Introduction To Community Health Nursing Outline

COMMUNITY
2nd Year, 1st Semester

HEALTH NURSING PRELIMS
INTRODUCTION TO COMMUNITY HEALTH NURSING
OUTLINE purposes of companionship, desiring to achieve a sense of

I. Terms family.
A. Public Health
B. Public Health Nursing BASED ON LOCUS OF POWER
C. Community Health Nursing - You consider this bc to see how it influences the family
II. Basic Principles of CHN
A. Individual 1. Patrifocal/Patriarchal family – a union in which the man has
B. Family the main authority and decision-making power
C. Population group 2. Matrifocal/ Matriarchal family – a union in which the woman
D. Community has the main authority and decision-making power
3. Egalitarian – equal amount of authority
TERMS 4. Matricentric – prolonged absence of the father as in the case
of families of OFWs which gives the mother a dominant position
PUBLIC HEALTH in the family, although the father may in a way share the
• Is the science and art of preventing disease, prolonging life and decision-making power with the mother
promoting health , and efficiency through organized community
effort FAMILY HEALTH TASK
• To enable every citizen to realize his birthright to enable health • Achieve wellness
and longevity (Dr. C.E. Winslow) o Recognize problems
Charles Edward Winslow
• The art of science in the context of politics so as to reduce o Decision-making
inequalities in health while ensuring the best health for the o Nursing care
greater number o Home environment
o Community resources
PUBLIC HEALTH NURSING • It is the nurse’s responsibility to assess whether the family is
“Special field of nursing •The practice of nursing in national and local government health able to attend to these tasks or not
that combines theskills of
departments (which include health centers and rural health • Failure = Family Nursing Problems
nursing, public health,
and somephases of social units) and public schools
assistance and functions POPULATION
aspart of the total public•It is community health nursing practiced in the public sector
health program. • A group of people
COMMUNITY HEALTH NURSING • Sharing same characteristics, developmental state,
• Utilization of the nursing process (ADPIE) in the different levels exposure to environment would mean common health
of clientele problems
• Individuals, families, population groups, communities
• Concerned with : promotion of health, prevention of disease and COMMUNITY
disability rehabilitation (according to Araceli Maglaya) • A group of people sharing geographic boundaries, values,
• Goal: raise level of health of the citizenry by helping and interests, and *cultural heritage
communities and families cope with the discontinuities in and • * – each is unique
threats to health and maximize their potential for high level • Consists of :
wellness a. Geographic boundaries
o This goal is achieved through multi-sectoral efforts b. Institutions, Network, Communication
c. Common interest
BASIC PRINCIPLES OF CHN d. Problem can be identified = solved
• Community : Patient e. Populations
• Family : Unit of care
• Part of the health care system and the larger human services Our client are the families (composed of individuals)
system
Active Partner – they are participative in setting up care. You as a
• 4 Levels of Clientele – Individual, Family, Population Group,
student nurse, you help facilitate in health teaching
Community
INDIVIDUAL • CHN practice is affected by developments in health
technology and changes in society
• Sick or well
o E.g : community dati is bukirin, ngayon urbanized
• Seek consultation (different settings
na siya
• Entry point in the family o Hindi accessible yung health care facilities sa
mga rural areas (yung iba kinakarga lang, walang
FAMILY ambulance)
• Small social system
• 2 or more people living together
• Blood / marriage / adoption / arrangement over a period of
time
FAMILY COMPOSITION
1. Nuclear family – father + mother + child/children
2. Extended family – nuclear + relatives of one or both spouses
3. Blended family – composed of one separated/divorced or
widowed adult with his/her children, they live together in one
household (ex: kardashians)
4. Single-parent – composed of either father or mother with
his/her biological or adopted children
5. Same sex/homosexual family – composed of gay/lesbian
partners living together
6. Cohabiting or communal family – consists of unrelated
individuals or families who live together under one roof for
TRANSCRIBED BY: @wondeulz on twitter

COMMUNITY
PHILIPPINE HEALH CARE DELIVERY SYSTEM
HEALTH CARE DELIVERY SYSTEM • Initiate public discussion on health issues and disseminate
• The Philippine Healthcare delivery system is defined as “ the policy research outputs to ensure informed public participation
totality of all policies, facilities, equipment, products, human in policy decision making.
resources and services which address the health needs, • Oversee implementation, monitoring and evaluation of national
problems and concerns of the people.” health plans, programs and policies.
• Large, complex, multilevel, and multidisciplinary
o Multidisciplinary – we are working hand in hand with other GOAL OF THE DOH
organizations like NGOs (red cross) Ø Implementation of health sector reforms thru the Health Sector 1999
Reform Agenda (HSRA).
MAJOR PLAYERS Ø These are areas that need to be reformed.
A. Public Sector – largely financed through a tax-based budgeting o Local health systems
system at both the national and local levels and where o Hospital systems
healthcare is generally given for free at the point of service. o Public Health Programs
a. National Level – DOH as lead agency o Health Financing
b. Local Level – lead by local government units (health o Health Regulation
centers) • These five areas have been identified as critical in transforming
B. Private – paid and market-oriented the health system into one that ensures the delivery of cost
a. Commercial – JCI accredited; the standards they are effective services, universal access to essential services and
following are based on the framework of JCI / other first adequate and efficient financial resources.
world countries • Universal access is hard because of our geographic eme
b. Non-Commercial – (archipelago kasi tayo)
The direction being pursued by DOH is guided by
NATIONAL LEVEL (DEPT. OF HEALTH) - MDGs – Millennium Development Goals
• Vision : leader in promoting health - SGGs – Sustainable Development Goals (17)
• Mission : equitable, sustainable, and quality health for all - MTPDP – Medium-Term Philippine Development Plan
Filipinos. Special consideration for the poor and vulnerable (1993-1998) [Achieve full industrialization of the PH by the
year 2000]
ROLES AND FUNCTIONS - HSRA – Health Sector Reform Agenda
– E.O. 102: DOH as National Health Authority - FOURmula One For Health (Now: Fourmula One Plus) 2005
– L.A.C.E - National Objectives For Health
Leadership in Health MILLENIUM DEVELOPMENT GOALS

• Leader in the formulation, monitoring and evaluation of national
health policies, plans and programs
• Advocate in the adoption of health policies, plans and programs
to address national and sectoral concerns.
• National policy and regulatory institution on which local
government units , non- government organizations and other
members of the health sector involved in social welfare and
development or their thrusts and directions for health.
Administrator of specific services

• Manage selected health facilities and hospitals
• National Referral centers like special or tertiary hospitals
• Referral centers for local health systems like tertiary and special
hospitals, reference laboratories, training centers, centers for
health promotion, centers for disease control and prevention
and regulatory offices. SUSTAINABLE DEVELOPMENT GOALS
• Referral Centers – PHC, PHL, San Lazaro Hospital (for
HIV pts), NKTLI
• Administer direct services for emergent health concerns that
require new complicated technologies
• Provide emergency health response services including a
referral and networking system for trauma, injuries, catastrophic
events epidemics, and widespread public danger, upon the
direction of the President and in consultation with the concerned
local government unit (LGU).
• PGH almost became a covid admitting hospital
• Administer special components of specific programs like:
o Tuberculosis
o Schistosomiasis
o HIV-AIDS
1. No poverty
o Anti-Smoking Campaign
2. Zero Hunger
o Breast Feeding Program
3. Good Health and well being
4. Quality Education
Capacity builder and Enabler
5. Gender equality
• Ensure the highest achievable standards of quality health care,
6. Clean water and sanitation
health promotion and health protection.
7. Affordable and clean energy
• Innovate new strategies in health to improve the effectiveness 8. Decent work and economic growth
of health programs. 9. Industry, innovation, and infrastructure
10. Reduced inequalities

11. Sustainable cities and communities With the aim of attaining the goals outlined in the Philippine
12. Responsible consumption and production Development Plan 2017-2022 and the Sustainable Development
13. Climate action Goals, building on the concept of Fourmula One for Health 2005
14. Life below water to 2010, the medium-term strategic framework for 2017 to 2022
15. Life on land expands the four pillars of health reforms and highlights greater
16. Peace, justice, and strong institutions focus on performance accountability towards the Filipino people,
17. Partnerships for the goals thus, Fourmula One Plus for Health or F1+, with its tagline
“Boosting Universal Health Care”.
• They are a UN Initiative.
• The Sustainable Development Goals (SDGs), officially known OBJECTIVES OF FOURMULA ONE PLUS
as Transforming our world: the 2030 Agenda for Sustainable • Provide the overall policy directions for DOH offices, its
Development, are an intergovernmental set of aspiration Goals attached agencies, and local government units in terms of
with 169 targets. prioritizing activities related to the FOURmula One Plus for
Health 2017-2022.
HEALTH SECTOR REFORM AGENDA (HSRA) • Provide guidance to development partners, other government
• Local health systems agencies, and private stakeholders in identifying priority areas
• Hospital systems for health services and support.
• Public Health programs
• Health Financing GENERAL GUIDELINES
• Health Regulation • 4mula 1+ for Health shall organize critical initiatives in health
into four strategic pillars, namely: Financing, Regulation,
FRAMEWORK FOR THE IMPLEMENTATION OF THE HSRA Service Delivery, Governance, plus a cross cutting initiative on
Ø FOURmula ONE for Health intends to implement critical Performance Accountability.
interventions as a single package backed by effective • The implementation of 4mula 1+ for Health shall focus on
management infrastructure and financing arrangements thru a sustainable, manageable, and critical interventions that
sector-wide approach. optimize available resources, supported by evidence and
sufficient groundwork, and produce tangible results that are felt
FOURMULA ONE FOR HEALTH by Filipinos.
• This is directed towards ensuring accessible and affordable • The reforms shall be implemented under the concept of a whole
quality health care specially for the more advantaged and (society, government, and system) approach that encompasses
vulnerable sectors of the population. the entire health sector and other social determinants impacting
• FOUR ELEMENTS (Go Go Fires) health.
• Good Governance • The Functional management arrangements shall be defined in
• Health Financing terms of specific offices and institutions having clear mandates,
• Health Regulation performance targets, and support systems, Within well- defined
• Health Service Delivery time frames in the implementation of reforms within each pillar.
GOOD GOVERNANCE VISION Filipinos are among the healthiest people in

• to enhance health system performance at the national and local Southeast Asia by 2022 and Asia by 2040
levels. Key players for this element include: MISSION To lead the country in the development of a
a. Philippine Health Insurance Corporation (PHIC) thru the productive, resilient, equitable, and people-
National Health Insurance Program centered health system for Universal Health
b. Department of Health thru sector- wide policy support Care
c. The NHIP is a prudent purchaser of health care, thus influencing CORE VALUES • Professionalism
the health care market and related institutions. • Responsiveness
• Integrity
HEALTH FINANCING • Compassion
• To foster greater, better, and sustained investments in health. • Excellence
• The NHIP reduces the financial burden of health care costs STRATEGIC • Better health outcomes
placed on Filipinos. GOALS • More responsive health system
• More equitable healthcare financing for
HEALTH REGULATION health
• To ensure the quality and affordability of health good and
services. STRATEGIC PILLARS
• Universal Health Care for Filipinos Act (Senate Bill 1896)
1. FINANCING
The NHIP’s role in accreditation and payments based on quality • OBJECTIVE : secure sustainable investments to improve
serves as impetus for an improved performance in the health health outcomes and ensure efficient and equitable use
sector. of health resources
• INTERVENTIONS :
o Efficiently mobilize and equitable distribute more
HEALTH SERVICE DELIVERY resources for health
• To improve and ensure the accessibility and availability of basic o Rationalize health spending
and essential health care in both public and private facilities and o Focus financial resources towards high impact
services. interventions
• Essential service delivery
2. SERVICE DELIVERY
Yung + sa 4Mula One + is performance accountability • OBJECTIVE : Ensure the accessibility of essential quality
health products and services at appropriate levels of care
LOCAL LEVEL : LGUs • INTERVENTIONS :
o Increase access to quality essential health
R.A. 7160 / LOCAL GOVERNMENT CODE OF 1991 products and services
• Made possible the devolution of powers, functions and o Ensure equitable distribution of human resources
responsibilities to the local government, both provincial and for health
municipal, as well as autonomous regional government and o Ensure equitable access to quality health
metropolitan authority. facilities

o Engage service delivery networks to deliver

comprehensive package of health services
3. REGULATION
• OBJECTIVE : Ensure high quality and affordable health
products, devices, facilities, and services
• INTERVENTIONS :
o Harmonize and streamline regulatory systems
and processes
o Develop innovative regulatory mechanisms for
equitable distribution of quality such as adopting
a network licensing and network accreditation of
health facilities
4. GOVERNANCE
• OBJECTIVE : strengthen leadership and management
capabilities, coordination, and support mechanism
necessary to ensure functional, people-centered, and
participatory health systems
• INTERVENTIONS :
o Strengthen sectoral leadership and management
o Improve organizational development and
performance
o Ensure evidence-based decision making and
health policy development
5. PERFORMANCE ACCOUNTABILITY
• OBJECTIVE : use the performance management
systems to drive better execution of policies and
programs in the DOH while ensuring responsibility to all
stakeholders
• INTERVENTIONS :
o Institute transparency and accountability
measures
o Shift to outcome-based management approach

COMMUNITY
FAMILY NURSING PROCESS
COMMUNITY HEALTH NURSING DIAGRAM
- The health of the family

affects the individual, and the
health of the individual affects
the family.
- There are different levels of
clientele in Community Health
o the family made up of
individuals, make up a
community together
with population groups
(population groups are
people who share a
specific characteristic—
for example elderly,
pregnant women, etc.)
PHASES OF THE NURSING PROCESS Ida Jean Orlando
Basic Phases of the Nursing Elaboration of the Nursing

Process Proces
Establishing a Working
Relationship
Assessment
the process of collecting &
processing data/information
about the client
is the identification of the
client’s needs & problems
Diagnosis
based on the analysis of the
data gathered
Specific Planning Outcomes
Measurable (statement of SMART
Attainable
Realistic
objectives or desired
Time bound outcomes)
Planning Planning Interventions
(responsive to client’s problems STEP 1 – 1ST LEVEL OF ASSESSMENT
& should contribute to the Ø Define/categorize the health conditions/problems:
attainment of the desired
outcomes)
• Status or condition
translation of the care plan into
Implementation • Answers to “what”
concrete action
1. Family structure & characteristics
The process of making 2. Socio-economic & cultural factors
Evaluation judgments as to the extent the 3. Environmental factors
objectives were met 4. Health status of each family member
5. Values placed on health promotion, health maintenance, &
IN ASSESSING … prevention of disease
Consider to ask yourself the following questions:
1. What are the data that I should collect? • The process of determining existing and potential health
2. What do I need these data for? conditions or problems of the family
3. Should I believe all the things that the client told me?
4. What made me believe or disbelieve what she/he said?
5. How did my personal presentation and manner of asking 1. PRESENCE OF WELLNESS CONDITION
questions affect my interviewee?
• A clinical Nursing judgment of client’s transition from a
6. How should I have presented myself?
specific level of wellness to a higher level.
7. Are the data/information adequate to make a diagnosis? If
o POTENTIAL – based on client’s performance,
not, what other data should I have collected?
current competencies or clinical data but NO
8. What methods of data gathering and tools do I need?
explicit expression of client desire.
o READINESS – based on client’s current
competencies or performance, clinical data and
explicit. Expression of desire to achieve a higher
level of state on health promotion and
maintenance.
2. PRESENCE OF HEALTH THREATS
• Conditions that are conducive to disease and accident or
may result to failure to maintain wellness or realize health
potential.
3. PRESENCE OF HEALTH DEFICITS

• Instances for failure in health maintenance.

