TB s/s.
• Screening by chest X-ray - annually among all health
facility consults.
• Active case finding – in congregate settings, targeted
communities & workplaces using CXR as primary
screening tool and Xpert as diagnostic test.
• All people living with HIV (PLHIV) - screened for the TB
co infection.
• All health facilities - screen workers for TB annually –
using both symptom and CXR screening.
J.A.K.E 10 of 26
• Household & close contacts of all ages of diagnosed
TB pt -all be screened using symptoms & CXR
- Symptom-based screening – refers to screening using
any of the 4 cardinal TB signs & symptoms, at least two
weeks
- Screening by chest X-ray – refers to using chest X-ray to
identify presumptive pulmonary. TB (PTB) which will
manifest with common abnormalities that are suggestive
of PTB
- Primary screening tool – refers to test or tool used
initially to detect presumptive TB in systematic screening
of TB. It may be symptom-based or chest X-ray
- Diagnosis
• After a presumptive TB case is identified, diagnosis
through bacteriologic confirmation must be
conducted. Sputum should be collected for an Xpert
MTB/RIF test.
• It requires collection of the necessary specimens for
testing, performing the test (Xpert, SM or TB LAMP),
and making a diagnosis based on the results.
• Bacteriologically confirmed TB (BCTB) – refers to a
patient from whom a biological specimen,either
sputum or nonsputum sample, is positive for TB by
smear microscopy, culture orrapid diagnostic tests
(such as Xpert MTB/RIF, line probe assay for TB, TB
LAMP).
o A rapid diagnostic test (RDT), such as Xpert
MTB/RIF, shall be the primary diagnostic test for
PTB and EPTB in adults and children
o Smear microscopy (whether brightfield or
fluorescence microscopy) or loop mediated
isothermal amplification (TB LAMP) shall be the
alternative diagnostic test if Xpert is not
accessible. Unavailability of Xpert MTB/RIF test
shall not be a deterrent to diagnose TB disease
bacteriologically.
GeneXpert MTB/RIF
- For simultaneous rapid tuberculosis diagnosis and rapid
antibiotic sensitivity test. It is an automated diagnostic
test that can identify Mycobacterium tuberculosis (MTB)
DNA and resistance to rifampicin (RIF).
- Xpert MTB/RIF results and interpretation are the following:
• T = Mycobacterium tuberculosis (MTB) detected;
rifampicin resistance not detected.
• RR = MTB detected; rifampicin resistance detected.
• TI = MTB detected; rifampicin resistance
indeterminate.
• N = MTB not detected.
• I = Invalid/no result/error
- TB LAMP loop-mediated isothermal amplification
- TB-LAMP is a new manual TB detection method based on
the novel loop-mediated isothermal amplification (LAMP)
platform from Eiken Chemical Co. in Japan.
- TB-LAMP features that makes it attractive as a diagnostics
platform for resource-poor settings: it is fast (15-40 min),
isothermal (requiring only a heat block), robust to
inhibitors and reaction conditions that usually
adversely affect polymerase chain reaction (PCR)
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
methods, and it generates a result that can be detected
with the naked eye.
- Since 2005, FIND and Eiken have been collaborating to
develop an assay for TB that could be implemented in
place of microscopy to improve the accuracy of TB
detection at microscopy centres and similar laboratories.
Smear Microscopy (SM)
- Prepare sputum cup or 50 ml conical tube. Accomplish
Form2a. Laboratory Request &Result Form.
- Instruct patient to expectorate one sputum sample on the
spot for diagnostic testing with Xpert (if not available, SM
or TB LAMP). Collect 1ml for Xpert MTB/RIF and TB LAMP
and 3–5 ml for SM.
- For SM, instruct to collect a second sample one hour later
or an early-morning sputum sample the following day.
Follow-up within three days if patient fails to submit a
second specimen unless the first specimen already tests
positive for acid-fast bacillus (AFB) in which case the
second specimen will not be necessary
- Only contraindication to sputum for bacteriological
diagnosis of TB is massive hemoptysis Final laboratory
diagnoses are reported as follows:
• Positive = at least one sputum smear is positive for
AFB (+n, 1+, 2+, 3+)
• Negative = both sputum smears are negative for AFB.
Treatment regimens for DS-TB
The First Line TB medication are Isoniazid, Rifampicin,
Pyrazinamide and Ethambutol
Regimen 1: Intensive Phase: 2HRZE; Continuation
Phase :4HR
Eligible TB Patients are:
1) PTB or EPTB (except central nervous system [CNS], bones,
joints) whether new orretreatment, with final Xpert result:
a) MTB, RIF sensitive
b) MTB, RIF indeterminate
2) New PTB or new EPTB (except CNS, bones, joints), with
positive SM/TB LAMP or clinically diagnosed, and:
a) Xpert not done*
b) Xpert result is MTB not detected
Regimen 2 : Intensive Phase : 2HRZE; Continuation Phase:
10HR
Eligible TB Patients are:
1) EPTB of CNS, bones, joints whether new or retreatment,
with final Xpert result:
a) MTB, RIF sensitive
b) b MTB, RIF indeterminate
2) New EPTB of CNS, bones, joints, with positive SM/TB
LAMP or clinically diagnosed, and:
a) Xpert not done*
b) Xpert result is MTB not detected
Prevention Health Professional:
- Find the TB patient early and provide treatment through
DOT (directly observed treatment) to cure the patient.
- Individual: Adopt a healthy lifestyle to boost the immune
system.
• Engage in physical activity or exercise regularly.
• Get enough rest.
• Eat a balanced diet.
J.A.K.E 11 of 26
• Keep the living area well ventilated.
• Maintain personal hygiene.
• Cover the nose and mouth when coughing and
sneezing.
- Turnaround time (TAT the time from collection of first
sputum sample to initiation of treatment for TB. The
desired turnaround time is five working days (also referred
to as Program TAT).
Treatment Adherence Interventions
- includes social support such as material support (e.g.
food, incentives, transportation); psychological support;
tracers such as home visit or digital health
communication; medication monitoring; and staff
education that collectively aims to ensure completion of
treatment
- Other Model of Treatment Supervision:
• 99DOTS is a low-cost approach for monitoring and
improving TB medication adherence. Using 99DOTS,
each anti-TB blister pack is wrapped in a custom
envelope, which includes hidden phone numbers that
are visible only when doses are dispensed. 99DOTS
patients receive a series of daily reminders (via SMS
and automated calls).
• Smart pillboxes This is a digital medication monitor
that combines the functionality of a low-cost
medication box with a small-scale, battery-powered
sensor and mobile data connection. Patients store
and organize their TB medications in the box, and
when they open the box for daily medication intake,
the sensor is activated and sends dosing- event
information in real-time to the adherence platform
using the mobile data connection.
• Video-supported treatment (VOT) An Android
application (app) that utilizes video recording and
mobile communication to remotely monitor and
support TB medication intake. Using an asynchronous
video approach (in contrast to synchronous “live”
video) patients are guided to record videos of
themselves ingesting their daily medication. videos
are automatically synced via secure mobile
connection with the adherence platform, where they
are then reviewed by the patient’s health-care
provider and marked as complete.
Patient-Centered Tuberculosis Care
• Recognizes and respects the patient’s rights and values.
Considers patient as significant partner who actively
partakes in decisions on diagnosis and treatment.
• Holistic approach as pillar by WHO in its End TB Strategy.
Capitalizes on trust-based relationship between patient
and provider. TB care changes beyond mere clinical
service delivery towards addressing patient’s social and
economic situations underling occurrence of TB disease
• Policies are the following:
- Respect patient autonomy and support self-efficacy.
- Patient’s physical comfort, safety & wellness will be
maximized. Integrated care for TB and other co-
morbidities.
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
- Provide Psycho-emotional support & protection from
social isolation or discrimination
- Link TB patients to social protection measures,
Impact of poverty and food insecurity on TB diagnosis
and treatment will be recognized and addressed
Comprehensive Philippine Plan of Action to Eliminate
Tuberculosis (RA 10767)
- A program of the national government to eliminate
tuberculosis in the Philippines
- Immediate release of Anti -TB services during and after
natural and man-made disaster
- Provision of Health services - Free laboratory in DOH
hospital. Supply of free medication in health centers in
coordination with LGU
- Research, Demonstration Project, education and training
- Education Program – Encourage faculty of allied health
and health institution to intensify information and
education program, include in curriculum development
thus increase students’ opportunity to learn principles of
preventing, detecting, motoring and controlling of TB
- Inclusion in Basic Education Modules on the principles of
preventing, detecting, motoring and controlling of TB
- Media Campaign on spitting in public spaces and
unhygienic behavior that undermine TB prevention
- Regulation on Sale and Use of Anti TB drugs – “No
prescription, No Anti-TB Drug
- PhilHealth TB Package
Integrated TB Information System (ITIS)
- A DOH-developed official information system to collect,
consolidate TB information under NTP.
