NCM204 RLE – Community Health Nursing Rotation

Skills Lab #4
Community Health Nursing Rotation ü Pathophysiology
o Etiology – causes of problem:
Concept: Care of Mother, Child and Family in
Community Health Setting (precipitating and predisposing
factors)
Date: November 19, 2021 § Predisposing – contribute to
development of disease
Preliminary Requirements:
§ Precipitating – triggered the
• Clearance for 2nd-4th rotation onset of disease/disorder
• Student profile with picture o Symptomatology (s/sx) – include
ALL possible s/sx of disease (Esp.
Requirements and Criteria: cardinal signs)
§ 2ND COLUMN:
description/rationale
ü Management (diagnostics, medical, nursing
management)
o Nsg management:
§ Problem prioritization
(identify everything the
compute, justify) # of
Journal Reading: members = # of FNCP
(individual)
o *If w/o surgical management = do
not include
ü Prognosis (good/poor; justify)
ü DOH program that will address the problem
(2 paragraphs per program)
ü Nsg theory (description)
o Last paragraph: how do u used the
theory to provide care?
ü Summary (3 paragraphs) ü References (APA) – 5 years; alphabetical
ü Rx (personal POV) order

Case Analysis:

ü Intro: start w/ brief definition/description of

CHN, care of family, description of
disease/disorder assigned. Followed by
statistics (recent) [global, national, local]
o Last paragraph: overview of case
analysis
ü Objectives (1 general, specific obj) SMART
 NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
FNCP: • Nursing home
visit and bag
technique
• Expanded
program on
immunization
Distribution of topics Individual
for reading student
profile
Writing of student’s
ü Cues: ALL cues in scenario profile
ü Health Prob (1st level assessment) Day Team building Readings
ü Fam Nsg Problem (5 statements to choose 2 submitted
from) Discussion
o Include: knowledge, skills • DOH Prenatal
ü Interventions (marami) >10 Services
Quizzes via Family
o LONG TERM
QUIPPER problems
identified and
Group Work: prioritized
Case Scenario,
identification of
problems
Week 2
Day Preconference Problems
3 Prioritization of prioritized
problems
ü Visual aids (do not copy paste everything
Day Preconference Prioritization
from manuscript)
4 Presentation of presented
o Bullet type prioritized problems and corrected
o Complete text: FNCP only Day Preconference FNCP
o Each slide – 7 lines 5 Presentation of
o Font: 28-32 Prioritized Problem
o No animation Group work: FNCP
Schedule of Activities:
Week 3
Day Preconference
Week 1 6 Lecture: NTP
Day Skills Lab *Sharing of readings
1 Orientation: Quiz
A. PCIP
B. Grading Group work: CA
System Post-conference
C. Requirements Day Preconference Case
7 analysis
Discussion/Review *Sharing of readings manuscript
• Typology of Group work: CA (to integrate
nursing Post-con FNCP in nsg
problems management)
• Prioritization Week 4
of family Day Preconference
problems 8 *Sharing of readings
• FNCP Presentation of CA
Post-con