• Others, specify : _____________________________

4. PRESENCE OF FORESEEABLE CRISIS SITUATIONS/STRESS
POINTS 2. Inability to make decisions with respect to taking appropriate
• Anticipated periods of unusual demand on individual or health actions due to...
family in terms of adjustment / family resources. • Failure to comprehend the nature/magnitude of the
problem/condition.
• Low salience of the problem/condition.
STEP 2 – 2ND LEVEL OF ASSESSMENT (Perception, Realities, • Feeling of confusion, helplessness and/or resignation
and Attitudes) • brought about by perceived magnitude/severity of the
• Assumptions of health tasks situation or problem, i.e., failure to break down problems
• Answers to “why” into manageable units of attack.
• Find out which among the health tasks are not being fulfilled → • Lack of/inadequate knowledge/insight as to alternative
Family health problem (based on typology) courses of action open to them.
o Recognize the presence of a wellness state or health • Inability to decide which action to take from among a list of
condition alternatives.
o Make decisions about taking appropriate health actions • Conflicting opinions among family members/significant
o Provide nursing care to the sick, disabled, dependent, or others regarding action to take.
at-risk family members • Lack of/inadequate knowledge of community resources for
o Maintain a home environment conducive to health care.
maintenance and personal development • Fear of consequences of action, specifically.
o Utilize community resources for health care o Social consequences
o Economic consequences
After identifying a problem, further investigate by asking the sample o Physical consequences
questions below to explore why the problems exist. o Emotional/psychological consequences
• Negative attitude towards the health condition or problem -
Going through the following procedures: By negative attitude is meant one that interferes with
1. Determine if the family recognizes the existence of the condition rational decision making.
or problem. If not, explore the reasons why.
• Inaccessibility of appropriate resources for care, specifically
- What do you think about the condition of your...?
o Physical inaccessibility
- What do you think is the reason why he appears
o Cost constraints or economic/financial
thin/lethargic?
inaccessibility
• Lack of trust/confidence in the health personnel/agency.
2. If the family recognizes the presence of the condition/problem,
determine if something has been done to maintain the wellness • Misconceptions or erroneous information about proposed
state/resolve the problem. course(s) of action
- What have you done to improve the condition/situation? • Others, specify : _____________________________
- What improvements in the condition of...have been
observed? 3. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of the
3. Determine if the family encounters other problems in family due to...
implementing the interventions for the wellness state/potential, • Lack of / inadequate knowledge about the disease/health
health threat, health deficit or crisis. condition (nature, severity, complications, prognosis and
- What were the problems/barriers encountered in...? management).
- What do you think are the reasons why there is no • Lack of / inadequate knowledge about child development
improvement in the condition of...? and care.
- Why did you not continue doing what we have discussed • Lack of / inadequate knowledge of the nature and extent of
regarding …? nursing care needed.
- How did you do it? How often did you do it? • Lack of the necessary facilities, equipment and supplies for
care.
4. Determine how all the other members are affected by the wellness • Lack of / inadequate knowledge and skill in carrying out the
state/potential, health threat, health deficit or stress point. necessary interventions/treatment/procedure/care (e.g.,
- How are the other members affected by...? complex therapeutic regimen or healthy lifestyle program).
- How are the other members reacting to...? • Inadequate family resources for care, specifically:
o Absence of responsible member
NOTE : The end result of the 2nd level assessment is a set of family o Financial constraints
nursing problems for each health problems. o Limitations/lack of physical resources (e.g.,
• A health problem is a situation or condition which interferes Isolation room)
with the promotion and/ or maintenance of health and • Significant person's unexpressed feelings (e.g.,
recovery from illness or injury. hostility/anger, guilt, fear/anxiety, despair, rejection) which
• A health problem becomes a nursing problem when it is affect his/her capacity to provide care.
stated as the family's inability to perform adequately • Philosophy in life which negates/hinder caring for the sick,
specific health tasks for a particular problem/ nursing disabled, dependent, vulnerable/at-risk member.
diagnosis. • Member's preoccupation with own concerns/Interests.
• Prolonged disease or disability progression which exhausts
FAMILY NURSING PROBLEM STATEMENTS • supportive capacity of family members
• Altered role performance - specify:
1. Inability to recognize presence of the condition or problem o Role dental or ambivalence
due to... o Role strain
• Lack of or inadequate knowledge. o Role dissatisfaction
• Denial about its existence or severity as a result of fear of o Role conflict
consequences of diagnosis of problem, specifically: o Role confusion
o Social-stigma, loss of respect of peer/significant o Role overload
others • Others, specify : _____________________________
o Economic/cost implications
o Physical consequences 4. Inability to provide a home environment conducive to health
o Emotional/psychological issues/concerns maintenance and personal development due to...
• Attitude/philosophy in life which hinders • Inadequate family resources, specifically:
recognition/acceptance of a problem. o Financial constraints/limited financial resources.

o Limited physical resources (e.g.lack of space to

construct facility) –– CATEGORIES OF HEALTH PROBLEMS
• Failure to see benefits (specifically long-term ones) of
investment in home environment improvement. WELLNESS CONDITION
• Lack of / inadequate knowledge of importance of hygiene • Potential or readiness
and sanitation. • A clinical judgement about a client in transition from a
• Lack of / inadequate knowledge of preventive measures. specific level of wellness or capability to a higher one
• Lack of skill in carrying out measures to improve home • Ex. “potential capability for healthy people
environment
• Ineffective communication patterns within the family. HEALTH THREAT
• Lack of supportive relationship among family members. • Conducive to disease, threat surrounding client
• Negative attitude/philosophy in life which is not conducive • Conditions that are conducive to disease, accident, or failure
to health maintenance and personal development. to realize one’s health potential
• Lack of / inadequate competencies in relating to each other • Ex. Family history of asthma
• for mutual growth and maturation (e.g. reduced ability to
meet the physical and psychological needs of other HEALTH DEFICIT
members as a result of family’s preoccupation with current • Actual problem is present
problem or condition). • Instances of failure in health maintenance (disease,
• Others, specify : _____________________________ disability, developmental lag)
5. Failure to utilize community resources for health care due • Ex. Illness state such as pulmonary tuberculosis
to...
• Lack of / inadequate knowledge of community resources for FORESEEABLE CRISIS
health care. • Anticipated period of unusual demands
• Failure to perceive the benefits of health care/services. • Anticipated periods of unusual demand on the individual or
• Lack of trust/confidence in the agency/personnel. family in terms of adjustment or family resources
• Previous unpleasant experience with health worker. • Ex. Fifth pregnancy for an unemployed couple
• Fear of consequences of action (preventive, diagnostic, and
therapeutic rehabilitative), specifically:
o Physical/psychological consequences 2 TYPES:
o Financial consequences • 1st level – definition of wellness state or health problems
o Social consequences (e.g., loss of esteem of as an end-product of 1st level of assessment.
peer/significant others) o Example: Dental Caries as a Health Deficit.
• Unavailability of required care/service.
• Inaccessibility of required care/service due to:
• 2nd level – define the family nursing problem/family
nursing diagnosis, stated as inability to perform a specific
o Cost constraints
health task and the reason why/etiology as an end-product
o Physical inaccessibility, i.e., location of facility
of 2nd level of assessment.
• Lack of or inadequate family resources, specifically:
o Manpower resources (e.g., baby sitter)
o Statement: family’s inability to perform a (specific
health task) due to (reason why the family cannot
o Financial resources (e.g, cost of medicine
perform such tasks).
prescribed)
• Feeling of alienation to/lack of support from the community,
o Example: Inability to recognize the presence of
dental caries as a problem due to lack of
e.g., stigma due to mental illness, AIDS, etc.
knowledge about its effect on health.
• Negative attitude/philosophy in life which hinders
effective/maximum utilization of community resources for
health care. • Inability to + Family Health Task + due to ____
o Inability to recognize the presence of a health
• Others, specify : _____________________________
condition due to lack of knowledge
FAMILY HEALTH TASKS
• Recognize the presence of a wellness state or health
condition/problem.
STEP 4 – PRIORITY SETTING / SCORING
• Make decisions about appropriate health action to maintain
wellness or manage health problems.
NATURE OF THE PROBLEM
• Providing nursing care to the sick, disabled, dependent and
• Base it on the 1st level of assessment
at-risk family member
• Maintaining a home environment conducive to good health MODIFIABILITY OF THE CONDITION
and personal development.
• Refers to the probability of success in enhancing the
• Utilize community resources for health care wellness state, improving the condition, minimizing,
alleviating, or totally eradicating the problem through
NOTE: intervention
- These health tasks are the bases in identifying family
problems PREVENTIVE POTENTIAL
- A family has a nursing problem if a family cannot effectively
• Refers to the nature and magnitude of future problems that
perform its tasks.
can be minimized or totally prevented if intervention is done
on the problem under consideration
STEP 3 – DIAGNOSIS
SALIENCE
• Refers to the family’s perception and evaluation of the
• 1st level – decide whether the problem is: problem in terms of seriousness and urgency of attention
o Health threat needed
o Health deficit • Example : The family knows it’s a problem but they don’t do
o Foreseeable crisis anything about it (score : 1)
o Wellness
• 2nd level – determine which family health task was not
fulfilled and identify the reason (due to what). Choose from
the 4 family tasks listed below which task the family is not
able to fulfill, hence resulting to the presence of a problem.

CRITERIA WEIGHT STEP 6 – DEVELOPING THE INTERVENTION PLAN

Nature of the Problem 1 • The nurse needs focus her choice of interventions on
• Wellness 3 helping the family minimize or eliminate the possible
• Health Deficit 3 reasons for or causes of the family’s inability to do it
• Health Threat 2 the health tasks.
• Foreseeable Crisis 1 o Help the family recognize the problem.
Modifiability 2 o Guide the family on how to decide on
• Easily Modifiable 2 appropriate health actions to take.
• Partially Modifiable 1 • Develop the family’s ability and commitment to
0 provide.
• Not Modifiable
o Contracting – creative intervention that can
Preventive Potential 1
maximize opportunities to develop the
• High 3
ability and commitment of the family to
• Moderate 2
providing nursing care to its members.
• Low 1
• Enhance the capability of the family to provide a home
Salience 1 environment conducive to health maintenance and
• A problem, immediate attention 2 personal development.
• A problem, not needing attention 1 • Facilitate the family’s capability to utilize community
• Not perceived as a problem 0 resources for health care.
• In implementation, the nurse could either be motivated
HOW TO COMPUTE ? or overwhelmed and frustrated.
!"#$%& (")*+ • A dynamic attitude is required.
31
,-.ℎ+0# 1)00-2&+ (")*+ • Meeting the challenges is the essence of Family
• Add scores from all criteria to get the total score for that Nursing Practice.
problem. Higher score makes the problem a priority. • Expert caring is demonstrated when the nurse carries
• For example: out interventions based on the family’s understanding
and lived experiences.
Poor environmental condition and sanitation due to presence of
breeding or resting sites of vectors of diseases as a Health STEP 7 – EVALUATION PLAN
Threat • The evaluation plan specifies how the nurse will
CRITERIA COMPUTATION ACTUAL determine changes in health status, condition, or
SCORE situation and achievement of the outcomes of care
Nature of the Health Threat 2/3 x 1 0.63 (goals and objectives).
Problem (2)
Modifiability Partially
1/2 x 2 1.00
Modifiable (1)
Preventive Moderate (2)
2/3 x 1 0.67
Potential
Salience A problem, not
needing
1/3 x 1 0.33
attention (1)
TOTAL : 2.67
• Decide on a score for each of the criteria.
• Divide the score by the highest possible score and multiply by
the weight (Score/Highest Score) x Weight.
• Sum up the score for all the criteria. The highest score is 5,
equivalent to the total weight.
STEP 5 – FORMULATION OF GOALS AND OBJECTIVES
GOAL
• A general statement of the condition or state to be brought
about by specific courses of action.
• After nursing intervention, the family will be able to take
care of the disabled child competently.
• Cardinal Principle: goals must be set jointly with the family
to ensure commitment.
OBJECTIVES
• More specific statements of the desired results or outcomes
of care (client-centered).
• After the nursing intervention, the malnourished preschool
members of the family will increase their weights by at least
1lb/month.
• After nursing intervention, the family will be able to:
• Feed the mentally challenged child according to
prescribed quantity and quality of food.
• Teach the mentally challenged child simple skills
related to the activities of daily living.
• Apply measures taught to prevent infection in the
mentally challenged member.
Ø The more the specific the objectives, the easier is the
evaluation of their attainment. Specifically stated objectives
define the criteria for evaluation.
Ø Objectives and evaluation are directly related.