- An electronic information system that is used to collect,
consolidate and report data coming from all TB facilities
managing TB under NTP
- All private and public health facilities within the NTP
network shall adapt the implementation of ITIS
- The RHU shall use the data as a recording and reporting
tool for TB and encode on a daily basis. In case on offline
basis, shall submit information to KMITS on regular basis
and request KMITS to update data in the central database.
- Al ITIS implementing site submits report on quarterly and
annually basis.
Dengue Fever and Dengue Hemorrhagic Fever
- Dengue fever and dengue hemorrhagic fever are acute
viral infections that affect infants, young children, and
adults.
- Cause:
• Dengue virus has four serotypes : (DENV1, DENV2,
DENV3 and DENV4)
• 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.
• Dengue has no treatment but the disease can be early
managed.
- Transmission: Dengue virus is transmitted by day biting
Aedes aegypti and Aedes albopictus mosquitoes.
J.A.K.E 12 of 26
- Laboratory Tests:
1) Dengue NS1 RDT
• Requested between 1-5 days of illness
• Use to detect dengue virus antigen during early
phase of acute dengue infection
• for free in all health centers and selected public
hospitals nationwide
2) Polymerase Chain Reaction (PCR)
• One of the gold standard laboratory tests to
confirm dengue virus.
• Molecular based test confirmatory test
• Available only in dengue sub-national and
national reference laboratories
3) Nucleic Acid Amplification Test- Loop Mediated
Isothermal Amplification Assay (NAATLAMP)
• A novel molecular-based confirmatory test used
to detect dengue virus.
• Work just like PCR but cheaper and simpler in
nature.
• In the pipeline to be introduced under the
National Dengue Prevention and Control Program
in district and provincial hospitals
4) Plaque Reduction Neutralization Test (PRNT)
• Gold standard to characterize and quantify
circulating level of anti-DENV neutralizing
antibody (NAb)
• Available only at the dengue national reference
laboratory
5) Dengue IgM/IgG
• Requested beyond five days of illness
• Use to detect dengue antibodies during acute late
stage of dengue infection (IgM) and to determine
previous infection (IgG)
• May give false positive result due to antibodies
induced by dengue vaccine
• May cross react with other arboviral diseases
such as Chikungunya and Zika
• DOH augmentation is limited to selected
government hospitals only
6) Other tests:
• Total While Blood Cell (WBC) count
• Platelet
• Hematocrit
• Routinely used in hospitals as standard dengue
diagnostic tests
• Look for trend of decreasing WBC, decreasing
platelet and increasing hematocrit
Dengue Case Classification and Level of Severity
1) Dengue without warning signs
- Dengue without warning can be further classified
according to signs and symptoms and laboratory tests
as suspect dengue, probable dengue and confirmed
dengue.
a) Suspect dengue – 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,
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
vomiting, diarrhea, flushed skin, rash (petechial,
Hermann’s sign)
b) 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)
c) 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)
2) 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
hematocrit and/or decreasing platelet count
3) Severe dengue.
- severe plasma leakage leading to
- shock (DSS)
- fluid accumulation with respiratory distress
- severe bleeding
- as evaluated by clinician
• severe organ impairment
o Liver: AST or ALT ≥ 1000
o CNS: e.g. seizures, impaired consciousness
o Heart: and other organs (i.e. myocarditis,
renal failure)
Phases of Dengue Infection
1) Febrile Phase
- Usually last 2-7 days
- Mild hemorrhagic 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.
2) 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.
- warning signs occurs, severe dengue may follow near
the time of defervescence which usually happens
between 24 to 48 hours.
3) Recovery Phase
- Happens in the next 48 to 72 hours in which the body
fluids go back to normal.
- Patients’ general well-being improves.
J.A.K.E 13 of 26
- 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.
Management (based on patient type)
1) Group A – patients who may be sent home
- These are patients who are able to:
- Tolerate adequate volumes of oral fluids
- Pass urine every 6 hours
- Do not have any of the warning signs particularly when
the fever subsides
- Have stable hematocrit
2) 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:
- Warning signs
• 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 hemolytic diseases such as sickle cell
disease and autoimmune diseases, etc.)
• Social circumstances such as living alone or living
far from health facility or without a reliable means
of transportation.
• Referring facility has no capability to manage
dengue with warning signs and/or severe dengue.
3) 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:
• Severe plasma leakage leading to dengue shock
and/or fluid accumulation with respiratory
distress;
• Severe hemorrhages;
• 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.
Program Strategy: Prevention and Control
Follow the 4-S against Dengue:
1) Search and Destroy
• Cover water drums and pails.
• Replace water in flower vases once a week.
• Clean gutters of leaves and debris.
• Collect and dispose all unusable tin cans, jars,
bottles and other items that can collect and hold
water.
2) Self-Protection Measures
• Wear long pants and long-sleeved shirt.
• Use mosquito repellant every day.
•
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
3) Seek Early Consultation
• Consult the doctors immediately if fever persists after
2 days and rashes appears.
4) Say Yes to Fogging When There is an Impending
Outbreak or a Hotspot
Schistosomiasis
- This disease affects the liver, central nervous system, and
other organs where eggs of Schistosoma japonicum get
lodged, causing granuloma formation.
- Manifestation of the disease depends on the species a
person is infected with.
- Acquired mostly through personal habits & livelihood
requiring contact with schisto-infested waters.
- Cause: A blood fluke (parasite) called Schistosoma
japonicum in the Philippines
- Mode of Transmission: Transmitted through a tiny
freshwater snail (Oncomelania hupensis quadrasi)
- Signs and Symptoms
• Abdominal pain
• Low-grade fever
• Loose bowel movement
• Bloody stool
• Inflammation of the liver
• Bulging of the abdomen
• Enlargement of the spleen
• Complications in various organ systems caused by
chronic schistosomiasis (for example, gastrointestinal
system, heart, liver, brain)
- Diagnostic Method
• Stool examination through Kato Katz Method
• Serologic test: COPT (circumoval precipitin tests) and
ELISA (enzyme-linked immunosorbent assay)
- Treatment
• Prognosis: curable at the early stage but fatal in the
advanced stage
• Drug of choice: Praziquantel tablets available for free
at the Schistosomiasis Control Teams (SCTs) or
health centers
- Prevention and Control
• Submit stool for examination to the SCT or health
center.
• Construct and use sanitary toilets.
• Avoid contact or exposing oneself to schisto-infested
waters.
• Fence off or tie stray animals.
• Keep environment clean and participate in community
efforts to control disease.
• Consult SCTs or health centers for additional
information.
Laws for the control of communicable disease
• RA 10767 – An Act Establishing a Philippine Plan of Action
to Eliminate Tuberculosis as Public Health Problem
• RA 3573 – otherwise known as the "Law on Reporting of
Communicable Diseases", which requires all individuals
and health facilities to report notifiable diseases to
national and local health authorities.
J.A.K.E 14 of 26
• RA 4073 – An Act Further Liberalizing the Treatment of
Leprosy by Amending and Repealing Certain Sections of
the Revised Administrative Code
• RA 8504 – An act promulgating policies and prescribing
measures for the prevention and control of HIV/aids in the
Philippines, instituting a nationwide HIV/aids information
and educational program, establishing a comprehensive
hive/aids monitoring system, strengthening the Philippine
national aids council, and for other purposes
• RA 9482 - “Anti-Rabies Act of 2007” An Act Providing For
The Control And Elimination Of Human And Animal Rabies,
Prescribing Penalties For Violation Thereof And
Appropriating Funds Therefor
• Batas Pambansa Bilang 97 – An Act Providing for the
Compulsory Immunization of Livestock, Poultry and other
Animals against Dangerous Communicable Diseases. The
Act required the Secretary of Agriculture to make
compulsory the vaccination of susceptible animals and
poultry should there be a threat or existence of a highly
communicable animal or avian disease in a certain
locality.
