CONTENTS OUTLINE

Bag Technique
Breastfeeding or Lactation Management Education Training
Communicable Disease (Vector Borne)
Communicable Diseases (Chronic)
Control of Acute Respiratory Infections (CARI)
Control of Diarrheal Diseases (CDD)
Expanded Program for Immunization (EPI)
Herbal Medicine Plants Approved by the DOH
Integrated Management of Childhood Illnesses (IMCI)
Management of a Child with an Ear Problem
Maternal and Child Health Nursing Program
Non-Communicable Diseases and Rehabilitation
Family Planning Program
 Bag Technique
Definition

Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform

nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care.

Public health bag – is an essential and indispensable equipment of the public health nurse which he/she has to carry

along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.

Rationale

To render effective nursing care to clients and /or members of the family during home visit.

Principles
1. The use of the bag technique should minimize if not totally prevent the spread of infection from
individuals to families, hence, to the community.
2. Bag technique should save time and effort on the part of the nurse in the performance of nursing
procedures.
3. Bag technique should not overshadow concern for the patient rather should show the effectiveness
of total care given to an individual or family.
4. Bag technique can be performed in a variety of ways depending upon agency policies, actual home
situation, etc., as long as principles of avoiding transfer of infection is carried out.

Special Considerations in the Use of the Bag

1. The bag should contain all necessary articles, supplies and equipment which may be used to
answer emergency needs.
2. The bag and its contents should be cleaned as often as possible, supplies replaced and ready for
use at any time.
3. The bag and its contents should be well protected from contact with any article in the home of the
patients. Consider the bag and it’s contents clean and /or sterile while any article belonging to the patient
as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the user to
facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding
contamination of the bag and its contents.
6. The bag when used for a communicable case should be thoroughly cleaned and disinfected before
keeping and re-using.

Contents of the Bag

 Paper lining
 Extra paper for making bag for waste materials (paper bag)
 Plastic linen/lining
 Apron
 Hand towel in plastic bag
 Soap in soap dish
 Thermometers in case [one oral and rectal]
 2 pairs of scissors [1 surgical and 1 bandage]
 2 pairs of forceps [ curved and straight]
 Syringes [5 ml and 2 ml]
 Hypodermic needles g. 19, 22, 23, 25
 Sterile dressings [OS, C.B]
 Sterile Cord Tie
 Adhesive Plaster
 Dressing [OS, cotton ball]
 Alcohol lamp
 Tape Measure
 Baby’s scale
 1 pair of rubber gloves
 2 test tubes
 Test tube holder
 Medicines
 betadine
 70% alcohol
 ophthalmic ointment (antibiotic)
 zephiran solution
 hydrogen peroxide
 spirit of ammonia
 acetic acid
 benedict’s solution

Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures
Actions Rationale

1. Upon arriving at the client’s home, place the

bag on the table or any flat surface lined with
paper lining, clean side out (folded part touching
the table). Put the bag’s handles or strap beneath
the bag. To protect the bag from contamination.

2. Ask for a basin of water and a glass of water if

faucet is not available. Place these outside the To be used for handwashing.
work area. To protect the work field from being wet.

3. Open the bag, take the linen/plastic lining and

spread over work field or area. The paper lining,
clean side out (folded part out). To make a non-contaminated work field or area.

4. Take out hand towel, soap dish and apron and

the place them at one corner of the work area
(within the confines of the linen/plastic lining). To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel. Leave

the plastic wrappers of the towel in a soap dish in Handwashing prevents possible infection from one care provid
the bag. to the client.

6. Put on apron right side out and wrong side with To protect the nurses’ uniform. Keeping the crease creates
crease touching the body, sliding the head into
 the neck strap. Neatly tie the straps at the back. aesthetic appearance.

7. Put out things most needed for the specific

case (e.g.) thermometer, kidney basin, cotton
ball, waste paper bag) and place at one corner of
the work area. To make them readily accessible.

8. Place waste paper bag outside of work area. To prevent contamination of clean area.

To give comfort and security, maintain personal hygiene and

9. Close the bag. hasten recovery.

10. Proceed to the specific nursing care or

treatment. To prevent contamination of bag and contents.

11. After completing nursing care or treatment,

clean and alcoholize the things used. To protect caregiver and prevent spread of infection to others

12. Do handwashing again.

13. Open the bag and put back all articles in their
proper places.

14. Remove apron folding away from the body,

with soiled sidefolded inwards, and the clean side
out. Place it in the bag.

15. Fold the linen/plastic lining, clean; place it in

the bag and close the bag.

16. Make post-visit conference on matters

relevant to health care, taking anecdotal notes
preparatory to final reporting. To be used as reference for future visit.

17. Make appointment for the next visit (either

home or clinic), taking note of the date, time and
purpose. For follow-up care.

After Care

1. Before keeping all articles in the bag, clean and alcoholize them.
2. Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps and
cover the bag.

Evaluation and Documentation

1. Record all relevant findings about the client and members of the family.
2. Take note of environmental factors which affect the clients/family health.
3. Include quality of nurse-patient relationship.
4. Assess effectiveness of nursing care provided.

