Module 2 Clinic Visit

Clinical Practicum Primary Health Care-2 (CP-PHC-2)
MODULE 2 CLINIC VISIT
Home visit involves contacting the family at their house to discuss wellness needs, including
resources such as preventive, pro-active, curative or rehabilitative treatment at the door of a community
health nurse or health professional.
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AMELIA C. ANTONIO, ANA BLESILDA C. ATENDIDO, MANCECILIA R. VERGARA, MAN
MAN
NORTH LUZON PHILIPPINES STATE COLLEGE
LESSON 1 Expanded Program on Immunization and Maternal Health
Program
With the commitment of our country to Universal Child Immunization(UCI) Goal acceleration of
EPI coverage had begun in 1986. The achievement of the fully immunized child (FIC) coverage of 80%
was noted one year ahead of the target date of UCI in 1990. The development of the EPI manual of
Operations with it’s clear guidelines, better planning, correct immunization practices and program
implementation contributed to the success of the program.
The conceptualization and introduction of the disease reduction initiative in early 90s contributed
to the decline of numerous cases of the immunizable diseases.
The four major strategies included:
1) Sustaining high routine FIC coverage of at least 90% in all provinces and cities,
2) Sustaining the polio free country for global certification,
3) Eliminating measles by 2008,
4) Eliminating neonatal tetanus by 2008.
The year 1992 was marked by the Presidential Proclamation #46 with the affirmation of the
commitment to the Universal Child Immunization and the Mother Immunization Goal which was
highlighted by the launching of the Polio Eradication Project, at the same year the high routine
coverage of FIC of 92% was achieved nationwide.
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National Immunization days were conducted in 1993-1997 nationwide, this was the period of
excitement where all concerned agencies public and private sector participated in the
OplanAlisDisis.
From 1998 up to present our country is embarking on Measles Elimination. Mass measles
vaccination among children ages 9 months to less than 15 years were given nationwide
regardless of immunization status.
In 2000 our country has been certified polio free in Kyoto Japan. The challenge is difficult to
sustain since we are at risk of importing polio from endemic areas.
The country’s neonatal tetanus (NT) rate is below 1/1,000 live births. There are few cities and
provinces that still have high NT rates. A Maternal and Neonatal Tetanus Elimination Plan has
been developed for the implementation of NT elimination.
The Concept and Importance of Vaccination
Immunization is the process by which vaccines are introduced into the body before infection sets in.
Vaccines are administered to induce immunity thereby causing the recipient’s immune system to react
to the vaccine that produces antibodies to fight infection. Vaccinations promote health and protect
children from disease-causing agents. Infants and newborns need to be vaccinated at an early age since
they belong to a vulnerable group. They are susceptible to childhood diseases.
Over-all Goal: To reduce the morbidity and mortality among children against the most common
vaccine-preventable diseases
Specific Goals:
1. To immunize all infants/children against the most common vaccine-preventable diseases.

2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b and German measles.
6. To prevent extra pulmonary tuberculosis among children.
LEGAL BASIS OF EPI
PD.996 (SEPTEMBER 16, 1976)
 Providing for compulsory basic immunization for infants and children below eight years of
age
RA 7846 (DECEMBER 30, 1994)
 An Act Requiring Compulsory Immunization Against Hepatitis-B for Infants and Children
Below Eight (8) Years Old, Amending for The Purpose Presidential Decree No. 996, And
Appropriating Funds Therefor
RA 10152 (JULY 26, 2010)
 Mandatory Infants and Children Health Immunization Act of 2011. The mandatory
includes basic immunization for children under 5 including other types that will be
determined by the Secretary of Health.
Strategies:
 Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every

Barangay (REB) strategy
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REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was
introduced in 2004 aimed to improve the access to routine immunization and reduce drop-outs.
There are 5 components of the strategy, namely: data analysis for action, re-establish outreach
services, , strengthen links between the community and service, supportive supervision and
maximizing resources.
 Supplemental Immunization Activity (SIA)
Supplementary immunization activities are used to reach children who have not been vaccinated or
have not developed sufficient immunity after previous vaccinations. It can be conducted either
national or sub-national –in selected areas.
 Strengthening Vaccine-Preventable Diseases Surveillance
This is critical for the eradication/elimination efforts, especially in identifying true cases of measles
and indigenous wild polio virus
 Procurement of adequate and potent vaccines and needles and syringes to all health facilities
nationwide
ELEMENTS:
1. Target Setting – (0 – 12 mos.)