Day Preconference
9 Presentation of CA
Post-con
Day Preconference Shifting via
10 *Sharing of readings quipper
Presentation of CA Eval – written
Shifting Exam and shared
Eval & sharing of
insights
Typology of Nursing Problems in
Family Nursing Practice
By: Sir Luke Avila, RN
1st Level Assessment – health problem
Identifying potential (problem that may arise soon,
risks) and existing health problems = actual
problem.
A. Presence of Wellness Condition – potential
or readiness nsg judgement of transition
from a higher level of wellness.
B. Presence of Health Threat – accident
hazards, failure to take action, risk factors
C. Presence of Health Deficits – failure in
health maintenance (w/ disease:
un/diagnosed)
D. Presence of Foreseeable Crisis/Stress Point
– anticipated period of unusual demand on
individual/ family in adjustment/family
resources
2nd Level Assessment – family nursing problem
Determining the family nursing problems. What
problem encountered in altered health tasks. What
is the reason of illness??
A. Inability to recognize he presence of the
condition/problem
B. Inability to make decisions w/ respect to
taking appropriate health action
C. Inability to provide adequate nursing care to
the sick, disabled, dependent or
vulnerable/at risk member of family
D. Inability to provide a home environment
conducive to health maintenance and
personal development
E. Failure to utilize community resources for
health care
NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
Prioritization
• Nature of problem
o Wellness state
o Health deficit health
o Health hazard
o Presence of Foreseeable
Crisis/Stress Point
• Modifiability of the problem – probability of
success enhancing the wellness state,
improving condition
o Factors:
§ Current knowledge,
technology, and intervention
§ Resources of family, nurse
and community
• Preventive Potential – nature/magnitude that
can be minimized or totally eradicated
o Factors:
§ Gravity/severity of the
problem – the more severe,
the lower the preventive
potential
§ Duration – length of time the
problem is existing (direct
relationship to gravity)
§ Current Management –
presence of appropriateness
of interventions *what are
they doing to minimize the
problem?
§ Exposure of high-risk groups
• Salience – family’s perception and
evaluation of the condition in terms of
seriousness and urgency of attention
needed or family readiness