• EO 84 – Declaring March as the Rabies Awareness Month,
Rationalizing the Control Measures for the Prevention and
Eradication of Rabies and Appropriating Funds.
• RA 1136 – An Act Reorganizing the Division of
Tuberculosis in the Department of Health. The Division of
Tuberculosis in the Department of Health, hereinafter
called the Division, is re-organized. There is created the
National Advisory Council on Tuberculosis to be
composed of the Secretary of Health, as Chairman
• MEMO CIRCULAR 98-155 – Pronounced the National
Tuberculosis Control Program as the highest priority
health program of LGUs
• Presidential Proclamation No. 46 of 1992 – reaffirm the
commitment of the Philippines to the Universal Child and
Mother Immunization (UCMI) goal by launching the
Philippines Poliomyelitis Eradication Project
• Presidential Proclamation 1204 of 1998 – declare the
month of June of every year starting this year 1998 as the
National Dengue Awareness Month and the formulation of
National Dengue Prevention and Control Program to
reduce morbidity and mortality due to dengue
• Administrative Order No. 24 series of 1996 – National
Tuberculosis Control Program, adapted DOTS in the
management of TB
• EO 187 s.2003 – Instituting a Comprehensive and Unified
Policy for the Tuberculosis Control in the Philippine.
Terminologies
• Close contact – a person who shared an enclosed space,
such as the household, a social gathering place,
workplace or facility, for extended periods within the day
with the index case during the three months before
diagnosis in the case of TB
• Incubation Period - time interval between the initial
infection and the signs and symptoms
• Hotspots – Areas with increasing number of cases for two
consecutive weeks
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Knowledge Management and Information Technology
Service (KMITS) – Office under DOH responsible in the
development and management of a health information
system like an ITIS.
• Sign - objective evidence of a disease the physician can
observe and measure
• Symptoms - evidence of disease that is experienced or
perceived (subjective) subjective changes in body function
noted by patient but not apparent to an observer
TRENDS IN PUBLIC HEALTH: NATIONAL AND GLOBAL
Health Promotion / Healthy Lifestyle Directions &
Challenges
- Rationale / bases: Rapid rise of NCD/CVD, CA, Diabetes,
Kidney prob. & COPD
- Challenges: Health Promotion strategy to link
unbalanced differences in health status among
populations between & within countries through:
a) Focus on determinants of health (WHO)
b) Healthy Environment
• Safe physical environment
• Supportive economic and Physical Condition
• Adequate supply of good food
• Restricted access to tobacco and alcohol
c) Effective Health Services
• Adequacy of preventive services
• Appropriateness of health services
d) Emphasis on Importance of Empowerment to
promote & sustain healthy environment & healthy
lifestyles:
• Heathy Diet and weight control
• Regular physical activity and exercise
• Stress management
• Control of Tobacco & Alcohol Use
• Food Safety
• Injury Prevention
Creative Options and Initiatives
- Necessitating multi-agency partnerships, advocacy,
health public policy and organizational practices, national
and international networking
a) Interventions to address challenges / issues on
b) poverty and health
• Health in the hands of the people, emphasis on
‘being-in-charge’
• Participatory approach to develop Community
Competence
• Interdisciplinary and Interagency collaboration
through counterpart strategies.
c) Development of healthy settings
• Healthy Workplaces, Marketplaces, Villages,
Cities / Municipalities, Health promoting Schools,
Health Promoting hospitals and Healthy Islands
• Although initiated in western countries, the health
promoting setting was started in 1997 in the
Philippines thru AO 341.
• Principal Elements of Healthy Cities Project
(WHO,2000)
J.A.K.E 15 of 26
- Political / LGU commitment with written
policy statement
- Future vision / goal through consensus
- Intersectoral committee / task force with the
designation of a coordination and program
me to involve community & others in planning
and implementation
- Development of a city health profile with
health risk factors related to physical and
social environment, identification of priority
health problems, through intersectoral
discussion, & formulation of local action plan
for resolving priority health problem.
- Priority problems are undertaken by multi-
disciplinary teams with community
participation & not by single government
agency
- Indicators for monitoring of target and plan,
mechanism for regular review (e.g. annual
progress review meetings)
Acute Care / Illness Care Increasingly Being Delivered in
home / community setting
- Rational / Bases
• Early Hospital Discharge due to increasing cost of
hospital care / services, insurance requirements, etc.
• Increasing burden of chronic and palliative care
• By 2010 in the USA, 70 % to 80% illness care will be in
home setting
- Challenges / Creative Options
• Expertise / Competence in Specific Areas in Acute
Care in Home Setting
• Case Management as nucleus if the continuum of
care with the nurse case manager as orchestrator of
services in precise and synchronous fashion thru use
of critical pathways, care maps and disease
management protocol
• Nurse role varies from monitoring long -term needs to
managing current episode of care
• Effective use of two- way referral system
• Enhance potential of families on acute / illness on
palliative care or reduce burden
Focus on Care of population Aggregates to Promote
Healthy Transitions
- Rationale / Bases
• Population shift leads to: Increasing health problem
among elders, ethnic and marginalized group.
Emphasis on child, adolescent, reproductive /
women’s health
• Increasing scope, magnitude and impact of disaster
around the world
- Challenges / Creative Options
• Expertise / Competence on use of epidemiologic
Approach to care for population group
• Work / Group Approach to Enhance / Empower
potential of population groups
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Expertise / competence on Disaster precaution,
mitigation, preparedness and relief response
including risk assessment and multidisciplinary
management strategies to ensure effective delivery of
effective responses to the short, medium- and long-
term health needs of the disaster – stricken
population
• Promoting equity to access needed health and social
services specially to women and marginalized group
who are ill-prepared & have difficulty surviving and
recovering in times of disaster due to discrimination
• Use of “Human Becoming “Approach. Help clients
handles, polarities, transition and trajectories based
on understanding the meaning of “lived experienced.’
Ten Threats to Global Health (WHO, 2019)
Air pollution and climate change
- Microscopic pollutants in the air can penetrate respiratory
and circulatory systems, damaging the lungs, heart and
brain, killing 7 million people prematurely every year from
diseases such as cancer, stroke, heart and lung disease.
- Around 90% of these deaths are in low- and middle-
income countries, with high volumes of emissions from
industry, transport and agriculture, as well as dirty
cookstoves and fuels in homes.
- The primary cause of air pollution (burning fossil fuels) is
also a major contributor to climate change. The world is
still on a course to warm by more than 3°C this century.
- Additional deaths per year, from malnutrition, malaria,
diarrhea and heat stress. Air pollution is considered by
WHO as the greatest environmental risk to health.
Noncommunicable diseases
- Noncommunicable diseases, such as diabetes, cancer
and heart disease, are collectively responsible for over
70% of all deaths worldwide. 15 million people dying
prematurely, aged between 30 and 69.
- Rise of these diseases has been driven by five major risk
factors: tobacco use, physical inactivity, the harmful use
of alcohol, unhealthy diets and air pollution.
- These risk factors also exacerbate mental health issues,
that may originate from an early age: half of all mental
illness begins by the age of 14, but most cases go
undetected and untreated.
- WHO work with governments to help them meet the global
target of reducing physical inactivity by 15% by 2030
- Several environmental factors which are linked to
urbanization can discourage people from becoming more
active, such as:
• Fear of violence and crime in outdoor areas
• High-density traffic
• low air quality, pollution
• lack of parks, sidewalks and sports/recreation
facilities
Global influenza pandemic
- WHO is constantly monitoring the circulation of influenza
viruses to detect potential pandemic strains: 153
institutions in 114 countries are involved in global
surveillance and response.
J.A.K.E 16 of 26
- Every year, WHO recommends which strains should be
included in the flu vaccine to protect people from
seasonal flu.
Fragile and vulnerable settings.
- Fragile settings exist in almost all regions of the world.
Protracted crises (through a combination of challenges
such as drought, famine, conflict, and population
displacement) and weak health services leave people
living in these areas without access to basic care.
- WHO strengthen health systems so that they are better
prepared to detect and respond to outbreaks, as well as
able to deliver high quality health services, including
immunization.
Antimicrobial resistance
- Antimicrobial resistance (AMR) is the ability of bacteria,
parasites, viruses and fungi to resist medicines –
threatens to unable easy treat infections such as
pneumonia, tuberculosis, gonorrhea, and salmonellosis.