Breastfeeding or Lactation Management

Education Training
Introduction

Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following

laws support the full implementation of this program:

 Executive Order 51
 Republic Act 7600
 The Rooming-In and Breastfeeding Act of 1992

Program Objectives and Goals

 Protection and promotion of breastfeeding and lactation management education training

Activities and Strategies

1. Full Implementation of Laws Supporting the Program

a. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of

infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas,

feeding bottles, teats etc. )

b. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992

 An act providing incentives to government and private health institutions promoting and practicing
rooming-in and breast-feeding.
 Provision for human milk bank.
 Information, education and re-education drive
 Sanction and Regulation
 2. Conduct Orientation/Advocacy Meetings to Hospital/ Community

Advantages of Breastfeeding:

Mother

 Oxytocin help the uterus contracts

 Uterine involution
 Reduce incidence of Breast Cancer
 Promote Maternal-Infant Bonding
 Form of Family planning Method (Lactational Amenorrhea)

Baby

 Provides Antibodies
 Contains Lactoferin (binds with Iron)
 Leukocytes
 Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli

Positions in Breastfeeding of the baby:

1. Cradle Hold = head and neck are supported

2. Football Hold
3. Side Lying Position

BEST FOR BABIES

REDUCE INCIDENCE OF ALLERGENS

ECONOMICAL

ANTIBODIES PRESENT

STOOL INOFFENSIVE (GOLDEN YELLOW)

TEMPERATURE ALWAYS IDEAL

FRESH MILK NEVER GOES OFF

EMOTIONALLY BONDING

EASY ONCE ESTABLISHED

DIGESTED EASILY

IMMEDIATELY AVAILABLE

NUTRITIONALLY OPTIMAL

GASTROENTERITIS GREATLY REDUCED

 Communicable Disease (Vector Borne)
Leptospirosis (Weil’s disease)

 An infectious disease that affects humans and animals, is considered the most common zoonosis in
the world

Causative Agent:

Leptospira interrogans

Sign/Symptoms:
 High fever
 Chills
 Vomiting
 Red eyes
 Diarrhea
 Severe headache
 muscle aches
 may include jaundice (yellow skin and eyes)
 abdominal pain
 Treatment:

PET – > Penicillins, Erythromycin, Tetracycline

Malaria

 Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or marsh fever) is an
infectious disease that is widespread in many tropical and subtropical regions.

Causative Agent:

Anopheles female mosquito

Signs & Symptoms:

 Chills to convulsion
 Hepatomegaly
 Anemia
 Sweats profusely
 Elevated temperature

Treatment:
 Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering
the endemic area.
 Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine
 Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable
preventive and vector control meas

Preventive Measures: (CLEAN)

 Chemically treated mosquito nets
 Larvae eating fish
 Environmental clean up
 Anti mosquito soap/lotion
 Neem trees/eucalyptus tree

Filariasis

 name for a group of tropical diseases caused by various thread-like parasitic round worms
(nematodes) and their larvae
 larvae transmit the disease to humans through a mosquito bite
 can progress to include gross enlargement of the limbs and genitalia in a condition called
elephantiasis

Sign/Symptoms:

Asymptomatic Stage

 Characterized by the presence of microfilariae in the peripheral blood

 No clinical signs and symptoms of the disease
 Some remain asymptomatic for years and in some instances for life

Acute Stage
 Lymphadenitis (inflammation of lymph nodes)
 Lymphangitis (inflammation of lymph vessels)
 In some cases the male genitalia is affected leading to orchitis (redness, painful and tender
scrotum)

Chronic Stage

 Hydrocoele (swelling of the scrotum)

 Lyphedema (temporary swelling of the upper and lower extremities
 Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities,
scrotum, breast)

Management:
 Diethylcarbamazine citrate or Hetrazan
 Ivermectin,
 Albendazolethe
 No treatment can reverse elephantiasis

Schistosomiasis

 parasitic disease caused by a larvae

Causative Agent:

Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

 Bulging abdomen
 Abdominal pain
 Loose bowel movement
 Low grade fever
 Inflammation of liver & spleen
 Pallor
 Seizure

Preventive measures
 health education regarding mode of transmission and methods of protection; proper disposal of
feces and urine; improvement of irrigation and agriculture practices
 Control of patient, contacts and the immediate environment

Treatment:
 Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)

Dengue

 DENGUE is a mosquito-borne infection which in recent years has become a major international
public health concern..
 It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-
urban areas.

Sign/Symptoms: (VLINOSPARD)
 Vomiting
 Low platelet
 Nausea
 Onset of fever
 Severe headache
 Pain of the muscle and joint
 Abdominal pain
 Rashes
 Diarrhea

Treatment:
 The mainstay of treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion

Communicable Diseases (Chronic)

Tuberculosis
 TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent:

Mycobacterium Tuberculosis

Sign/Symptoms:
 cough
 afternoon fever
 weight loss
 night sweat
 blood stain sputum

Prevalence/Incidence:
 ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
 Sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management

 Ventilation systems
 Ultraviolet lighting
 Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
 drug therapy

Preventing Tuberculosis
 BCG vaccination
 Adequate rest
 Balanced diet
 Fresh air
 Adequate exercise
 Good personal Hygiene

National Tuberculosis Control Program – Key policies

 Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are
negative after 2 or more sputum exams
 Treatment – shall be given free and on an ambulatory basis, except those with acute complications
and emergencies
 Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB
patients.
 DOTS (Direct Observed Treatment Short Course)
 Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of
smear-negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extra-
pulmonary TB (meningitis, pleurisy, etc.)
 Intensive Phase (given daily for the first 2 months) – Rifampicin + Isioniazid + pyrazinamide
+ ethambutol.
 If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum
is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined
for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then
another smear exam is done at the end of the 3rd month.
 Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH +
rifampicin daily
 Category 2-previously-treated patients with relapses or failures.
 Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+
ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol
on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more
month and then another sputum exam is done. If still positive after 4 months, intensive phase is
continued for the next 5 months.
 Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+
ethambutol
 Category 3 – new TB patients whose sputum is smear negative for 3 times and chest x-ray result
of PTB minimal
 Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
 Maintenance Phase (daily for the next 2 months) – Isioniazid + rifampicin

Leprosy

 Sometimes known as Hansen’s disease

 is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
 Gerhard Armauer Hansen
 Historically, leprosy was an incurable and disfiguring disease
 Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms

Early stage (CLUMP) Late Stage (GMISC)

Change in skin color Gynocomastia

Loss in sensation Madarosis(loss of eyebrows)

Ulcers that do not heal Inability to close eyelids (Lagopthalmos)

Muscle weakness Sinking nosebridge

Painful nerves Clawing/contractures of fingers & nose

Prevalence Rate
 Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.