2. Cold chain Management (for vaccine life span and utilization)
3. Information, education and communication
3 Reasons:
a. For parents, to be motivated to submit their child to immunization
b. To provide health teachings on benefits and importance of immunization
c. To inform the public about its availability and schedule (RHU every WEDNESDAY.
BHS ONCE A MONTH, and remote area QUARTERLY)
4. Assessment and evaluation of the programs overall performance
5. Surveillance, studies and research.
SEVEN CHILDHOOD PREVENTABLE DISEASES

1. Tuberculosis (Primary Complex if less than 3 years old)
2. Diphtheria
3. Pertussis
4. Neonatal Tetanus
5. Poliomyelitis
6. Hepatitis B
7. Measles
Polio Eradication:
 The Philippines has sustained its polio-free status since October 2000.
 Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to 83%. A least
95% OPV3 coverage need to be achieved to produce the required herd immunity for protection.
Introduction to New Vaccines
 For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization
program. Immunization will be prioritized among the infants of families listed in the National
Housing and Targeting System (NHTS) for Poverty Reduction nationwide.
 The Government of the Philippines has allocated Ph. 1.6 billion for the procurement of these 2
vaccines.
GENERAL PRINCIPLES WHICH APPLY IN VACCINATING CHILDREN:

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 It is safe and immunologically effective to administer all EPI vaccines on the same day at
different sites of the body.
 Measles vaccine should be given as soon as the child is 9 months old, regardless of whether other
vaccines will be given on that day. Measles vaccines given at 9 months provide 85% protection
against measles infection. When given at one year and older provides 95% protection.
 The vaccination schedule should not be restarted from the beginning even if the interval between
doses exceed the recommended interval by months or years.
 Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not
contraindications to vaccination. Generally, one should immunize unless the child is so sick that
he needs to be hospitalized.
THE ABSOLUTE CONTRAINDICATIONS TO IMMUNIZATION ARE:
 DPT2 or DPT 3 to a child who has had convulsions or shock within 3 days the previous
dose. Vaccines containing the whole cell pertussis component should not be given to
children with an evolving neurological disease(uncontrolled epilepsy of progressive
encephalopathy)
 Live vaccines like BCG vaccine must not be given to individuals who are
immunosuppressed due to malignant disease (child with clinical AIDS), therapy with
immunosuppressive agents, or irradiation.
 It is safe and effective with mild side effects after vaccination. Local reaction, fever and systemic
symptoms can result as part of the normal immune response.
 Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody
response. Lengthening the interval between doses of vaccines leads to higher antibody levels.
 No extra doses must be given to the children/mother who missed a dose of DPT/HB/OPV/TT.
The vaccination must be continued as if not time has elapsed between doses.
 Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything
other than the diluent supplied with them.
 False contraindications to immunizations are children with malnutrition, low grade fever, mild
respiratory infections and other minor illnesses and diarrhea should not be considered a
contraindication to OPV vaccination. Repeat BCG vaccination if the child does not develop a
scar after 1st injection.
 Use one syringe one needle per child during vaccination.
THE FOLLOWING ARE NOTCONTRAINDICATION. INFANTS WITHTHESE

CONDITIONS SHOULD BEIMMUNIZED:
1. Allergy or asthma (except if there is a known allergy to a specific component of vaccine

mentioned above)
2. Minor respiratory tract infection
3. Diarrhea
4. Temp. below 38.5 C
5. Family history of adverse reaction following immunization
6. Family history of convulsions, seizures
7. Known or suspected HIV infection
8. with no signs and symptoms of AIDS
9. Child being breastfed
10. Chronic illness such as diseases of heart, lung, kidney or liver
11. Stable neurological condition such as cerebral palsy or Down’s Syndrome
12. Premature or low birthweight (vaccination should not be postponed)
13. Recent or imminent surgery
14. Malnutrition
15. History of jaundice at birth
NOTE: If parent strongly objects to an immunization for a sick infant, do not give it. Ask the
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mother to come back when child is well.
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1. TARGET SETTING
 Involves the calculation of the eligible population for immunization services
 3% FROM THE TOTAL POPULATION=INFANTS
 3.5% FROM THE TOTAL POPULATION=PREGNANT
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RECONSTITUTING THE FREEZE DRIED BCG VACCINE
1. Always keep the diluent cold

2. Using a 5ml. syringe fitted with along needle, aspirate 2 ml. of saline solution from the opened
ampule of diluent.
3. Inject the 2ml. saline into the ampule of freeze-dried BCG.
4. Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and expel
it slowly into the ampule several times.
5. Return the reconstituted vaccine on the slit of the foam provided in the vaccine carrier.
GIVING BCG VACCINE

1. Clean the skin with a cotton ball moistened with water and let skin dry.
2. Hold the child’s arm with your left hand so that your hand is under and your thumb and finger
come around the arm and stretch the skin.
3. Hold the syringe in your right hand with the bevel and the scale pointing up towards you.
4. Lay the syringe and needle almost flat along the child’s arm.
5. Insert the tip of the needle into skin – just the bevel. Keep the needle flat along the skin and the
bevel facing upwards, so the vaccine only goes into the upper layers of the skin.
6. Put your left thumb over the needle end to hold it in position. Hold the plunger between the index
and middle fingers of the right hand and press the plunger in with your right thumb.
7. If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange
peel will appear at the injection site.
8. Withdraw needle gently.
NOTE:
1. Any remaining reconstituted vaccine must be discarded after 6 hours or at the end of the
immunization sessions, whichever comes first.
2. The small raised lump appears at the injection site, usually disappears within 30minutes.
3. After 2 weeks, a red sore form that is about the size of the end of an unsharpened pencil.
4. The sore remains for another two weeks and then heals, a small scar, about 5mmacross remains.
This is a sign that the child has been effectively immunized.
5. Repeat BCG vaccination if the child does not develop a scar after the 1st injection
BCG vaccine is moderately effective. It has a protective efficacy of:

50 % against any TB disease
64 % against TB meningitis
74 % against death from TB
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GIVING TETANUS TOXOID VACCINE

1. Shake the vial.
2. Clean the skin with a cotton ball, moistened with water and let skin dry.
3. Place your thumb and index finger on each side of the injection site and grasp the muscles
slightly. The best injection site for a woman is outer side of the upper arm.
4. Quickly push the needle, going deep in to the muscle.
5. Slightly pull the needle back to be sure it is not into a vein.
6. Inject the vaccine, withdraw the needle and press the injection spot quickly with apiece of cotton.
ROLE OF A MIDWIFE IN IMPROVING THE DELIVERY OF IMMUNIZATION IN THE

COMMUNITY
AS A
MIDWIFE, YOU NEED TO:

1. Actively master list infants eligible for vaccination in the community.
2. Immunize infants following the recommended immunization schedule, route of administration,
correct dosage and following the proper cold chain storage of vaccines.
3. Observe aseptic technique on immunization and use one syringe and one needle per child. This
reduces blood-borne diseases and promotes safety injection practices.
4. Dispose used syringes and needles properly by using collector box and disposing it in the septic
vault to prevent health hazard.
5. Inform, educate and communicate with the parents
6. To create awareness and motivate to submit their child for vaccination.
7. to provide health teachings on the importance and benefits of
a. immunization, importance of follow up dose to avoid defaulters and
b. normal course of vaccine.
8. to inform immunization schedule as adopted by local units.
9. Conduct health visits in the community to assess other health needs of the community and be
able to provide package of health services to targets.
10. Identify cases of EPI target diseases per standard case definition.
11. Manage vaccines properly by following the recommended storage of vaccines.
12. Record the children given with vaccination in the Target Client list and
13. GECD/GMC or any standard recording form utilized.
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14. Submit report and record of children vaccinated, cases and deaths on EPI diseases, vaccine
received and utilized and any other EPI related reports.
15. Identify and actively search cases and deaths of EPI target diseases following standard case
definition.
Introduction to New Vaccines
 In 2012, Rotavirus and Pneumococcal vaccines were introduced in the national immunization
program. Immunization was prioritized among the infants of families listed in the National Housing
and Targeting System (NHTS) for Poverty Reduction nationwide.
 The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2
vaccines
REFERENCES:
Cuevas,F.P.et.al. (2007). Public health nursing in the Philippines. Manila.National League of

Philippine Government Nurses.
Maglaya.A.S.(2004). Nursing practice in the community. Marikina City. Aragonauta

Corporation.
Sia,M.L. (2008) Community health and communicable disease and nursing reviewer.Quezon
City,RMSIS Publishing.
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Module 2 Clinic Visit

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Module 2 Clinic Visit

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Clinical Practicum Primary Health Care-2 (CP-PHC-2)

MODULE 2 CLINIC VISIT

LESSON 1 Expanded Program on Immunization and Maternal Health

The Concept and Importance of Vaccination

1. To immunize all infants/children against the most common vaccine-preventable diseases.

LEGAL BASIS OF EPI

PD.996 (SEPTEMBER 16, 1976)

RA 7846 (DECEMBER 30, 1994)

RA 10152 (JULY 26, 2010)

 Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every

 Supplemental Immunization Activity (SIA)

 Strengthening Vaccine-Preventable Diseases Surveillance

1. Target Setting – (0 – 12 mos.)

SEVEN CHILDHOOD PREVENTABLE DISEASES

Introduction to New Vaccines

GENERAL PRINCIPLES WHICH APPLY IN VACCINATING CHILDREN:

THE ABSOLUTE CONTRAINDICATIONS TO IMMUNIZATION ARE:

THE FOLLOWING ARE NOTCONTRAINDICATION. INFANTS WITHTHESE

1. Allergy or asthma (except if there is a known allergy to a specific component of vaccine

mother to come back when child is well.

RECONSTITUTING THE FREEZE DRIED BCG VACCINE

1. Always keep the diluent cold

GIVING BCG VACCINE

BCG vaccine is moderately effective. It has a protective efficacy of:

GIVING TETANUS TOXOID VACCINE

ROLE OF A MIDWIFE IN IMPROVING THE DELIVERY OF IMMUNIZATION IN THE

MIDWIFE, YOU NEED TO:

Introduction to New Vaccines

Cuevas,F.P.et.al. (2007). Public health nursing in the Philippines. Manila.National League of

Maglaya.A.S.(2004). Nursing practice in the community. Marikina City. Aragonauta

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