- Leads to prolonged hospital stays and the need for more
expensive and intensive care. The inability to prevent
infections could seriously compromise surgery and
procedures such as chemotherapy. Medical procedures,
such as surgery, including caesarean sections or hip
replacements, cancer chemotherapy, and organ
transplantation, will become more risky.
- Resistance to tuberculosis drugs. Half a million new cases
of rifampicin-resistant TB (RR-TB) identified globally, of
which the vast majority have multi-drug resistant TB
(MDR-TB), a form of tuberculosis that is resistant to the
two most powerful anti-TB drugs, isoniazid and rifampicin
- Resistance to fluoroquinolone antibiotics in E. coli, used
for the treatment of urinary tract infections, is widespread.
- Bacteria Staphylococcus aureus are part of our skin flora
and are also a common cause of infections both in the
community and in health-care facilities. People with
methicillin-resistant Staphylococcus aureus (MRSA)
infections are 64% more likely to die than people with
drugsensitive infections.
- In N. gonorrhoeae, resistance has rapidly emerged to
sulphonamides, penicillin, tetracyclines, macrolides,
fluoroquinolones, and early generation cephalosporins. In
most countries, the injectable extended-spectrum
cephalosporin (ESC) ceftriaxone is the only remaining
empiric monotherapy for gonorrhea.
- Drug-resistant HIV (HIVDR). – People receiving
antiretroviral therapy can acquire HIVDR, and people can
also be infected with HIV that is already drug resistant.
Among immunocompromised patient, ongoing viral
replication and prolonged drug exposure lead to resistant
strains. Resistance has developed to most antivirals
including antiretroviral (ARV) drugs. WHO ARV guidelines
now recommend the adoption of a new drug, dolutegravir,
as the preferred first-line treatment for adults and children.
- Malaria has Partial resistance to artemisinin and
resistance to a number of the ACT partner drugs has been
confirmed in Cambodia, Lao People’s Democratic
Republic, Myanmar, Thailand, and Viet Nam in Malaria
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
- Drug-resistant Candida auris, one of the most common
invasive fungal infections, is already widespread with
increasing resistance reported to fluconazole,
amphotericin B and voriconazole as well as emerging
caspofungin resistance.
- What accelerates the emergence and spread of
antimicrobial resistance? The main drivers of
antimicrobial resistance include the misuse and overuse
of antimicrobials; lack of access to clean water, sanitation
and hygiene (WASH) for both humans and animals; poor
infection and disease prevention and control in health-
care facilities and farms; poor access to quality,
affordable medicines, vaccines and diagnostics; lack of
awareness and knowledge; and lack of enforcement of
legislation.
- Leads to:
• prolonged hospital stays
• more expensive
• intensive care
• compromise surgery and chemotherapy.
• risky: Medical procedures, such as surgery, including
caesarean sections or hip replacements, cancer
chemotherapy, organ transplantation,
Ebola and other high-threat pathogens
- In 2018, the Democratic Republic of the Congo saw two
separate Ebola outbreaks, both of which spread to cities
of more than 1 million people. One of the affected
provinces is also in an active conflict zone.
- WHO’s R&D Blueprint identifies diseases and pathogens
that have potential to cause a public health emergency
but lack effective treatments and vaccines. This watchlist
for priority research and development includes Ebola,
several other hemorrhagic fevers, Zika, Nipah, Middle East
respiratory syndrome coronavirus (MERS-CoV) and Severe
Acute Respiratory Syndrome (SARS) and disease X, which
represents the need to prepare for an unknown pathogen
that could cause a serious epidemic. “Disease X”*
Weak Primary Health Care
- Primary health care is usually the first point of contact
people have with their health care system, and ideally
should provide comprehensive, affordable, community-
based care throughout life.
- Yet many countries do not have adequate primary health
care facilities. This neglect may be a lack of resources in
low- or middle-income countries, but possibly also a
focus in the past few decades on single disease
programme. In October 2018, WHO co-hosted a major
global conference in Astana, Kazakhstan at which all
countries committed to renew the commitment to primary
health care made in the Alma-Ata declaration in 1978.
Vaccine hesitancy
- The reluctance or refusal to vaccinate despite the
availability of vaccines – threatens to reverse progress
made in tackling vaccine-preventable diseases
- The reasons why people choose not to vaccinate are
complex; a vaccines advisory group to WHO identified
complacency, inconvenience in accessing vaccines, and
lack of confidence are key reasons underlying hesitancy.
J.A.K.E 17 of 26
Health workers, especially those in communities, remain
the most trusted advisor and influencer of vaccination
decisions, and they must be supported to provide trusted,
credible information on vaccines.
Dengue
- A mosquito-borne disease that causes flu-like symptoms
and can be lethal and kill up to 20% of those with severe
dengue, has been a growing threat for decades. A high
number of cases occur in the rainy seasons of countries
HIV
- The progress made against HIV has been enormous in
terms of getting people tested, providing them with
antiretrovirals (22 million are on treatment), and providing
access to preventive measures such as a pre-exposure
prophylaxis (PrEP, which is when people at risk of HIV take
antiretrovirals to prevent infection).
- Reaching people like sex workers, people in prison, men
who have sex with men, or transgender people is hugely
challenging. Often these groups are excluded from health
services. A group increasingly affected by HIV are young
girls and women (aged 15–24), who are particularly at high
risk and account for 1 in 4 HIV infections in sub-Saharan
Africa.
Nursing Competency
- NURSING COMPETENCY includes core abilities that are
required for fulfilling one's role as a nurse
- NCSBN (2005) defines competence as the application of
knowledge, interpersonal decision making, and
psychomotor skills within the context of public health,
safety, and welfare
- Listed below are the competencies or skills specific to
BSN.
• Apply knowledge of physical, social, natural and
health sciences and humanities in the practice of
nursing.
• Perform safe, appropriate and holistic care to
individuals, families, population, groups and
community utilizing nursing process.
• Apply guidelines and principles of evidence-based
practice in the delivery of care.
• Practice nursing in accordance with existing laws,
legal, ethical and moral principles.
• Communicate effectively in speaking, writing and
presenting using culturally-appropriate language.
• Report/document client care accurately and
comprehensively.
• Collaborate effectively with inter-, intra- and multi-
disciplinary and multicultural teams.
• Practice beginning management and leadership skills
using system approach in the delivery of client care.
• Conduct research with an experienced researcher.
• Engage in lifelong learning with a passion to keep
current with national and global developments in
general, and nursing and health developments in
particular.
• Demonstrate responsible citizenship and pride in
being a Filipino
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Apply techno-intelligent care systems and processes
in health care delivery.
• Uphold the nursing core values in the practice of the
profession.
• Apply entrepreneurial skills in the delivery of nursing
care.
CULTURE – DELIVERING HEALTH CARE TO THE FILIPINO
- Cultural Heritage includes: cultures, customs, beliefs,
rites, rituals, ceremonies, indigenous knowledge, social
customs and traditions, arts, crafts, music, political and
ideological beliefs that influence culture and behavior,
history, practices concerning the natural environment,
religious and scientific traditions, language, sports, food
and drink, calendars, traditional clothing, cybercultures in
the digital world, and emerging new cultures which will
become the heritage of the future.(Barker, 2013)
- Culture is a set of beliefs, values, and assumptions about
life that are widely held among a group of people and is
transmitted intergenerationally (Leininger, 2002).
- 2014 Lancet Commission on Culture and Health argued
that “the systematic neglect of culture in health and
health care is the single biggest barrier to the
advancement of the highest standard of health worldwide”
(WHO, 2017).
- Culture determines how health care information is
processed, received, and distributed; how rights and
protections are exercised; what is considered to be a
health problem; how symptoms and concerns of the
problem are expressed; who provides treatment for the
problem; and what type of treatment should be given
(Giger, 2012; Purnell and Paulanka, 2012; Spector, 2012).
- Understanding the beliefs and practices these clients
bring to the clinical setting, their responses to health and
illness, and the type of health care they expect to receive
are important data that nurses should draw on when
developing a plan of care for clients. (Stanhope, 2014)
- Ex. Colorful fiestas happening all-year round. Celebrating
fiesta is an influence of the Spanish colonizers and was
mainly done to honor the patron saints.