COMMUNITY
HEALTH INDICATORS AND NATIONAL HEALTH OBJECTIVES
health status of a population
HEALTH INDICATORS Pneumonia 57,808 56.0
• Serve as proxy measure for determining if the strategies and Cerebrovascular Diseases 56, 938 55.2
interventions implemented by the health sector and other Hypertensive Diseases 33,452 32.4
stakeholders led to overall improvements in health outcomes. Diabetes Melitus 33,295 32.3
• Increasing average life expectancy Other Heart Diseases 28,641 27.7
o Projected average life expectancy Respiratory Tuberculosis 24,462 23.7
Chronic Lower Respiratory
24,365 23.6
Tract Infections
Remainder Of Diseases Of
19,759 19.4
The Genitourinary System
TEN LEADING CAUSES OF MORBIDITY

(PHILIPPINES, 2016)
# OF RATE PER 100k
• Slow decline in maternal mortality ratio (per 100,000 live birth) DISEASE
DEATHS POPULATION
o Maternal mortality ratio Acute Respiratory Infection 3,080,343 2,970.2
Hypertension 886,203 854.5
ALRTI & Pneumonia 786,085 758.0
Urinary Tract Infection 288,588 278.3
Influenza 216,074 208.3
Bronchitis 200,176 193.0
Acute Watery Diarrhea 139,770 134.8
• Slow decline in infant and under-five mortality rates (per 1,000 TB Respiratory 87,422 84.3
live birth) Acute Bloody Diarrhea 57,647 55.6
o Infant mortality rate (light green) & under-5 mortality rate Dengue Fever 56,487 54.5
(dark green)
PHILIPPINE HEALTH PICTURE (1998 – 2018)
Increased from
Estimated
73,147,776 to 44.6% increase
population
105,755,180
Decreased from 33.3 29.3 %
Crude birth rate
to 15.8 decrease
• High prevalence of stunting over the years among children Increased from 4.8 to
Crude death rate 15.7% increase
under 5 years 5.6
o Prevalence of stunting among children under 5 years Declined from 17.3 to 27.0%
Infant death rate
12.6 decrease
Maternal death 1998 MDR is equal to
rate the 2018 MDR (1.0)
Increased from 17.3 to
Fetal death ratio 36.8% increase
12.6
EPIDEMIOLOGY
• Study of the distribution and determinants of health-related
2016 HEALTH OUTCOMES RANKING (SEA COUNTRIES) states or events in specified population and its application to the
• 7th in average life expectancy prevention and control of health problems
• 6th in maternal mortality ratio – 2015 • DISTRIBUTION: analysis by time, places, and classes of
• 6th in infant mortality rate people affected
• 11th (worst) in TB incidence rate • DETERMINANTS: include biological, chemical, physical, social,
cultural, economic, genetic, and behavioral factors that
influence health
PRACTICAL APPLICATIONS
1. Assessment of the health status of the community or community
diagnosis
2. Elucidation of the natural history of disease
3. Determination of disease causation
4. Prevention and control of disease
5. Monitoring and evaluation of health interventions
6. Provision of evidence for policy formulation
HEALTH INDICATORS
• Quantitative measures usually expressed as RATES, RATIO, or
PROPORTION that describe and summarize various aspects of
the health status of the population
TEN LEADING CAUSES OF MORTALITY • Also used to determine factors that may contribute to a
(PHILIPPINES, 2016) causation and control of diseases, indicates priorities for
# OF RATE PER 100k resource allocation, monitors implementation of health
DISEASE programs, and evaluates outcomes of health programs
DEATHS POPULATION
Ischemic Heart Disease 74,134 71.8
Neoplasm 60,470 58.5
TYPES OF HEALTH INDICATORS

Ø Morbidity CRUDE OR GENERAL RATES

• Prevalence • Are referred to the total living population. It must be presumed
• Incidence that the total population was exposed to the risk of the
occurrence of the event.
Ø Mortality
• Crude and Specific death rates DEATH
• Maternal Mortality • Is the permanent disappearance of all evidence of life at any
• Infant Mortality time after live birth has taken place (postnatal cessation of vital
• Neonatal Mortality functions without capability of resuscitation).
• Postnatal Mortality
• Child Mortality FETAL DEATH
• Is the death prior to the complete expulsion or extraction of a
Ø Population product of conception from its mother, irrespective of the
• Age-sex structure of the population duration of pregnancy; the death is indicated by the fact that
• Population density after such separation the fetus does not breathe or show any
other evidence of life, such as beating of the heart, pulsation of
• Migration
the umbilical cord, or definite movement of voluntary muscles.
• Population Growth (crude birth rate, fertility rate)
FETAL DEATH RATE (FDR)
Ø Provision of Health Care
• Measures pregnancy wastage. Death of the product of
• Access to health programs and facilities
conception prior to its complete expulsion, irrespective of
• Availability of health resources’ duration of pregnancy.
DATA INCIDENCE RATE (IR)
• Philippine Health Statistics (PHS) series is the DOH’s annual • Measures the frequency of occurrence of the phenomenon
publication that complies statistics on vital health events during a given period of time. Deals only with new cases.
providing comprehensive summary of the country’s current stats
on natality, morbidity, mortality INFANT MORTALITY/DEATH
• PHS is a product of the collaborative effort of the Philippine • Is the death of an infant under one year of age.
Statistics Authority (PSA) INFANT MORTALITY RATE (IMR)
• PHS is intended to serve as one of the bases of planning, • Measures the risk of dying during the 1ST year of life. It is a good
implementation, & assessment of health progs and services of index of the general health condition of a community since it
health authorities at various levels of health sectors reflects the changes in the environmental and medical
conditions of a community
SOURCES OF DATA
• Population Statistics
• Natality and Mortality Statistics LATE FETAL DEATH
• Notifiable Disease Statistics • The death of fetus with 28 or more completed weeks of
gestation.
CLASSIFICATION OF DATA
• Geographic classification LIVE BIRTH
• Age • Is the complete expulsion or extraction from its mother of a
• Diseases and cause of death product of conception, irrespective of the duration of the
• Sex pregnancy, which after such separation, breathes or shows any
other evidence of life, such as beating of the heart, pulsation of
ANALYSIS AND INTERPRETATION OF DATA the umbilical cord, or definite movement of voluntary muscles,
• Small frequencies whether or not the umbilical cord has been cut or the placenta
• Computation of statistical indices is attached; each product of such birth is considered liveborn.
• Completeness of registration and notification
MATERNAL MORTALITY
DEFINITION OF TERMS • Is the death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the
ATTENDED site of the pregnancy, from any cause related to or aggravated
• refers to the cases given medical care at any point in time during by the pregnancy or its management, but not from accidental or
the course of the illness which directly caused death. Medical incidental causes.
care may either be provided directly by a medical doctor or
indirectly by allied health care providers, i.e., nurses and MATERNAL MORTALITY RATE
midwives who are under the direct supervision of a medical • It measures the risk of dying from causes related to pregnancy,
doctor. childbirth and puerperium. It is an index of the obstetrical care
• Otherwise, case is categorized as "death unattended" needed and received by the women in a community.
NEONATAL DEATH
BIRTH ORDER • death among live births during the first 28 completed days of life.
• The numerical order of a child in relation to all previous
pregnancies of the mother. NEONATAL DEATH RATE
• Measures the risk of dying during the Ist month of life. May serve
BIRTH WEIGHT as index of the effects of prenatal care and obstetrical
• First weight of the fetus or newborn obtained after birth. management on the newborn.
CRUDE BIRTH RATE (CBR) PLACE OF OCCURRENCE

• Measure of one characteristic of the natural growth or increase • refers to the place where the vital event took place.
of a population.
PREVALENCE RATE (PR)
CRUDE DEATH RATE (CDR) • Measures the proportion of the population which exhibits a
• Is measure of one mortality from all causes which may result in particular disease at a particular time. This can only be
a decrease of population. determined following a survey of the population concerned.
Deals with total (old and new) number of cases.

PROPORTIONATE MORTALITY (PM)

• Shows the numerical relationship between deaths from a cause
(or groups of causes), age (or groups of age) etc, and the total
number of deaths from all causes in all ages taken together. Not
a measure of risk of dying.
RATE
• In Vital Statistics, a rate shows the relationship between a vital
event and those persons exposed to the occurrence of said
event, within a given area and during a specified unit of time. It
is evident that the persons experiencing the event (the
numerator) must come from the total population exposed to the
risk of same event (the denominator).
RATIO
• Used to describe the relationship between two (2) numerical
quantities or measures of events without taking considerations
to the time or place.
• These quantities need not necessarily represent the same
entities, although the unit of measure must be the same for both
numerator and denominator of the ratio.
SPECIFIC DEATH RATE

• Describes more accurately the risk of exposure of certain
classes or groups to particular diseases. To understand the
forces of mortality, the rates should be made specific provided
the data are available for both the population and the event in
their specifications. Specific rates render
SPECIFIC RATE
• The relationship is for a specific population class or group. It
limits the occurrence of the event to that portion of the population
definitely exposed to it.
TOTAL FERTILITY RATE (TFR)

• Refers to the number of children a woman would have by the
time she reaches age 50 under a given fixed fertility schedule. It
is sometimes referred to as completed family size. It is the
average number of births per 100 females aged 15-49 years.
USUAL RESIDENCE
• Refers to the place where the person/deceased habitually or
permanently resides.
FORMULAS

o Done through instruments that routinely monitor and

evaluate client feedback on health goods used and
services received
MORE EQUITABLE HEALTHCARE FINANCING

• Access of Filipinos (poor and underserved) to affordable and
quality health goods and services will be expanded through
mechanisms that provide them with adequate financial risk
protection from the high and unpredictable cost of healthcare
o Reduce catastrophic OOP payments such as through public
subsidies targeted towards the poor
PILLARS
FINANCING
• Sustained investments for equitable health care
• OBJECTIVE : Sustainable investments for health secured
efficiently used, and equitable allocated for improved health
outcomes
• SPECIFIC TARGETS :
NATIONAL OBJECTIVES FOR HEALTH
- More resources for health efficiently mobilized and
• Medium term roadmap of the PH towards achieving universal
equitably distributed
healthcare
- Health spending rationalized
• Specifies objectives, strategies, and targets of the DOH F1 plus - Financial resources focused towards high impact
for health interventions
o Pillars : Financing, Service Delivery, Regulation,
Governance, Performance Accountability HEALTH SERVICE DELIVERY
• Three strategic goals
• Wider Access to Essential
o Better health response
• Health Care
o More responsive Health system
• OBJECTIVE : Access to essential quality health products and
o More equitable healthcare financing
services ensured at appropriate levels of care
- Access to quality essential health products and services
increased
- Equitable access to quality health facilities ensured
- Equitable distribution of Human Resources for Health
(HRH) guaranteed
- Service delivery networks organized and engaged
REGULATION
• Safe, Quality, and Affordable Health care
• OBJECTIVE : High quality and affordable health products,
devices, facilities, and services ensured
- Regulatory systems and processes harmonized and
streamlined
- Innovative regulatory mechanisms developed for equitable
distribution of quality and affordable health goods and
services
GOVERNANCE
• Functional and People-Centered Health System
• OBJECTIVE : Strengthened leadership and management
capacities, coordination, and support mechanisms necessary to
ensure functional, people centered and participatory health
system
STRATEGIC GOALS • SPECIFIC TARGETS :
- Strengthened sectoral leadership and management
BETTER HEALTH OUTCOMES - Improved organizational development and performance
• Health sector will sustain gains and address new challenges in - Improved processes for procurement and supply chain
1. Maternal newborn and child health management that ensure the availability and quality of
2. Nutrition health commodities
3. Communication disease elimination - Ensured generation and use of evidence in health policy
4. Non communicable disease prevention and treatment development, decision making, and program planning and
implementation
• Improvements in health outcomes will be measured through
sentinel indicators PERFORMANCE ACCOUNTABILITY
1. Life expectancy • Transparent and Responsive Health Sector
2. Maternal and infant mortalities • OBJECTIVE : Better health attained through transparent,
3. Non Communicable disease mortalities responsive, and responsible health sector management
4. TB incidence • SPECIFIC TARGETS :
5. Stunting among under-5 year olds - Transparency and accountability measures at all levels
institutionalized
MORE RESPONSIVE HEALTH SYSTEM - Outcome-based management approach used
• Quality health good and services as well as the manner in which
they are delivered to the population will be improved to ensure
people-centered healthcare provision

COMMUNITY
HEALTH NURSING MIDTERMS
MATERNAL AND REPRODUCTIVE HEALTH PROGRAMS
DEFINITION OF TERMS
ANTENATAL CARE
• Access and use of health care during pregnancy, which includes
screening, interventions, education, emergency care
BASIC EMERGENCY OBSTETRIC NEWBORN CARE (BEmONC)

• Facility that is capable of performing emergency obstetric
functions
1. Being able to deliver oxytocin.
2. Anti–convulsant.
3. Assistive delivery.
4. Removal of retained products of conception.
5. Removal of placenta.
6. Emergency newborn interventions:
a. O2 support
b. Resuscitation
COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN

CARE (CEmONC) NEONATAL INFANT, AND CHILD HEALRG OUTCOMES
• Tertiary level regional hospital or medical center capable of • Trend in infant death declined in the past 15 yrs
BEmONC functions plus surgical delivery, and emergency • Significant redaction noted → 1990 to 1993
neonatal care • Slim increase in 1998
• BEmONC + 3 more functions • Neonatal mortality rates remain relatively constant at 17 per
1. CS delivery services 1,000 live births
2. Blood blanking and transfusion services
3. Other highly specialized obstetric interventions
MATERNAL HEALTH OUTCOMES
• Hemorrhage and hypertension

- Leading causes of maternal mortality (41% of direct
causes)
- Highly preventable by provision of quality obstetric care:
o Strengthened BEmONC
o Prompt navigation mechanisms
o Timely referral of high risk cases
o Access to CEmONC-capable facility
• Other factors affecting maternal and neonatal outcomes

- Quality of antenatal care
- Inadequate supply of blood and drugs in referral hospitals
- Unavailability of emergency transport
- Untimely decision-making for early referral
• These gaps continue to be widespread in the past years NUTRITION OUTCOMES

- These problems may be especially more adverse during the 2019 EXPANDED NATIONAL NUTRITION SURVEY (JUNE 2020)
COVID-19 pandemic as routine healthcare services were
initially disrupted. –– TREND OF MALNUTRITION PREVALANCE (UNDER 5 Y/O)
• In 2019, there was a 28.8% decrease in stunting prevalence (0-
EXTRA NOTES
5 y/o)
- Smooth flow of referral.
o 30.3% in the previous year
- DOH already has a laid our programs however it is about
• Wasting increased (5.6% to 5.8%)
how it is implemented.
- Ability of the facilities. • Underweight prevalence at 19% (=)
- Abilities of the patient to access the facilities. • Overweight and obesity decreased from 4.0% to 2.9%
- Hemorrhage: blood supply.
- Ambulances, transportation support.
- Leading causes of death in PH:
- Tuberculosis
- Heart disease
- Diabetes
- • Malaria
-

–– TREND OF MALNUTRITION PREVALANCE AMONG

ADOLESCENTS • Antenatal care
o Services provided by skilled health professionals to
• Stunting & wasting prevalence among 5-10 y/o increased pregnant women aged 10-49 y/o in order to ensure the
• Underweight prevalence increased best health conditions for the mother and baby
• Overweight and obesity decreased o Provision of
§ Iron tablets with folic acid – improves overall
neurologic function of the baby
§ Iodine
§ Calcium carbonate – bone development
§ Also !! take vitamin C since they are
immunocompromised
• Immunizations prevent maternal and neonatal tetanus
o Unsanitary conditions during delivery
o Poor umbilical cord care
• Screening for syphilis, hepa B, HIV
o Triple elimination of mother to child transmission
• Amidst the pandemic, facility-based delivery remains at 90%
o 59% – deliveries happened in pubhealth facilities
o 39% – done in private facilities
• Proportion of women giving birth at home or had delivered
accidentally while in transit to a health facility
o 90% – Attended by skilled health professional
o 57% – physician
o 32% – midwives
–– TREND ON MALNUTRITION PREVALENCE AMONG o 2% – nurses
ADOLESCENTS (10-19 Y/O) • Recommendations post partum
• Stunting prevalence slightly increased from 26.3% in 2018 to o 2 visits within 7 days from birth and subsequent visits
26.8% in 2019 follow the immunization schedule
• Wasting prevalence from 11.3% to 11.7% o Visits early detection and management of infections,
• Overweight and obesity decreased from 11.6% to 9.8% birth complications, or other life- threatening conditions
o Newborn postnatal checks allow giving advice to mother
MATERNAL HEALTH SERVICES KEY INTERVENTIONS on proper care for the newborn
• DOH and other health facilities and LGUs implement the RPRH o Hygiene and breast feeding
program to ensure that the health care needs of mothers and • Family planning organization of the Philippines (FPOP) provided
babies continue to be prioritized and served 118,265 gynecological and obstetrics care services
• Telemedicine was introduced o Gynecological services – counselling, consultations and
- NOTE : there are certain medical conditions that can be management, prevention (papsmear) investigation
diagnosed only on physical evaluation of a patient. (manual breast exam, bimanual pelvic exam, lab test).
o Such as in pregnancy → high risk factors in may o Obstetric services – pre and post natal care and delivery
be missed
• 90% of all preggy women still delivered in health facilities and
were attended by skilled health professionals NATIONAL SAFE MOTHERHOOD PROGRAM
• This is a manifestation that provision of essential health services
continued amidst the COVID-19 VISION
- For Filipino women to have full access to health services
towards making their pregnancy and delivery safer
MISSION
- Guided by the Department of Health FOURmula One Plus
thrust and the Universal Health Care Frame, the National
Safe Motherhood Program is committed to provide rational
and responsive policy direction to its local government
partners in the delivery of quality maternal and newborn
health services with integrity and accountability using
proven and innovative approaches
OBJECTIVES
1. Collaborating with Local Government Units
- Establish sustainable, cost-effective approach of delivering
health services
- Ensures disadvantaged women to acceptable
and high qual health services
- Enable them to give birth safely in health facis
near them
MATERNAL HEALTH SERVICES KEY INTERVENTIONS 2. Establishing core knowledge base and support systems
• Birthing centers are required to have - They should be able to facilitate the delivery of quality
o a doctor who is at least trained on BEmONC, maternal and newborn health services in the country
o stand by ambulance or patient transport vehicle (PTV)
o memorandum of agreement or understanding (MOA/MOU)
with a hospital PROGRAM COMPONENTS
§ in case an emergency referral becomes inevitable
• Health workers providing maternal and newborn services were LOCAL DELIVERY OF THE MATERNAL-NEWBORN SERVICE
also encouraged to continue with pregnancy tracking and PACAKGE
service delivery utilizing electronic platforms (Health Center FB
Page, Text Messaging, E-mail, Telephone Consulting) and • Supports LGUs in establishing and mobilizing the service
home visits if feasible while still adhering to strict infection delivery network of public and private providers to enable them
prevention and control measures to deliver the integrated maternal-newborn service package

1. Establishment of critical capacities to provide quality maternal- - this change brought about the establishment the
newborn services through the organization and operation of a BEmONC-CEmONC network within the bigger
network of Service Delivery Teams consisting of: Service Delivery Network (SDN)
• Barangay Health Workers 2. improved quality of FP counseling and expanded service
• BEmONC Teams composed of Doctors, Nurses and availability of post-partum family planning in hospitals and
Midwives primary birthing centers
2. In collaboration with the Centers for health Development and 3. The integration of cervical cancer, syphilis, hepatitis B and
relevant national offices: Establishment of Reliable Sustainable HIV screening among others into the antenatal care
Support Systems for Maternal-Newborn Service Delivery protocols.
through such initiatives as:
• Establishment of Safe Blood Supply Network with support –– An Integrated Package of Women’s Health and Safe
from the National Voluntary Blood Program Motherhood Services
• Behavior Change Interventions in collaboration with the • Shift from centrally controlled national programs operating
Health Promotion and Communication Service separately and governed independently at various levels of the
• Sustainable financing of maternal - newborn services and health system to an LGU governed independently at various
commodities through locally initiated revenue generation levels of the health system that delivers an integrated women’s
and retention activities including PhilHealth accreditation health and safe motherhood service package
and enrolment. • Focused on maximizing synergies among key services that
influence maternal and newborn health and on ensuring a
NATIONAL CAPACITY TO SUSTAIN MATERNAL-NEWBORN continuum of care across levels of the referral system.
SERVICES • A woman, whatever her age and specially if she is
1. Operational and Regulatory Guidelines disadvantaged, who seeks care from a public health provider for
• Identification and profiling of current FP users and reproductive health concerns, could expect to be given a
identification of potential FP clients and those with unmet comprehensive array of services that addresses her most critical
need for FP (permanent or temporary methods) reproductive health needs.
• Mainstreaming FP in the regions with high unmet need for
FP –– Reliable Sustainable Support System
• Development and dissemination of Information, Education • Support systems for Maternal-Newborn service delivery is
Communication materials Advocacy and social mobilization anchored on Philhealth accreditation of birthing centers and
for FP individual membership or enrolment into the Sponsored
Program.
2. Network of Training Providers • This mechanism ensures sustainable financing of quality
• 31 Training Centers that provide BEmONC Skills Training maternal-newborn services efficiently eliminating out-of- pocket
expenditures for antenatal, facility delivery and postnatal care.
3. Monitoring, Evaluation, Research, and Dissemination with • The system likewise includes systems for safe blood supply and
support from the Epidemiology Bureau and Health Policy stakeholder behavior change, through a combination of
Development and Planning Bureau advocacy and interpersonal communication during clinic visits.
• Monitoring and Supervision of Private Midwife Clinics in
cooperation with PRC Board of Midwifery and Professional –– Stronger Stewardship and Guidance from the DOH Program
Midwifery Organizations Manager and Regional Coordinators
• Maternal Death Reporting and Review System in collaboration • DOH provides stewardship and guidance through
with Provincial and City Review Teams a. Evidence-based guidelines and protocols on maternal-
• Annual Program Implementation Reviews with Provincial Health newborn services
Officers and Regional Coordinators b. A system for recognizing providers of emergency
obstetrics and newborn care (BEmONC) training program
PROGRAM ACCOMPLISHMENTS / STATUS c. Monitoring, evaluation, and research on the new
• DOH thru the NSMP shall continue to update its strategies to maternal-newborn strategies
address concerns
a. Control of STIs and mother to child transmission of HIV THE REPRODUCTIVE HEALTH PROGRAM
b. Confront demand and supply side obstacles to access for
disadvantaged women inc. indigenous women of RA 10354 – Responsible Parenthood and Reproductive Health
reproductive age Act of 2012
- Aka Reproductive Health Law
• It will continue to monitor policy implementation and check its - Benigno Aquino III ; Jan 17, 2013
effectiveness - Methods, techniques, and services that contribute to
reproductive health and wellbeing by preventing and
• LGUs will be encouraged to address the gaps identified during
solving reproductive health problems.
maternal death reviews
• Relevant policies that responds to maternal needs have been
• The reproductive health program of the Philippines adopts the
passed
life-span approach.
- Prevention of illegal and unsafe abortions
- Management of post-abortion complication • It recognizes the fact that RH is a concern that affects different
age brackets
• Implementation of this policy is expected to reduce maternal
death by 21% • Covers a variety of ages
• 95% of birthing centers have teams trained on basic emergency
10 ELEMENTS OF REPRODUCTIVE HEALTH CARE
obstetric and newborn care
1. Family planning
2. Maternal and child health and nutrition
(The following changes have been systematically mainstreamed into
3. Prevention and control of reproductive tract infections, STIs
the safe motherhood service delivery network (BEmONC-CEmONC
and HIV/AIDS
network)
4. Adolescents reproductive health
5. Prevention and management of abortions and its
–– Strategic Change In The Design Of Safe Motherhood Services
complications
6. Prevention and management of breast and reproductive
1. A shift in emphasis from the risk approach that identifies
tract cancers and other gynecological conditions.
high-risk pregnancies during the prenatal period to an
7. Education and counseling on sexuality and sexual health
approach that prepares all pregnant for the complications
8. Men’s reproductive health and involvement
at childbirth
9. Prevention and management of violence against women
and children

10. Prevention and treatment of infertility and sexual

dysfunction ANC SCHEDULE
1st Tri Visit #1: 8 to 12 wks
NOTES Contact #1: up to 12 wks
- Everything that is part of your reproduction (coverage of 2nd Tri Visit #2: 24 to 26 wks
the program) Contact #2: 20 wks
- Law that protects children and women: VAWC RA 9262 / Contact #3: 26 wks
Violence Against Women & Children 3rd Tri Visit 3: 32 wks
Visit 4: 36 to 38 wks
INTEGRATED MNCHN SERVICE Contact #4: 30 wks
MNCHN – Maternal, Newborn, and Child Health and Nutrition Contact #5: 34 wks
Contact #6: 36 wks
• Covering a spectrum of known cost-effective public health and Contact #7: 38 wks
clinical management measures Contact #8: 40 wks
• Reduces exposure to and severity of risks for maternal and
neonatal dealths –– Standard prenatal physical examination per visit includes:
• Prevents their direct causes 1. Wt and Ht – imp to monitor any changes, weight will be the
• NO WOMAN DIES GIVING BIRTH, NO NEWBORN DIES AT baseline for any adjustment.
BIRTH 2. VS – baseline, assess possible infections or complications
• Consists of health services that are both preventive and curative like hypertension which is risky.
and established to lower the risk and respond to the direct 3. Assessment for pallor → anemia (decrease in RBC),
causes of maternal and neonatal deaths to improve their health supplements are needed like iron and follic.
• Pandemic → challenges to deliver routine life-saving 4. Abdominal examination – Fundic height, Fetal position,
interventions FHT (110-160bpm or 120-60bpm)
Ø Pregnant women and mothers with newborns may 5. Assessment of edema → should be cautious at 3rd
experience difficulties accessing services due to transport trimester, if the edema is systemic or entire body is having
disruptions and lockdown measures or be reluctant to come edema, it might indicate that the patient is having pre-
to health facilities because of fear of infection eclampsia or other conditions.
Ø Health facilities became covid 19 centers or other 6. Assessment of thyroid enlargement
institutions were closed
• The safest place for a women to deliver her baby is at a –– Basic Prenatal Services
functional health facility with a skilled birth attendant • History taking – obtain all necessary information (thoroughly).
• PE
THREE LEVELS OF CARE IN THE MNCHN SERVICE DELIVERY • Treatment of disease
NETWORK • Tetanus of toxoid
1. Community level service providers or community health care • Supplementation
team • Health education
• Laboratory and dental examination – check for amount of
2. BEmONC-Capable facility hemoglobin and if lack of calcium that may cause tooth decay.
- Parenteral admin of oxytocin in the 3rd stage of labor • Referral services
- Oxytocin is for contractions • Daily iron (RBC) and folic acid supplementation (prevent neural
- Parenteral admin of loading dose of anticonvulsant tube defects)
- For pre-eclamptic pts, give MagSulf - with 300mg Fe Sulfate (5th month) and 0.4mg of folic acid
- Performance of assisted deliveries (imminent breech (as early as possible)
delivery) - recommended for ALL pregnant women to prevent anemia,
- Removal of retained products or conception puerperal sepsis, LBW, preterm birth
- Manual removal of retained placenta
• Daily calcium supplements
- Emergency newborn interventions
- 1.5 to 2g divided in three doses in populations where there
- Newborn resuscitation
is low dietary calcium intake
- O2 support
- reduce risk of pre-eclampsia as early in the pregnancy
3. CEmONC-capable facility
- Can perform 6 signal function as in BEmONC as well as
Notes:
- CS delivery services
- Folic acid is very important because it can help prevent
- Blood banking and transfusion services
some major birth defects of the baby's brain (anencephaly)
- Other highly specialized OB interventions
and spine (spina bifida).
- Iron to make more blood to supply oxygen to your baby
KEY STRATEGIES OF MNCHN
- Importance of Calcium: for the growth and development of
1. Family planning and pre-pregnancy services
the fetuses.
2. Prenatal care
3. Facility based deliveries
MATERNAL ASSESSMENT
4. Immediate postpartum and post natal care
Detection of the following conditions in pregnancy:
a. Breastfeeding
• Anemia – Hgb below 110/mg/dL, clinical assessment, Hgb, color
b. NB screening
scale.
c. Postnatal visits
d. Immunizations • ASB – gram stain and dipstick test.
- ASB – Gram Stain
- ASB: Asymptomatic Bacteriuria (ASB) is used to suggest
PRENATAL
that a patient has bacteria in the urine but not a true
• All RHUs and BHS should have a masterlist of preggy women
infection; related conditions are UTI.
in their respective catchment areas
• IPV (Intimate Partner Violence).
• Woman = case notes/Home based Mother's Record to identify
- Oblivious bruises.
RF, and danger signs in pregnancy
- Ensure that the environment is private or conducive for her
• Midwife – led continuity of care.
to share
- A trained BHW shall be trained to use the HBMR when
- Ask the mother separately without the husband
licensed health personnel are not available.
• Others: GDM (24 to 28 weeks – risk factor screening), tobacco,
• Antenatal care contact schedule – with a minimum of eight smoking, alcohol, substance abuse, TB and HIV with syphilis
contacts to reduce perinatal mortality and improve women’s
(high – prevalence setting.
experience of care