Management:
 Dapsone, Lamprene
 clofazimine and rifampin
 Multi-Drug-Therapy (MDT)
 six month course of tablets for the milder form of leprosy and two years for the more severe form
 Leprosy Control Program
 WHO Classification – basis of multi-drug therapy
 Paucibacillary/PB – non-infectious types. 6-9 months of treatment.
 Multibacillary/MB – infectious types. 24-30 months of treatment.
 Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting
treatment
 Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of
ROM regimen
 For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister
packs taken monthly within a max. period of 9 mos.
 All patients who have complied w/ MDT are considered cured and no longer regarded as a case of
leprosy, even if some sequelae of leprosy remain.
 Responsibilities of the nurse:
 Prevention – health education, healthful living through proper nutrition, adequate rest,
sleep and good personal hygiene;
 Casefinding
 Management and treatment – prevention of secondary injuries, handling of utensils;
special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the
need for medical check-up from time to time; mental & emotional support
 Rehabilitation-makes patients capable, active and self-respecting member of society.

Control of Acute Respiratory

Infections (CARI)
Classification

A. No Pneumonia: Cough or Cold

1. No chest in drawing
2. No fast breathing ( <2 mos. – <60/min,2-12 mos. – less than 50 per minute; 12 mos. – 5 years – less
than 40 per minute)

Treatment:

1. If coughing more than 30 days, refer for assessment

2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4. Treat fever/wheezing if present
 Home Care:

1. Feed the Child

 Feed the child during illness

 Increase feeding after illness
 Clear the nose if it interferes with feeding

2. Increase Fluids

 offer the child extra to drink

 Increase breastfeeding

3. Soothe the throat and relieve the cough with a safe remedy

4. Watch for the following signs and symptoms and return quickly if they occur

 Breathing becomes difficult

 Breathing becomes fast
 Child is not able to drink
 Child becomes sicker

B. Pneumonia

1. No chest in drawing
2. Fast breathing (less than 2 mos- 60/min or more ; 2-12 mos. – 50/min or more; 12 mos. – 5 years –
40/min or more)

Treatment

1. Advise mother to give home care

2. Give an antibiotic
3. Treat fever/wheezing if present
4. If the child’s condition gets worst, refer urgently to hospital; if improving, finish 5 days of antibiotic.

Antibiotics Recommended by WHO

 Co-trimoxazole,
 Amoxycillin, Ampicillin, (p.o)
 or Procaine penicillin (I.M.)

C. Severe Pneumonia

1. Chest indrawing
2. Nasal flaring
3. Grunting ( short sounds made with the voice)
4. Cyanosis

Treatment

 Refer urgently to hospital

 Treat fever ( paracetamol), wheezing ( salbutamol)

D. Very Severe Disease

1. Not able to drink

2. Convulsions
3. Abnormally sleepy or difficult to wake
4. Stridor in calm child
5. Severe undernutrition

Treatment

 Refer urgently to hospital

Assessment of Respiratory Infection

Ask the Mother

1. How old is the child?

2. Is the child coughing? For how long?
3. Age less than 2 months: Has the young infant stopped feeding well?
4. Age 2 months up to 5 years: Is the child able to drink?
5. Has the child had fever? For how long?
6. Has the child had convulsions?

Look, Listen

1. Count the breaths in one minute.

Age Fast Breathing

Less than 2 months 60/minute or more

2 months- 12 months 50/minute or more

12 months – 5 years 40/minute or more

2. Look for chest in drawing.

3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes

with air entering the lungs.

4. Look and listen for wheeze. Wheeze is a soft musical noise which shows signs that breathing out (exhale) is difficult.

5. See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis)

6. Feel for fever or low body temperature.

7. Check for severe under nutrition

 Control of Diarrheal
Diseases (CDD)
Management of the Patient with Diarrhea

A. No Dehydration
 Condition – well, alert
 Mouth and Tongue – moist
 Eyes – normal
 Thirst – drinks normally, not thirsty
 Tears – present
 Skin pinch – goes back quickly
 TREATMENT PLAN A- HOME Treatment.

Three Rules for Home Treatment

1. Give the child more fluids than usual

 use home fluid such as cereal gruel
 give ORESOL, plain water
2. Give the child plenty of food to prevent under nutrition
 continue to breastfeed frequently
 if child is not breastfeed, give usual milk
 if child is less than 6 months and not yet taking solid food, dilute milk for 2 days
 if child is 6 months or older and already taking solid food, give cereal or other starchy food
mixed with vegetables, meat or fish; give fresh fruit juice or mashed banana to provide potassium; feed
child at least 6 times a day. After diarrhea stops, give an extra meal each day for two weeks.
3. Take the child to the health worker if the child does not get better in 3 days or develops any of the
following:
 many watery stools
 repeated vomiting
 marked thirst
 eating or drinking poorly
 fever
 blood in the stool

Oresol Treatment

Amount of ORS to give after each loose Amount of ORS to provide for use at
Age stool home

< 24 months 50-100 ml 500 ml/day

2-10 years 100- 200 ml 1000 ml/day

10 years up As much as wanted 2000 ml/day

 B. Some Dehydration
 Condition – restless, irritable
 Mouth and Tongue – dry
 Eyes – sunken
 Thirst – thirsty, drinks eagerly
 Tears – absent
 Skin pinch – goes back slowly
 WEIGH PT, TTT. PLAN B

Approximate amount of ORS to give in 1st 4 hours

Age Weight (kg) ORS (ml)

4 months 5 200- 400

4- 11 months 5- 7.9 400- 600

12-23 months 8- 10.9 600- 800

2-4 yrs. 11- 15.9 800- 1200

5-14 yrs. 16- 29.9 1200- 2200

15 yrs. up 30 up 2200- 4000

1. If the child wants more ORS than shown, give more

2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful every 1-2 min.
5. If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS, give plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A

Use of Drugs during Diarrhea

 Antibiotics should only be used for dysentery and suspected cholera

 Antiparasitic drugs should only be used for amoebiasis and giardiasis

C. Severe Dehydration
 Condition – lethargic or unconscious; floppy
 Eyes – very sunken and dry
 Tears – absent
 Mouth and tongue – very dry
 Thirst- drinks poorly or not able to drink
 Skin pinch – goes back very slowly
 Treatment PLAN C- treat quickly
1. Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal Saline
3. Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
 Role of Breastfeeding in the Control of Diarrheal Diseases Program

Two problems in CDD

1. High child mortality due to diarrhea
2. High diarrhea incidence among under fives
 Highest incidence in age 6 – 23 months
 Highest mortality in the first 2 years of life
 Main causes of death in diarrhea :
 Dehydration
 To prevent dehydration, give home fluids “am” as soon as diarrhea starts and if
dehydration is present, rehydrate early, correctly and effectively by giving ORS
 Malnutrition
 For under nutrition, continue feeding during diarrhea especially breastfeeding.