- Ex. Kamayan. Filipinos love to eat and when the food is
especially sumptuous, they eat kamayanstyle. From the
Filipino word kamay or hand, kamayan is the traditional
way of dining using one’s bare hands.
Filipino Customs and Tradition
• Ex. Child marriage like in the indigenous people of the
Tagakaolo community in Mindanao. The legal age to get
married in the Philippines is 18 but the practice is widely
spread across particularly in rural and isolated areas
where poverty, access to education and social norms
plays a crucial role. (SaveThe Child.org)
• Ex. In Ifugao, the dead is carried to the “lubuk” (grave) for
the internment. Grave is a tunnel built in a hill side. It
could be individual grave or clan for several generations. It
has small opening but has a large space inside. Rocks and
soil are put in place after a person is buried and opened
J.A.K.E 18 of 26
again if another is to be buried or the bones of a deceased
is exhumed for the purpose of “bogwa” (Tuguinay,2009).
• The Ifugao Rituals in Honoring the dead.
• Ex. Use of local alcoholic beverages such as tuba or a
basic fermented drink from nipa palm and coconut.
Lambanog, a distilled tuba. Laksoy, tempered by the
addition of fruits. Basi of Ilocano.
Filipino Values, Traits and Beliefs
• Ex. Practiced as a sign of respect to elders, pagmamano is
one of the oldest and most notable Filipino tradition there
is. Mano means hand in Spanish, fittingly so as
pagmamano is done by gently tapping the hand of the
elder to a younger person’s forehead. The elder in return
says “God bless you” hence why the act is also often
referred to as “bless”.
• Ex. Values for families. Many Filipinos are reluctant to
embrace birth control, since having a number of children
is socially
• Ex. Having fondness for family reunions during secular
and religious holidays such as Christmas, New Year’s Eve,
All Saints' Day, Holy Week, Fiestas, homecomings,
birthdays, weddings, graduations, baptisms, funerals etc.
is evidence that Filipino people valued not only our
cultural tradition but the spirit of our family.
• Ex.Filipino Traits
- Ilocanos have a reputation for being very hard working
and extremely frugal, which undoubtedly results from
their difficult life on their ancestral farms, that have
notoriously poor soil conditions
- Visayan is the archetypal opposite. The abundant
marine resources and rich volcanic soils of the central
islands has helped to produce a culture that values
music, fun, and gregarious personal relations
Cultural Diversity
- Cultural diversity is a complex and multifaceted concept
that denotes the differences amongst individuals,
particularly those linked to values, attitudes, beliefs,
norms, behaviors, customs, and ways of living. (Nies, M,
2015).
• Catholics fast or abstain from meat on Ash
Wednesday and each Friday of Lent
• Muslims refrain from eating during the daytime hours
for the month of Ramadan but are permitted to eat
after sunset
• Mormons refrain from ingesting all solid foods and
liquids on the first Sunday of each month
Cultural Competence
- Cultural competence is understanding as well as
respecting the groups’ values and beliefs so as to function
effectively in caring for members of that cultural group
- Cultural competence comprises more than having
sensitivity or awareness of cultures. It demands an active
process of learning and developing skills to engage
effectively in cross-cultural situations and reevaluating
these skills over time. (Nies, M, 2015)
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
- Barriers to Developing Cultural Competence:
• Stereotyping is ascribing certain beliefs and behaviors
about a given racial and ethnic group to an individual
without assessing for individual differences.
• Prejudice is the emotional manifestation of deeply
held beliefs about a group that is not based on reason
or experience but rather on negative or favorable
preconceived feelings. Often precursors for
discriminatory acts based on prejudging, limited
knowledge about, misinformation about, fear of, or
limited contact with individuals from that group.
Those who are prejudiced wish to deny the individuals,
on the basis of race, skin color, ethnicity, or social
standing, the opportunity to benefit fully from
society’s offerings of accessible health care,
education, good jobs, and community activities.
• Racism is a form of prejudice that occurs through the
exercise of power by individuals and institutions
against people who are judged to be inferior on the
basis of intelligence, morals, beauty, inheritance, and
self-worth. Individuals are denied certain
opportunities (e.g., jobs, housing, education, and
health care) typically enjoyed by the larger group
because of some characteristic over which they have
no control.
• Ethnocentrism, or cultural prejudice, is the belief that
one’s own cultural group determines the standards by
which another group’s behavior is judged.
• Cultural Imposition is the belief in one’s own
superiority, or ethnocentrism, and is the act of
imposing one’s cultural beliefs, values, and practices
on individuals from another culture.
• Cultural Conflict is a perceived threat that may arise
from a misunderstanding of expectations when
nurses are unable to respond appropriately to another
individual’s cultural practice because of unfamiliarity
with the practice (Andrews and Boyle, 2012).
• Culture Shock is the feeling of helplessness,
discomfort, and disorientation experienced by an
individual attempting to understand or effectively
adapt to a cultural group whose beliefs and values are
radically different from the individual’s culture.
Terminologies
• Antimicrobials - including antibiotics, antivirals,
antifungals and antiparasitic - are medicines used to
prevent and treat infections in humans, animals and
plants. Multi- and pan-resistant bacteria is also known as
“superbugs.”
• Disease X - represents the knowledge that a serious
international epidemic could be caused by a pathogen
currently unknown to cause human disease
• Exercise - is a subcategory of physical activity that is
planned, structured, repetitive, and aims to improve or
maintain one or more components of physical fitness.
• Physical activity - is defined as any bodily movement
produced by skeletal muscles that require energy
expenditure
J.A.K.E 19 of 26
• Beliefs- is a perception about the reality of things and are
shared ideas about how the world and his environment
operate. It is influenced by emotions, attitudes, values,
ideology, and religion
• Culture - represents shared norms, values, traditions, and
customs of a group that typically define and guide
appropriate and inappropriate attitudes and behaviors.
• Norms are the rules by which human behavior is governed
and result from the cultural values held by the group.
• Subculture i- used for fairly large aggregates of people
who share characteristics that are not common to all
members of the culture and that enable them to be a
distinguishable subgroup.
• Tradition - a belief or behavior (folk custom) passed down
within a group or society with symbolic meaning or special
significance with origins in the past
• Value refers to a desirable or undesirable state of affairs.
Values are a universal feature of all cultures, although the
types and expressions of values differ widely.
INFORMATION TECHNOLOGY AND COMMUNITY HEALTH
eHealth
- It is the use of ICT for health; recognized by WHO as cost-
effective means of using ICT in the health care services,
health surveillance, health literature, health education
and research.
- The power of data and information are:
1) Continuity of interoperability of care stops in unlikely
event that a record gets misplaced.
2) Illegible handwriting poses misinterpretation of data.
3) Patient privacy is compromised.
4) Data are difficult to aggregate.
5) Actual time for patient care gets limited
eHealth Situation in the Philippines
- Two Main Challenges Of Today’s Health System:
1) Access to health care services
2) Access to real time information for decision making.
- 70% of population living in rural are struggling with no or
limited access to quality inpatient and outpatient care
services.
- Health demographics showed segmented distribution of
health facilities and healthcare providers.
- Only 13% of healthcare providers and 40% tertiary
hospitals are situated in non-urban areas; on the average,
time it takes to travel to local health facility takes around
39 minutes
- Promoting Ground For eHealth Access: Ubiquity of mobile
technologies & availability of internet services in country,
DOH introduced health information systems. With aim to
improve access of health data. Some of which are the
following:
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022

• eFHSIS simulation eHealth projects in the Philippines used in

• Online National Electronic Injury Surveillance System community health practice
(ONEISS) • eFHSIS (Electric Field Health Service Information
• Philippine Health Atlas System)
• United Health Management Information System - TYPE: Health Information System and Electronic
Reporting
Using eHealth in the Community - Developed by DOH Online version of FHSIS
Universal Health Care and ICT Where FHSIS can be uploaded data
- Known as the KP or Kalusugang Pangkalahatan aims to - System Scope: Data processing and reporting at
attain efficiency by using IT in all agencies of health care the Municipal, City, Provincial and Regional Level
- Three priority health directions of KP are: - Health Geographic information systems (Health
1) Financial risk protection GIS) – a combined computer mapping with
2) Improved access to quality hospital and health care additional database management & data analysis
facility where spatial pattern of diseases in population
3) Attainment of health related MDG for public health analysts and decision making to
Electronic Medical Record (EMR) and Electronic Health understand causes, to plan interventions, to find
Record (EHR) solutions
- Electronic Medical Record (EMR) – collection of medical
information about a person that is stored on a computer
- It is used interchangeably with HER. The Electronic
Medical Record replaces the paper version of a patient’s
medical history with the Electronic Health Record
includes more health data, test results, and treatments. It
also is designed to share data with other electronic health
records so other healthcare providers can access a
patient’s healthcare data.
