NURSING PRACTICE 1
totally free SERVICES)
COMMUNITY HEALTH NURSING
(PART 1)
PRIMARY HEALTH CARE
ALMA ATA DECLARATION
September 6-12, 1978
 First International Conference on PHC
 PHC goal: HEALTH FOR ALL BY THE
YEAR 2000
 ALMA-ATA, Kazakhstan, RUSSIA
(USSR)
 Sponsored by WHO and UNICEF
ASTANA DECLARATION
 October 25-26, 2018
 Marks by 40 years since the first
Global Conference on PHC
 Declaration of Astana took place in
Astana, Kazakhstan
 Hosted by WHO, UNICEF and the
Government of Kazakhstan
LETTER OF INSTRUCTION (LOI) 949
 Philippines First Asian country to
have adopted PHC as a national
strategy
 The legal basis of PHC was signed by
Pres. Ferdinand Marcos
 Signed by October 19, 1979
 HEALTH FOR ALL FILIPINOS (by the
year 2000) AND HEALTH IN THE
HANDS OF THE PEOPLE (by the
year 2020)
 END GOAL of PHC approach is for
people to be SELF-RELIANT
PRINCIPLES OF PHC: 4 A’s of PHC
1) ACCESSIBILITY
 Essential and appropriate
health services are available to
citizens within a reasonable
geographical distance by an
appropriate provider and within
a time frame that is appropriate
(Not more than 5 km away
and 30 minutes to travel)
2) AVAILABILITY
 Care can be obtained
whenever people need it (24/7)
3) AFFORDABILITY
 The cost should be within the
means and resources of the
individual and the country (not
4) ACCEPTABILITY
 Health services offered area to
be in accordance to the
prevailing beliefs and
practices of the intended
clients of care.
COMMUNITY PARTICIPATION
 Citizens and communities have a
right and responsibility to be active
partners in making decisions about
their own health and the health of
their communities.
 Heart and Soul of PHC
 The ideal word for COMMUNITY
PARTICIPATION is “The nurse is
working WITH THE PEOPLE”
HEALTH PROMOTION
 Focus or enabling citizens to increase
control over and improve their
health and well-being
 BASIC PRINCIPLE: PREVENTION IS
BETTER THAN CURE
APPROPIRATE TECHNOLOGY
 The people, procedures, equipment,
drugs, and resources used are
EFFECTIVE and CULTURALLY
ACCEPTABLE to individuals and the
community
 Use of cheaper, scientifically valid
tools and methods that are all
suitable and acceptable to the
families and communities
 E.g. use of herbal medicines,
acupuncture, acupressure
INTERSECTORAL COLLABORATION
 Partnership between community and
health agencies
 E.g.
a) Referral system among the RHU
b) NGOs
c) Local social welfare and
Development Office
SOCIAL MOBILIZATION
 Enhancing people participation
 Process of BRINGING TOGETHER
ALL SOCIETAL AD PERSONAL
INFLUENCES TO RAISE
AWARENESS of and demand for
healthcare, assist in the delivery of
 resource and services, and cultivate SANITARY 1:20,000
sustainable individual and community INSPECTOR
involvement. DENTIST 1:50,000
CONTACT 1:800
DECENTRALIZATION TRACERS
 Transfer of authority, functions
and/or resources from the center to the LEVELS OF PHC WORKERS
periphery within a specific sector 1) GRASSROOTS/VILLAGERS
 The Philippines decentralized  First contact of the community
government health services in 1992  Initial link to healthcare
through devolution with the  Renders simple
Implementation of the Local curative/preventive health
Government Code (RA 7160) measures
4 MAJOR PILLARS OF PHC  Serves as the foundation of
(CORNERSTONES) healthcare
1) INTERSECTORAL LINKAGES  Trained local individuals in the
(Multisectoral) community provides
2) USE OF APPROPRIATE  BATA:
TECHNOLOGY a) BHWs
3) SUPPORT MECHANISM MADE b) Auxiliary Volunteers
AVAILABLE c) Traditional Birth
4) ACTIVE COMMUNITY Attendants/ TBA
PARTICIPATION (sustained by social (Trained hilots)
mobilization) d) Albularyos

COMPONENTS OF PHC: “MAD 2) INTERMEDIATE LEVEL

ELEMENTS” OF PHC  First source of professional
1) Mental Health health care
2) Access to Sentrong Sigla  Attends health problems
3) Dental Health beyond the competence of
4) Education In Concerning Prevailing grassroots workers
Health Problems a) Rural Sanitary
5) Locally Endemic Disease Preventions Inspectors
And Control b) Medical Practitioners
6) Expanded Program Of Immunization and their Assistants
Against Major Infectious Diseases (RA c) Registered Midwives
10152) d) Nurse in Public Health
7) Maternal And Child Healthcare (PHN)
Including Family Planning 3) FIRST LINE HOSPITAL PERSONNEL
8) Essential Drugs Arrangement  Provide backup health services
9) Nutritional Food Supplement, And for cases that needs
Adequate Supply Of Safe And Basic hospitalization
Nutrition a) Doctors with
10) Treatment Of Communicable And Specialties:
Non-Communicable Diseases And 1. OB
Promotion Of Mental Health 2. Pediatrician
11) Safe Water And Sanitation 3. Cardiologist
4. Dentist
DOH STANDARD RATIO OF HEALTHCARE b) Other Healthcare
WORKERS Professionals
c) Nurse Specialist
BARANGAY HEALTH 1:20 HOUSEHOLDS d) Anesthesiologist and
WORKERS Surgeon
MIDWIFE 1:5,000
NURSE 1:20,000 LEVELS OF HEALTHCARE DELIVERY
MD/PHYSICIAN 1:20,000 SYSTEM
 1) PRIMARY 3. Exercise
 Basic health procedures 4. Not Smoking
 25-75 beds capacity c) Hygiene
 Puericulture centers/Birthing in (HANDWASHING)
or Lying in d) Immunization/Inoculatio
 Rural Health Unit (RHU) (RA n
1082) e) Isolation of the
 Community Health Centers Or diagnosed sick child to
Barangay Health Station (BHS) pregnant mother
2) SECONDARY f) Intake or use of
 Referral system of primary Prophylactic drugs
level 1. Antiretroviral drugs
 Minor operations and 2. Chloroquine tablets
laboratory examinations (Prophylaxis of
 100-200 beds capacity malaria)
 Outpatient Department 3. Doxycycline
Hospitals (Prophylaxis of
 Provincial Hospitals leptospirosis)
 District Hospitals/Emergency 4. Crede’s
District Hospital Prophylaxis
3) TERTIARY (prevent
 Referral system of secondary gonorrheal/chlamydi
level al eye infection)
 Highly specialized staff and g) Vector Control
technical equipment 1. Destroy breeding
 Complex medical and surgical sites (for Dengue,
interventions Zika prevention)
 Major operations and invasive 2. Clear hanging trees
procedures in the riverbanks (for
 Medical Centers & National Malaria prevention)
Hospitals 2) SECONDARY LEVEL
 Regional Hospitals  Target: Sick or at risk
 Training and Teaching individuals
Hospitals  GOAL: SCREENS clients for
early detection and prompt
3 LEVELS OF PREVENTION treatment of the disease
1) PRIMARY LEVEL  INTERVENTION: Early
 Target: HEALTHY individuals diagnosis and treatment
 GOAL: To prevent/delay the  ACTIVITIES:
actual occurrence of disease a) Case finding tools
 INTERVENTION: Health 1. Skin Slit Smears
Promotion and Disease for leprosy
Prevention 2. Sputum smear
 HEALTH EDUCATION for TB
 Basic health service 3. Swab Test for
that aims to modify COVID-19
harmful practices of b) Blood tests
people and their 1. CBC for blood
unscientific knowledge disorders
and attitude (Pancytopenia)
 ACTIVITIES: 2. ELISA
a) Health Education (Confirmatory
1. Family Planning for Dengue)
2. Genetic Counseling 3. Western Blot for
b) Healthy Lifestyle Habits HIV
1. Health Diet (Confirmatory)
2. Rest
 4. CD4 T cell f) Self-Management
Count Education for patient
(Confirmatory with diabetes
for AIDS) g) Use of
c) Contact tracing chemotherapeutic drugs
d) Quarantine (separation and radiation for cancer
of contact to well h) Provide family therapy
individuals) for abusive families;
e) Disease surveillance remove children from
f) Diagnostic Tests home
1. Ultrasound
2. CXR
3. MRI
4. CT Scan DEPARTMENT OF HEALTH
5. Mammography  Dr. Francisco Duque III (DOH
g) Treatment/Cure of Secretary)
disease  VISION: Filipinos are among the
h) Examination of breast healthiest people in Southeast Asia by
(BSE) 2022, and Asia by 2040
i) Examination of Testes  MISSION: To lead country in the
(TSE) development of a productive, resilient,
j) OPLAN Timbang equitable and people centered health
k) Screening Test & system
Selective Examinations
1. Newborn ROLES AND FUNCTIONS OF DOH
Screening 3 BASIC FUNCTIONS “LEA”
2. Screening for 1) LEADERSHIP IN HEALTH
hypertension  Serve as the national policy and
l) Trauma & CRISIS regulatory institution
PREVENTION (stress  Provide leadership in formulation,
debriefing) monitoring and evaluation of
3) TERTIARY LEVEL national health policies
 Target: Individuals with  Serve as advocate in the adoption
diagnosed illness and advance of health policies, plans and
disease programs to address national and
 GOAL: Reduce impact/limit sectoral concerns
disability, prevent sequelae and  FORMULATE
prevent death  Creates the policies, protocols,
 INTERVENTION: rules and regulations of health
Rehabilitation in the Philippines.
 ACTIVITIES:  ADVOCATE
a) Therapies  Protect the right of the people
1. Physical therapy  REGULATE
2. Occupation  All hospitals must have
therapy certification of cooperation from
(Prostheses DOH
use)  Make sure affordable and safe
b) Health care and health services in the country
treatment for those 2) ENABLER & CAPACITY BUILDER
infected by COVID-19 “IME”
c) Use of assistive devices  INNOVATE
d) Maintenance drugs  Update of health practices in
among patient with the country.