*Divide score by highest possible score then multiply
by weight
Example:
o Health threat – 2/3*1 = 0.67
o Easily modifiable – 2/2*2 = 2
o Moderate – 2/3*1 – 0.67
o Not perceived as problem – 0/2*1 =
0 Factors to Consider:
• Total = 3.34 (highest score is 5)
Higher score = more prioritized
Format for FNCP
• Can merge date & cues
o Day of assessment: day of 1st read
the case scenarios
o Subj and obj cues
• Intervention tandem with objectives
o A. objective # | (next column)
interventions under to achieve
intervention
NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
Community Health Nursing
by: Ma’am Tita Dabi
Home Visit – a professional face to face contact
to the pt/family
Preparing for a Home Visit – Principles:
1. A home visit should have a purpose or
objective
2. Make use of all available information about
the pt./family through;
a. Family health records
b. Knowledge of health center
personnel
c. Other agencies that rendered
services to the pt/family
3. Planning should revolve around the
essential needs of the individual/family but
priority should be given to those needs
recognized by the family itself
4. Continuing care should involve the
individual/family
5. Planning should be flexible and practical
• Physical, psychological and education
needs of the individual/family
• Acceptance of the family for the services
offered, their willingness and interest to
cooperate
• Careful evaluation of past services given to
a family and how this family made use of
such nursing services
• Ability of the pt./family to recognize their
own needs their knowledge of available
resources and their ability to use these
resources on their own accord
• Other health agencies and # of health
personnel already involved in the care of the
family
• Policy of a given agency and the emphasis
placed in a given health program
Making a Home Visit:
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Skills Lab #4
ü Test tubes (2pcs)
ü Disposable syringe
• Before leaving the clinic, have the correct ü Acetic acid
name and address of pt. ü Test tube holder (5ml, 2ml)
• Record these cases have been reviewed as ü Denaturated alcohol
regards to previous visits ü 2pcs droppers
• Bring watch w/ 2nd hand, pen, memo ü Disposable needles (optional)
book/nbook, umbrella ü Sterile CBs
• Upon arrival, observe the rules of courtesy
(ring bell, knock) Principles in the Use of the Bag:
• After being admitted, introduce yourself • Bag should contain all necessary articles,
professionally (if 1st visit). Explain the supplies, and equipment which may be
purpose of visit used to answer emergency needs
• Nurse should sit down and talk with the pt. • Bag and its components should be cleaned
in order to obtain needed information as often as possible, supplies replaced and
• Select the most responsible member of the ready for use at any time.
family to assist during the visit and to give • Bag and contents should be wel protected
care or treatment in the period between from contact with any article in the home of
visits the pts. Consider the bag and contents
• Look for a place to put down the bag or a clean while any article belonging to the
table or chair 6ft. away from the bedside. patient as dirty/contaminated
Line the table with newspaper before putting • Arrangement of the content should be the
down the bag one most convenient to the user to facilitate
CHN Bag and Bag Technique efficiency and avoid confusion
An essential and indispensable equipment of • Handwashing as frequently as the situation
the CH Nurse which she has to carry along w/ her calls for helps minimize or avoid
when she goes out home visiting contamination of the bag and its contents
• The bag when used for a communicable
What does the bag contain? case, should be thoroughly cleaned and
disinfected before keeping and re-using
ü Soap in soap dish
ü Kidney basin Bag Technique
ü Bottles containing: plastic and paper A stool by which the nurse, during home visit,
wrappers can perform a nsg procedure w/ ease and deftness,
ü Medicine glass saving time and effort with view of effective nursing
ü 70% alcohol care to clients/pts.
ü Tissue paper
ü Thermometer Principles:
ü Sterile water
1. The use of the bag technique should
ü Waste receptacle
minimize, if not totally prevent, the spread of
ü Tongue depressor
infection from individual to families to the
ü Soap suds solution
community.
ü Apron
2. Bag technique should save time and effort
ü Plaster
on the part of the nurse in the performance
ü Hydrogen peroxide
of the nursing procedures.
ü Towel lining
3. Bag technique should not overshadow the
ü Operating sponge
nurse’s concern for the client, but rather
ü Spirit of ammonia
show her effectiveness in providing total
ü Match
care to an individual or family.
ü Reagent strips
ü Benedict’s solution
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4. Bag technique can be performed in a variety
of ways depending upon agency policies,
actual home situations, etc. as long as
principles of avoiding transfer of infection is
carried out.
Steps in Performing Bag Technique: *nursing
Urine Test for Sugar: *page 264
manual page 263
1) Measure 5 ml of Benedict's solution in a
1. Upon arrival at the client's home, place the
medicine glass.
bag on the table lined with a clean paper.
2) Pour solution into the test tube over the
2. Ask for a basin of water or glass of drinking
waste receptacle
water if tap water is not available.
3) Light the alcohol lamp.
3. Open the bag and take out the towel and
4) Heat the solution until it boils.
soap.
5) Once it boils, add 8 drops of urine and boil
4. Wash hands using soap and water. Wipe to
the mixture for 5 minutes After 5 minutes,
dry.
observe for any change in color
5. Take out apron from the bag and put it on
with the right side out.
6. Put out all necessary articles needed for the Blue = negative
specific care. (Sugar and albumin testing).
Greenish-blue = Traces
7. Close the bag and put it in one corner of the
working area. Yellowish-green=+3
8. Proceed in performing the necessary Orange-yellow or brick red
nursing care and treatment.
Urine Test for Albumin: *page 264
1. Fill test tube 2/3 or ¾ full of urine and place
it in the kidney basin.
2. Light the alcohol lamp
3. Heat upper portion of the test tube with
urine. *Video for bag technique: start 10:53 (in recorded
4. After the urine boils, compare the heated video); end 44:00
portion with the lower portion of the test
tube. The result is negative if there is no Expanded Immunization
cloudiness
5. If there is cloudiness after boiling, add 5
Program
By: Maria Catherine Belarma
drops of acetic acid to the urine over the
waste receptacle. **DOH Program for children 5 years old and
6. Reboil the urine below
7. If cloudiness disappears after boiling, the
urine is negative for albumin and the The Expanded Program on Immunization
cloudiness is only due to the presence of (EPI) was established in 1976 to ensure that
phosphates. infants/children and mothers have access to
8. If cloudiness remains after boiling, it is routinely recommended infant/childhood vaccines
positive for albumin.
Immunization – process where in person is made
immune/resistant to an infectious disease thru
administration of a vaccine (i.e., COVID vaccines)