- Electronic Health Record - A person's electronic and
longitudinal record of health encounters across numerous • eIMCI (Electronic Integrated Management of
facilities over his lifetime. It contains all personal health Childhood Illness)
information belonging to an individual. - TYPE: eLearning
- Reflects his entire health history across his lifetime - Developed in 2009 by Ateneo Innovation Center
including data from multiple providers from a variety of - Electronic version of IMCI
healthcare settings (WHO). - Accessible in mobile device
Telemedicine
- One of the five goals of the DOH’s National eHealth
Strategic Framework for 2010– 2016 is to capitalize on ICT.
- Aimed to provide better health services to geographically
isolated and disadvantaged areas (GIDAs).
- Telemedicine is a remote diagnosis & treatment of
patients by means of telecommunications. Defined as
delivery of health care services where distance is critical
factor by all health care professionals using ICT
- For: exchange of valid info, diagnosis, treatment,
prevention of disease/ injury, research & evaluation &
continuing education of healthcare providers (WHO)
- Four elements that are specific to telemedicine (WHO)
1) Purpose is to provide clinical support.
2) Intended to overcome geographical barriers,
connecting users who are not in the same physical • NTHC Learning videos – National Telehealth Center
location - TYPE: eLearning
3) Involves the use of various types of ICT. - Funded by USAID (United State Agency for
4) Goal is to improve health outcomes. International Development)
eLearning - Developed by UP MLA -NTHC
- The use of electronic tools to aid in teaching. - Created elearning videos for TB, stroke, bird flu &
- Can be done synchronously, asynchronously, or in a child poisoning
combination of both. • SPASMS (Synchronized Patient Alert via SMS)
- Can be in form of instructional video & informational text - TYPE: Alert System
blast to social network help group and interactive - Add on to WAH (Wireless Access System)
- Reminder for patient on due for ff up
J.A.K.E 20 of 26
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• SPEED (Surveillance in Post Extreme Emergencies &
Disasters)
- TYPE: Disaster Management & SMS Reporting
- Objectives:
o Detect early unusual increase in CD & NONCOM
health conditions
o Monitor health trends determine. effectiveness of
intervention
o Enable identification of response to handle
emergency
- Target Beneficiaries
o Ultimate beneficiaries: disaster affected
populations
o Immediate beneficiaries: health emergency
managers & decision makers
- Project of World Health Organization (WHO) and DOH
Health Emergency Management Staff (DOH HEMS)
- Allow CH Nurse submit daily reports of prevalent
diseases STAT after disaster via SMS, e mail & other
ICT
- Sends Immediate Notification Alerts (INAs) to CH
Nurses for possible outbreaks based on available
data
- Allow CH Nurse submit daily reports ofprevalent
diseases STAT after disaster via SMS, e mail & other
ICT
- Legal Framework:
o Republic Act 10121: Phil Disaster Risk Reduction
and Mgt Act of 2010
o DOH Admin Order 2004-168: National Policy on
Health Emergency and Disasters
• RxBox
- TYPE: Telemedicine
- Multi component device comprising: BP monitor,
pulse oxymeter, ECG, fetal heart rate monitor,
maternal tocometer temperature sensor
- provide better access to life saving health care service
in isolated disadvantaged areas.
- Telemedicine device:
o capturing medical signals through built in medical
sensors,
o stores data in EMR & transmits health info via
internet to clinical specialist in PGH for expert
advice.
o Improved local referral system by facilitating
teleconsultations (audio video conferences )
within National Telehealth Service Program.
o Reduce overall cost of healthcare enables health
workers to diagnose, monitor & treat patients
within rural health facility ,
- Funded by DOST-PCHRD (Dept of Science &
Technology Phil Council for Health Research)
- Develop by UP-Mla EEIE (UP Electrical & Electronics
Engineering Institute), UP National Institute of Physics
& UPM NTHC
- Since 2014, total of 143 units of RxBox had been
deployed in the country.
• Buddyworks
J.A.K.E 21 of 26
- TYPE: Telemedicine and eLearning
- Implemented in 2004 by UP-Mla NTHC (National
Telehealth Center funded by eGovernment of
Commission of information communication
Technology
- Allow those in GIDA to send referrals to medical
specialist of UP PGH via SMS & eMail
• SEGRIS (Sergworks Rural Health Information System)
- TYPE: Electronic Medical Record
- Electronic Medical Record developed for RHU
- Developed by Sergworks, a local software company in
Davao
• SHINE (Secure Health Information Network Exchange)
- TYPE: Electronic Medical Record and SMS Reporting
- Electronic Medical Record developed by SMART
Communication http://shine.ph
• Wireless Access for Health (WAH)
- TYPE: Electronic Medical Record and Health
Information System
- Augmented the existing CHITS by connecting health
center in BROADBAND internet access
- Implemented in 2010 in Tarlac
- Done by Private public partnership ( of Qualcomm,
UPM NTHC,USAID, SMART, DOH IMS, Center for
Health Devp ..( Region III, RTI International, National
Epidemiological Center (Tarlac State University local
government
• CHITS (Community Health Information Tracking
System)
- TYPE: Electronic Medical Record
- Developed in 2004 by Dr. Herman Tolentino, by UP
Mla College of Medicine, Medical Informatics Units.
- Began in Pasay Health Center, then applied in more
than 48 health centers.
- Program divided in diff module depending on health
program such as EPI, NTP
- Free and Open Source Software
- https://demo2010.chit.ph for demo
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
Good Data Qualities
1) Accuracy - Ensures that documentation reflects the event
as it happened. A computerized system, a computer can
be instructed to check for specific fields for validity and
alert the user to a potential data collection error.
2) Accessibility – A data characteristic which ascertains
data availability should the patient or any member of the
health care staff needs it.
3) Comprehensiveness – Data inputted should be complete.
Done by making sure that all required fields in the
patient’s record are properly filled up.
4) Consistency/ Reliability – Having no discrepancies in
data recorded makes it consistent.
5) Currency – All data must be up-to-date and timely.
Exemplified when the community health nurse records
data at point-of-care or when it happened.
6) Definition – Data should be properly labelled and clearly
defined. Ex: 36 is just an ordinary number unless it is
labelled as an age of a person.
Roles of Community Health Nurses in eHealth
1) Data and records manager – Monitors the trend of
diseases through the EMR, allowing for targeted
interventions for health promotion, disease prevention
curative services, or rehab. Nurses also maintain the
quality of data in the EMRs, making sure everything is up-
to-date.
2) Change Agent – Nurses act as change agents by working
closely with the community and implementing eHealth
with them and not for them. They also collaborate with
leaders, policy makers, stakeholders and other
community health professionals to determine their
knowledge and awareness on eHealth and appropriate ICT
tools. Nurses then build baseline eHealth knowledge and
help develop appropriate eHealth tools for the community.
3) Educator – Nurses provide health education to individuals
and families through ICT tools, participate on making
eLearning videos on a specific disease in which the
patients can watch during their waiting time at the health
center.
4) Telepresenter - In the event that a patient needs to be
referred to a remote medical specialist through
telemedicine, nurses may function as a Telepresenter.
Meaning that the nurse may need to present the patient’s
case to a remote medical specialist.
J.A.K.E 22 of 26
5) Client Advocate – As an advocate, nurses must
safeguard patient records, ensuring confidentiality and
privacy of all patient information are being upheld.
6) Researcher - Nurses responsible for identifying possible
points for research and developing a framework, based on
data aggregated by the system. Also pursues continued
nursing informatics education, with the goal of developing
a research framework.