hypertension  MONITOR
e) Blood pressure and  All hospitals in the country
Blood sugar monitoring have license from DOH
  All hospitals in the country are
checked by the DOH
 ENSURE
 Must have safe and quality
health services
3) Administrator of specific services
 EMERGENCY SERVICES “EMA”
 In case of emergencies, the
DOH must ensure safe and
quality healthcare services
 MANAGE SELECTED HOSPITAL
 Specific hospitals are funded
are from DOH
 E.g. Philippine General
Hospital
 Specialized Hospitals =  Pneumonia = single largest
Specific cases (e.g. National
Kidney Institute, Philippine
Heart Centre)
 ADMINISTER BASIC SERVICES
 To provide basic health
services
UNIVERSAL HEALTH CARE (RA 11223)
 KALUSUGAN PANGKALAHATAN
(KP)
 Highest possible quality of healthcare
for EVERY Filipino
 Care that is accessible, efficient,
equitably distributed, adequately
funded, fairly financed, and
appropriately used by an informed and
empowered public
UHC’S 3 THRUSTS
 KEY PLAYERS IN UHC: DOH, LGU &
PhilHealth
1) FINANCIAL RISK PROTECTION
 Through expansion in enrollment
and benefit delivery of the National
Health Insurance Program (NHIP)
or PhilHealth
2) IMPORVED ACCESS TO QUALITY
HOSPITALS AND HEALTHCARE
FACILITIES
 Upgrading government-owned and
operated hospitals and health
facilities
 Rehabilitation and Construction of
Critical Health Facilities
 Treatment Packs for HTN and DM
 Obtained and distributed to RHUs
3) ATTAINMENT OF HEALTH-REALTED
MDGs
 MDG signed: September 2000
 Target: 2015
 Goals: 8 MDGs
 To reduce maternal and child
mortality
 TO reduce morbidity and mortality
from TB, Malaria and incidence of
HIV/AIDS
 8 MDGs
1) Eliminate Extreme Poverty And
Hunger
2) Achieve Global Primary Education
3) Promote Gender Equality And
Empower Women
4) Reduce Child Mortality (reduce the
under-five mortally rate by 2/3 in
year 2015)
infectious cause of death in
children worldwide (under-
five)
 Diarrhea =
 Asphyxia = Common cause
of newborn deaths
5) Improve Maternal Health (reduce
maternal mortality by 3 quarters
(3/4) in 2015)
 Direct Maternal Deaths
(HOUSE)
a) Hemorrhage
b) Obstructed Labor
c) Unsafe Abortion
d) Sepsis
e) Eclampsia
6) Combat Malaria, HIV/AIDS, And
Other Diseases (Including
neglected tropical diseases)
7) Ensure Environmental
Sustainability
8) Develop A Universal/Global
Partnership For Development
SUSTAINABLE DEVELOPMENT GOALS
1) No Poverty
2) 0 (Zero) Hunger
3) Good Health & Well-Being
4) Education (Quality)
5) Equality (Gender)
6) Clean Water And Sanitation
7) Affordable And Clean Energy
8) Decent Work And Economic Growth
9) Industry, Integration And Infrastructure
10) Reduced Inequalities
11) Cities And Communities (Sustainable)
12) Consumption And Production
13) Climate Change Action
14) Life Below Water
15) Life On Land
 16) Peace, Justice & Strong Institution  TCL will be transmitted to the
17) Partnership For Goals next facility in the form form of
REPORTING FORMS
IMPORTANT NOTES:  TCLS TO BE MAINTAINED
a) MDGs 4 & 5 is the priority of the ARE:
DOH a) TCL for Prenatal
b) Reduce Child Mortality And Improve b) TCL for Postpartum
Maternal Health are 2 goals which are Care
VERY specific to Maternal Child c) TCL for Family Planning
Health (MCH) d) TCL for Under One year
 Infant Mortality Rate = most old children
sensitive indicator that reflects e) TCL for Sick Children
the health of the community f) NTP TB Register
c) Reduction of maternal mortality of 75% (National Leprosy
by year 2015 Control Program)
d) NATIONAL PRIORITY: MDG 1 3) TALLY/REPORTING FORMS
(Eradicate Extreme Poverty)  Reporting forms is the ONLY
mechanism through which
FILED HEALTH SERVICE INFORMATION date are routinely transmitted
SYSTEM (FHSIS) from one facility to another
 Provides a summary of data on health  Reports are submitted directly
service delivery and selected programs to the PROVINCIAL HEALTH
from the barangay level up to the OFFICE (PHO)
national level  E-2 is the Maternal Death Form
 Reporting forms from BHU
Facility to the PHO
 FHSIS Importance:  Output Reports are solely
a) Facilitates information for produced by the PHO
monitoring and evaluating health  Data submitted to the PHO is
program implementation processed using
b) Help local government determine MICROCOMPUTER
public health priorities  The recommended frequency
c) Service delivery monitoring in tallying activities and
d) It monitors health status of the services using tally sheets is
community DAILY
e) Source of data to detect any  Counting of the tally sheet is
unusual occurrence of a disease done at the END OF THE
MONTH
COMPONENTS OF FHSIS
1) INDIVIDUAL TREATMENT RECORD RA 7160 (Devolution Code or Local
(ITR) Government Code)
 Use to record patient  Aims to transform local government
address, full name, age, units into self-reliant communities
symptoms and diagnosis and active partners
(piece of paper/patient
consultation record) LOCAL HEALTH BOARD (LHB)
 Individual treatment record or 1) PROVINCIAL HEALTH BOARD
FAMILY TREATMENT a) Chairman: GOVERNOR
RECORD is the fundamental b) Vice Chairman: Provincial Health
block or foundation of FHSIS Officer
2) TARGET CLIENT LIST (TCL) c) MEMBERS:
 Primary Advantage: Lets 1. Chairman, Committee on
nurses and midwives save Health of Sangguniang
time and effort in monitoring Panlalawigan
treatment and services to 2. DOH Representative
beneficiaries (PHN)
 3. NGO Representative b) Toothache
(Private Sector) c) Neutralize free radicals & lowers
2) CITY & MUNICIPAL HEALTH BOARD cholesterol level
a) Chairman: MAYOR  PREPARATION:
b) Vice Chairman: Municipal Health a) Fried, roasted soaked in
Officer vinegar for 30 minutes
c) MEMBERS: b) Blanched in boiled water
1. Chairman, Committee on for 15 minutes
Health of Sangguniang c) Take 2 pieces 3x a day
Panlungsod AFTER MEALS
2. DOH Representative 4) BAYABAS (Psidium Guajava)
(PHN) a) Stomach Flu/Diarrhea
3. NGO Representative b) Use for Wound Washing
(Private Sector) c) Gets rid of fungi, amoeba, and
 TAKE NOTE: bacteria
a) MIDWIFE is NOT a member of d) Antiseptic activity
the Health Board e) Toothache
b) Midwives are the FRONTLINE  PREPARATION:
WORKERS in COMMUNITY a) Young leaves can be
and RHU boiled taken 3-4x a day for
c) Midwives links the community diarrhea
to RHU b) Warm decoction for gargle
in toothache
RA 8423 – TRADITIONAL AND 5) YERBA BUENA (Mentha Cordifolia)
ALTERNATIVE MEDICINAL ACT (TAMA) of a) ANALGESIC
1997 b) Pruritus or itchiness
 By Juan Flavier c) Arthritis/Rheumatism
1) LAGUNDI (Vitex Negundo) d) Insect bites and swollen gums
a) Sprain and Skin Diseases e) Nausea & Vomiting
b) Headache & Fever f) Flatulence or Gas pain
c) Rheumatism g) Loss of consciousness
d) Eczema temporarily (syncope) –
e) Dysentery alternative of spirit of ammonia
 PREPARATION: h) Menstrual pain
a) Decoction: Boil ½ cup of  PREPARATION:
chopped fresh or dried a) For PAIN: boil leaves in 2
leaves in 2 cups of water glasses for 15 minutes
for 10-15 minutes b) Divide
b) Drink half cup 3 times a c) Decoction in 2 parts and
day drink one
c) Pounded leaves for 6) SAMBONG (Blumea Balsamifera)
headache and rheumatism a) Antiurolithiasis
2) ULASIMANG BATO/PANSIT- b) Diuretic
PANSITAN (Peperonia Pellucida) c) Anti-edema
a) Gouty arthritis (Great Toe pain) d) NOT used for kidney infections
b) Others: Boils and abscesses  PREPARATION:
c) Uric Acid lowering Agent a) Decoction of leaves – boil
d) Tophi prevention chopped leaves in a glass
e) YES you can boil it or eat like a of water
salad b) Divide into 3 parts
 PREPARATION: c) Drink one part every 3
a) ½ cup of leaves boiled in a hours
glasses for water 7) AKAPULKO (Cassia Alata L.)
b) Divide into 3 parts and a) Antifungal parasites herb
drink one part 3x a day b) Ringworm (Fungal)
3) BAWANG (Allium Sativum) c) Athlete’s Foot
a) Hypertension d) Tinea flava
 e) Scabies (Parasite)
 PREPARATION:
a) Pounded fresh matured
leaves
b) Can be made into a soap,
cream or paste applied to
affected area 1-2x a day
c) Apply cream all over the
body for scabies
8) NIYOG NIYOGAN (Quisqualis Indica)
a) Anti-helminthic
b) Expel worms or parasite like
roundworms, tapeworms,
hookworms.
 PREPARATION:
a) Take seeds 2 hours
AFTER dinner
b) CHILDREN: at least 4-7
seeds
c) ADULTS: at least 8-10
seeds
d) CONTRAINDICATED
less than 4 years old
9) TSAANG GUBAT (Carmona Retusa)=
Wild Tea
a) Antispasmodic (Cramps)
b) Body cleanser/wash
c) Diarrhea
d) Oral Hygiene or canker sores
e) Mouth wash used in “SAGIPIN:
UNANG NGIPIN” (fluoridation of
teeth)
f) Eczema
g) Natural remedy for biliary colic
10) AMPALAYA (Momordica Charantia)
a) DM Type 2
 PREPARATION:
a) Chopped leaves
b) Boil in a glass of water for
15 minutes
c) Take 1/3 cup 3x a day
AFTER MEALS
REMINDERS ON THE USE OF HERBAL
MEDICINE
1) Boil using a clay pot and remove
cover while boiling at low heat
2) Only one kind of herbal plant for each
type of symptoms
3) No use of insecticides as these may
leave poison on plants
4) Use only part of the plant being
advocated
5) Symptoms persist after 2-3 doses –
CONSULT physician
BOTIKA NG BARANGAY/BOTIKA NG
BAYAN (BnB)
 Botika ng Barangay (BnB), a
government-initiated poverty
alleviation program to increase access
of community people to affordable
medicines
 VENDOR: At least 2 BHW
 MANAGED BY: legitimate community
organization. NGOs and/or LGUs
DRUGS SOLD IN BnB
1) RIPES (TB drugs)
2) NIFEDIPINE
3) AMOXICILLIN (1st line antibiotic of
pneumonia)
4) ALBENDAZOLE
5) PARACETAMOL
6) COTRIMOXAZOLE (2nd line antibiotic
of pneumonia)
7) ORS (Oresol)
to 8) QUININE
 ASPIRIN is NOT BEING SOLD in BnB
IMMUNIZATION PROGRAM
 VACCINE HISTORY:
1) EDWARD JENNER
 Founder of Vaccinology in the
West (1796)
 After he inoculated a 13 y/o
boy with vaccinia virus
(cowpox) which demonstrated
immunity to smallpox
 In 1798, the FIRST smallpox
vaccine was developed
 Smallpox vaccine was the
FIRST SUCCESSFUL
VACCINE to be developed
 WHO declares GLOBAL
eradication of Smallpox (May
1980)
 LAST WILD CASE of small pox
– Somalia (1977)
EXPANDED PROGRAM ON IMMUNZATION
(established in 1976)
 IMMUNIZATION
 Process of introducing
vaccine into the body before
infection sets in providing
ARTIFICIAL ACTIVE
IMMUNITY
 WHO stated that as many as 2-3
million deaths among children per year
could have been prevented by
ACCESS TO IMMUNIZATION
 SCHEDULE: WEDNESDAY
  Designated NATIONAL Wednesday of April and May
IMMUNIZATION DAY or from 1996 to 2000 as
“Patak Day” “KNOCKOUT POLIO DAYS”
 WEEKLY: Rural Health Units  ONLY OPV doses can lead to
 MONTHLY: Barangay Health Stations polio eradication
 QUARTERLY: Remote areas (Far-  OPV given simultaneously to
flung) all children younger than 5 y/o
2) PROCLAMATION NO. 135, s. 2001
VACCINE PREVENTABLE DISEASES  POLIO-FREE MAINTENANCE
1) Tuberculosis – BCG IMMUNIZATION CAMPAIGN
2) Diphtheria & Pertussis –  Last wild Poliomyelitis case in
DPT/Pentavalent the Philippines was in 1993
3) Measles – Measles Vaccine  Philippines was certified
4) Poliomyelitis – OPV and IPV POLIO-FREE country on
a) OPV – Albert Sabin October 29,2000 in Kyoto,
b) IPV – Jonas Salk Japan
5) Tetanus  19 years after, On September
a) CHILDREN = DPT 19,2019, a new polio outbreak
b) Mothers = Tetanus Toxoid was reported by POLIO VIRUS
6) Hepatitis B – HepB vaccine 2
7) Diarrhea caused by Rotavirus –  3 Viral Strains of Polio
Rotavirus vaccine a) Brunhilde Type 1
8) Meningitis – PentaHIB vaccine b) Lansing type 2
c) Leon type 3
FALSE TRUE/ABSOLUTE 3) PROCLAMATION NO. 4, s. 1998
CONTRAINDICATIO CONTRAINDICATIO  LIGTAS TIGDAS MONTH
NS NS  September 16 – October 14,
Fever NOT more than Convulsions within 7 1998
38.5 degrees C days after DPT  Free measles vaccines
vaccine between the ages of 9 months
Seizures 4 days – less than 15 years
before DPT 1 4) PRESIDENTIAL DECREE 996
Vomiting Anaphylaxis to any  COMPULSORY basic
components of immunization for infants and
vaccine children below 8 years of age
Respiratory HIV/AIDS with signs 5) REPUBLIC ACT NO. 7846
Conditions (Cough & and symptoms  COMPULSORY Hepatitis B
Colds) immunization among infants &
Like BROMA children less than 8 years old
vaccines  Newborn infants of women with
a) BCG Hepatitis B shall be given
b) Rotavirus immunization against Hepatitis
c) OPV B within 24 hours after birth
d) Measles 6) RA No. 10152
e)  MANDATORY infants and
Malnutrition Children Health Immunization
Act of 2011
Anaphylaxis after a  TAKE NOTE:
Diarrhea previous dose a) If the infant is sick, and
Hepatitis the parent strongly
Neural Problems objects for the
immunization, DO NOT
REGULATORY LAWS GIVE IT
1) PROCLAMATION NO. 773, s. 1996 b) Ask the mother to
 Declaring April 17 and May 15, comeback when child is
1996 and every third well
FULLY IMMUNIZED CHILD (FIC) “BACK TO BAKUNA” Program
1) Before 12 months  School based immunization program
2) Before 1st birthday of child he/she must provides free measles and rubella
have completed: vaccines including booster doses of
a) 1 dose of BCG tetanus-diphtheria vaccines to public
b) 3 doses of DPT school children from kindergarten to
c) 3 doses of OPV Grade 7 (ages 5-13 y/o)
d) 3 doses of HepB  For Grade 4 females: HPV
e) 1 dose of Measles immunization, a protection against
cervical cancer
FREEZE DRIED:
1) BCG GENERAL PRINCIPLES IN VACCINATING
2) Others: Yellow Fever and HIB CHILDREN
1) Give doses less than 4 weeks interval
MOST SENSITIVE TO HEAT/SUNLIGHT: may lessen the antibody response
1) OPV 2) Lengthening the interval between
2) Measles doses of vaccine leads to a higher
3) MMR antibody levels
3) Avoid using the same arm or leg for
MOST SENSITIVE TO COLD/FREEZING more than 1 injection
1) DPT 4) Do not give more than 1 dose of the
2) DT SAME VACCINE to a child in one
3) TT session
4) HepB 5) If the vaccination schedule is
5) Pentavalent Vaccine interrupted, it is NOT NECESSARY to
6) PCV vaccine RESTART.