Interventions to prevent diarrhea

1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of small children
7. measles immunization

Breastfeeding
1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants.
2. Advantages of breastfeeding in relation to CDD

a. Breast milk is sterile

b. Presence of antibodies protection against diarrhea

c. Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria.

3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24- 27% in infants under 6 months of age.

4. When to wean?

 4-6 months – soft mashed foods 2x a day

 6 months – variety of foods 4x a day

Summary of WHO-CDD recommended strategies to prevent diarrhea

1. Improved Nutrition

 Exclusive breastfeeding for the first 4-6 months of life and partially for at least one year.
 Improved weaning practices

2. Use of safe water

 collecting plenty of water from the cleanest source

 protecting water from contamination at the source and in the home

3. Good personal and domestic hygiene

 handwashing
 use of latrines
 proper disposal of stools of young children
 4. Measles immunization

Expanded Program for Immunization (EPI)

Principles of EPI

1. Epidemiological situation

2. Mass approach
3. Basic Health Service

The 7 immunizable diseases

1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B

Target Setting

 Infants 0-12 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old

Objectives of EPI

 To reduce morbidity and mortality rates among infants and children from six childhood immunizable
disease

Elements of EPI

 Target Setting
 Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that
the vaccines were maintained under proper environmental condition until the time of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies

Administration of vaccines

Form & # of
Vaccine Content Dosage Doses Route

BCG (Bacillus Calmette Live attenuated Freeze dried 1 ID

Guerin) bacteria
 Infant- 0.05ml

Preschool-0.1ml

DT- weakened
toxin

DPT (Diphtheria Pertussis

Tetanus) P-killed bacteria liquid-0.5ml 3 IM

OPV (Oral Polio Vaccine) weakened virus liquid-2drops 3 Oral

Plasma
Hepatitis B derivative Liquid-0.5ml 3 IM

Freeze dried-
Measles Weakened virus 0.5ml 1 Subcutaneous

Schedule of Vaccines

Vacci Age at Interval

ne 1st dose between dose Protection

BCG is given at the earliest possible age protects against the

BCG At birth possibility of TB infection from the other family members

DPT 6 weeks 4 weeks An early start with DPT reduces the chance of severe pertussis

The extent of protection against polio is increased the earlier OPV

OPV 6weeks 4weeks given.

An early start of Hepatitis B reduces

Hepa @birth,6th
B @ birth week,14th week the chance of being infected and becoming a carrier.

Meas 9m0s.- At least 85% of measles can be prevented by immunization at this

les 11m0s. age.

 6 months – earliest dose of measles given in case of outbreak

 9months-11months- regular schedule of measles vaccine
 15 months- latest dose of measles given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations of DPT,
OPV, BCG, Anti Hepatitis, Anti measles.
 Tetanus Toxiod Immunization

Schedule for Women

%
Vaccine Minimum age interval protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

1year later/during next

TT4 pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

 There is no contraindication to immunization except when the child is immunosuppressed or is very,

very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles
vaccine, report such to the doctor immediately.
 Malnutrition is not a contraindication for immunizing children rather; it is an indication for
immunization since common childhood diseases are often severe to malnourished children.

Cold Chain under EPI

 Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time
it is given to child or pregnant woman.
 The allowable timeframes for the storage of vaccines at different levels are:
 6months- Regional Level
 3months- Provincial Level/District Level
 1month-main health centers-with ref.
 Not more than 5days- Health centers using transport boxes.
 Most sensitive to heat: Freezer (-15 to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
 BCG
 DPT
 Hepa B
 TT
 Use those that will expire first, mark “X”/ exposure, 3rd- discard,
 Transport-use cold bags let it stand in room temperature for a while before storing DPT.
 Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are utilized
before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to
identify those near to expire vaccines.
 Herbal Medicine Plants Approved by the DOH

Lagundi (Vitex negundo)

Uses & Preparation:

 Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15
minutes)Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in water to produce a
glass, three times a day)
 Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound with the
decoction
 Headache – Crush leaves may be applied on the forehead
 Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area

Yerba (Hierba ) Buena (Mentha cordifelia)

Uses & Preparation:

 Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15 minutes.
Divide decoction into 2 parts, drink one part every 3 hours.
 Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap. Massage sap
on painful parts with eucalyptus
 Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)
 Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle
solution
 Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in
aching tooth cavity
 Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion.
 Nausea & Fainting – Crush leaves and apply at nostrils of patients
 Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a paste, rub
on affected area
 Pruritis – Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area.

Sambong (Blumea balsamifera)

Uses & Preparation:

 Anti-edema, diuretic, anti-urolithiasis – Boil chopped leaves in a glass of water for 15 minutes until one glassful
remains. Divide decoction into 3 parts, drink one part 3 times a day.
 Diarrhea – Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours.

Tsaang Gubat (Carmona retusa)

Uses & Preparation:

 Diarrhea – Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4 parts. Drink 1 part
every 3 hours
 Stomachache – Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.

Niyug-niyogan (Quisqualis indica L.)

Uses & Preparation:

 Anti-helmintic – The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated
after one week. (Caution: Not to be given to children below 4 years old)

Bayabas/Guava (Psidium guajava L.)