Objective: to reduce morbidity and mortality among
infants/children against the most common vaccine-
preventable diseases.
6 vaccine-preventable disease were initially included
in EPI:
a. Tuberculosis – very contagious; attacks
lungs and sometimes, spread to brain and
spine (tb meningitis); caused by
mycobacterium tuberculosis
b. Poliomyelitis – infectious viral disease;
often affects children under 5 yrs old; spread
from one person to another by contaminated
water/food; multiplies in intestine then
invades nervous system (paralysis in
children)
c. Diphtheria – serious bacterial infection that
affects mucous membrane of throat and
nose; spread easily from one person to
another; corynebacterium diptheriae; spread
by direct contact using the object used by the
person (i.e., sharing of cups); very infectious
if you are in front of the infected person
(sneezing, blowing his/her nose)
d. Tetanus – acute infectious; clostridium
tetani; very serious in neonates “neonatal
tetanus”
e. Pertussis – whooping cough; higly
contagious respiratory disease; s/sx: violent
cough = hard to breath; easily spread thru
droplet infection; Bordetella pertussis.
f. Measles – “rubeola”; 1 dose of measle
vaccine; presents a lot of complications ®
red eye, red rashes; gives complication in
severe pneumonia = death in children with
measles
Specific Goals:
1. To immunize all infants/ children
2. To sustain the polio-free status of the
Philippines.
3. To eliminate measles infection.
4. To eliminate the maternal and neonatal
tetanus
5. To control diphtheria, pertussis, hepatitis B,
and German Measles.
6. To prevent extrapulmonary tuberculosis
among children.
NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
Mandates
Republic Act. No. 10152
“Mandatory Infants and Children Health
Immunization Act of 2011”
• Signed by President Benigno Aquino 111
• The mandatory includes basic immunization
for children under 5 including other types that
will be determined by the Secretary of Health
Presidential Decree No. 996
September 16 1996
“Providing for Compulsory Basic Immunization for
Infants and Children below eight years of age”
• Basic Immunization against certain diseases
shall be compulsory for infants and children
below eight years of age
• Public schools give another dose of DPT in
grade 1 pupils
Fully Immunized Child (FIC)
• 1997 - Are those who were given BCG, 3
doses of OPV, 3 doses of DPT, and Hepa B
vaccine, and 1 dose of measles vaccines
before the child reaches 12 months of
age. (right time and right interval)
• 2013 - A child who received 1 dose of BCG,
3 doses of OPV, 3 doses of Pentavalent (5-
IN-1 vaccine namely diphtheria, tetanus,
pertussis, hepatitis B, and Haemophilus
influenzae type B), 3 doses PCV
(pneumococcal) vaccine, and 1 dose of
measles vaccines before the child reaches
12 months of age. (right time and right
interval)
Completely Immunized Children (CIC) – Refers to
children who completed their immunization at the
age of 12-23. Basically, not at the desired age and
time.
o Child who received 1 dose of BCG, 3 doses
of DPT, 3 doses of HEPA, 3 doses of OPV,
1 dose of measles but not on the desired age
and time
Note: you cannot give vaccine before the prescribed
age
 NCM204 RLE – Community Health Nursing Rotation
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• Can be delayed after few days BUT cannot § Indicator that the vaccine was
be earlier kept at the temperature that
the potency required
Target Setting:
• Infants 0-12 months
• Pregnant and Postpartum Women – given
tetanus toxoid
• School Entrants/Grade 1 or 7 years old –
another dose of DPT given in school
Cold Chain Logistics Management
• Vaccine distribution through cold chain is
designed to ensure that the vaccines were
maintained under proper condition until the
time of administration
• Cold chain is a system used to maintain
potency of vaccine from the manufacturer to
the time it is given to a child/pregnant woman
• The allowable timeframes for the storage of
vaccines at different levels are: “Schedule ng Pagbibigay ng Bakuna para sa mga
o 6 months – regional level Batang Isang Taon Pababa”
o 3 months – provincial/district level
o 1 month – main health centers w/ ref
o Not more than 5 days – health
centers using transport boxes
• Most sensitive to heat: freezer (-15 to -25
degrees C) – OPV
• Sensitive to heat and freezing (body of ref.
+2 to +8 degrees C)
o BCG
o Measles
o Pentavalent (DPT, Hepa B, HIB)
o Tetanus Toxoid
• FEFO “first expiry and first out” vaccine is
Sample Immunization Card:
practiced to assure that all vaccines are
utilized before the expiry date. Proper
arrangement of vaccines and/or labeling of
vaccines’ expiry date are done to identify
those near to expire vaccines
Unused BCG should be discarded how many hours
after reconstitution? 4 HOURS
Causes a scare: BCG
Most sensitive to heat: OPV
Example:
o Red – expire by December
o Orange – expire by January
o Yellow – expiry by February