6) Minimal intervals between doses to
NEW MANDATED VACCINES catch up as quickly as possible if it is
1) ROTAVIRUS interrupted
 Prevents diarrhea 7) Immunity provided by vaccines is
2) PNEUMOCOCCAL CONJUGATE ARTIFICIAL ACTIVE:
VACCINES ( PCV13) a) More than 1 vaccine is to be
 Prevents pneumonia administered, inject it at different
3) INACTIVATED POLIO VACCINE (IPV) sites of body
 Given to infant at 3 ½ b) Mild asthma, stable cerebral
months (14 weeks) palsy or down syndrome is NOT
 TAKE NOTE: a contraindication
a) Give PCV to infants as a series c) Use single syringe (1 syringe
of 3 doses, 1 dose at each of per vaccine) when giving more
these ages: than 1 vaccine
o 1 ½ months (6 weeks) d) NEVER reconstitute freeze dried
o 2 ½ months (10 weeks) vaccine anything other than the
o 3 ½ months (14 weeks) diluent supplied with them
b) Children who miss their shots or e) Effective and still safe if more
start the series later should still than 1 vaccine is given on the
get the vaccine same day
f) DO NOT ADMINSTER live
PENTALENT VACCINE vaccines to persons who are
 Vaccine (5 in 1) that contains Five significantly immune
antigens: compromised
1) Diphtheria
2) Pertussis COLD CHAIN
3) Tetanus  SYSTEM of storing and transporting
4) HepB vaccines at recommended
5) Haemophilus influenzae type temperatures from the point of
B manufacture to the point of use
  Primary PURPOSE: MAINTAIN WATER BOTTLES
POTENCY of vaccine 1) Place water bottles on the top shelf,
floor and in the door racks
VACCINE STORAGE 2) Putting water bottles in the unit can
1) Store VARICELLA at freezing help maintain stable temperatures
temperatures cause by frequently opening and
2) Temperature should be checked closing unit doors or a power failure
TWICE A DAY 3) Label all water bottles DO NOT DRINK
3) One in the morning and one in the late
afternoon REFRIGERATOR
4) Refrigerator: Stand-alone refrigerator 1) NO foods, drinks or other drugs are to
and freezer be kept in a refrigerator
5) Avoid direct contact of vaccine to ice 2) Check and record temperature 2x a
6) Goodies, foods and drinks should day in temperature log for 2-7 days
NEVER be stored 3) DEFROST the refrigerator when ice
7) Ensure to keep refrigerator away from becomes more than 0,5 cm thick, or
sunlight and at least (10cm) distance once a month, whichever comes first
from the wall 4) Record temperature, date, time and
initials of the person in monitoring log
COLD CHAIN REMINDERS: sheet
1) NEVER store any vaccine in a
dormitory style or bar style combined 2 COMPARTMENTS:
unit 1) REFRIGERATOR (Main
2) NEVER place vaccines and diluents in Compartment)
the DOOR shelves (Temperature is  Kept between +2 degrees C
not stable) and +8 degrees C
3) AVOID frequent opening and closing  Used for storing vaccines and
of doors diluents
4) Place vaccines and diluents in the  E.g.
center of the unit 2 or 3 inches away a) BCG
from walls, ceiling, floor. And door b) DPT
5) AVOID freezing of diluents as the vial c) HepB
may burst when frozen d) TT
6) DO NOT STORE vaccines in deli, fruit 2) FREEZER
or vegetable drawers or in the door  Kept between -15 degrees C to
7) Place vaccines and diluents with the -25 degrees C
earliest expiration dates in front of  Average of 20 degrees C
those with later expiration dates  Used for freezing ice packs
8) Do not return reconstituted vaccines  For heat sensitive vaccines
(BCG, Measles) or opened PCV 10 (OPV & Measles)
vials to the refrigerator. They should  OPV is the MOST sensitive to
be discarded at the end of the heat and fragile vaccine
immunization session or after 6 hours,
whichever comes first, STORING:
9) The refrigerator should not be packed 1) FREEZING COMPARTMENTS
too full (to allow air to circulate) a) Ice cubes
10) Vaccines should be stored carefully b) Ice packs
between +2 degrees C and +8 2) MAIN COMPARTMENT
degrees C at all times a) TOP
11) Freeze-sensitive vaccines 1. OPV
(Pentavalent, PCV10, TT & HepB) 2. Measles
should be kept away from the freezing b) MIDDLE
compartment, refrigeration plates, side 1. DPT
linings or bottom lining of refrigerators 2. TT
and frozen ice packs 3. Diluent
c) LOWER
1. Water bottles
  NUMBER OF DOSES: 5 doses
STORAGE TIME FRAMES  ROUTE: PO
1) 6 MONTHS – Regional Level 6) MEASLES
2) 3 MONTHS – Provincial Level/District  CONTENT: Live Attenuated Virus
Level (weakened)
3) 1 MONTH – Main Health Centers with  TYPE: Freeze dried
refrigerator  DOSAGE: 0.5 mL
4) NOT MORE THAN 5 DAYS – Health  NUMBER OF DOSES: 1 dose
centers using transport boxes  ROUTE: SQ

ESSENTIAL ELEMENTS: BCG

1) Personnel to manage vaccine  At birth or Any time after birth
distribution  NORMAL SIDE EFFECTS
2) Equipment for vaccine storage & a) KOCH’S PHENOMENON
transport  Acute inflammatory process
3) Maintenance of equipment starting 24 hours after
4) Monitoring injection and may last 2-4
5) COLD CHAIN MANAGER: PHN days
 Wheal formation (small
VACCINES: raised lump of 10 mm of
1) BCG (Bacillus Chalmette Guerin) diameter)
 CONTENT: Live Attenuated  Disappears within 30
Bacteria minutes
 TYPE: Freeze Dried b) ULCER/RED SORE FORMATION
 DOSAGE:  May appear 2 weeks after
a) Infant/birth: 0.05 mL injection and may persist for
b) Preschool: 0.1 mL another 2 weeks to heal
 NUMBER OF DOSES: 1dose  Keep dry and clean (Do not
 ROUTE: ID using 26G needle put any ointment on the sore
syringe or give the child any
2) Hepatitis B medicine)
 CONTENT: Plasma Derivative
(HbsAg)/ RNA Recombinant c) SCAR FORMATION
 TYPE: Liquid  About 5 mm
 DOSAGE:  Scar at 12 weeks after
a) Infant/birth: 0.5 mL injection (2-5 months)
 NUMBER OF DOSES:3 doses  Sign that the child has
 ROUTE: IM been effectively
3) DPT (Diphtheria-Pertussis-Tetanus) immunized
 CONTENT: DT weakened toxin/  ABNORMAL ADVERSE EFFECTS
P-killed bacteria a) INDOLENT ULCERATION
 TYPE: Liquid  WATCH OUT FOR: Signs
 DOSAGE: 0.5 mL of Infection
 NUMBER OF DOSES: 3 doses  Abscess formation and
 ROUTE: IM swelling of glands in
4) OPV (Oral Polio Virus) armpits
 CONTENT: Live Attenuated Virus (lymphadenopathy)
(weakened)  Abscess may be due to:
 TYPE: Liquid 1. UNSTERILE
 DOSAGE: 2 drops (0.1 mL) needle/syringe was
 NUMBER OF DOSES: 3 doses used (#1 cause)
 ROUTE: PO 2. Too much vaccine
5) Rotavirus Vaccine was injected
 CONTENT: Live Attenuated Virus 3. Wrong technique of
(weakened) administration
 TYPE: Liquid  MANAGEMENT:
 DOSAGE: 5 drops (0.5 mL)
 1. Do not incise and
Drain
2. Use warm water
compresses over the
injection site or
suppurating lymph
node/s 4-5 times a
day
HEPATITIS B
 Transmission at birth is possible give:
a) HepB 1 – At Birth
b) HepB 2 – 6 weeks
c) HepB 3 – 14 weeks
 When transmission at birth is less
likely, the recommended schedule is:
a) HepB 1 – 6 weeks
b) HepB 2 – 10 weeks
c) HepB 3 – 14 weeks
 COMMON SIDE EFFECTS:
a) MILD FEVER (1-2 days)
 Teach mother to perform
TSB
 Advise to give
Paracetamol every 4 hours
if temperature is above
38.5 degrees C
 REFER if fever last for 4
days
b) SORENESS, REDNESS OR
SWELLING IN THE INJECTION
SITE
 Teach mother to perform
COLD compress FIRST
before HOT compress
DPT
 The recommended schedule is: 4
weeks interval between doses
a) DPT 1 – 6 weeks
b) DPT 2 – 10 weeks
c) DPT 3 – 14 weeks
 MILD REACTIONS:
a) FEVER
 Child may have fever in
the evening AFTER
receiving DPT vaccine
 Fever should disappear
within a day
 NOTE: FEVER that begins
more than 25 hours after a
DPT injection is
UNLIKELY to be a step is to CHECK the vial for
reaction to the vaccine
b) SORENESS
c) PAIN
d) REDNESS OR SWELLING AT
INJECTION SITE
 WATCH OUT FOR: ABSCESS
FORMATION
 An abscess may develop a
week or more after a DPT
infection due to:
1. Unsterile needle or
syringe was used
2. Wrong technique
3. Vaccine was note
injected into the muscle
 DPT vaccine should NOT be given:
a) Children over 5 years of age
b) Children who have suffered a
severe reaction to a previous
dose of DPT vaccine
 Instead, a COMBINATION OF
DIPHTHERIA AND TETANUS
TOXOIDS (DT) should be given
OPV
 The recommended schedule is: 4
weeks interval between doses
a) OPV 1 – 6 weeks
b) OPV 2 – 10 weeks
c) OPV 3 – 14 weeks
 NO SIDE EFFECT
ROTAVAC
 The recommended schedule is:
d) ROTAVAC 1 – 6 weeks
e) ROTAVAC 2 – 10 weeks to a
maximum of 32 weeks
 Rare and mild side effects
 Fussiness, mild diarrhea, and vomiting
MEASLES
 Regular schedule: 9 months
 NOTE: if the child aged 6-9 months
when hospitalized should receive
measles vaccine apart from the
scheduled vaccine at 9 months
 In case of outbreak: may be given at 6
months (EARLIEST dose)
 LATE dose: 15 months
 Catch up dose: 4-5 y/o
IMPORTANT NOTES:
1) It is safe to vaccinate a sick child who
is suffering from a minor illness
2) When handling vaccines, the FIRST
EXPIRATION DATE
3) Use standard refrigerator with
separate freezer door and seal for
vaccines
4) Vaccines can be mixed in a single
syringe when:
a) Vaccines are licenses and
labeled to be mixed
5) BCG vaccine protects against TB in
infants
6) BCG vaccine amber glass ampules is
to protect from ultraviolet and
fluorescent light to MAINTAIN
POTENCY
7) BCG also should be discarded AFTER
6 HOURS of reconstitution because of
risk of contamination d/t lack of
preservative and loss of potency
8) BCG vaccine is NOT damaged by
freezing
9) Store BCG Vaccine and its diluent
side-by-side in a refrigerator or vaccine
carrier
10) BCG is administered via ID route at
(R) deltoid
11) NEVER immunize in buttocks, IM
vaccines like HepB, DPT, IPV,
Pentavalent and PCV should be
administered muscle of the upper
outer of the thigh
12) Measles is given ONCE, SQ injection
in the OUTER UPPER (R) arm
13) The Measles, Mumps, Rubella,
Vaccine (MMR) can be stored either in
the freezer or the refrigerator
14) Protect reconstituted measles vaccine
from sunlight. WRAP IT WITH FOIL
15) If a child has diarrhea, give OPV as
usual but administer an extra dose
 5th dose, at least 4 weeks after
he or she has received the last
dose in the schedule
16) Diphtheria and Tetanus toxoid parts re
damaged by freezing
17) For outreach session using vaccine
carriers or old box:
a) Do not let DPT, TT or HepB
vaccine vials touch the cold
dogs/ice packs.