- GDM obstetric care facilities is less

- Gestational diabetes mellitus. than 1%.
- Increase blood sugar. 7.
- Applicable test: glucose measurement; OGTT
(oral glucose tolerance test). EmONC SIGNAL FUNCTIONS
- HIV positive mother
- CS delivery to avoid contact of secretion.
FETAL ASSESSMENT
• DFMC
- Cardiff count to ten/kick charts (10 in 12 hours)
• SFH
- Synthesis fundal height
- measurement and abdominal palpation (24 weeks onward
+/-2)
• Fetal ultrasound examination (before 24 weeks)
–– Preventive Measures
FACILITY / INCFRASTRUCTURES
• ASB – 7 day antibiotic regimen
A. Barangay health station (BHS)
• Tetanus Toxoid Vaccine
B. Rural health unit(RHU)
- If known, give 2 (1month apart) at least 2 weeks delivery
C. Lying-in clinic
- + 1 after 6 months
D. Birthing home
- + 2 more every year or every subsequent pregnancy
E. District hospital
= 5 TOTAL FOR LIFETIME
F. Any other similar structure
G. Other Basic Services
MCNHN CORE SERVICE PACKAGE
a. Micronutrient supplementation
Ø 3-DELAY MODEL: Factors to Delayed Care
i. Iron Folate 60mg tab OD
ii. Vitamin 1 at least 5000 IU every week
iii. Iodized salt
b. Tetanus toxoid immunization ff the
recommended schedule (5 to be complete).
c. Family Planning
i. Modern methods
ii. Informed choice
iii. Birth spacing
iv. Respect for life
v. Responsible parenting
d. Provision of oral health services
e. STI/HIV/AIDS counseling, nutrition, personal
hygiene and abortion
f. STI screening (syndromic approach)
g. Adolescent and youth services including
counseling and RH education
h. Promotion of healthy lifestyle
i. Management of lifestyle related diseases
j. Prevention and management of other diseases
CEmONC POSTNATAL CARE

EMERGENCY CARE INDICATORS Life support management for:
• LBW newborns
Original Six Emergency Obstetric Care Indicators With • Premature NB
Modification • Sick NB
INDICATOR ACCEPTABLE LEVEL
1. Availability of emergency 1. There are at least five
• Sepsis
obstetric care: basic and emergency obstetric care • Fetal alcohol syndrome
comprehensive (able to facilities (including at least • Asphyxia
perform CS and blood one comprehensive facility) • Severe birth trauma
transfusion) care facilities for every 500 000 population.
2. Geographical distribution of 2. All subnational areas at
• Severe jaundice
emergency obstetric care least five emergency
Notes:
facilitates obstetric care facilities
- Alcohol = Downer = it means that the longer you take
3. Proportion of all births in (including at least one
alcohol, the more depressed you are.
emergency obstetric care comprehensive facility) for
- Alcohol is a depressant with some stimulant effects. In
facilities. every 500 000 population.
small doses, it can increase your heart rate, aggression,
4. Meeting the need for 3. Minimum acceptable level to
and impulsiveness. However, in larger doses, alcohol
emergency obstetric care: be set locally.
typically causes sluggishness, disorientation, and slower
proportion of women with 4. 100% of women estimated
reaction times, as it decreases your mental sharpness,
major direct obstetric to have major direct obstetric
blood pressure, and heart rate.
complications who are complications are treated in
treated in such facilities. emergency obstetric care
5. CS sections as a proportion facilities
of all birth 5. Estimated proportion of
6. Direct obstetric case fatality births by caesarian section in
the population is not less
than 5% or more than 15%
6. Case fatality rate among
women with direct obstetric
complications in emergency

WHO INTRAPARTUM GUIDELINES OF 2018 recommended for healthy pregnant women requesting pain
relief during labor, depending on a woman’s preferences.
FIRST STAGE OF LABOR
• Manual techniques, such as massage or application of warm
Use of following definitions of the latent and active first stages of labor packs, are recommended for healthy pregnant women
recommended for practice requesting pain relief during labor, depending on a woman’s
preferences.
LATENT FIRST STAGE
• Pain relief for preventing delay and reducing the use of
• Period of time characterized by painful uterine contractions augmentation in labor is not recommended.
and variable changes of the cervix including some degree
of effacement and slower progression of dilation up to 5cm • For women at low risk, oral fluid and food intake during labor is
for first and subsequent labors recommended.
• Encouraging the adoption of mobility and an upright position
ACTIVE FIRST STAGE
during labor in women at low risk is recommended.
• Period of time characterized by regular painful uterine
contractions, a substantial degree of cervical effacement • Routine vaginal cleansing with chlorhexidine during labor for the
and more rapid cervical dilatation from 5cm until full dilation purpose of preventing infectious morbidities is not
of first and subsequent labors recommended.
• Routine clinical pelvimetry on admission in labor is not
recommended for healthy pregnant women.
• Women should be informed that a standard duration of the
• Routine cardiotocography is not recommended for the
latent first stage has not been established and can vary widely
assessment of fetal well-being on labor admission in healthy
from one woman to another.
pregnant women presenting in spontaneous labor.
• Each childbirth or labor is unique.
• The use of amniotomy alone for prevention of delay in labor is
• Duration of active first stage (from 5cm until full cervical dilation) not recommended.
usually not extend beyond 12 hours in first labors and usually
• The use of early amniotomy with early oxytocin augmentation
does not extend beyond 10 hours in subsequent labors.
for prevention of delay in labor is not recommended.
• For pregnant women with spontaneous labor onset, the cervical
• The use of oxytocin for prevention of delay in labor in women
dilatation rate threshold of 1cm/hour during active first stage (as
receiving epidural analgesia is not recommended.
depicted by the partograph alert line) is inaccurate to identify
women at risk of adverse birth outcomes and is therefore not • The use of antispasmodic agents for prevention of delay in labor
recommended for this purpose. is not recommended (e.g., Buscopan which hastens labor).
• A minimum cervical dilatation rate of 1cm/hour throughout • The use of intravenous fluids with the aim of shortening the
active first stage is unrealistically fast for some women and is duration of labor is not recommended.
therefore not recommended for identification of normal labor
progression. A slower than 1-cm/hour cervical dilatation rate SECOND STAGE OF LABOR (CHILDBIRTH)
alone should not be a routine indication for obstetric • The use of the following definition and duration of the second
intervention. stage of labor is recommended for practice.
• The second stage is the period of time between full cervical
• Labor may not naturally accelerate until a cervical dilatation
dilatation and birth of the baby, during which the woman has an
threshold of 5 cm is reached. Therefore, the use of medical
involuntary urge to bear down, as a result of expulsive uterine
interventions to accelerate labor and birth (such as oxytocin
contractions.
augmentation or caesarean section) before this threshold is not
• Women should be informed that the duration of the second
recommended, provided fetal and maternal conditions are
stage varies from one woman to another. In first labors, birth is
reassuring.
usually completed within 3 hours whereas in subsequent labors,
• Auscultation using a Doppler ultrasound device or Pinard fetal birth is usually completed within 2 hours.
stethoscope is recommended for the assessment of fetal • Women in the expulsive phase of the second stage of labor
wellbeing on labor admission. should be encouraged and supported to follow their own urge
• Routine perineal/pubic shaving prior to giving vaginal birth is not to push.
recommended. • For women with epidural analgesia in the second stage of labor,
• Administration of enema for reducing the use of labor delaying pushing for one to two hours after full dilatation or until
augmentation is not recommended. the woman regains the sensory urge to bear down is
• Digital vaginal examination at intervals of four hours is recommended in the context where resources are available for
recommended for routine assessment of active first stage of longer stay in second stage and perinatal hypoxia can be
labor in low-risk women. adequately assessed and managed.
• For women in the second stage of labor, techniques to reduce
• Intermittent auscultation of the fetal heart rate with either a
perineal trauma and facilitate spontaneous birth (including
Doppler ultrasound device or Pinard fetal stethoscope is
perineal massage, warm compresses and a “hands on”
recommended for healthy pregnant women in labor.
guarding of the perineum) are recommended, based on a
• Epidural analgesia is recommended for healthy pregnant woman’s preferences and available options.
women requesting pain relief. • Routine or liberal use of episiotomy is not recommended for
• During labor, depending on a woman’s preferences. women undergoing spontaneous vaginal birth
• Parenteral opioids, such as fentanyl, diamorphine and • Application of manual fundal pressure to facilitate childbirth
pethidine, are recommended options for healthy pregnant during the second stage of labor is not recommended.
women requesting pain relief during labor, depending on a
woman’s preferences. Notes:
Ø An episiotomy is a cut (incision) through the area between
• Relaxation techniques, including progressive muscle relaxation,
your vaginal opening and your anus. This area is called the
breathing, music, mindfulness and other techniques, are

perineum. This procedure is done to make your vaginal

opening larger for childbirth. POLICIES AND LAWS
THIRD STAGE OF LABOR RA 10354 Responsible Parenthood and Reproductive

Health Law (RPRH Act of 2012).
• The use of uterotonics for the prevention of postpartum
AO 2008-0029 Implementing Health Reforms to Rapidly
hemorrhage (PPH) during the third stage of labor is Reduce Maternal and Neonatal Mortality.
recommended for all births. Guidelines Governing the Payment of
• Oxytocin (10 IU, IM/IV) is the recommended uterotonic drug for Training Fees relative to the Attendance of
Department
the prevention of postpartum hemorrhage (PPH). Health Workers to Basic Emergency
Order 2009-0084
• In settings where oxytocin is unavailable, the use of other Obstetric and Newborn Care Skills Training
Course at Duly Designated Training Centers
injectable uterotonics (if appropriate,
Establishment of Basic Emergency
ergometrine/methylergometrine, or the fixed drug combination Obstetric and Newborn Care Training
of oxytocin and ergometrine) or oral misoprostol (600 μg) is AO 2011-0011
Centers in Regional Hospitals and Medical
recommended. Centers.
• Delayed umbilical cord clamping (not earlier than 1 minute after Guidelines in the Administration of Life
birth) is recommended for improved maternal and infant health Saving Drugs During Maternal Care
AO 2015-0020
and nutrition outcomes. Emergencies by Nurses and Midwives in
Birthing Centers
• In settings where skilled birth attendants are available,
Guidelines on the Provision of Quality
controlled cord traction (CCT) is recommended for vaginal Antenatal Care in All Birthing Centers and
births if the care provider and the parturient woman regard a AO 2016-0035
Health Facilities Providing Maternity Care
small reduction in blood loss and a small reduction in the Services.
duration of the third stage of labor as important. National Policy on the Prevention of Illegal
• Sustained uterine massage is not recommended as an AO 2018-0003 and Unsafe Abortion and Management of
intervention to prevent postpartum hemorrhaged (PPH) in Post- Abortion Complications.
women who have received prophylactic oxytocin.
.
CARE OF NEWBORN
• In neonates born through clear amniotic fluid who start
breathing on their own after birth, suctioning of the mouth and
nose should not be performed.
• Newborns without complications should be kept in skin-to-
skin contact (SSC) with their mothers during the first hour
after birth to prevent hypothermia and promote
breastfeeding.
• All newborns, including low-birth-weight (LBW) babies who are
able to breastfeed, should be put to the breast as soon as
possible after birth when they are clinically stable.
• All newborns should be given 1 mg of vitamin K intramuscularly
after birth (i.e., after the first hour by which the infant should be
in skin-to- skin contact with the mother and breastfeeding
should be initiated the mother and baby are ready.
• Bathing should be delayed until 24 hours after birth. If this is not
possible due to cultural reasons, bathing should be delayed for
at least six hours. Appropriate clothing of the baby for ambient
temperature is recommended. This means one to two layers of
clothes more than adults, and use of hats/caps. The mother and
baby should not be separated and should stay in the same room
24 hours a day
CARE OF THE WOMAN AFTER BIRTH

• Post-partum abdominal uterine tonus assessment for early
identification of uterine atony is recommended for all women.
• Routine antibiotic prophylaxis is not recommended for women
with uncomplicated vaginal birth.
• Routine antibiotic prophylaxis is not recommended for women
with episiotomy.
• All post-partum women should have regular assessment of
vaginal bleeding, uterine contraction, fundal height,
temperature and heart rate routinely during the first 24 hours
starting from the first hour after birth
o Blood pressure should be measure shortly after birth
o If normal, the second BP measurement should be
taken within six hours
• Urine void should be documented within six hours.
• After an uncomplicated vaginal birth in a health care facility,
health mothers and newborns should receive care in the facility
for at least 24 hours after birth.