• VVM (Vaccine Vial Monitoring)

o Thermo chromic label – colored lilac
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o Do not feed the baby 30 mins after
giving OPV (to avoid stimulating
vomiting)
Sites of Injection:
• Intramuscular:
Pentavalent
• Vastus Lateralis – antero-
lateral mid aspect of the
thigh (penta, hep. B, IPV,
PCV)
• Note: pentavalent should
always be given at the right
side of pt.
• Intradermal: BCG – deltoid region of the
arm)
o Instruct mother to not apply alcohol
(can kill vaccine)

Immunization Schedule:
Vac- Minimum # of Dos Inte Ro Site
cine age of 1st dose age rval ute • Oral: OPV – 2 drops
dose o Squeeze the plastic portion; 2 drops
BCG @ birth 1 0.05 - ID R deltoid of
mL the arm
in the side of mouth
Penta- 6 weeks 3 0.5 4w IM Vastus
Valent mL lateralis
OPV 6 weeks 3 2 4w Oral Mouth
drops
PCV 6 weeks 3 0.5 4w IM Vastus
mL lateralis
Measles 9 mos. 1 0.5 - SQ Upper outer
AMV1 mL portion of
arm
MMR 12-15 1 0.5 - SQ Upper outer
mos. mL portion of • SQ: measles and MMR (upper outer portion
arm
IPV 14 weeks 1 0.5 - IM Vastus
of the arm)
mL lateralis
RTV 6 weeks 3 1 mL 4w PO Side of the
mouth

Considerations:
• OPV
o Ask if child has fever or any other Routes:
condition/illness
o Dependent on HC protocol, OPV is
not given if the pt. is on antibiotics
o If with LBM, instruct parent to
comeback after 1 week to give
another dose of OPV to complete
dosage of OPV

Date: November 20, 2021
Department of Health Programs
and Services
By: Celina Angeli V. Aseneta, RN
Maternal and Child Care Programs
Objective: improve well being of mother and children
through the delivery of comprehensive maternal and
child related services utilizing the primary health
care (PHC) approach
Why is our focus the mother/child? higher rate in
mortality and morbidity (a lot of cases) = focus care
in them to reduce rate of mortality and morbidity
Safe Motherhood: means ensuring that all women
receive the care they need to be safe and healthy
through pregnancy and childbirth
NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
Target Clients: PREGNANT WOMEN
Services Offered:
• Antenatal care and counseling – birth
planning
• Skill attendants (PHW, barangay health
workers, nurses and doctors) with
necessary equipment and supplies
• Post-partum and newborn care
• Family planning
• Birth spacing information – teach parents
(mothers and fathers) of proper birth
spacing; WHO recommend min. of 2 years
interval in pregnancies
o Pregnancies of interval with less than
18 mos. = increased risk for neonates
(LBW, premature, NICU admissions)
o Give more time for mother to
breastfeed their baby; allow mother
to replenish nutrients that were lost
from previous pregnancy
• Services through reproductive lifespan and
before and after pregnancy
• Community education on safe mother hood
for women
• Political and financial commitments – local,
national and international governments
Prenatal Care: medical and nursing care
recommended before/during pregnancy
Schedule:
• 1st to 7th month: once a month
• 8th month: twice
• 9th month: weekly
Services offered:
• Height, weight BMI
• Laboratory Examination (CBC, UA)
• Giving of Iron/ferrous – prevent IDA
• Tetanus Toxoid Immunization
• Dental check up
• Counselling – esp. for teen
pregnancies/unprepared couples
Importance of Prenatal Visits:
• Early assessment and detection of high-risk
factors (can be addressed right away)