b) Put or wrap newspaper or
cardboard around DPT, TT, or
HepB to protect them from
freezing
18) PERTUSSIS vaccine is damaged by
heat
19) Pertussis causes the fever after DPT
shot
20) If a child spits out, regurgitates the
vaccine drops, or vomits immediately
after a dose of OPV, it is safe to repeat
the doe (DO NOT BF immediately)
VACCINATION CARD
a) Date of administration
b) Vaccine manufacturer
c) Vaccine lot number
d) Name and title of the person who
administered the vaccine
HERD IMMUNITY
 Occurs when a high percentage of the
community is immune to a disease
(through a vaccination and/or prior
illness) making the spread of the
disease from person to person is
unlikely.
TARGET SETTING
1) BCG
 Number of Doses: 1
 Number of Doses per ampule: 20
 Wastage factor: 2.5
2) HepB
 Number of Doses: 3
 Number of Doses per ampule: 10
 Wastage factor: 1.10
3) DPT
 Number of Doses: 3
 Number of Doses per ampule: 20
 Wastage factor: 1.67
4) OPV
 Number of Doses: 3
 Number of Doses per ampule: 20
 Wastage factor: 1.67
5) MEASLES
 Number of Doses: 1
 Number of Doses per ampule: 10
 Wastage factor: 2
6) TETANUS TOXOID
 Number of Doses: 5
 Number of Doses per ampule: 10
 Wastage factor: 1.67
STEP 1: DETERMINE THE ELIGIBLE
POPULATION OUT OF THE GIVEN TOTAL
POPULATION
COMPUTE FOR ELIGIBLE POPULATION
 FORMULA: TOTAL POPULATION x
Target Setting = Eligible Population
 For Target Setting of Eligible
Population:
a) Total number of children &
infants for immunization = 3%
or 0.03
b) Total number of mothers for
immunization = 3.5% or 0.035
  EXAMPLE: Midwife Lorna was
assigned to Bgy. San Roque with 20
000 population. How many infants are
expected to receive measles injection
 TP = 20 000
 EP = 3% (Infants)
 20 000 x 0.03 = 600 infants
STEP 2: DETERMINE THE TOTAL VACCINE
REQUIRED (TVR)
 FORMULA: Eligible Population x
Number of doses to complete
immunization = TVR
 600 infants x 1 dose of measles = 600
TVR
STEP 3: DETERMINE THE ANNUAL
VACCINE DOSES REQUIRED (AVR)
 FORMULA: Total Vaccine dose
Required x Wastage Factor of the
vaccine (refer to table above)
 600 (TVR) x 2 (constant wastage
factor of measles) = 1200 AVR
EXAMPLE 1: Lorna has an eligible target of
600 (0-1 y/o) for the current year. If she
computes her EPI target on anti-measles.
How many vials of 10 doses will she need?
 ANSWER: 120 vials
 600 x1 = 600
 600 x 2 = 1200
 1200/10 = 120 vials
STEP 4: DETERMINE ANNUAL VACCINE
AMPULE OR VIAL (AVA)
 FORMULA: Annual Vaccine Doses
Required (AVR)/number of doses per
ampule
 1200 (AVR)/ 10 doses per ampule of
measles = 120 ampules of measles
EXAMPLE 2: Nurse Ling Ling has a total
eligible target of 205 (mothers), If she
computes her EPI target on Tetanus Toxoid,
how many vials of 20 doses will she need?
 205 x 5 (doses of TT) = 1025
MATERNAL HEALTH PROGRAM
MCHP
 The Philippines is tasked to reduce the
Maternal Mortality Ratio (MMR) by
three quarters or 75% by 2015 to
achieve its MDG
 This means a MMR of 112/100, 000
live births in 2010
 80/100,000 live births by 2015
HOME BASED MOTHER’S RECORD
(HBMR)
 Tool used when rendering prenatal
care containing risk factors and danger
signs
 A system for recording risk factors,
early sings of complications, referrals
and treatment of the mother
 PANEL 1: Maternal Information
(demographics)
 PANEL 2: Danger signs/Risk
factors/Present pregnant condition
 PANEL 3: Actions by referral
 PANEL 4: Family planning/Postpartum
Care
RISK FACTORS
a) Height 145 cm tall (4 ft & 9 in)
b) Age below 18 y/o (PIH) ; above 35 y/o
(H-mole, Placental Previa)
c) Recent pregnancy was C/S delivery
d) Multiparity and last baby born was less
than a years ago
e) Family history of DM, Hypertension,
and Heart disease
f) Underlying condition like TB, Goiter,
Bronchial Asthma, Severe Anemia
g) Less than 45 kg or more than 80 kg
weight
DANGER SIGNS
1) Any type of vaginal bleeding
2) Headache, Dizziness, Blurred Vision
(Pre-Eclampsia/Gestational HTN)
3) Puffiness of the face and hands (Facial
Edema/Peripheral Edema)
4) Pale and Anemic
5) Any watery discharges (PROM)
MATERNAL DEATHS
 Maternal Mortality: 10-11 mothers die
each day d/t pregnancy and delivery
complication
 MATERNAL DEATH:
 Death of a woman while
pregnant or within 42 days of
termination of pregnancy
DIRECT MATERNAL DEATHS (HOUSE)
a) Hemorrhage
b) Obstructed Labor
c) Unsafe Abortion
d) Sepsis
 Endometriosis (most common
puerperal sepsis)
e) Eclampsia and PIH

DAILY IRON & FOLIC ACID
SUPPLEMENTATION DURING
PREGNANCY
 WHO & National Guidelines
recommended all pregnant women
should receive a daily Oral Fe and
Folic Acid supplementation dose of
DAILY 60 mg of Fe + 400mcg (0.4 mg)
Folic Acid for 6 months (125 days)
 To prevent maternal anemia,
puerperal sepsis, LBWs and
Preterm birth
 Folic Acid is the chief
 TAKE NOTE: Folic acid should be
commenced as early as possible
(ideally before conception) to prevent
NTDs
PRENATAL CONTACT/VISIT
 8 or more Prenatal contacts for
antenatal care can reduce perinatal
deaths by up to 8 per 1000 births when
compared to 4 visits
 It recommends pregnant women to
have their first contact in the FIRST 12
weeks AOG with subsequent contacts
taking place at:
a) 20 weeks AOG
b) 26 weeks AOG
c) 30 weeks AOG
d) 34 weeks AOG
e) 36 weeks AOG
f) 38 weeks AOG
g) 40 weeks AOG
NUTRITION
 Emphasize the importance of nutrition
during each prenatal contacts
1) Eat nutritious foods like fruits &
vegetables
2) Avoid excessive weight gain
3) Daily oral Fe and Folic Acid (600
mg Fe + 400 mcg Folic Acid)
4) Daily calcium supplementation
(1.5-2 g)
 Prevents eclampsia
5) NO SMOKING and NO
DRINKING ALCOHOL
TETANUS TOXOID IMMUNIZATION
 Both mother & child are protected
against tetanus & neonatal tetanus
 A series of 2 doses of TT vaccination
must be received by a women 1month
before delivery to protect baby from
neonatal tetanus
 And the 3 booster dose shots to
complete the 5 doses following the
recommended schedule provide full
protection for both mother & child.
 The mother is then called a “FULY
IMMUNIZED MOTHER” (FIM)
 There are many kinds of vaccines
used to protect against tetanus, all of
which are combined with vaccines for
other diseases: DT, DTaP, TD, Tdap
TETANUS TOXOID
 To protect mother and her baby against
Clostridium-borne infection; injected
TWICE during pregnancy
 Dose: 0.5 mL
 Route: IM
 Site: (R) & (L) Deltoid/Buttocks
 1st Pregnancy (G1) – give TT1 and TT2
(CBQ)
 2nd Pregnancy (G2) – give TT3 (1st booster
dose)
 3rd Pregnancy (G3) – give TT4 (2nd booster
dose)
 4th Pregnancy (G4) 0 give TT5 (3 rd booster
dose)
TAKE NOTE:
1) If a pregnant mother received TT
injection, she is protected from tetanus
infection through ARTIFICIAL ACTIVE
IMMUNITY
2) 2 TT doses (TT2) protects for 1-3 years
although some studies indicate even
longer protection
3) TT is SAFE during pregnancy
4) If a pregnant mother has received 2
doses of TT. The baby is protected
from tetanus neonatorum through
NATURAL PASSIVE IMMUNITY
5) TT3 is administered 6 months after TT2
6) The nurse understands that the client
can be considered fully immunized
against tetanus if she received how
many booster doses of TT? ANSWER:
THREE
7) Which of the following dose of TT is
given to the mother to protect her infant
from neonatal tetanus and likewise
provide 10 years protection for the
mother? ANSWER: TT4
8) Of the mother receives TT4 vaccine:
this will give her protection that lasts up
to 10 years
9) A pregnant woman had just receive 4 th
dose of TT, subsequently her baby will
 have protection against tetanus for how
long? ANSWER: 1 year
INTRAPARTAL CARE:
 Deliver at the Health Facility
 FOLLOW UNANG YAKAP
PROTOCOL
1) Dry thoroughly (first 30 seconds)
2) Skin to skin contact (after 30
minutes)
3) Properly timed cord clamping
(within 1-3 minutes)
4) Early Breastfeeding and Rooming
In (within 90 minutes)
IMMINENT HOME DELIVERY
 In case of imminent delivery at home,
birth attendants must be aware of the
CLEAN principles of HOME
DELIVERY
 5 CLEANS:
1) CLEAN hands of attendant
2) CLEAN surface
3) CLEAN cord
4) CLEAN cord tie without dressing
5) CLEAN and dry wrapping of baby
POSTPARTUM CARE
 Delay facility discharge for at least 24
hours
 Visit women and babies with home
births WITHIN THE FIRST 24 hours
 FIRST 24 hours assess for vaginal
bleeding, uterine contractions, vital
signs and voiding within 6 hours
POSTPARTUM VISIT
 Provide every mother and baby a total
of 4 POSTPARTAL VISITS on:
a) 1st visit: 1st day (within first 24
hours)
b) 2nd visit: Day 3 (48-72 hours)
c) 3rd visit: Between 7-14 days
d) 4th visit: 6 weeks
 For a woman who delivered at the
health facility:
a) 1st visit: within FIRST week
preferably 2-3 days after
delivery
b) 2,d visit: end of puerperium or
4-6 weeks after delivery
MICRONUTRIENT DEFICIENCY (IVI)
a) IRON = causing ANEMIA
b) VITAMIN A = causing NIGHT
BLINDNESS
c) IODINE = causing CRETINISM
NUTRITION
 Nutrition LAW: PD 491
 Nutrition month: JULY
 MOST VULNERABLE TO
MALNUTRITION:
a) Children
b) Lactating mothers
c) Infants
d) Pregnant
 RA 8976 – Philippine Food
Fortification Act of 2000
 FOOD FORTIFICATION:
 Addition of Sangkap Pinoy or
Micronutrient such as Vitamin
A, Iron and Iodine to food.