7) Other computer-based information system developed
by the DOH:
• Integrated Clinic Information System (iClinicSys) for
RHU/IICs, PHOs, MHO/CHOs, and BHS,
• A homegrown EMR of Department of Health
Philippines, which supports the functions of a clinic,
i.e. barangay health station, rural health unit, or other
health care facility that is devoted to providing primary
health care service of patients
• Integrated Hospital Operations and Management
Information System (iHOMIS) for hospitals
Factors affecting eHealth in the Country
1) Limited Health Budget
2) Emergence of Free & Open Source Software - "open
source" makes source code free, available for everyone,
cuts cost in developing software
3) Decentralized government – Diverse & unrelated eHealth
projects all over country. Needs to connect with each
other, having EMR system for all health centers
4) Target Users are Unfamiliar with Technology – Requires
training of personnel on basic computer skills, use of
software & maintenance of equipment. Limited Health
Budget
5) Surplus of "Digital Native" Registered Nurses "Digital
Nurses" is a person who grew up & is famililar with digital
technologies. RN Heals (Registered Nurses for
Enhancement & Local Systems ) provide nurses in a
underserved, remote area for one year.
Terminologies
• eHealth - is the use of information and communication
technologies (ICT) for health(WHO). The eHealth unit
works with partners at the global, regional and country
level to promote and strengthen the use of ICT in health
development
• eHealth Solutions - is the cost-effective and secure use
of information and communication technologies in
support of the health and health-related fields including
healthcare, health surveillance and health education,
knowledge, and research (WHO); examples are EHRSs like
EMRS, HMIS and registry systems.
• Health Care Provider - is a licensed health care
professional such as doctors, nurses, dentists and
midwives, among others, who provides health services to
health care clients
• Health Facility - is a building or physical structure where
health services to health care clients are being provided. It
is synonymous with institutional health care provider
(IHCP).
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
• Health Information System (HIS) refers to a system
designed to manage healthcare data. This includes
systems that collect, store, manage and transmit a
patient’s electronic medical record (EMR), a hospital’s
operational management or a system supporting
healthcare policy decisions.
• Information and Communication Technology - refers to
all devices, networking, applications and systems used to
transmit, store, create and share information.
• Interoperability - is the ability by which systems and
devices can exchange data and interpret that shared data.
• Medical Alert Systems, also known as personal
emergency response systems, offer a fast and easy way
for the elderly, people with health issues
• National eHealth Governance Structure (NeHGS) - is
the overarching structure created to oversee and provide
direction and technical guidance in the establishment of
the National eHealth Program.
NURSE ENTREPRENEUR
- International Council of Nurses (ICN) member countries
are developing innovative role of nurse. These are:
Advance Nursing Practice and Nurse Entrepreneurship
- Characteristic of Advance Nursing Practice: Based on
three dimension (ICN)
a) educational preparation
b) nature of practice and
c) regulatory mechanism
- ANP has:
• advance level of educational program,
• a formal system of licensure,
• registration and certification or credentialing
• higher degree of autonomy and independent practice,
• advanced assessment & decision making skills
• with recognized advanced clinical competencies
• capable of integrating research, education and
clinical management,
• perform case management, provide consultant
service to other health professionals &
• recognize as first point of entry for service.
- Other country-specific regulation: right to prescribe meds
and treatment, authority to refer to other professionals,
admit to hospitals & title protection
- Nurse Entrepreneurs – have ability to perform wide range
of activities & services focus on health promotion, disease
prevention, rehabilitation and management consultancy.
- Definition by ICN proprietor of a business that offers
nursing services of a direct care, educational research,
administrative or consultative nature
- Definition according to ICN is “salaried nurse who
develops, promotes & delivers innovative health, nursing
programme or projects within a given health care setting
- Defined by: Philippine Nursing Law Republic Act 9173) –
States that was independent nurse practitioner, nurses
are primary responsible for the promotion of health and
prevention of illness.
- Personal Qualities of Nurse Entrepreneurs are:
independent, risk-takers, visionary, good organizer,
J.A.K.E 23 of 26
planner and proactive. Coupled with appropriate
education, competence and knowledge.
- Practice Requirement:
• Board of Nursing is mandate to “regulate and
supervise the practice of nursing”
• BON Resolution No. 14 S. 1999 – Guidelines for
Nursing Specialty Certification. AIM is providing
mechanism of ensuring that practitioner fulfil
requirement practice. Ex. BON resolution 459 –
promulgated with rules and regulation governing
practice of nursing for observance, guidance of
practitioners of mother and child nursing
• The document is entitled as “Standards of Safe
Nursing Mother and Child in the Philippines,” It
includes a section stating that the Mother and Child
Nursing Association of the Philippine (MCNAP) as the
accrediting body of the Mother and Child Nursing
Specialty Accreditation.
• Requirements for Specialization: combined
educational preparation, work experience and
passing the specialty qualifying examination. (October
2001)
• Levels of Specialization are:
- Generalist – Level 1
- Nurse Clinician I (Level II)
- Nurse Clinician II (Level III)
- Clinical Nurse Specialist (Level IV)
• Competency –based Framework: Submitted to the
school technical group for development,
implementation & evaluation of curricula. This
strengthens nursing program.
• Performance Audit – To find out areas of strength and
weakness. Performed in partnership with a nurse with
experienced in nursing administration
- Community – Based Projects
• Metro Manila Development Screening for
Preschoolers
• Health Promotion Nursing Clinic – Wellness Nursing
Clinic
Health Promotion Nursing Clinic
• Risk Assessment can be using the Assessment Data
based for Family Nursing Practice as a tool
• Intervention can be in form of promotion or reinforcement
of positive health practice
• Counselling is provided for clients at-risk. Ex. based on
Lifestyle related diseases, these are obesity, physical
inactivity, smoking and alcohol abuse based on the
Control and Prevention of Non-Communicable Disease
• Clients may also refer to Physician, based on result of
risk-assessment
• Ex. Clients consulting for nutrition. health maintenance,
mobility and sleep pattern
• Activities should be on the basis of pre-formulated
guidelines
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
WAYS to Deliver Nursing Care In A High Level Of
Competence
1) First requirement: Establish legal basis for practice.
- Nurse should have advance competency and
capability for decision-making
- through credentialing which is the recent
development in Philippines
- Ex. MCNAP (Maternal and Child Nursing Association
in the Philippines is the credentialing organization for
mother and child nursing practitioners. With levels of
specialization from Generalist (Level I) to Clinical
Nurse Specialist (Level IV) Requirement for
specialization are a combination of educational
preparation, work experience, passing of specialty
qualifying examination (MCNAP, 2001 45).
Promulgated last October 2001, which is a step for
advance nursing practice.
- Credentialing can be by licensure, registration,
recognition (Schober, 2006), depends on country’s
resources and regulation.
2) Standard of Care Practice is defined as a local practice
situation that is professionally agreed, both desirable and
achievable. For nursing clinics, these are:
- Define the nursing service to be provide
- List criteria for admission, enrollment, discharge from
the program or service
- Delineate areas of responsibility, function of health
team members
- Establish system of documentation
- Setting up system of reimbursement
- Ex. of standard of Care is the American Nurses
Association (ANA) Standards of Clinical Nursing
Practice with 15 standards of professional
performance & with appropriate measurement criteria
3) Use Guidelines
- Ex. Philippine Guidelines for Periodic Examination
(2204)
- Guidelines provides for effective screening for
diseases among apparently healthy Filipinos
- Guidelines provide flexible recommendations that can
be adapted to specific needs
- Guidelines are useful reference as to what test clients
need to have
4) Use Accurate and Concise Documentation
- If not documented, no nursing care done. Include
clinical information, patient’s understanding.
J.A.K.E 24 of 26
- A comprehensive documentation if required for
insurance reimbursement
- Example: For a detailed nursing practice activity for
nutritional concern, include the following:
• Assess using nutritional assessment tool
• Analysis of body and dietary composition
• Participate in meal planning
• Give pointers on therapeutic diet
• Refer to a doctor if with medical condition or risk
condition
• Monitor guidelines
- The Guidelines include: data to assess client’s
condition, interventions option (Dependent,
Independent, Collaborative), signs and indication that
client needs referral, signs client is not making
progress
Commonly Nursing Diagnoses For Nursing Clinic
- Ex. Alteration in Nutrition, Alteration in Comfort: Pain,
Disturb Sleeping Pattern Impaired Health Maintenance,
Impaired Mobility, Ineffective Coping: Individual Wellness
Diagnoses for Nursing Clinic
- A diagnoses very useful for healthy clients who requires
teaching for health promotion, disease prevention and
personal growth.
- Ex. Expressed as “Readiness for Enhanced, Potential for
Enhanced or Potential for Growth
Establish outcomes of care:
- Make attainment of goal clear and precise.