Uses & Preparation:

 For washing wounds – Maybe use twice a day
 Diarrhea – May be taken 3-4 times a day
As gargle and for toothache – Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Boil
chopped leaves for 15 minutes at low fire. Do not cover and then let it cool and strain

Akapulko
(Cassia alata L.)

Uses & Preparation:

 Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) – Fresh, matured leaves are pounded. Apply
soap to the affected area 1-2 times a day

Ulasimang Bato (Peperonica pellucida)

Uses & Preparation:

 Lowers uric acid (rheumatism and gout) – One a half cup leaves are boiled in two glass of water over low fire.
Do not cover pot. Divide into 3 parts and drink one part 3 times a day

Bawang (Allium sativum)

 Uses & Preparation:
 Hypertension – Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled water for 15
minutes. Take 2 pieces 3 times a day after meals.
 Toothache – Pound a small piece and apply to affected area

Ampalaya (Mamordica Charantia)

Uses & Preparation:

 Diabetes Mellitus (Mild non-insulin dependent) – Chopped leaves then boil in a glass of water for 15 minutes.
Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals

Reminders on the Use of Herbal Medicine

1. Avoid the use of insecticide as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.

Integrated Management of Childhood Illnesses

(IMCI)
Definition
 IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
 IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of
deaths from communicable diseases in children under five

Goal

 By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal
of reducing it by two thirds by 2015.

Aim
 To reduce death, illness and disability, and to promote improved growth and development among
children under 5 years of age.
 IMCI includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.

IMCI Objectives
 To reduce significantly global mortality and morbidity associated with the major causes of disease in
children
 To contribute to the healthy growth & development of children
 IMCI Components of Strategy
 Improving case management skills of health workers
 § Improving the health systems to deliver IMCI
 Improving family and community practices

**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
 Cough and/or fast breathing
 Lethargy/Unconsciousness
 Measles rash
 “Very sick” young infant

Possible course/ associated condition:

 Pneumonia, Severe anemia, P. falciparum malaria
 Cerebral malaria, meningitis, severe dehydration
 Pneumonia, Diarrhea, Ear infection
 Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:

 Acute Respiratory Infection
 Diarrhea
 Fever
 Malaria
 Measles
 Dengue Fever
 Ear Infection
 Malnutrition

The IMCI Case Management Process

 Assess and classify
 Identify appropriate treatment
 Treat/refer
 Counsel
 Follow-up

The Integrated Case Management Process

Check for General Danger Signs:

 A general danger sign is present if:
 The child is not able to drink or breastfeed
 The child vomits everything
 The child has had convulsions
 The child is lethargic or unconscious

Assess Main Symptoms

 Cough/DOB
 Diarrhea
 Fever
 Ear problems

Assess and Classify Cough of Difficulty of Breathing

 Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx,
trachea, air passages or lungs.
 Assess and classify PNEUMONIA

 Cough or difficult breathing

 An infection of the lungs
 Both bacteria and viruses can cause pneumonia
 Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized
infection).

** A child with cough or difficult breathing is assessed for:

 How long the child has had cough or difficult breathing

 Fast breathing
 Chest indrawing
 Stridor in a calm child.

Remember:

 ** If the child is 2 months up to 12 months the child has fast breathing if you count 50
breaths per minute or more
 ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths
per minute or more.

Color Coding

YELLOW
PINK (Treatment at outpatient GREEN
(URGENT REFERRAL) health facility) (Home management)

OUTPATIENT HEALTH FACILITY HOME

OUTPATIENT HEALTH FACILITY  Treat local infection  Caretaker is counseled on:

 Give oral drugs  Home treatment/s
 Pre-referral treatments  Advise and teach  Feeding and fluids
 Advise parents caretaker  When to return immediately
 Refer child  Follow-up  Follow-up

 Give first dose of an appropriate

REFERRAL FACILITY antibiotic
 Give Vitamin A
 Emergency Triage and SEVERE PNEUMONIA OR VERY  Treat the child to prevent low bloo
Treatment ( ETAT) sugar
 Diagnosis, Treatment SEVERE DISEASE  Refer urgently to the hospital
 Monitoring, follow-up  Give paracetamol for fever > 38.5

 Give an appropriate antibiotic for

days
 Soothe the throat and relieve coug
with a safe remedy
 Any general danger sign  Advise mother when to return
or immediately
 Chest indrawing or PNEUMONIA  Follow up in 2 days
 Stridor in calm child  Give Paracetamol for fever > 38.5
  If coughing more than more than
days, refer for assessment
 Soothe the throat and relieve the
NO PNEUMONIA : COUGH OR cough with a safe remedy
 Advise mother when to return
COLD immediately
 Fast breathing  Follow up in 5 days if not improvin

 No signs of pneumonia or
very severe disease

Assess and classify DIARRHEA

A child with diarrhea is assessed for:

 How long the child has had diarrhoea

 Blood in the stool to determine if the child has dysentery
 Signs of dehydration.

Classify DYSENTERY
 Child with diarrhea and blood in the stool
 If child has no other severe classification:
 Give fluid for severe dehydration ( Pla
Two of the following signs? C ) OR
 Abnormally sleepy or  If child has another severe classification :
difficult to awaken  Refer URGENTLY to hospital with moth
 Sunken eyes giving frequent sips of ORS on the way
 Not able to drink or  Advise the mother to continue
drinking poorly SEVERE breastfeeding
 Skin pinch goes back very DEHYDRATION  If child is 2 years or older and there is choler
slowly in your area, give antibiotic for cholera

 Give fluid and food for some dehydration ( P

B)
Two of the following signs :  If child also has a severe classification :
 Refer URGENTLY to hospital with moth
 Restless, irritable giving frequent sips of ORS on the way
 Sunken eyes SOME  Advise mother when to return
 Drinks eagerly, thirsty DEHYDRATION immediately
 Skin pinch goes back slowly  Follow up in 5 days if not improving

 Home Care
 Give fluid and food to treat diarrhea at home
 Not enough signs to ( Plan A )
classify as some or severe NO DEHYDRATION  Advise mother when to return immediately
dehydration  Follow up in 5 days if not improving

SEVERE  Treat dehydration before referral unless the

PERSISTENT child has another severe classification
DIARRHEA  Give Vitamin a
 Dehydration present  Refer to hospital

 Advise the mother on feeding a child who ha

PERSISTENT persistent diarrhea
DIARRHEA  Give Vitamin A
 No dehydration  Follow up in 5 days
  Treat for 5 days with an oral antibiotic
recommended for Shigella in your area
DYSENTERY  Follow up in 2 days
 Blood in the stool  Give also referral treatment

Does the child have fever?