SANGKAP PINOY SEAL PROGRAM (SPSP)
 A strategy to encourage food
manufacturers to fortify processed
foods or food products with essential
nutrients at levels approved by DOH
and use its seal
 The seal is a guide used by
consumers in selecting nutrition’s
foods
MANDATORY FOOD FORTIFICATION
1) RICE – with Iron
2) WHEAT FLOUR – with vitamin A and
Iron
3) REFINED SUGAR – with vitamin A
4) COOKING OIL – with vitamin A
5) Other staple foods:
a) STAR Margarine (1992)
 FIRST ever product to
partner with DOH and the
FIRST to reserve the
Sangkap Pinoy Seal
GOVERNMENT SUPPORT PROGRAMS
1) Sustansya Para Sa Masa
2) Pan De Bida (Pandesal with Vitamin
A)
3) NUTRI BAN
4) SALT FORTIFICATION
a) RA 8172 (Act for Salt Iodization
Nationwide –ASIN LAW)
b) Use salt with “FIDEL” seal
(Fortification for Iodine
Deficiency Elimination)
IODINE
 For proper functioning of thyroid,
growth and development of the brain
  Iodine deficiency is a leading cause of IRON DEFICIENCY ANEMIA (IDA)
preventable brain damage and  Normal Hgb Level:
reduced IQ among children worldwide a) MALES: 14-18 g/dL
 Iodine Deficiency Disorder (IDD) b) FEMALES: 12-16 g/dL
during pregnancy may result in  According WHO, anemia is defined as:
stillbirth, miscarriage, and congenital a) Hgb levels <12 g/dL in women
abnormalities such as cretinism b) Hgb levels <13 g/dL in men
 For iodine supplementation give  In children above 2 years old
iodized oil capsule with 200 mg iodine,  Anemia is worsened by hookworm and
1 cap for 1 year whipworm
 Give Mebendazole + Iron supplement
GOITER  RISK INDIVIDUALS: WOMEN
 Common in mountainous or inlands or a) Women at childbearing age
uplands areas where iodine content in b) Old age/elderly
the soil, water and food are different c) Menstrual and GI bleeding
 Endemic goiter is more common (heavy)
among girls than boys and among d) Enteric parasitism (hookworm,
women than men. ascaris & trichuris)
 Effect of iodine deficiency to fetus may e) Not enough iron intake
be born mentally and physically  CLINICAL MANIFESTATIONS:
retarded PALENESS
a) Pallor
OBESITY b) Anorexia
 A risk factor for many chronic diseases c) Lightheadedness
including heart disease, cancer, d) Easy fatigability
hypertension and DM. e) Nail brittleness (koilonychia)
 ABC for healthy nutrition: f) Enlargement of spleen
1) Aim for fitness g) SOB
2) Build a healthy base h) Sore/cramps of muscles
3) Choose sensibly (restless legs syndrome)
 PREVENTION & MANAGEMENT:
3 SOMATOTYPES OR BODY TYPES a) Liver products
1) ECTOMORPH = Skinny; Difficulty in b) Lean & Red meats
gaining weight c) Legumes
 Narrow hips and clavicles d) Leafy green vegetables
 Small joints (wrist/ankles) 1. Camote (Sweet
 Thin build Potatoes)
 Stringy muscle bellies 2. Kangkong
 Long limbs 3. Malunggay
2) MESOMORPH = Naturally muscular;  TREATMENT of IDA: FeSO4
easy gain and loses weight a) Mainstay treatment
 Wide clavicles b) Continued for about 2 months
 Narrow waist after correction of the anemia
 Thinner joints c) Ferrous sulfate is the most
 Long and round muscle bellies common and CHEAPEST form
3) ENDOMORPH = Round; Difficulty in of iron utilized
losing weight; slower metabolism  MOST COMMON SIDE EFFECTS OF
 Blocky IRON
 Thick rib cage a) Constipation
 Wide/thicker joints b) Unpleasant taste
 Hips as wide (or wider) than c) Nausea & Vomiting
clavicles d) Tarry stool (Dark discolored
 Shorter limbs stool)
 High body fat (Central Obesity)  NORMAL side effect
 Pear-shaped
 High tendency to store body fat VITAMIN A DEFICIENCY (VAD)
 VAD Causes:
 a) Inadequate nutritional intake of Given after 100,000 200,000 IU
Vitamin A rich foods 2 weeks IU (Red capsule)
b) Lack of fats/oils in diet (Blue
c) Rapid utilization of Vitamin A capsule)
during course of illness
d) Liver disorders = 80-90% of VITAMIN A SUPPLEMENTATION FOR
Vitamin A is stored in liver PREGNANT AND POSTPARTUM
e) Long term drinking alcohol MOTHERS (Table at the back)
lowers Vitamin A levels in the
liver TREATMENT SCHEDULE FOR
 VULNERABLE GROUPS XERPOHTHALMIA FOR PREGNANT
a) Infants WOMEN
b) Preschoolers a) Pregnant women with night-
c) Pregnant blindness
 VAD S/Sx: b) 1 capsule of 10,000 IU (Colorless
a) NIGHT BLINDNESS (EARLIST capsule)
SIGN) c) 1 capsule, once a day regardless of
 Impaired dark adaptation d/t lack of the AOG
rhodopsin (NYCTALOPIA)
b) XEROPHTHALMIA PROTEIN ENERGY MALNUTRITION (PEM)
 Dry, thickened conjunctiva and cornea  TYPES INCLUDE:
c) BITOT’S SPOTS a) KWASHIORKOR
 Foamy soapsuds-like spots on white  PROTEIN malnutrition predominant
part of the eye b) MARASMUS
 CALORIE deficiency intake
d) KERATOMALACIA c) MARASMIC KWASHIORKOR
 Corneal erosions and ulcerations  Marked protein deficiency and marked
e) BLINDNESS (END STAGE) calorie insufficiency signs present,
 Irreversible eye blindness sometimes referred to as the MOST
SEVERE FORM OF MALNUTRITION
VITAMIN A SUPPLEMENTATION
 Provides PROTECTION UP TO 6 NUTRITIONAL INDICATORS
MONTHS 1) Arm Circumference (MUAC) – GOLD
Standard
SCHEDULE INFANTS PRESCHOOLERS 2) Low Height for Age (STUNTING)
(6-11 (12-59 months) 3) Low Weight for Age (Underweight)
months) 4) Low Weight for Height (Wasting)
TODAY 100,000 200,000 IU  TAKE NOTE: classical indicator used
IU (Red capsule) by experts to diagnose MARASMUS:
(Blue a) Weight for Height (WFH) Z
capsule) score of less than -3
AFTER 6 100,000 200,000 IU  BEST INDICATOR OF MORTALITY
MONTHS IU (Red capsule)
(Blue MUAC INDICATORS (Mid-Upper Arm
capsule) Circumference) (Table at the back)
Given 100,000 200,000 IU
immediately IU (Red capsule) SERUM ALBUMIN
upon (Blue  Found to be a better predictor of
diagnosis capsule) underlying malnutrition than BMI
 Most widely used laboratory measures
(GIVE ONE of nutritional status
CAPSULE)  Good marker of nutritional status
Given the 100,000 200,000 IU
next day IU (Red capsule) MARASMUS
(Blue  Wasting/Withering Malnutrition
capsule)
  Cause by TOTAL CALORIC a) Dry sparse discolored hair
DEFICIENCY (FLAG SIGN)
 HALLMARK SIGN: b) Growth retardation
a) Visible generalized muscle c) Anemia
wasting/withering d) Skin lesions
 CLINICAL MANIFESTATIONS: 1. Hyperkeratosis
CALORIES 2. Dermatoses
a) Caloric deficiency (deficiency of 3. Dyspigmentation
ALL NUTRIENTS)
b) Active & Irritable COMMUNITY HEALTH NURSING (PART 2)
c) Liver is NOT enlarged (NO
FATTY LIVER) ENVIRONMENTAL SANITATION
d) Old man look/Chipmunk face or
Monkey face with Lanugo REGULATORY LAWS:
e) Retarded growth (Severe) 1) PD 825 – Anti Improper Garbage
f) Infants under 1 year old are Disposal (CBQ)
commonly affected 2) PD 856 – Code Of Sanitation
g) Eager or Voracious appetite 3) RA 6969 – Toxic Waste Management
h) Severe Muscle Wasting 4) RA 8749 – Clean Air Act
 TAKE NOTE: MARASMUS may also 5) RA 9003 – Ecological Solid Waste
have: Management (CBQ)
a) Baggy pants appearance 6) RA 9211 – Tobacco Regulation Act
(REFER IMMEDIATELY!) 7) RA 9275 – Clean Water Act
b) No hair color changes (appears 8) EO 26 – Smoked Free Environment
normal)
c) Loose wrinkled skin/Emaciated GOALS
look 1) MDG 7 – Ensure Environmental
d) Weight loss Sustainability By 2015
e) Child is like skin & bones (RIBS 2) SDG 13 – Climate Change Action By
ARE VERY PROMINENT) 2030 (at least decrease of 2° C)
f) Child may also have diarrhea &
dehydration SOLID WASTE MANAGEMENT: 5 R’s
1) REDUCE: Minimize amount of waste we
KWASHIORKOR create
 Edematous Malnutrition 2) REUSE: Using items more than once
 Caused by PROTEIN DEFICIENCY 3) RECYCLE: Putting a product to a new
 HALLMARK SIGN: Edema of both feet use
 CLINICAL MANIFESTATIONS: 4) RECOVER: Practice of putting waste
PROTEINS products to use
a) Pot belly/Large swollen 5) REFUSE: Refuse wasteful and polluting
protruding belly (ENLARGED products
FATTY LIVER)
b) Ribs are NOT PROMINENT ENVIRONMENTAL SANITATION
c) Occurs in children older than  Encompasses the control of
18 months to 2 y/o environmental factors that are
d) Thin muscles & small MUAC connected to disease transmission
e) EDEMATOUS “Moon face”  SDG is for everyone to have an
appearance ADEQUATE AND EQUITABLE
f) Increased risk of infection SANITATION by 2030
g) No or lack of appetite  Father of Public Hygiene & Sanitation:
(anorexia) Moses
h) Sluggish, apathetic, lethargic,
unresponsive GLOBAL WARMING
 Global Warming Potential
 TAKE NOTE: KWASHIORKOR may  The heat absorbed by any
also have: greenhouse gas in the
atmosphere, as a multiple of the
 heat that would be absorbed by GREEN  WET
the same mass of carbon dioxide  Non-Infectious Waste
 CAUSE: Greenhouse gases (Carbon  E.g. leftover foods,
Dioxide) peelings, rotten products,
 Greenhouse Effect fish bones
 Ability of certain atmospheric gas
to trap the heat in earth surface
 Albedo Effect YELLOW  Infectious
 Ability of the earth surface to  Pathologic Waste
reflect (bounce back) sunlight  E.g. gauze, wound
(heat) back to the atmosphere. dressings, diapers,
 Asphalt Road = 0% Albedo Effect umbilical cord, placenta,
(absorbs heat from the sun) used N95 masks, used
 Ice/Snow/Clouds = 100% Albedo PPEs
Effect  Infectious
YELLOW  Chemical Waste/
GREENHOUSE GASES: WITH Pharmaceutical Waste
1) WATER VAPOR BLACK  Heavy Metal
 most abundant greenhouse gas BAND  E.g. betadine, acid,
 acts as a FEEDBACK to the formaldehydes, expired
climate drugs
2) CARBON DIOXIDE ORANGE  Radioactive Waste
 Main contributor “forcing” climate  Toxic Waste
change  E.g. radio isotopes, used
 Produce through burning of x-ray films, any
fossil fuels equipment used in
3) METHANE (CH4) radiotherapy
4) NITROUS OXIDE (N20)
5) CHLOROFLUOROCARBONS (CFCs) RED  Sharps
 TAKE NOTE:  Toxic Waste
 O2 and CO2 are NOT  E.g. needles, syringes,
Greenhouse gases scalpel blades, stylets,
 VITAL SIGNS OF THE EARTH: WARM ampules, blood lancets
a) Warming Global Temperature BLUE  Recyclable Materials
b) A Climate Change
c) Rising Sea Levels
d) Melting Ice Glaciers (Most Visible APPROVED TYPE OF WATER FACILITIES
Sign of Global Warming) 1) LEVEL 1 (POINT SOURCE)
 With an outlet but without a
SOLID WASTE SEGREGATION: distribution system (Rural
1) Prevention of Deforestation Areas)
2) Promote Reforestation  250 m away from farthest user
3) Waste Segregation  It caters 15-25 households
BLACK  DRY  Delivers 40-140 L of water per
 Non-Infectious Waste minute
 E.g. paper products  Water needs boiling for 3
(Most common waste in minutes
hospitals), plastic, bottles  E.g. Protected wells,
Developed springs
2) LEVEL 2 (COMMUNAL FAUCET)
 With a source, reservoir, piped
distribution network and
communal faucets
 25 m away from farthest user
 It caters 100-125 households
  Delivers 40-80 L of water per 4) Right Storage
minute  WHO Five Key Principles Of Food
 Water needs boiling for 3 Hygiene:
minutes 1) Keep Clean (Right Preparation)
 E.g. Stand posts (poso/pump), 2) Separate Raw And Cooked
Artesian wells Foods (Right Preparation)
3) LEVEL 3 (WATERWORKS SYSTEM)  Separate raw meat,
 With a source, reservoir, piped poultry, seafood and eggs
distribution network and from ready-to-eat foods.