- Nurse and client are both conscious what necessities to
change.
- Inputs by additional health professional are welcome.
- Ex. Outcome of Care
• loses 2 kg of body weight per 2 weeks
• attains CBG within normal
- Activities to attain result will be itemized.
- Monitoring result will be communicated by patient every
day to the practitioner
- Work closely with physician if there is a need to
adjustment dose of medication such as insulin
- With these the practitioner can estimate the quantity of
visits, type of monitoring, also makes reimbursement and
payment for services clearer.
Nursing Consultation and Components
• Independent Intervention
- Actions and practice that a nurse is licensed to
prescribe, perform and delegate based on knowledge
and skills
• Dependent Intervention
- Those prescribed by the physician and carried out by
the nurse
• Collaborative Interventions
- Called as interdependent Interventions
- Carried out with other members of the health team
- Includes coordination of health care services
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022
Most common Consultation in a Clinic-based Practice
• Problems on comfort,
• Problems on body composition,
• Perceived high level of stress,
• Menstrual concern,
• High Blood Pressure
Duration of Nursing Consultation
- 30 minutes to one hour of focused interaction
- Steps:
1) Initial is to establish rapport: Greet patient with a
smile, introduce practitioner’s name, ask client what
name/form of address they prefer to be called.
2) Put the preferred name for future use
3) Ask patient to sign form with basic identifying data:
Creation of Healing Space
- Performed in several ways in a nursing clinic
- To release tension – client sit comfortably, remove shoes,
wear slippers. Set aside belongings
- To create healing atmosphere – Use relaxing essential oil
in burner like chamomile, lavender
- Clients are used to having “something to bring” after
consultation.
- Have a written nursing prescription. Include reminders.
Pointers for care & instructions they need to carry out as
part of their interventions, include next schedule of visit.
- Client were made to experience interventions on sensory
level, verbal instruction, aromatherapy, massage & Reiki
- At the end of session, the practitioner – need to have a
review of the plan of action and agreement on
management. Gives client a run through on what transpire
during visit & prepares for closure of visit.
- Plan for subsequent visit & its purpose identified.
- Record care given. Feedback on care is documented.
Documentation – makes nurse aware of progress and
reference for next visit.
Charging Client Nursing Professional Fee
• Practice in other country: Nursing fee is charge in the
National Health Insurance, included as legitimate provider
of care, based on provision of health insurance system &
cover their services as part of health care
• ICN Guidelines for Nursing Entrepreneurs: Suggested
Criteria for calculation of fee
- Complexity of task, Professional responsibility implied,
Level of Expertise Required, Time involved, Equipment
Needed
• Principles served as basis for Professional Independent
Practice:
- There will be standard fee for treatment and follow up
consultation – charged less if visit is for monitoring or
checking of patient progress, cost of the fee is
discussed with client to give them opportunity to
decide, no client will be deprived of nursing services
just because of “lack” of monetary capability
- Set a standard fee for consultation / treatment
- Set a sliding scale to accommodate client capacity to
pay
- Professional fee is paid after consultation
J.A.K.E 25 of 26
- Marketing the Services of the Nursing Clinic
Marketing
- This is for the viability of the venture. So that the
population will know about the services.
- Flyers – contains services offered, schedule, location of
clinic, practitioners and the contact number.
- Having short talk about the clinic in a various office,
explanation of services and open forum about 15 minutes
and then giving of flyers
- Common questions are about: Nursing Services offered,
Duration of consultation, Credentials of Practitioner,
Problems that they can consult with the nurse, Cost of
consultation of a specific treatment cost
- Referrals for satisfied clients/ patients
Establish Linkages and Referral System
Linkages
- Referral to and from medical practitioners
- With health agencies and other health providers
- How to Establish Linkages?
• Make a presentation of services being offered
• Discussion of fees for nursing service
• Have brochures of the nursing service to the health
provider services offered, schedule, location of the
clinic, name of person to be contacted.
Referrals:
- Have a referral form.
• With data that are useful: such as what type of
nursing service the nurse will provide and why the
patient is being referred to the doctor
Phil health-Accredited Birthing Homes of Registered
Nurses
- As per Phil Health Circular 2017-0023 (Revision 1),
Registered nurses can become professional heath care
providers for the three (3) packages in PhilHealth-
accredited birthing homes.
- They can apply for accreditation with the Philippine Health
Insurance Corporation (PhilHealth) as providers of
maternity care, newborn care and normal spontaneous
delivery packages in accredited birthing homes.
- Once accredited, the nurses will receive payment from
PhilHealth for services rendered to members who are
availing themselves of the MCP, NCP or NSD packages in
accredited birthing homes.
- In A Primary Care Facility
• The policy stated that nurses who will qualify for
accreditation may provide services for family planning
benefits being performed and reimbursed in primary
care facilities such as intra-uterine device (IUD)
insertion and Subdermal Contraceptive Implant
Package, subject to additional requirements such as
training.
- This is in recognition of their vital roles in the local health
care system. They are among the promoters of primary
health care, acting as front liners in communities to
deliver public health services.
 COMMUNITY HEALTH NURSING 2: BSN 3RD YEAR 1ST SEMESTER FINAL 2022

- Requirements: To qualify for accreditation, nurses must
be:
• licensed practitioners and
• must have completed training on Basic Emergency
Obstetric and Newborn Care from Department of
Health (DOH) institutions.
• at least two (2) years’ experience in the labor or
delivery room of at least a Level 1 hospital.
• It is important for the applicants to adhere to the
standards of the Nursing profession and with the
Code of Ethics for Registered Nurses.
• They must comply with the provisions set forth in the
Performance Commitment that they will sign with
PhilHealth,
• Must be active PhilHealth members with qualifying
premium contributions at the time of application.
• The nurses, however, may be affiliated with a
maximum of three (3) Phil Health accredited
nonhospital birthing facilities.
- Monitoring: They will be subjected to performance
monitoring in accordance with the Health Care
- Providers: Performance Assessment System (HCP-PAS)
articulated in PhilHealth Circular 2016-0026.
countries are developing innovative role of nurse through
Advance Nursing Practice and Nurse Entrepreneurship
• Marketing - The American Marketing Association defines
marketing as the process of planning and executing the
conception, pricing, promotion and distribution of ideas,
goods and services to create exchanges that satisfy
individual and organizational goals.
• Philippine Health Insurance Corporation (PhilHealth) -
Government corporation attached to DOH. It administers
the National Health Insurance Program, which was
established to provide health insurance coverage &
ensure affordable, accessible health care services for all
Filipinos.
• Referrals - an act of referring someone or something for
consultation, review, or further action.
• Reiki – touch therapy
• Standards of Nursing Practice developed by the
American Nurses' Association (ANA) provide guidelines for
nursing performance. They are the rules or definition of
what it means to provide competent care
TRUST YOURSELF!! GOOD LUCK PIPOL!!

Terminologies
• Advance Nursing Practice - reference to advanced
nursing roles or advanced levels of nursing practice often
used interchangeably with “Advanced Practice Nursing.”
Defined as a registered nurse who has acquired the expert
knowledge base, complex decision-making skills and
clinical competencies for expanded practice, the
characteristics of which are shaped by the context and/or
country in which s/he is credentialed to practice. A
master’s degree is recommended for entry level. (ICN ).
Characteristic of Advance Nursing Practice based on
three dimension (ICN) : a. educational preparation
b.nature of practice & c.regulatory mechanism
• Auric Fields – Physical and Non – physical layer of body.
Traditional healing
• Basic Emergency Obstetrics and Newborn Care
(BEmONC) Provider - is a capable private health facility
or an appropriately upgraded public health facility that is
either a Rural Health Unit (RHU) and/or its satellite
Barangay Health Station (BHS) or Hospital capable of
performing the following emergency obstetric functions.
• Conventional paradigms – Physical Body as the basis for
assessment
• Healing Space - Based on Gurudevi Ahalya Running Deer
Mahakali, a spiritual leader and shamatic healer.
Performed in several ways in a nursing clinic to release
tension, to create healing atmosphere.
• Independent Practice Nurse - Defined as "a registered
nurse who provides professional nursing services, as a
proprietor of a business, through direct patient care,
education, research, administration or consultation"
(Nurse Entrepreneurship -Seizing the Challenge by Carol L
Hamilton). International Council of Nurses (ICN) member

J.A.K.E 26 of 26