**Decide:

 Malaria Risk
 No Malaria Risk
 Measles
 Dengue

Malaria Risk
 Give first dose of quinine ( under medical supervision
if a hospital is not accessible within 4hrs )
 Give first dose of an appropriate antibiotic
VERY SEVERE  Treat the child to prevent low blood sugar
FEBRILE DISEASE /  Give one dose of paracetamol in health center for hig
 Any general fever (38.5oC) or above
danger sign or MALARIA  Send a blood smear with the patient
 Stiff neck  Refer URGENTLY to hospital

 Blood smear ( +
)

If blood smear not

done:  Treat the child with an oral antimalarial

 Give one dose of paracetamol in health center for hig
 NO runny nose, fever (38.5oC) or above
and  Advise mother when to return immediately
 NO measles, and  Follow up in 2 days if fever persists
 NO other causes MALARIA  If fever is present everyday for more than 7 days, refe
of fever for assessment

 Give one dose of paracetamol in health center for hig

 Blood smear fever (38.5oC) or above
( – ), or  Advise mother when to return immediately
 Runny nose, or FEVER : MALARIA  Follow up in 2 days if fever persists
 Measles, or UNLIKELY  If fever is present everyday for more than 7 days, refe
Other causes of fever for assessment

No Malaria Risk
 Give first dose of an appropriate antibiotic
 Treat the child to prevent low blood sugar
 Any general danger VERY SEVERE  Give one dose of paracetamol in health center for
sign or FEBRILE DISEASE high fever (38.5oC) or above
 Stiff neck  Refer URGENTLY to hospital

 No signs of very FEVER : NO  Give one dose of paracetamol in health center for
severe febrile disease MALARIA high fever (38.5oC) or above
 Advise mother when to return immediately
 Follow up in 2 days if fever persists
  If fever is present everyday for more than 7 days,
refer for assessment

Measles

 Give Vitamin A
 Clouding of cornea  Give first dose of an appropriate antibiotic
or SEVERE COMPLICATED  If clouding of the cornea or pus draining from
 Deep or extensive MEASLES the eye, apply tetracycline eye ointment
mouth ulcers  Refer URGENTLY to hospital

 Give Vitamin A
 If pus draining from the eye, apply tetracycli
 Pus draining from MEASLES WITH EYE OR eye ointment
the eye or MOUTH COMPLICATIONS  If mouth ulcers, teach the mother to treat wi
 Mouth ulcers gentian violet

 Measles now or MEASLES

within the last 3 months  Give Vitamin A

Dengue Fever
 Bleeding from nose or
gums or
 Bleeding in stools or
vomitus or
 Black stools or vomitus
or
 Skin petechiae or
 Cold clammy extremities  If skin petechiae or Tourniquet test,are the
or only positive signs give ORS
 Capillary refill more than  If any other signs are positive, give fluids
3 seconds or rapidly as in Plan C
 Abdominal pain or SEVERE DENGUE  Treat the child to prevent low blood sugar
 Vomiting HEMORRHAGIC FEVER  DO NOT GIVE ASPIRIN
 Tourniquet test ( + )  Refer all children Urgently to hospital

 DO NOT GIVE ASPIRIN

 Give one dose of paracetamol in health
center for high fever (38.5oC) or above
FEVER: DENGUE  Follow up in 2 days if fever persists or chil
 No signs of severe HEMORRHAGIC UNLIKELY shows signs of bleeding
dengue hemorrhagic fever  Advise mother when to return immediatel

Does the child have an ear problem?

 Give first dose of

appropriate antibiotic
 Give paracetamol for
MASTOIDITIS pain
 Tender swelling behind the ear  Refer URGENTLY

 Pus seen draining from the ear and discharge is ACUTE EAR  Give antibiotic for 5
reported for less than 14 days or INFECTION days
 Ear pain  Give paracetamol for
pain
  Dry the ear by wickin
 Follow up in 5 days

CHRONIC EAR
 Pus seen draining from the ear and discharge is INFECTION  Dry the ear by wickin
reported for less than 14 days  Follow up in 5 days

NO EAR
INFECTION  No additional
 No ear pain and no pus seen draining from the ear treatment

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLE AMOXYCILLIN

BID FOR 5 DAYS BID FOR 5 DAYS

Adult Tablet Syrup

Age or Weight tablet Syrup

2 months up to 12 months

( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml

12 months up to 5 years ( 10

– 19kg ) 1 7.5 ml 1 10 ml

B. For Dysentery

COTRIMOXAZOLE AMOXYCILLIN
 BID FOR 5 DAYS

BID FOR 5 DAYS

TABLET SYRUP SYRUP 250MG/5ML

AGE OR WEIGHT

2 – 4 months 1.25 ml ( ¼ tsp )

( 4 – < 6kg ) ½

5 ml

4 – 12 months ½ 2.5 ml ( ½ tsp )

( 6 – < 10 kg ) 5 ml

1 – 5 years old 1 ( 1 tsp )

( 10 – 19 kg ) 7.5 ml

C. For Cholera

TETRACYCLINE COTRIMOXAZOLE

QID FOR 3 DAYS BID FOR 3 DAYS

 AGE OR WEIGHT Capsule 250mg Tablet Syrup

2 – 4 months ( 4 – < 6kg ) ¼ 1/2 5ml

4 – 12 months ( 6 – < 10 kg ) ½ 1/2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