individual household taps  Use separate cutting
 Tilt for densely populated urban boards and keep raw
communities meat way from other
 Water does need boiling for 3 foods in shopping cart
minutes  Wipe surfaces and sweep
 E.g. NAWASA floor
3) Cook Thoroughly Reaching 70°
APPROVED TYPE OF TOILET FACILITIES C (Right Cooking)
1) LEVEL 1
Eggs, ground meats 160 °F
a) NON-WATER CARRIAGE
1. Pit Latrines Poultry, Fowl & 165° C
2. Pit Privies Leftovers
3. Reed Odorless Earth Fresh pork meat, 145°C
Closet steaks, chops &
4. Bored Hole roasts
b) LESS WATER CARRIAGE
1. Pour Flush Toilets
2. Aqua Privies 4) Keep Food at Safe
2) LEVEL 2 Temperatures (Right Storage)
 Water carriage facility with  Keep refrigerator at 40°C
septic tank/vault or below.
 E.g. Water sealed & flushed  Refrigerate leftovers
toilets within 2 hours of cooking
3) LEVEL 3 5) Use Safe Water And Raw
 Toilet facility with septic tank or Materials (Right Source)
vaults connected to a  Keep boiling for 1-3
sewerage system and minutes
treatment plan  Always check expiration
 TAKE NOTE: date of products
 Toilets, septic tank,  AVOID buying canned
garbage MUST be 25 goods with dents and
m/70 ft. away from the deformations
water source  SAFETY RULE: WHEN
IN DOUBT, THROW IT
NOT APPROVED TYPE OF TOILET OUT
FACILITIES:
1) LEVEL 1 HEALTH
a) Bucket Latrine  Is a state of complete physical, mental
b) Overhung Toilet (Coastal Areas) and social well-being and not merely
c) Cat Hole Latrine the absence of disease or infirmity
d) Flying Saucers (WHO)
 HEALTH TRIANGLE: Physical, Social
FOOD SANITATION PROGRAM & Mental Health
 4 RIGHTS OF FOOD SAFETY  10 DETERMINANTS OF HEALTH:
1) Right Source BIG CHEESE
2) Right Preparation 1) Behavior
3) Right Cooking 2) Income
 3) Gender & Genetics (Internal  Self-reliance in health & enhanced
Variable) capabilities
4) Culture 3) ULTIMATE GOAL
5) Health Services  Raise level of health of the
6) Education & Literacy citizenry
7) Employment 4) In CHN
8) Social Support Network a) Client-Active Participant
9) Environment (External Variable) b) Full Involvement Recipient Care
5) GOAL FO CHN:
COMMUNITY a) Through multisectoral efforts
 A group of people with common 6) PRIMARY TOOL
characteristics or interest living a) Health Education
together within a territory or 7) PURPOSE of CHN
geographical boundary a) To make a change
 TAKE NOTE: 8) MOST IMPORTANT ROLE in CHN:
1) COMMUNITY is the PRIMARY a) Health Educator
CLIENT in CHN 9) The indicator of effective communication
2) FAMILY is UNIT OF SERVICE in a) Feedback
CHN
3) POPULATION is the FOCUS OF PUBLIC HEALTH NURSING
EPIDEMIOLOGY in CHN  The science and art of (Winslow, 1920):
 BEST DEFINITION: People with a a) Preventing Disease
sense of belonging or common b) Prolonging Life
identity c) Promoting Physical And Mental
 COMMUNITY HEALTH NURSING Health
 Coined CHN: Ruth Freeman d) Efficiency Through Organized
 Coined PHN: Lillian Wald Community Effort (Winslow, 1920)
 Utilization of the nursing process in  Nurse is a COMMUNITY LEADER
the different levels of clienteles  by Florence Nightingale
 Specific field of nursing that  Lillian Wald
combines the skills of nursing,  FIRST PHN
public health, and some phases of  FOUNDER of PHN
social assistance and functions  Coined the term Public Health
 Part of paramedical and medical Nursing
intervention which is concerned on  GOAL of PHN:
the health of the whole population a) For people to attain their
 CHN AIMS: birthrights of health and longevity
a) Health Promotion  MOST PROMINENT FEATURE:
b) Disease Prevention a) Public health focuses on
c) Management of Factors PREVENTIVE, NOT CURATIVE
Affecting Health services
 PRIMARY GOAL: b) PREVENTION IS BETTER THAN
a) To enhance the capacity of CURE
individuals, families and  Place to apply PHN: Rural Health Unit
communities to cope with  Person for Requirements Approval:
their health needs Municipal Mayor
 CHN PHILOSOPHY  QUALIFICATIONS: RN in the
a) Based on the WORTH AND Philippines
DIGNITY of man (by Dr.  TAKE NOTE:
Margaret Shetland)  In the event that the MHO is
unable to perform his duties or
MUST KNOW ABOUT CHN: functions or is NOT AVAILABLE,
1) Primary focus of CHN the PHN will take charge of the
 Health Promotion & Disease MHO’s responsibilities.
Prevention  PHN = SUPERVISOR of midwife
2) PRIMARY GOAL of CHN  Midwife = first line of service to client’s
needs
 2) EXTENDED/MULTIGENERATIONAL
Roles of PUBLIC Health Nurse  Relatives live together in one
a) CLINICIAN household
 Provide nursing care  mother, father, children,
 Healthcare provider grandparents, tito/tita
 Taking care of the sick  MOST COMMON TYPE of
b) HEALTH EDUCATOR family IN THE PHILIPPINES
 Conduct health teachings
 Disseminate correct information
 Educating people 3) DYAD
 Make life changes  Husband or wife (must be
 MOST IMPORTANT ROLE MARRIED)
c) SUPERVISOR  Early marriage life
 Leader of Midwives 4) SINGLE Parent
 Monitors and supervises the  One parent and child/ren
performance of midwives  mother and child/father and
d) MANAGER child
 Leader of Nurses 5) COHABITATION
e) RESEARCHER  live-in with/without child/ren
 Gather data  Not married
 E.g. contact tracing 6) BLENDED family
f) FACILITATOR  2 families mixed together
 Provide guidance/assistance to the  Married couple with their
community children from previous
 Establish multi-sectoral linkages by marriages
referral system 7) SAME SEX/HOMOSEXUAL
 Self-reliance  Family with a Gay and/or
g) COORDINATOR Lesbian partner
 Organize activities of the 8) COMMUNAL
community  Live in a single area but not
blood related
Clienteles in CHN  E.g. dorm-mates/board-mates
1) Individual = Entry Point 9) COMPOUND
2) Families = Basic Unit Of Service/Care  Live in a single area but blood
3) Community = Primary Client related
4) Population Group = Point Of Specific  E.g. Neighboring houses are
Care brothers and sisters
a) Children attending Schools 10) FOSTER FAMILY
(Aggregate Population)  Adopted children
b) Pregnant Mothers 11) ALTERNATIVE FAMILY
c) Infants  Relationships include multi-
d) Elderly adult households
e) Religious Groups  Skip generation families
f) Indigenous People  E.g. Grandparents caring for
grandchildren, Communal
FAMILY groups with children,
 Unit of Service in the community “nonfamilies” (adults living
 A small social system (2) or more alone), Cohabitating partners,
people living together who are related Homosexual couples
by blood, marriage, adoption 12) BEANPOLE
 Family comprised of 4 or more
CLASSIFICATION OF FAMILIES generations
1) NUCLEAR (TRADITIONAL)
 mother, father, children
 Must be MARRIED couple
 MOST COMMON TYPE of
family
Types of family ACCORDING TO POWER 2. READINESS FOR
1) PATRIARCHAL/PATRIFOCAL ENHANCED WELLNESS
 Males have the POWER in the STATE
house  Judgment on wellness
 Father is the decision-maker, state
and makes the rules  Based on current
2) MATRIARCHAL/MATRIFOCAL competencies and
 Females have the POWER in performance
the house  Clinical data and explicit
 Mother is the decision-maker, expression of desire to
and makes the rules achieve higher level of
3) PATRICENTRIC functioning.