COMMUNITY
ESSENTIAL INTRAPARTUM AND NEWBORN CARE
BACKGROUND 3. Properly timed cord clamping after 1 to 3 minutes

• 1 of 42 nations where 90% of global under- five mortality Ø Prevents anemia and premature brain death
have been documented Ø Waiting for the pulsations to stop which allows the
• 82,000 Filipino children die annually before their 5th blood to flow from the placenta to the baby
birthday Ø Decreases the risk of iron deficiency anemia
• 37% of these children are NBs less than 28 days old
o mostly of preventable causes (asphyxia or 4. Non-separation of newborn from mother for early
sepsis) breastfeeding and rooming-in
o sanitation, septic technique
• Highest number of NB deaths: first two days of life IMMEDIATE NB CARE –– FIRST 90 MINS
• Labor, delivery, and immediate postpartum period: critical
• Marked LACK IN THE PRACTICE OF NEWBORN CARE A. DRY AND PROVIDE WARMTH
intervention • Call out time of birth
• Responses: WHO (Clinical Practice Pocket Guide) • Immediately dry the baby
• Newborn Care until the First Week of Life (2009) o Use clean, dry cloth, and dry the baby thoroughly
• Early Essential Newborn Care (2014) o Wipe eyes, face, head, front, back, arms, and
legs
• AO 2009-0025: ESSENTIAL NEWBORN CARE
o Do a quick check of baby’s breathing while drying
PROTOCOL MANDATE
o Signed on December 1, 2009 • Remove wet cloth and place baby in skin-to-skin contact
o Institutionalizes policies and guidelines for with the mother
government and private health facilities to adopt • Cover the baby and mother with a clean warm cloth
the essential newborn care protocol • Cover the baby’s head with a bonnet
ENC / ESSENTIAL NEWBORN CARE NOTE

• Package of evidenced-based practices recommended by - Do not do routine suctioning
the DOH, PhilHealth, and the WHO as the standards of care - During the first 30 seconds, do not suction unless
in all births by skilled attendants in all government and mouth/nose is are blocked
private settings - Do not suction meconium unless the baby is vigorous
• Basic component of DOH’s MMCHN strategy - Meconium – first poop
o Seeks to rapidly reduce maternal and newborn
morbidity and mortality
o NB care has been incorporated in the provision
B. IF BREATHING OR CRYING
of service
• CONTINUE SKIN-TO-SKIN CONTACT
• ENC practices for newborn care constitute a series of time-
• Avoid routine suctioning that may cause trauma or
bound, chronologically ordered, standard procedures that
introduce infection
a baby receives at birth
• Postpone routine procedures such as weighing and
• Addresses
measurements
o MDG #4 (REDUCE CHILD MORTALITY)
• SSC with baby prone on mother’s abdomen or chest and
o MDG #5 (IMPROVE MATERNAL HEALTH)
turn baby’s head to one side
UNANG YAKAP CAMPAIGN • Keep babies back covered with a blanket and a bonnet
• A call to action by the Department of Health supported by
the WHO based on the ENC AO NOTE
o national and local sectors - Do NOT separate baby from mother as long as the
o public and private health and related sectors baby is well and the mother does not need urgent
o individuals and organizations medical stabilization
o mass media and academe - Do NOT wipe off the vernix
• to strengthen alliances to implement the Essential Newborn - Do NOT bathe the baby during the first 24 hours of life
Care protocol. - Place ID band on ankle
- If baby is to be separated, clamp and cut the cord and
NOTE put the baby on a safe and warm surface close to the
- both public and private sectors mother
- if the baby is normal, practice rooming in
o injection stuff blah blah will be done while C. EARLY SKIN TO SKIN CONTACT
performing unang yakap • General perception: for the mother – baby bonding
- if baby needs more critical interventions -> NICU
• Other benefits:
o B = breastfeeding success (initiation and
4 TIME-BOUND INTERVENTIONS
exclusivity)
1. Immediate & thorough drying
o L = Lymphoid tissue system stimulation
Ø WHO recommends leaving vernix caseosa on your
o E = Exposure to maternal skin flora
baby's skin for at least 6 hours but preferably 24 hours
o S = Sugar (protection from hypoglycemia)
Ø Don’t remove immediately after birth
o T = thermoregulation
Ø Prohibited since drying prevents hypothermia
Ø Encourages the bond for skin to skin contact with the
D. INJECT OXYTOCIN INTO THE MOTHER’S ARM OR THIGH
mother
• 10 units oxytocin IM to prevent uterine atony
• Uterine atony is the inability to on contract hence leads to
2. Early skin to skin contact
hemorrhage.
Ø Exposes to the mother’s normal flora
Ø Essential for baby’s survival • Oxytocin promotes uterine contraction.
Ø Stability for both mother and baby

E. DO APPROPRIATELY TIMED CORD CLAMPING AND NOTES

CUTTING - LBW babies without complications must be maintained in
• Ensure use of sterile gloves when handling the cord. SSC to immediately after birth and thorough drying to
• Clamp and cut the cord after cord pulsations have stopped prevent neonatal hypothermia
(between 1-3 mins).
o Clamp at 2cm from umbilical base NB CARE –– FROM 90 MINUTE TO 6 HOURS
o Apply second clamp at 5cm from the umbilical A. EXAMINE THE BABY
base. • After detachment from breast
o Cut close to the first clamp. o Hand hygiene
• Do NOT milk the cord towards the baby o Examine thoroughly
o May cause brain bleed o ID band around the ankle
o Weigh baby and record
F. INITIATION OF BREASTFEEDING • Explain procedure to mother
• Leave baby on mother’s chest in SSC with head turned on • Check for breathing difficulties
to one side and mother in a semi-upright position or on her o Grunting
side o Chest in-drawing
• Observe baby for feeding cues (OTLR) o Fast or slow RR (Normal Rate is 30-60
o Opening of the mouth breaths/min)
o Tonguing • Check the baby’s temperature (36.5-37.5C), eyes for
o Licking redness, swelling, or pus draining, umbilical stump for
o Rooting oozing blood
• Suggest to mother to nudge her baby towards the breast • Check for abdominal distention
• Crying is a late sign of hunger • Look at the head, trunk, and all limbs of the baby and check
• BF every 2-3 hours for possible birth injuries
• Provide BF support to ensure good positioning and • Look for signs of fracture
attachment • Look for malformations
o Make sure baby’s neck is not flexed or twisted • Examine skin for cuts or abrasions
o Make sure baby is facing the breast with the • Check for cleft palate or lip
baby’s nose opposite her nipple and chin • Inform mother of findings
touching the breast • Refer for special treatment as necessary
o Hold the baby’s body close to her body • Help mother BF
o Support the baby’s whole body not just the neck
and shoulders B. ADMINISTER MEDICINE
o Wait until her baby’s mouth is opened wide • Vitamin K prophylaxis (1mg IM) 0.1mL
o Move baby onto her breast, aiming at the lower o Prevent bleeding
lip well below the nipple • Hepatitis B (10mcg IM) 0.5mL
• Look for signs of good attachment and suckling o Prevent infection in the liver
o Mouth wide open • BCG / Bacille Calmette-Guerine (ID) 0.05mL
o Lower lip turned outwards o Prevent serious infections due to tuberculosis
o Baby’s chin touching the breast • Record the injections
o Slow and deep suckling, with some pauses
• BF is a learned behavior for both baby and mother C. DRY CORD CARE
o Baby will make several attempts to BF before • Keep cord stump loosely covered with clean clothes
being successful
• Fold diaper below the stump
o Health workers should avoid interfering with this
• Put nothing on the stump
process
• Wash stump with clean water and soap only if its soiled and
• If attachment or suckling is not good, try again, and
dry it thoroughly with a clean cloth
reassess.
• Seek care if the umbilicus is red or draining pus
• Do not leave the mother and baby alone
• Do NOT bandage the stump or abdomen
• Monitor breathing and warmth.
• Avoid touching the stump unnecessarily
NOTES
- Do NOT touch the baby unless there’s a medical indication CARE PRIOR TO DISCHARGE: AFTER THE FIRST 90 MINUTES
- Do NOT give sugar water, formula or other prelacteals
- Do NOT give bottles or pacifiers A. ADVISE ON STAYING IN THE FACILITY
- Do NOT throw away colostrum • Uncomplicated vaginal birth
o Colostrum is the first secretion from the • Mother and NB to receive care in the birthing facility for at
mammary glands after giving birth least 24 hours
§ rich in antibodies
B. SUPPORT UNRESTRICTED, ON DEMAND BF, DAY AND
G. EYE CARE NIGHT
• Explain to mother that you will be putting on ointment/drops • Rooming In
to prevent infection (OPHTHALMIA NEONATORUM) o Keep baby in the room with the mother, on her
• Erythromycin or Tetracyline Ointment or 2.5% povidone- bed or within easy reach– DO NOT SEPARATE
iodine drops • Support EBF/Exclusive breast feeding
o Inner to outer canthus • Assess BF in every NB before planning for discharge
• Do NOT wash away the eye ointment • Ask mother to alert you is she has difficulty BF
• Explain that EBF is the only feeding that protects NB
H. ADDITIONAL CARE against serious illness
• If mother is unable to maintain SSC due to complications o EBF means no other food or water except for BM
o Wrap NB in a clean, dry, warm cloth • Exclusive breastfeeding starts at birth with colostrum
o Place in a cot feeding and continues for 6 months
o Cover with a blanket o At 6 mos, complementary feeding of solids is
o Encourage another family member to keep the started while BF and this continues until 2 years
baby in s2s contact or use a radiant warmer if or beyond
room is <28ºC

C. ENSURE WARMTH OF THE BABY

• Ensure the room is warm (25-28C)
• Explain that keeping the baby warm is important to remain
healthy
• SSC as much as possible
• Dress baby or wrap in a soft, dry, clean cloth and cover
head with bonnet for the first few days
• Assess warmth every 4 hours by touching baby’s feet if
without a thermometer

COMMUNITY
FIRST 1000 DAYS + NEWBORN SCREENING + NATIONAL IMMUNIZATION PROGRAM
LAWS / POLICIES TO MEMORIZE –– VISION

• RA 11148 – First 1000 Days Law Ø Every Filipino child will be born healthy and well, with an
• RA 9288 – Newborn Screening Act of 2004 inherent right to life, endowed with human dignity and
reaching her/his potential with the right opportunities and
FIRST 1000 DAYS accessible resources.
• Law signed on November 28, 2018 (RA 11148)
• “Kalusugan at Nutrisyon ng Mag-Nanay Act”. –– MISSION
• Seeks to scale up the national and local health nutrition Ø To ensure that all Filipino children will have access to and
avail of total quality care for the optimal growth and
• programs through a strengthened integrated strategy for
development of their full potential.
maternal, neonatal, child health, and nutrition in the first
1000 days of life.
–– GOAL
• The First 1,000 Days of a child’s life start from the mother’s
Ø By 2030, all Filipino newborns are screened and properly
conception until the child reaches his or her second
managed for common and rare congenital disorder to
birthday.
reduce preventable deaths of newborns.
o 270 days of pregnancy
o 180 = 0-6 months of the infant
PROCEDURE
o 550 = 6th to 24th month of a child's life
1. Screening is done within 48 hours or at least 24 hours
• The law mandates the provision of “comprehensive, from birth but not later than 3 days after complete delivery.
sustainable, multisectoral strategies and approaches” o NB in intensive care may be exempted from the
o to address health and nutrition problems of
3 day requirement but must be tested by 7 days
newborns, infants and young children, pregnant of age.
and lactating women, and adolescent females 2. Heel Prick Test = A few drops of blood is drawn from
o “evidence-based nutrition interventions and
pricking the baby’s heel
actions” during the First 1,000 Days based on 3. Then it is blotched on a special absorbent card and dried
recommendations by the United Nations for at least 4 hours.
Children's Fund and the World Health
4. The procedure may be done by the physician, nurse,
Organization (WHO) midwife, or medical technologist
5. Results:
“GOLDEN WINDOW OF OPPORTUNITY” = for the child to achieve
• (+) Screen: Means NB has to be brought back for
his or her full potential in the different aspects of development.
further testing
• (-) Screen: Means result are normal.
NUTRITION MONTH
• The First 1,000 Days as a measure against malnutrition is
CONDITIONS SCREENED
the focus of the annual Nutrition Month campaign in July
1. Congenital Hypothyroidism (CH)
2021.
2. Congenital Adrenal Hyperplasia (CAH)
• Stunting (low height for their age) is one of the forms of 3. Phenylketonuria (PKU)
malnutrition, along with wasting, underweight, and 4. Galactosemia (GAL)
overweight. 5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
– most common condition among the panel of disorders.
Some Interventions WHO Recommended Include: 6. Maple Syrup Urine Disease (MSUD)
• Iron-folic acid supplementation
• Multiple micronutrient supplementation. Ø In the advent of the expanded newborn screening program,
• Calcium supplementation conditions being screened increased from 6 to more than 28.
• Iodization of salt
• Maternal dietary supplementation focused on adequate NBS DISORDERS
energy and protein
• Delayed cord clamping 1. Congenital Hypothyroidism (CH)
• Neonatal vitamin K administration • results from lack or absence of thyroid hormone
• Vitamin A supplementation o TH is essential for the physical and mental
• Kangaroo mother care for pre-term infants and those who development of a child
are small for gestational age • If the disorder is not detected and hormone replacement is
• Promotion of breastfeeding for the health and well-being of not initiated within two (2) weeks, the baby with CH may
women and children suffer from growth and mental retardation
NEWBORN SCREENING (NBS) 2. Congenital Adrenal Hyperplasia (CAH)