• Early prevention, monitoring and treatment
of Rh factors
o RH incompatibility – mother’s body
will reject
• Ensure safe delivery and healthy baby
• Getting correct advice on proper care during
pregnancy and delivery
During the initial visit:
• Diagnosis of pregnancy
• Define mother and fetal health status
• Determine gestational age of fetus
• Client education
• Initiate a plan for continuing obstetrical care
• History taking
• Physical examination
• Laboratory investigation
Physical Examination:
• Weight, height, body mass index (BMI)
• VS: BP, pulse, temperature
• Leopold’s maneuver
o A common and systematic way to
determine the position of a fetus
inside the woman’s uterus
o Performed: after 24 weeks gestation
when fetal outline can already be
palpated
**Not indicated to preterm and pt. with bleeding
NCM204 RLE – Community Health Nursing Rotation
Skills Lab #4
1. Fundal grip – presentation (closest
to birth canal)
2. Umbilical grip – position (back –
where FHT is heard)
3. Pawlik’s group – engagement
(engaged/not engaged)
4. Pelvic grip – attitude (degree of
flexion and extension)
Laboratory Tests
• A complete CBC
• Blood typing and screening for Rh
antibodies (antibodies against a substance
found in the RBC of most people)
• Or infections such as syphilis, hepatitis
gonorrhea, chlamydia, and human
immunodeficiency virus (HIV)
• For evidence of previous exposure to
chickenpox (varicella), measles (rubeola),
mumps, or German measles (rubella)
• For cystic fibrosis:
o Health care providers are recently
started to offer this even if there is
no family history of the disorder
Tetanus Toxoid
Vaccines that contain tetanus toxoid not only
protect women against tetanus, but also prevent
neonatal tetanus in their newborn infants.

4 distinct actions:
Immunization Schedule:

TT1 ASAP during -

pregnancy
TT2 4w later 80% Infants born to
mother will be
protected from
neonatal tetanus

3 yrs protection for

mother
TT3 6 mos. later 95% Infants born to
mother will be
protected from
neonatal tetanus

5 yrs protection for

mother
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TT4 1 yr later 99% Infants born to • Bartholomew’s Rule of Fourths – refers to
mother will be the relative position of the uterus in the
protected from
abdominal cavity
neonatal tetanus

10 yrs protection
for mother
TT5 1 yr later 99%

Counseling:

• Folic acid – prevent NTD, iron – prevent

IDA, calcium
• OTC off limits = can effect fetus (ask health
care provider first)
Obstetrical Data
LMP Last Menstrual Period – 1st day of last
menstruation
Example: GPA Gravida, Parity, Abortion

Mrs. B had her menstruation last Oct 24, 2021, and

it lasted for 5 days.

• Menses for 5 days: Oct 24-28

• LMP: Oct 24, 2021
AOG Age of Gestation

• Measured by week: based on LMP

• McDonald’s Method: FH/4 = AOG months
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TPAL Term, Preterm, Abortion, Living

• Term: 38-42 weeks

• Preterm: 28-37 weeks
• Abortion: less than 27w
• Living: presently living children

EDC Expected Date of Confinement (+/- 2 weeks)