 No mother, father gets
dominant power B. HEALTH THREATS
 E.g. Father is working (OFW,  Conductive to disease,
policeman) while mother stays accidents or failure
at house  To realize one’s health
4) MATRICENTRIC potential
 No father, mother gets  Examples:
dominant power 1. Family history of illness
 Mother is working (OFW, Hereditary like DM,
policewoman) while father HPN)
stays at house 2. Nutritional problems
5) EGALITARIAN Eating salty foods
 Both mother and father are the 3. Personal Behavior
decision-makers and makes Smoking
the rules Self-Medication
 EQUAL authority of both Sexual Practices
parents Drugs
Excessive Drinking
Types of family ACCORDING TO LOCATION 4. Inherent personality
1. PATRILOCAL characteristics
 Newlyweds reside nearby Short temperedness
father’s family side Short attention span
2. MATRILOCAL Family size beyond
 Newlyweds reside nearby what resources can
mother’s family side provide
3. BILOCAL 5. Short cross infections
 Newlyweds living near both 6. Poor home environment
sides 7. Lack/inadequate
immunization
8. Hazards
FAMILY CARE PLAN  Additional Examples:
 Blueprint of care to family BASURAS
a) Broken glasses and
FAMILY ASSESSMENT scattered sharp objects
b) Absence or lack of
TYPOLOGY OF NURSING PROBLEMS IN prenatal visits or clinic
FAMILY NURSING PRACTICE visits
1) FIRST LEVEL ASSESSMENT c) Safety hazards: Fires,
(Categories of health problems) Falls, and Accidents
A. WELLNESS CONDITION d) Unhealthy lifestyle:
1. WELLNESS POTENTIAL Faulty eating,
 Nursing judgments Sedentary
 No explicit expression of e) Rodents and Insects
client desire f) Absence or lacks of
immunization
 g) Sanitation issues and f) Separation or breakups
family history of and courtship
diseases g) Divorce & Annulment
C. HEALTH DEFICITS h) Entrance in School
 Failure in health maintenance i) Adolescence
(disease, disability, (Circumcision, Menarche,
developmental lag) Puberty)
 3 TYPES: j) Death of love ones
a) DISEASE/ILLNESS
1. URTI CRITERIA FOR RANKING HEALTH
2. Marasmus CONDITIONS AND PROBLEMS
3. Scabies ACCORDING TO PRIORITIES:
4. Edema 1) NATURE OF THE PROBLEM
b) DISABILITIES  Wellness condition, health
1. Blindness deficits, health threats & stress
2. Polio points.
3. Color Blindness 2) PREVENTIVE POTENTIAL
4. Deafness  Nature and magnitude of
c) DEVELOPMENTAL future problems
DISORDERS  Can be minimized or totally
1. Mental Retardation prevented
2. Gigantism  Intervention must be done on
3. Hormonal Problems the problem in this part.
4. Dwarfism 3) MODIFIABILITY OF THE PROBLEM
5. Trisomy 21  Probability in enhancing
wellness state
D. STRESS POINTS/  Improving condition
FORESEEABLE CRISIS  Minimizing, alleviating or totally
 Anticipated period of eradicating the problem
UNUSUAL DEMAND on  Intervention must be done
individual or family in terms of 4) SALIENCE
adjustment or family resources  FAMILY’S PERCEPTION
 Examples:  Evaluation of problem in terms
a) Entrance In School of seriousness and urgency of
b) Adolescents attention needed.
(Circumcision, Menarche, NATURE OF THE PROBLEM (Wt: 1)
Puberty) 1) HEALTH DEFICIT 3
c) Courtship (Falling In 2) HEALTH THREAT 2
Love, Breaking Up) 3) FORESEEABLE CRISIS 1
d) Marriage PREVENTIVE POTENTIAL (ABILITY)
e) Pregnancy (Wt: 1)
f) Abortion 1) HIGH 3
g) Puerperium 2) MODERATE 2
h) Death 3) LOW 1
i) Unemployment MODIFIABILITY OF THE PROBLEM
j) Transfer or relocation (Wt: 2)
k) Graduation 1) EASILY MODIFIABLE 2
l) Board exams 1
2) PARTIALLY MODIFIABLE
 Additional examples: PAPA IS DEAD
3) NOT MODIFIABLE 0
a) Pregnancy
SALIENCE (Wt: 1)
b) Abortion (loss in safety &
1) HIGH (serious - immediate 2
security)
attention)
c) Parenthood
d) Additional family member 2) MODERATE (serious – not 1
(newborn) immediate)
e) Income loss (loss of job) 3) LOW (not seen as a problem) 0
CHN PROCEDURES  Inform client:
a) Nature Of The
CLINIC VISIT Illness
A. PRE-CONSULTATION b) Appropriate
CONFERENCE Treatment And
 Pre-clinic lecture conducted Prevention
 Provide health education c) Control Measures
B. STANDARD PROCEDURES
PERFORMED DURING CLINIC 5) LABORATORY AND OTHER
VISITS DIAGNOSTIC EXAMINATIONS
1) REGISTRATION/ADMISSION  Identify a designated
 Greet the client upon referral laboratory when
entry needed.
 Establish rapport 6) REFERRAL SYSTEM
 Prepare the family  Two-way referral system
treatment record of new (BHS to RHU to hospital)
patients  Accompany the patient
 Record client’s chief when an emergency
complaints and clinical referral is needed.
history 7) PRESCRIPTION/DISPENSING
 Perform physical  Proper instructions on
examination drug intake
 First action in clinic visit 8) HEALTH EDUCATION
2) WAITING TIME  One-on-one counseling
 Give priority numbers  Reinforce health
 “First come, First served “ education
policy  Give appointments for
 Exemptions for next visits
emergency/urgent cases  LAST STEP of clinic visit
3) TRIAGING
 Manage program-based HOME VISIT
cases  Essential to prepare a plan to visit to
 Refer all non-program meet their needs of the client which
based cases to physician. assesses the living condition of the
 Other cases (no potential patient and health practices
danger),  ADVANTAGE: provides opportunity to
treatment/management is do FIRST HAND APPRAISAL of the
initiated by the nurse home situation
 Nurse decides to do her
own nursing diagnosis
 Refer clients to PURPOSES OF HOME VISIT:
physicians for medical a) Health care provider giving nursing
management care to the sick, postpartum, and her
4) CLINICAL EVALUATION newborn
 Validate clinical history b) Observation and assessment of living
and physical examination condition and family health practices
 Evidenced-based nursing c) May establishes close relationship
diagnosis and rational between health agencies
treatment based on DOH d) Educate family regarding health
programs are provided by promotion and disease prevention
the nurse
 Identify patient’s problem PRINCIPLES INVOLVED IN PREPARING
 Formulate nursing FOR A HOME VISIT
diagnosis and validate 1) Must have a purpose or objective
 Perform the nursing 2) Use of all available information about
intervention patient and the patient’s family
 Evaluate the intervention
 3) Set and give priority to the essential
needs of the family
4) The planning and delivery must
Involve the individual and family
5) Home visit must be FLEXIBLE
STEPS IN CONDUCTING HOME VISITS
1) Greet the patient and introduce
yourself (ESTABLISH RAPPORT)
(FIRST STEP)
2) State the purpose of your visit
3) Observe patient and Assess the health
needs
4) Put the bag in a convenient place
(stable table) then perform bag
technique
5) Perform physical examination and
nursing care
6) Impart health teachings
7) Record all important data, observation
and care rendered
8) Make appointment for a return visit
PHN BAG
 The public health bag is an essential
and indispensable equipment of a
PHN which she has to carry along
during her home visits.
 LEFT HAND must be the PHN bag in
a 45° angle flexed
 RIGHT HAND must hold the long,
black umbrella
BAG TECHNIQUE
 A tool which the nurse, during her visit
will enable her to perform a nursing
procedure with ease and depth, to
save time and effort, with the end view
of rendering effective nursing care to
clients.
IMPORTANT POINTS TO CONSIDER IN
THE USE OF THE BAG:
a) Should contain all the necessary
articles, supplies and equipment
(COMPLETE)
b) The bag and its contents should be
cleaned very often. (CLEAN)
c) Well protected from contact with any
article in the patient’s home.
d) Consider the bag and its contents
clean and sterile. (CONTAMINATION)
e) The arrangement of the contents of the
bag should be the one most
convenient to the user.
 Solution like 70% alcohol,
hydrogen peroxide and
heading are placed at the
BACK OF THE BAG
 Oral & Rectal thermometers,
syringes and needles should
be placed AT THE FRONT OF
THE BAG
 Thermometers should be
FACING DOWN
f) Hand washing is done frequently as
situation for (HANDWASHING)
 Helps minimizing and avoiding
contamination.
PRINCIPLES OF BAG TECHNIQUE
a) Minimize, if not, prevent the spread of
any infection (MOST IMPORTANT)
b) Save time and effort
c) Show effectiveness of total care given
to an individual
d) Performed in a variety of ways
depending on the agency’s policy or as
principles of avoiding transfer of
infection is always observed
COMMON BOARD QUESTIONS:
1) Upon arriving client’s home, place the
bag on the table or any flat surface
lined with paper lining, clean side out
(folded part touching the table)
2) Place the linen/plastic lining spread
over work field or area CLEAN SIDE
OUT
3) LAST item placed in the bag is the
PLASTIC/PAPER LINING
4) Sphygmomanometer (BP Cuff),
Stethoscope & Hypodermic needles
(0.5 in) IS NOT INCLUDED INSIDE
the PHN bag
5) DO NOT USE NEWSPAPERS only
clean papers as linings
6) FIRST thing you get from CHN bag –
SOAP in a SOAP DISH and HAND
TOWEL
7) AVOID FREQUENT opening of the
bag
8) AVOID SHAKING OR SWAYING the
bag when carrying it
9) Bag technique should not
overshadow but rather show the
effectiveness of the total care given to
the individual and family.
COPAR (Community Organizing Participatory
Action Research)
 CONTINUOIS and DYNAMIC
process of encouraging people
 Helps people to understand/develop
their awareness of their existing
 conditions by providing the skills, g) The Actual Site Selection
capacity training and working with the (CBQ)
people h) Initial Or Preliminary Social
 A social development approach that Investigation (PSI)
aims to transform into DYNAMIC. i) Ocular Survey/Windshield
PARTICIPATORY and POLITICALLY Survey Noting Accessibility,
RESPONSIVE community Geography, Terrain, And
 Framework of Primary Health Care Available Resources
 GOAL: Self-reliance j) Networking With LGUs And
 Role of Nurse in COPAR: NGOs And Other Department
FACILITATOR  ACTIVITIES OF PRE-ENTRY:
a) Profiling Of Communities
IMPORTANCE OF COPAR: SAME (Site Selection)
1) Self-Reliance to manage a b) Courtesy Call To Mayor
development program in the future c) Trains Students On Baseline
2) Active community participation and Survey
involvement is maximized d) Interview
3) Mobilized community resources for e) Ocular Survey/Windshield
community services Survey
4) Empowerment of the people and f) Networking with other
community development departments
g) Poster/Host Family
PRINCIPLES OF COPAR: POWER Selection
1) People’s participation should always  CRITERIA FOR SITE SELECTION:
pe present DEPRESSED
2) Oppressed and exploited sectors are a) Depressed and Exploited
most open to change Rural Community
3) With COPAR is lead to self-reliant b) Ensure acceptance (No
community strong resistance from the
4) Empowerment: power must reside in people)
the people c) Poor
5) Remember: COPAR should be for the d) Residents (100-200 families)
interest of the poorest sectors of the e) Economically depressed
society f) Safe (No Serious peace and
order problem)
PHASES OF COPAR g) Show high morbidity and
1) PRE-ENTRY PHASE (1-2 months) infant mortality cases
 INITIAL PHASE of the h) Ensure no similar agency
organizing process holding the same programs
 Looking for communities to i) Do not have BHS or nearby
serve or help (Area/Site hospital
Selection) CRITERIA FOR SITE SELECTION
 SIMPLEST PHASE POOR & a. Majority Below
 ACTIONS DEPRESSED Poverty
a) Formulation Of Goals & b. Lack of Income
Objectives c. Lack of
b) Institutional Goals Opportunities
c) Revision Of Curriculum INACCESSIBLE/ a. No hospital
d) Seek And Coordinate INADEQUATE within 5 km (30
Participation Of Other HEALTH minutes) from
Adjustments Within The SERVICES community
Institution b. No health
e) At The Community Level, centers
Encourage Dialogues With POOR HEALTH a. High Infant
The People STATUS Mortality Rate
f) Criteria For Site Selection b. High incidence
Development
 of e) Information campaign on
Communicable health programs
Diseases f) Participate in livelihood
c. High activities
Malnutrition g) Support and lend a hand in
Rate household chores
d. Lack of h) Ensure to be a ROLE MODEL:
Sanitation AVIOD gambling and drinking
NO STRONG RESISTANCE AGAINST alcohol
COMMUNITY ORGANIZATION i) Deepening social investigation
NO SERIOUS PEACE AND ORDER j) Potential Leader spotting
PROBLEM k) Core Group Formation
NO EXISTING COMMUNITY l) Self-Awareness & Leadership
ORGANIZATION/AGENCY Training (SALT)
 CRITERIA FOR POTENTIAL
2) ENTRY PHASE: PASOK LEADER: LEADS
 Phase for Social Preparation a) Low profile
(CBQ) b) Education: at least basic
 Actual entry of the nurse or primary education
community organizer into the c) Approachable/respected by
community (CBQ) both formal & informal sectors
 Sensitization of the people on d) Develops good
the critical events in their life communication skills
 Organizer motivates the people e) Serve willfully (CBQ)
to share their dreams and
ideas 3) COMMUNITY STUDY/DIAGNOSIS
 Known as the MOST CRUCIAL PHASE (RESEARCH PHASE)
PHASE (CBQ)  Selection o the research team
 GUIDELINES FOR ENTRY PHASE:  Training of researchers on data
PLEASE collection (CBQ)
a) Pay courtesy call upon entry  Planning for the actual
to the community to the local gathering of data
authorities (Barangay  Data gathering
Officials)  Training on data validation
b) Let them know your project  Community validation
objectives  Presentation of the community
c) Ensure to be a ROLE MODEL study/diagnosis and
d) Avoid raising recommendation
expectations/consciousness of  Prioritization of community
the community residents needs/problems for actions
e) Speech, behavior and lifestyle  METHODS OF DATA SELECTION
should be in keeping with a) Survey (MOST PRACTICAL)
those of the community  Using questionnaires
residents b) Interview (face-to-face)
f) Ensure to adopt a low-key  Using interview guide
profile c) Record Review (Checklist)
 OTHER INFORMATION: d) Census (MOST IDEAL of
a) Immersion/Integration/ data)
Sensitization with the  Provides biggest bulk of
community data
b) Establish Rapport  Complete enumeration of
c) Converse with people in their data
visual gatherings/area of e) Observation (Ocular surveys)
congregation  2 types of CENSUS
d) Living with the community a) DE FACTO
 ACTUAL phase
  Individuals are recorded  Setting up of financing scheme
in the geological area in implementation of livelihood
where they were projects
present at a specific  Training and continuing
time education of BHWs (CBQ)
b) DE JURE  Formulation/Ratification of by-
 RESIDENCY laws
 Individuals are  TAKE NOTE:
recorded by their place a) Formalize linkages,
of residence networks and referral
 Usual residence system
 The place where a b) Register organization to
person lives and SEC (Security and
sleeps most of the time Exchange Commission)
7) PHASE OUT PHASE
4) COMMUNITY ORGANIZATION &  Gradual turnover of works
CAPABILITY BUILDING PHASE  Transfer of community
 Election of officers and organizing and responsibilities
delineation of roles and tasks and documents to organization
 Leaders or groups are being  Need for Follow up
given trainings (formal, informal,
OJT) COMMUNICABLE DISEASES
 Entails the information of more  EPIDEMIOLOGY
formal structure  Study of the occurrences,
 Community meeting s to draw up distribution and determinants of
guidelines effort the organization health related states or events
 Team building Exercises in specified populations
 TAKE NOTE:  Backbone of disease
 A-R-A-S (Action-Reflection- prevention
Action Session)  EPIDEMIOLOGIC TRIAD
a) HOST-AGENT-
ENVIRONMENT
5) COMMUNITY ACTION PHASE b) Host
 Organization and training of  INTRINSIC FACTOR
BHWs  man as primary host
 PIME of health services c) AGENT
(Project Implementation,  ETIOLOGIC FACTOR
Monitoring and Evaluation)  Virus, bacteria, fungi,
 Resource mobilization parasites etc.