• RA 9288 or Newborn Screening Act of 2004 • CAH is an endocrine disorder that causes severe salt loss,
• Essential public health strategy that enables the early dehydration, and abnormally high levels of male sex
detection and management of several congenital disorders, hormones in both boys and girls
which if left untreated, may lead to mental retardation • If not detected and treated early, babies with CAH may die
and/or death within 7-14 days
• Early diagnosis and initiation of treatment, along with
appropriate long-term care help ensure normal growth and 3. Phenylketonuria (PKU)
development of the affected individual. • Baby cant properly use phenylalanine
• It has been an integral part of routine newborn care in most o Phenylalanine = building blocks of protein
developed countries for five decades, either as a health • Excessive accumulation of phenylalanine in the blood
directive or mandated by law. causes brain damage.
• Available since 1996.
4. Galactosemia (GAL)
• Babies are unable to process galactose
• Galactose = the sugar present in milk

• Accumulation of excessive galactose in the body can cause - They also need to complete additional doses during
many problems, including liver damage, brain damage and supplementary or catch-up vaccination campaigns
cataracts. announced by the Department of Health.
- Routine immunization coverage among children must be at
5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD) least 95%. Routine vaccines are provided by the
• Body lacks the enzyme called G6PD Government for free in public health centers and facilities.
o G6PD = helps RBCs function properly
• Babies with this deficiency may have hemolytic anemia NOTE !
resulting from exposure to oxidative substances found in Ø Unvaccinated children can develop diseases resulting in
drugs, foods and chemicals. prolonged or long-term disabilities, affecting their full physical,
• Most common deficiency. emotional and social development and wellbeing.
Ø Sick children are unable to go to school, which can hamper their
6. Maple Syrup Urine Disease (MSUD) becoming fully productive individuals.
• MSUD is a genetic metabolic disorder resulting from the Ø Prolonged treatment and out-of-pocket spending burdens
defective activity of the enzyme branched chain alpha-keto- families with medical expenses and lost time at work
acid dehydrogenase complex. - This can eventually lead to a lower quality of life for
• Accumulation of the branched chain amino acids are toxic individuals and families.
to the brain Ø VPDs are re-emerging and new infectious diseases are
affecting the country
OTHER NEWBORN SCREENING TESTS - This makes it important for various sectors to become
involved in immunization activities and services to achieve
HEARING TEST and sustain the desired herd immunity in the population.
–– AUDITORY BRAIN STEM RESPONSE (ABR) TEST LEGAL BASIS OF THE NP

• Used to assess the auditory brain stem and the brain’s • The fundamental law of the land – the 1987 Philippine
response to sound. Constitution – says that “The State shall adopt a
• A miniature earphone is inserted in the ear to play sounds. comprehensive approach to health development which
o If the newborn’s brain does not respond to the shall endeavor to make essential goods, health and other
sounds consistently, it may indicate a hearing social services available to all people at affordable cost.
problem. There shall be priority for the needs of the underprivileged,
sick, elderly, disabled, women, and children” (Article XIII,
–– OTOACOUSTIC EMISSIONS (OAE) TEST Section 11, 1987).
• Helps diagnose if certain parts of the infant’s ear respond
to sound Presidential Decree provides for compulsory basic
(PD) No. 996 immunization for infants and children
• A tiny earphone and a microphone are carefully inserted in
(September 16, 1976) below eight years old.
the ear, and sounds are played
o If there is no echo reflected in the ear canal Presidential implementing the Expanded Program
Proclamation No. 6, on Immunization (EPI), in response to
(measured by the microphone), it can imply
hearing loss. the United Nation’s goal of universal
child immunization by 1990.
PULSE OXIMETRY TEST Proclamation No. 46 reaffirmed the Philippines’ commitment
• Non-Invasive (September 16, 1992) to universal goal of eradicating polio by
2000 through child and mother
• Measures how much oxygen is in an infant’s blood
immunization.
• Babies with heart issues may show low blood oxygen levels
RA No. 7846 (An Act listed down basic immunization services
• A pulse oximeter machine is used for the test, which utilizes
requiring compulsory to be provided. These include
a harmless sensor placed on the baby’s skin
immunization against vaccination against:
• Can also determine if an infant has Critical Congenital Heart Hepatitis B for infants 1. tuberculosis (TB)
Disease (CCHD) and children below 2. diphtheria, pertussis and tetanus
eight years old, (DPT)
NATIONAL IMMUNIZATION PROGRAM (NIP) amending for the 3. poliomyelitis (administered orally)
• Used to be called Expanded Program on Immunization purpose Presidential 4. measles
• Established by the DOH in 1976 Decree No. 996, 5. rubella
• covers larger population – children, youth, senior citizen, December 30, 1994) 6. Hepatitis-B
special groups. in newborns within 24 hours after birth,
o Guided health workers to deliver immunization and (vii) provision of other basic
services based on national protocols and immunization services for infants and
standards. children below eight years of age.
o Eventually became the National Immunization DOH AO No. 39, s. guided the nationwide implementation
Program, which covered wider segments of the 2003 (April 21, 2003) of the EPI.
population. RA No. 10152 (July 2, mandated the adoption of a
• NIP provides immunity against 14 vaccine-preventable 2011) / Mandatory comprehensive, mandatory and
diseases (VPD) from only 6 in 1976. Infants and Children sustainable immunization program
• Expanded population coverage beyond infants and Health Immunization against VPDs among all infants and
pregnant women to include school children, Act of 2011 children under the age of five years.
adolescents/youth, senior citizens, and those in special These include vaccines against:
situations. (a) Tb
• Advances in immunization technology resulted in safer (b) DPT
vaccination equipment and use of combined vaccines (c) Poliomyelitis
which are easier to administer. (d) Measles
(e) Mumps
BENEFITS OF IMMUNIZATION (f) Rubella or German measles
- Vaccines , saving millions of lives each year. (g) Hepatitis B
- For routine vaccines to be effective, children need to (h) H. Influenza Type B (HIB)
complete the required doses according to schedule from and other types as may be determined
the time they are born until they are one year old. by the Secretary of Health

HISTORY OF NIP OBJECTIVES

1. To increase coverage of existing vaccines for targeted
1976 – Immunization program was officially launched in 1976. population groups across the life-stage.
Ø BCG vaccine against TB was administered to school 2. To provide additional protection to identified vulnerable
entrants groups from other VPDs through evidenced-base new
o BCG – bacille Calmette-guerin vaccines and technologies.
Ø Followed by vaccines against poliomyelitis, diphtheria, 3. To achieve the country’s commitment to priority global
tetanus, and pertussis (DPT) and measles. immunization goals.
1989 – Country achieved for the first time the universal child STRATEGIES
immunization goal of 90%. 1. Expand the package of quality immunization services and
scale up coverage.
1995 – Pledged to attain 3 immunizations global goals: Eradication 2. Generate client’s demand and multi-sectoral support for
of Poliomyelitis, Elimination of Neonatal Tetanus, and immunization services.
Control of Measles 3. Strengthen surveillance and response.
4. Build-up supervision, monitoring and evaluation.
2000 – Philippines reached polio-free status 5. Institute supportive governance, financing and regulatory
measures
2014 – Completed 2nd validation for the declaration of NT
elimination in 2014. COMMON VACCINE-PREVENTABLE DISEASES IN THE
PHILIPPINES
IMPLEMENTATION STATUS OF THE NIP
TUBERCULOSIS
1. Reduction of Death and Illness Due to VPDs • Agent: Bacterium (Mycobacterium Tuberculosis)
• The significant reduction of mortality and morbidity rates • Reservoir: Humans
due to diphtheria, pertussis, TB and measles from 1989 • Spread: Airborne droplets
to 2009 shows that vaccines are effective in curbing • Duration of Immunity Induced by Infection: Not known.
deaths and illnesses among newborns, infants and o Reactivation of old infection commonly causes
children. disease.
• Over the past 25 years, illness due to diphtheria, pertussis, • Risk Factors for Infection: Crowding Immunodeficiency
NT and TB dropped beginning 1995-1997. This continued Malnutrition in adults, alcoholism, diabetes, and HIV.
until 2016.
• Illness due to measles however continued to rise, with the HEPATITIS B
last notable increase from 2013 to 2014. • Agent: Virus
• Deaths due to diphtheria, pertussis, NT and measles • Reservoir: Humans
significantly dropped from 1989 to 2015. • Spread: Mother to newborn, child to child, blood, and
• Deaths from pertussis and diphtheria were zero since 1989 sexual intercourse. In developing countries, transmission at
and in 1996, respectively. birth or early childhood is dominant.
• Deaths due to tetanus continuously dropped over the years. • Duration of Immunity Induced by Infection: If infection
• Deaths due to measles dropped to zero only starting in resolves, life-long immunity.
• 2006. However, deaths from measles rose in 2013-2014 in • Risk Factors for Infection: Infected mother, unsafe
several provinces due to large measles outbreaks injections, unsafe blood transfusions, and multiple sexual
partners.
2. Philippine Commitment to International Declarations on
Immunization POLIO
• Agent: Poliomyelitis virus – stereotypes 1, 2, 3
The Philippines is a signatory to four international declarations on • Reservoir: Humans
immunization • Spread: Fecal-oral
• Polio Eradication – The Philippines was certified polio-free • Duration of Immunity Induced by Infection: Lifelong
since 2000. type-specific immunity
• Maternal-Neonatal Tetanus Elimination (MNTE) – MNTE • Risk Factors for Infection: Poor environment hygiene
in the Philippines has been validated for 16 regions except
for ARMM in 2015. National MNTE validation has been DIPTHERIA
achieved in 2017. • Agent: Toxin-producing bacterium (Corynebacterium
• Measles Elimination – still a challenge for the NIP Diptheriae)
o There was an increased incidence of Measles • Reservoir: Humans
during the outbreak of 2013-2014 • Spread: Close respiratory contact or contact with infectious
o Case Fatality Ratio (CFR) among laboratory and material
epidemiologically confirmed measles cases
• Duration of Immunity Induced by Infection: Usually life-
increased
long
o Situation has improved since then, in 2014 with
• Risk Factors for Infection: Crowding
continuous supplemental immunization activities
(SIA) among school age children.
PERTUSIS
• Accelerated Hepatitis B Control – Coverage at birth
• Agent: Bacterium (Bordetella Pertussis)
improved from 2009 to 2015. However, there is still a need
to maximize vaccination of newborns. • Reservoir: Humans
• Spread: Close respiratory contact
NIP GOAL, OBJECTIVES, AND STRATEGIES • Duration of Immunity Induced by Infection: No concrete
evidence
The 2016-2021 comprehensive multi-year strategic plan contains the • Risk Factors for Infection: Crowding
following goal, objectives, and strategies to be pursued by the
National Immunization Program TETANUS
• Agent: Toxin-producing bacterium (Clostridium Tetani)
GOAL • Reservoir: Soil Animal intestines
Ø To reduce morbidity and mortality rates due to vaccine- • Spread: Spores enter the body through wounds
preventable diseases. • Duration of Immunity Induced by Infection: No concrete
evidence