Primaquine

Give single
Primaquine
CHOLOROQUINE
dose in
Sulfadoxine +
health Give daily
Give for 3 days Pyrimethamine
center for P. for 14 days

Falciparum for P. Vivax Give single dose

TABLET TABLET TABLET

AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG)

DAY1 DAY2 DAY3

2months –

5months ½ ½ ½ ¼
 5 months –

12 months ½ ½ ½ 1/2

12months –

3 years old

1 1 ½ ½ ¼ ¾

3 years old –

5 years old 1½ 1½ 1 3/4 1/2 1

GIVE VITAMIN A

AGE VITAMIN A CAPSULES 200,000 IU

6 months – 12 months 1/2

12 months – 5 years old 1

GIVE IRON

Iron/Folate Tablet Iron Syrup

FeSo4 200mg + 250mcg Folate (60mg FeSo4 150 mg/5ml
AGE or WEIGHT elemental iron) (6mg elemental iron per ml )

2months-4months
(4 – <6kg ) 2.5 ml

4months – 12months
(6 – <10kg ) 4 ml

12months – 3 years (10

– <14kg) 1/2 5 ml
 3years – 5 years ( 14 – 19kg
) 1/2 7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 – <14kg ) ¼ 5 ml

3 years up to 5 years (14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE

 Give 500mg Mebendazole as a single dose in health center if :

 hookworm / whipworm are a problem in children in your area, and
 the child is 2 years of age or older, and
 the child has not had a dose in the previous 6 months

Management of a Child with an Ear Problem

Classification of Ear Infection
1. Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear)
 Treatment
a. Antibiotics
b. Surgical intervention
2. Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red, immobile ear
drum (Acute Otitis Media)
 Treatment
a. Cotrimoxazole,Amoxycillin,or Ampicillin
b. Dry the ear by wicking
3. Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis Media)
 Treatment
a. Most important & effective treatment: Keep the ear dry by wicking.
b. Paracetamol maybe given for pain or high fever.
c. Precautions for a child with a draining ear:
 Do not leave anything in the ear such as cotton, wool between wicking
treatments.
 Do not put oil or any other fluid into the ear.
 Do not let the child go swimming or get water in the ear.
 Maternal and Child Health Nursing Program
Philosophy
 Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle
 Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for
individuals and make each experience unique
 MCN is FAMILY CENTERED- the father is as important as the mother

Goals
 To ensure that expectant mother and nursing mother maintain good health, learn the art of child
care, has a normal delivery and bear healthy children
 That every child lives and grows up in a family unit with love and security, in healthy surroundings,
receives adequate nourishment, health supervision and efficient medical attention and is taught the
elements of healthy living

Classification of pregnant women

 Normal – healthy pregnancy
 With mild complications- frequent home visits
 With serious or potentially serious complication – referred to most skilled source of medical and
hospital care

Home Based Mother’s Record (HBMR)

 Tool used when rendering prenatal care containing risk factors and danger signs

Risk Factors
 145 cm tall (4 ft & 9 inches)
 Below 18 yrs old, above 35 yrs old
 Have had 4 pregnancies
 With TB, goiter, heart disease, DM, bronchial asthma, severe anemia
 Last baby born was less than 2 years ago
 Previous cesarian section delivery
 History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies born before
EDD, stillbirth
 Weighs less than 45 kgs. or more than 80 kgs.

Danger Signs
1. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor

Prenatal Care

Schedule of Visits
 1st – as early as pregnancy, 1st trimester
 2nd – 2nd trimester
 3rd & subsequent visits – 3rd trimester
 More frequent visits for those at risk with complications
 Tetanus Toxiod Immunization Schedule for Women
Per
cent
Prot
Vac Minimum Age ecte
cine Interval d Duration of Protection

As early as
possible during
TT1 pregnancy 0% None

At least 4 weeks Infants born to the mother will be protected from neonatal tetanus. Gives
TT2 later 80% years protection for the mother from the tetanus.

Infants born to the mother will be protected from neonatal tetanus.

At least 6 months
TT3 later 90% Gives 5 years protection for the mother.

At least 1 year
TT4 later 99% Gives 10 years protection for the mother

At least 1 year Gives lifetime protection for the mothers. All Infants born to that mother w
TT5 later 99% be protected.

Dose: 0.5ml

Route: Intramuscular

Site: Right or Left Deltoid/Buttocks

Components of Prenatal Visits

 History – taking
 Determination of obstetrical score- G, P, TPAL, AOG, EDD
 U/A for Proteinuria, glycosuria and infxtn
 Dental exam
 Wt. Ht. BP taking
 Exam of conjunctiva and palms for pallor
 Abdominal exam – fundic ht, Leopold’s maneuver and FHT
 Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement
 Health teachings- nutrition, personal hygiene, common complaints
 Tetanus toxoid immunization
 Iron supplementation – from 5th mo. Of pregnancy – 2 mos. Postpartum
 In goiter endemic areas – iodized capsule once a year
 In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole duration
of pregnancy
 Non-Communicable Diseases and Rehabilitation
Prevention and Control of Cardiovascular Diseases
 heart – 1st leading cause of death ; blood vessels – 2nd
 Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits
septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in
children
 Causes: environmental factors, maternal diseases or genetic aberrations
 Rheumatic Fever or Rheumatic Heart Disease: Systematic inflammatory disease that may
develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory
tract by group A beta-hemolytic streptococci.
 Hypertension: Persistent elevation of the arterial blood pressure.(primary or essential) ;frequent
among females but severe, malignat form is more common among males
 Ischemic Heart Disease/ Atherosclerosis: Condition usually caused by the occlusion of the
coronary arteries by thrombus or clot formation.
 higher among males than females for the latter are protected by estrogen before
menopause
 Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking
 Minor Risk Factor: stress, strong family history, obesity

Cardiovascular Disease
Period of Life Type of CVD Prevalence

At birth to early 2/ 1000 school children (aged 5-15

childhood Congenital Heart Disease yrs. old)