 Setting up of d) Environment
linkages/networks/ referral  EXTRINSIC FACTOR
system JOHN SNOW
6) SUSTENANCE AND  Anesthesiologist known as FATHER
STRENGTHENING PHASE (7-8 OF EPIDEMIOLOGY
months)  In 1800s: He studies epidemic of
 Occurs when the community CHOLERA erupted in Golden Square
organization has already been of Soho District, London (1854)
established
 Community members already 2 TYPES OF EPIDEMIOLOGY
actively participating in 8) DESCRIPTIVE EPIDEMIOLOGY
community wide undertaking  DISTRIBUTION
(CBQ)  It answers the questions
 Formulation and development WHEN, WHERE, and WHO
of SECONDARY leaders  The time, place and person
(CBQ)  Identify patterns among cases
and in populations by time,
place and person
  Surveys are used to find out b) Asian Flu
the nature of the population c) Spanish Flu (1918-1919)
affected by a particular disease d) Antonine Plague
noting the age, sex and e) Meningococcemia
occupation f) AH1N1
9) ANALYTIC EPIDEMIOLOGY g) Black Death/Bubonic
 DETERMINANTS Plague (Yersinia pestis)
 Discovers causes, risk factors, h) HIV/AIDS (Man Sex Man
modes of transmission Relationship)
 It answers WHY and HOW i) Ebola
 Includes the causes (including j) COVID-19 (SARS COV-2)
agents) and risk factors  March 11, 2020 –
(including exposure of sources) COVID 19 is now
 HALLMARK: Presence of global pandemic
comparison group
 Concerned with the search for RA 3573 (LAW ON REPORTING OF
cause and effects NOTIFIABLE DISEASES)
 Report to provincial and duty health
EPIDEMIOLOGIC PATTERNS office
1) SPORADIC  MIDWIFE REPORTS (under
 Intermittent Occurrence supervision of the nurse)
 Irregular interval  REPORT MEASLES & POLIO within
 Random locations 24 hours
 Scattered cases  Tetanus Neonatorum, Severe and
 E.g. rabies Acute Diarrhea, HIV must be reported
2) ENDEMIC within a WEEK
 Constant presence
 Usual prevalence of a disease in CHAIN OF INFECTION
a population within geographical 1) INFECTIOUS AGENT
area  Bacteria, Virus, Fungi, Protozoa
 Continuous occurrence  How to break the CHAIN?
 Steady frequency a) Rapid organism
 Over a period of time identification (DIAGNOSIS)
 Inherent in a given locality b) Prompt treatment
 E.g. Schistosomiasis in Leyte, c) Decontamination
Malaria in Palawan, Filariasis
3) EPIDEMIC VIRULENCE  Ability to cause a
 Outbreak disease
 Greater than usual  Overall strength to
 Short period of time usually in cause a disease
weeks INFECTIVITY  Capacity of agent to
 TYPES OF EPIDEMIC enter and multiply in a
a) POINT SOURCE – food susceptible host
poisonings INVASIVENE  Ability to penetrate an
b) CYCLICAL PATTERN – SS intact skin
Dengue fever PATHOGENI  Capacity if agent to
c) SECULAR trend – Influenza, CITY cause a clinical disease
Measles in the infected host
d) PROPAGATED – HIV/AIDS TOXIGENICIT  Capacity of agent to
4) PANDEMIC Y produce a toxin or
 Simultaneous occurrence of poison
epidemic ANTIGENICIT  Ability to combine
 Concurrent occurrence Y specifically with the final
 Same disease products of the mention
 Several countries (Worldwide) responses (i.e.
 PANDEMIC DISEASES: antibodies and/or cell-
a) MERS COV
 surface receptors) 4) MODE OF TRANSMISSION (means
by which the agent passes through
 KILLING MICROORGANISMS BY: from the portal of exit of the reservoir
a) DISINFECTION: killing of to the host)
microorganisms but NOT their DIRECT CONTACT INDIRECT CONTACT
spores  Reservoir to a
b) STERILIZATION: killing of all host by
microorganisms including suspended air
spores particles,
c) AUTOCLAVING: 15 lbs. vehicles and
pressure, moist heat and 250 vectors
°F CONTACT VEHICLE (inanimate
d) Blacks trips suggest successful objects)
autoclave Skin to skin contact,
2) RESERVOIR (any site where the kissing, sexual Indirectly transmit an
pathogen can multiply or merely contact, contact with infectious agent
survive until it is transferred to a host) soil or vegetation
 Human Reservoirs (Measles, 5 F’s:
Mumps, HIV, STI) infectious Feces, Food, Fluids,
 Animal Reservoirs (Anthrax– mononucleosis Fingers, Flies,
Sheep, Rabies-Dogs) (kissing disease) Fomites
 Environmental Reservoirs (plants,
soil and water) - Histoplasmosis Hookworm (spread NO DEVELOPMENT
 CARRIER by contaminated soil) of agent
 a person that harbors a
specific infectious agent Examples: Examples:
without discernible disease a) Multidrug a) Milk and Dairy
 serves as a potential resistant foods carrying
source of infection organism LISTERIOSIS
 How to break the CHAIN? (Methicillin) ( L.
a) Environmental sanitation b) Respiratory monocytogene
b) Good health & hygiene Infections s)
c) Decontamination/ c) Skin infections b) Food carrying
Sterilization (Wound, Salmonella
d) Dressing change tetanus, c) Water carrying
e) Appropriate linen disposal ringworm, Legionella
f) Proper feces and urine scabies) d) Blood can
disposal d) Wound carry Hepatitis
3) PORTAL OF EXIT (path by which the Infections e) Drugs can
organism leaves the reservoir) e) Enteric carry bacteria
 Mouth (vomit, saliva) Infections (GI from
 Cuts in the skin (blood) diseases) contaminated
 During diapering and toileting f) Eye infections infusion
(stool) (Conjunctivitis supplies
 Influenza & TB exits in respiratory ) f) Contaminated
tract blood, food,
 Cholera exits in feces water,
 How to break the CHAIN? inanimate
a) Control of secretions objects are
b) Hand hygiene vehicles of
c) Proper waste disposal transmission
d) Avoid taking, coughing or AIRBORNE
sneezing over open VECTOR (animal
wounds/sterile fields Less than 5 microns intermediaries)
e) Cover mouth and nose in size
when coughing/sneezing Animals/insects that
 Suspended longer can transmit the Mycoplasma,
disease Meningitis
Travels more than 3 h) Adenovirus
ft. DEVELOPMENT of Infection
agent i) Novel
Examples: Coronavirus
a) Measles e.g. Mosquitoes, (COVID-19)
b) TB Fleas, Ticks
c) Varicella AEROSOL

Tuberculosis,
DROPLETS (Body Measles, Chickenpox
fluids)
DROPLET OF
Spray with relatively SALIVA
large, short-range
aerosol Mumps, Rabies,
Infectious
More than 5 microns mononucleosis
in size
 Considered as the WEAKEST
Do not remain LINK
suspended in air for  Can be easily break by hand
very long washing
 Hand washing is the number one
Seldom travel more way to stop transmission of
than 3 feet infections
 HAND HYGIENE is the single most
Small pox and SARS effective and important technique
could reach persons to use in and controlling
located 6 feet or more transmission of infection
from source  3 elements of Hand
washing:
Examples: a) Soap (1-3 mL)
a) Flu b) Water (running clean
b) Rhinovirus water)
c) SARS c) Friction (Most important
d) Group A Strep element)
e) Neisseria  Hand washing is 40-60
meningitis seconds
 Minimum time each hands:
DROPLET 15 seconds
PRECAUTIONS:  Average time: 20 seconds
a) Streptococcal each hands
Infection and  BEST time: 30 seconds
Scarlet Fever  Minimum percentage of
b) Pertussis, ethanol: 60% ethanol
Pneumonia,  How to break the CHAIN?
Parvovirus R- a) Hand Hygiene
19 b) Isolation Precautions
c) Influenza c) Disinfection/Sterilization
d) Diphtheria d) Use Of PPE
e) Epiglottitis e) Aseptic Technique
f) Rubella 5) PORTAL OF ENTRY
g) Mumps,  Mouth, Cuts in the skin, Eyes
Measles,  How to break the CHAIN?
 a)
Hand Hygiene
b)
Aseptic Technique
c)
Wound Care
d)
Puncture-Resistant
Containers
6) SUSCEPTIBLE HOST
 How to break the CHAIN?
a) Recognize High-Risk
Patients
b) Prompt Treatment
c) Maintain Skin Integrity
d) Balanced Diet
e) Immunization
 RISK FACTORS OF A
SUSCEPTIBLE HOST
a) Children
b) Elderly
c) People with a weakened
immune system
d) Unimmunized people