• Risk Factors for Infection: Exposure to animal feces; PNEUMOCOCCAL DISEASE

infections with rust metals untreated wounds. • Agent: Bacteria
• Reservoir: Humans
MATERNAL-NEONATAL TETANUS • Spread: Close respiratory contact and airborne droplets
• Agent: Toxin-producing bacterium (Clostridium Tetani) • Duration of Immunity Induced by Infection: Some type-
• Reservoir: Infected mother specific immunity
• Spread: Infection through the umbilical cord of newborns • Risk Factors of Infection: Crowding
• Duration of Immunity Induced by Infection: None
• Risk Factors for Infection: Inadequately trained birth IMMUNIZATION
attendants, lack of supplies for clean and safe deliveries. • Process where a person is made immune or resistant to
an infectious disease typically by the administration of a
MENINGITIS AND PNEUMONIA CAUSED BY HAEMOPHILUS vaccine
INFLUENZA TYPE B • Vaccines stimulate the body’s own immune system to
• Agent: Haemophilus Influenzae Type B, Bacterium protect the person against subsequent infection or disease.
• Spread: Close respiratory contact Immunity – refers to protection from disease through the formation
• Duration of Immunity Induced by Infection: Usually life- of antibodies. There are two basic mechanisms for acquiring
long immunity:
• Risk Factors for Infection: Overcrowding leading to
exposure to the infections. PASSIVE IMMUNITY
• Acquired through the administration of products
ROTAVIRUS derived from human or animals providing short-term
• Agent: Virus protection, usually a few weeks or months.
• Reservoir: Humans o Rabies vaccine – not just given once, does not
• Spread: Fecal-oral just cover one type of vaccine, it covers a lot.
• Duration of Immunity Induced by Infection: Unknown • The three ways of gaining passive immunity are either from
• Risk Factors for Infection: Globally circulation virus strain, blood products, through administration of immune
and poor environmental hygiene globulins or vertical transmission from mother to
newborn.
MEASLES
• Agent: Virus ACTIVE IMMUNITY
• Reservoir: Humans • Formed by stimulating the immune system to produce
• Spread: Close respiratory contact and aerosolized droplets cellular and antibody immunity. Ways of producing active
• Duration of Immunity Induced by Infection: Lifelong immunity include:
• Risk Factors for Infection: Crowding o Exposure to an infection or disease, although
infection does not lead to immunity in all cases.
MUMPS
• Agent: Virus – EXPOSURE TO DISEASE THEN DEVELOP ANTIBIODIES
• Reservoir: Humans • Vaccination to produce immune responses similarly
• Spread: Close respiratory contact and airborne droplets evoked by natural infection without the development of the
• Duration of Immunity Induced by Infection: Lifelong disease and its complications.
• Risk Factors of Infection: Crowding • The immune response to vaccination is influenced by the:
o Nature and dosage of administered antigen
RUBELLA § we have live attenuated vaccine
o Route of administration
• Agent: Virus
§ mostly IM pero meron in oral, ID and
subq
• Spread: Close respiratory contact and airborne droplets o Adjuvants.
• Duration of Immunity Induced by Infection: Lifelong § other meds o Maternal antibodies.
• Risk Factors of Infection: Crowding o Age
o Nutritional status
JAPANESE ENCEPHALITIS o Co-existing disease and other host factors
• Agent: Virus
• Reservoir: Mosquitoes TYPES OF VACCINES
• Spread: Bite by infected mosquito
• Duration of Immunity Induced by Infection: Lifelong LIVE ATTENUATEED VACCINES
• Risk Factors of Infection: Presence of high burden of • Derived from wild viruses or bacteria which are modified or
disease causing vector weakened in laboratories.
• Immunity is elicited by replication of the attenuated
HUMAN PAPILLOMA VIRUS organism in the vaccinated person.
• Agent: Virus • The immune response to a live attenuated vaccine is
• Reservoir: Humans identical to that induced by natural infection.
• Spread: Sexual intercourse o e.g. influenza vaccine – flu like symptoms
• Duration of Immunity Induced by Infection: Not known • Immuno-deficient or immuno-compromised individuals may
• Risk Factors for Infection: Unsafe sexual practices only receive such vaccine with caution as this may cause
serious adverse reactions as a result of uncontrolled
INFLUENZA replications.
• Agent: Virus • evaluate monitor ensure that pt can really received by the
• Reservoir: Humans patient kasi kapag immune pwede adverse reactions mag
• Spread: Close respiratory contact and airborne droplets occur.
• Duration of Immunity Induced by Infection: Unknown or • Currently available live attenuated vaccines are those for:
weak immunity TB (BCG), Oral Polio, Measles, mumps, rubella, and JE.
• Risk Factors of Infection: Crowding
INACTIVATED VACCINES
• Produced by growing the bacteria or virus in culture media
which are then subjected to heat or chemical agents.

• In fractional or subunit form of these vaccines, organisms Number of Dose = 1

are treated to be able to derive those components needed Doses, Dosage = 0.5 mL
to produce the vaccines. Dosage, Route = IM @ outer part of mid-thigh
• Both the inactivated or sub-unit preparations must contain Route
sufficient antigenic mass to stimulate the desired response Schedule Given within 24 hours ideally 90 minutes after
since it is incapable of replicating inside the host. birth.
• Forms of inactivated vaccines include:
o Whole viruses (e.g. influenza, IPV, rabies) May still be given within 7 days
o Whole bacteria (e.g. pertussis, typhoid, cholera ) Precautions Birth dose must be given if there is a risk of
o Subunit or fractional vaccines (e.g. influenza, perinatal transmission
hepB, etc.) Storage Store between +2°C to +8°C
o Pure polysaccharides and conjugates (e.g. Hib,
PPV, PCV, etc.) • Protects against Hepa B infection.
o Toxoids: diphtheria, tetanus. • One of the safest and most effective vaccines (95%
• Inactivated vaccines may not elicit the range of effective in preventing chronic infection).
immunologic response provided by the live attenuated • Monovalent Hepa B (containing one antigen) to be used as
agents. a birth dose.
• Maintenance of long-lasting immunity with inactivated viral
or bacterial vaccines often requires periodic booster doses. Ø Hepatitis B virus is a dangerous liver infection that, when
• Unlike live attenuated vaccines, inactivated vaccines caught as an infant, often shows no symptoms for decades.
cannot replicate in or be excreted by the recipient as Ø It can develop into cirrhosis and liver cancer later in life.
infectious agent and thus cannot adversely affect Children less than 6 years old who become infected with
immunosuppressed hosts or their contacts. the hepatitis B virus are the most likely to develop chronic
infections.
ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS
POLIO VACCINE
Type of OPV = Live attenuated
Vaccine IPV = Inactivated
Number of OPV = 2 drops into the mouth
Doses, IPV = 0.5 mL, IM @ left out part of the upper thigh
Dosage,
Route Boosters - may be given as supplementary doses
during polio eradication
Schedule OPV: 6, 10, 14 weeks.
IPV: 14 weeks
Precautions Postpone if child has moderate to severe illness
Storage OPV must be kept frozen from -15°C to -25°C.
MEMORIZE Do not freeze IPV. It should be stored from +2°C

to +8°C.Store between +2°C to +8°C
• At Birth = BigHit (BH)
o BCG + Hepa B
• 6+10+14 = POPi • Protects against poliovirus, safe vaccines.
o Penta + OPV + PCV • Interruption of person-to-person transmission of the virus
o Yung “i” is IPV which is pang 14th wk lang !! led to global polio eradication.
• 9m+1y = MMR • Polio is a virus that paralyzes 1 in 200 people who get
infected.
TUBERCULOSIS VACCINE – BCG • 5 to 10 percent die when their breathing muscles are
Type of Vaccine Live Bacterial paralyzed.
Number of Doses, Dose = • No cure for polio once the paralysis sets in.
Dosage, Route Dosage = 0.05 ml
Route = ID Ø Oral Polio Vaccine - live attenuated (weakened) virus,
Schedule 90 mins after birth but can be given till 48 administered by drops, inexpensive and easy to administer,
after birth provides gut immunity, protects close contacts who are
(may be given at infant’s first contact with unvaccinated.
the health system before turning 1 y.o) o 3 doses of OPV produce immunity for all of the
poliovirus types in the vaccine.
If born of mothers positive for TB, should Ø Inactivated Polio Vaccine - contains killed virus,
be delayed and be given after one month administered by injection, highly effective, more expensive,
after negative PPD test provides immunity through blood.
Contraindications Known HIV infection and other immune o IPV is also highly effective in preventing paralytic
deficiency disease.
• Tuberculosis (TB) is an infection that most often attacks the DPT–HepB+Hib COMBINATION VACCINE (PENTAVALENT)
lungs. In infants and young children, it affects other organs Type of Pentavalent vaccine
like the brain Vaccine
o A severe case could cause serious complications Number given as 3 dose infancy schedule (some vaccines
or death. of Doses, like Diphtheria and Tetanus need booster doses)
• TB is very difficult to treat when contracted, and treatment Dosage,
is lengthy and not always successful Route 0.5mL, IM, right outer upper thigh.
• According to the 2020 World Health Organization global TB Schedule 6, 10, 14 weeks of age Pentavalent 1 starting at 6
report, the Philippines has the highest TB incidence rate in wks (min) with penta 2 and penta 3 at intervals of 4
Asia, with 554 cases for every 100,000 Filipinos wks (min) after each dose
Booster TETANUS
HEPATITIS B VACCINE > Childhood schedule of 5 doses (3 in infancy, 1 in
Type of Recombinant DNA early childhood (1-6 y.o) and 1 during adolescence
Vaccine

(12-15y.o), further dose in adulthood to provide MEASLES-RUBELLA(MR) & MEASLES-MUMPS-RUBELLA(MMR)

lifelong protection. Type of Live attenuated viral
Vaccine
DIPTHERIA Number Dose = 2
> Total childhood schedule of 6 doses (3 in infancy, of Doses, Dosage = 0.5 mL
4th at 2 years, 2 other doses with Td vaccine at Dosage, Route = SQ @ Upper arm
school age). Route
Storage Store between +2°C to +8°C Schedule MMR = 9 mos and 12 mos
Never freeze the vaccine.
BOOSTE – given at school age children at Gr1 and
• Called Pentavalent vaccine because it protects against 5 Gr7
diseases. CI For Measles Containing Vaccine (MCV)
o Diphtheria - Known allergy to vaccine components
o Pertussis (including neomycin and gelatin).
o Tetanus - Pregnancy.
o Hepatitis B
§ 80–90% of infants infected with - Severe congenital or acquired immune
Hepatitis B during the first year of life disorders, including advanced HIV
most likely to develop chronic infection/AIDS.
infections. AE Mild: fever, rash 5–12 days following
o Haemophilus influenzae type B. administration.
DIPTEHRIA
Ø Diphtheria infects the throat and tonsils, making it hard for Serious: Thrombocytopenia (decreased platelets),
children to breathe and swallow anaphylaxis, encephalitis.
o Severe cases can cause heart, kidney and/or
nerve damage. Joint pain when rubella containing vaccine (RCV) is
given to adult women; parotitis with mumps
PERTUSSIS (WHOOPING COUGH) component.
Ø Causes coughing spells that can last for weeks. In some Storage Store between +2°C to +8°C
cases, it can lead to troubled breathing, pneumonia, and
death.
MR & MMR IMMUNIZATION
TETANUS
Ø Tetanus causes very painful muscle contractions. It can Type of Measles-Rubella Measles, Mumps, and
cause children’s neck and jaw muscles to lock (lockjaw), Vaccine Vaccine Rubella Vaccine
making it hard for them to open their mouth, swallow, Target < 15 mos School age children
breastfeed or breathe. Even with treatment, tetanus is often Popultaion
fatal. Schedule 2 doses 2 doses
> 9 mos & 12 mos > Grade 1 (5-6 y/o)
INFLUENZA > Grade 7 (11-12 y/o)
Ø Influenza is an acute respiratory infection caused by Dosage 0.5 mL 0.5 mL
influenza viruses which circulate in all parts of the world.
Influenza can cause severe illness or death especially in • MEASLES – is a highly contagious disease with symptoms
people at high risk. that include fever, runny nose, white spots in the back of
the mouth and a rash
PNEUMOCOCCAL o Serious cases can cause blindness, brain
Type of Pneumococcal Polysaccharide and swelling and death
Vaccine Pneumococcal Conjugate • MUMPS – can cause headache, malaise, fever, and
Number of - PCV - three doses for infants swollen salivary glands
Doses, - 0.5mL, IM o Complications can include meningitis, swollen
Dosage, - Anterolateral part of the left thigh (vastus testicles and deafness
Route lateralis) for infants. • RUBELLA – infection in children and adults is usually mild,
- Upper arm (deltoid) for adults but in pregnant women it can cause miscarriage, stillbirth,
Schedule PCV - 6, 10 and 14 weeks of age for infants. infant death or birth defects
Storage Store between +2°C to +8°C. Never freeze the
vaccine.
OTHER VACCINES
• Vaccine against Streptococcus pneumoniae • Rotavirus vaccine
• Safe and well tolerated • Japanese encephalitis vaccine
• Pneumococcal diseases such as pneumonia and • Tetanus Diphtheria vaccine
meningitis are a common cause of sickness and death • Human Papilloma Virus vaccine
worldwide, especially among young children under 2 years • Seasonal Influenza vaccine
old
PCV & PPV IMMUNIZATION
Type of Pneumococcal Pneumococcal

Vaccine Conjugate Vaccine Polysaccharide
(PCV) Vaccine (PPV)
Target < 1 y/o 60-65 y/o
Popultaion
Schedule 6, 10, 14 wks @ 60 and 65 y/o
Dosage 0.5 mL 0.5 mL

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COMMUNITY

2nd Year, 1st Semester

OUTLINE purposes of companionship, desiring to achieve a sense of

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Leadership in Health MILLENIUM DEVELOPMENT GOALS

Administrator of specific services

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GOOD GOVERNANCE VISION Filipinos are among the healthiest people in

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o Engage service delivery networks to deliver

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COMMUNITY HEALTH NURSING DIAGRAM

- The health of the family

PHASES OF THE NURSING PROCESS Ida Jean Orlando

Basic Phases of the Nursing Elaboration of the Nursing

3. PRESENCE OF HEALTH DEFICITS

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• Others, specify : _____________________________

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o Limited physical resources (e.g.lack of space to

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CRITERIA WEIGHT STEP 6 – DEVELOPING THE INTERVENTION PLAN

STEP 5 – FORMULATION OF GOALS AND OBJECTIVES

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TEN LEADING CAUSES OF MORBIDITY

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Ø Morbidity CRUDE OR GENERAL RATES

CRUDE BIRTH RATE (CBR) PLACE OF OCCURRENCE

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PROPORTIONATE MORTALITY (PM)

SPECIFIC DEATH RATE

TOTAL FERTILITY RATE (TFR)

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o Done through instruments that routinely monitor and

MORE EQUITABLE HEALTHCARE FINANCING

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BASIC EMERGENCY OBSTETRIC NEWBORN CARE (BEmONC)

COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN

MATERNAL HEALTH OUTCOMES

• Hemorrhage and hypertension

• Other factors affecting maternal and neonatal outcomes

• These gaps continue to be widespread in the past years NUTRITION OUTCOMES

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–– TREND OF MALNUTRITION PREVALANCE AMONG

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10. Prevention and treatment of infertility and sexual

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- GDM obstetric care facilities is less

CEmONC POSTNATAL CARE

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perineum. This procedure is done to make your vaginal

THIRD STAGE OF LABOR RA 10354 Responsible Parenthood and Reproductive

CARE OF THE WOMAN AFTER BIRTH

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BACKGROUND 3. Properly timed cord clamping after 1 to 3 minutes

ENC / ESSENTIAL NEWBORN CARE NOTE

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E. DO APPROPRIATELY TIMED CORD CLAMPING AND NOTES

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C. ENSURE WARMTH OF THE BABY