1/1000 school children (aged 5-15 y

Early to late childhood Rheumatic Fever/ Rheumatic Heart Disease old)

Diseases of Heart Muscles Essential

Early Adulthood Hypertension 10/100 adults

Middle age to old age Coronary Artery Disease Cerebrovascular 5/100 adults
 Accident

Cardiovascular Disease
Diseases Causes/ Risk factors

Congenital Heart Disease Maternal Infections, Drug intake, Maternal Disease, Genetic

Rheumatic Fever/Rheumatic Heart

Disease Frequent Streptoccocal Sore Throat

Essential Hypertension Heredity, High Salt Intake

Coronary Artery Disease Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes Mellitus
(Heart Attack) Sedentary Life Style

Cerebrovascular Accident
(Stroke) Hypertension, Arteriosclerosis

Primary Prevention: CVD

Disease Primordial Specific Protection

Congenital Heart  Prevention of viral infection and intake of  Adequate treatment of

harmful drugs during pregnancy. viral infection during pregnancy
Disease  Avoidance of marriage between blood  Genetic counseling of
relatives blood related married couples.

Rheumatic Heart  Identification of cases of

 Prevention of recurrent sore throat thru rheumatic fever
Disease adequate environmental sanitation; avoidance of  Prophylaxis with penicilli
overcrowding; adequate treatment or erythromycin

Essential
 From early childhood
Hypertension  low salt diet  Continued low salt diet a
 adequate physical exercise adequate exercise

 cessation of smoking
Coronary Heart  Prevention of development/ acquisition of risk  control /treatment of
Disease (Heart factors diabetes, hypertension
 cigarette smoking  weight reduction
Attack)  high fat intake  change to proper diet
 high salt intake  Adjustment of activities

Cerebrovascular  all measures to prevent hypertension &  all measures to control

Accident arteriosclerosis hypertension & progression of
 (Stroke)
arteriosclerosis

Primary Prevention thru health education is the main focus of the program:
1. Maintenance of ideal body wt.
2. diet – low fat
3. alcohol/smoking avoidance
4. exercise
5. regular BP check up

Cancer Prevention and Early Detection

 Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the
destruction in the surrounding tissues.
 Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer,
skin cancer, prostate cancer.
 3rd leading cause of illness and death (Phil.)
 Incidence can only be reduced thru prevention and early detection

Nine Warning Signs of Cancer:

 Change in blood bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge
 Thickening or lump in breast or elsewhere
 Indigestion or difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness
 Unexplained anemia
 Sudden unexplained weight loss

Prevention & Early Detection

CA
type Prevention Detection

Lung No smoking None

Uterin
e Monogamy, Safe sex Pap’s smear every 1-3 yrs

Cervic
al Monogamy, Safe sex Pap’s smear every 1-3 yrs

Hep B vaccination, Less alcohol intake,

Liver Avoidance of moldy foods None

Regular medical checkup

Colon High fiber diet after 40 yrs of age

Rectu
m Low fat intake Fecal occult blood test DRE Sigmoidoscopy

No smoking, betel nut chewing, Oral

Mouth hygiene Regular dental check-ups
 Monthly SBE, Yearly exam by doctor, Mammography fo
Breast none 50 yrs old and above females

Skin No excessive sun exposure Assessment of skin

Prosta
te none Digital transrectal exam

Principles of Treatment of Malignant Diseases

 One third of all cancers are curable if detected early and treated properly.

Three major forms of treatment of cancer:

1. Surgery
2. Radiation Therapy
3. Chemotherapy

Nat’l Diabetes Prevention and Control Program

Aim:
 Controlling and assimilating healthy lifestyle in the Filipino culture (2005- 2010) thru IEC

Main Concern:
 modifiable risk factors ( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt.
,migration

Prevention and Control of Kidney Disease

1. Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function resulting from
the failure of the renal circulation or by glomerular or tubular damage causing the accumulation of
substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic,
endocrine, and metabolic functions.
2. Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative disease,
or disease of the blood vessels.
3. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its
complications unless dialysis or kidney transplant is performed.
4. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney.
5. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine
because of increased permeability of the glomerular capillary membrane
6. Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the
urinary tract with or without signs and symptoms.
7. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into
the blood and secretion, collection, and conduction of urine.
8. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged.

Program on Mental Health and Mental Disorders

Mental Health
 Mental health is not merely the absence of mental illness. According to the World Health
Organization (WHO) Manual on Mental Health, a person is in a state of sound mental health when,
 o He feels physically well
 o His thought are organized
 o His feelings are modulated
 o His behaviors are coordinated and appropriate
(*note: behaviors considered “normal” may vary according to cultural norms)
 Any person may develop mental illness regardless of race, nationality, age, sex civil status and
socio-economic background may develop mental illness.

Causes of Mental Illness

A Combination or One of These:

1. Biological factors
 Like hereditary predisposition, poor nutrition
2. Physical Factors
 Physical injuries, intoxication
3. Psychological Factors
 Failure to adjust to the difficulties in life.
4. Socio-economic Factors
 Unemployment, housing problems

How is Mental Illness Detected?

1. Interview and assessment by the Clinical Social Worker.

2. Psychological testing and evaluation.
3. Psychiatric interview and mental status examination.

Is Mental Illness Curable?

 Yes. Mental illness is curable if detected early and prompt and adequate treatment is given.
Treatment depends on severity of illness and includes:
 Pharmacotherapy (use of medicines)
 Various therapies (physical, recreational, occupational, environmental)
 Psychotherapy and others

Prevention of Mental Illness

1. Maintain good physical health.
2. Choose worthwhile activities and develop a hobby
3. Solve problems as they come and avoid excessive worrying.
4. Cultivate friendships and choose a friend to confide in.
5. Strike a happy medium between work and play.
6. Recognize early signs and symptoms.

Some Early Signs of Symptoms Mental Illness

 Persistent disturbance in sleep and appetite
 Over sensitiveness and excessive irritability
 Loss of interest in activities or responsibilities of previous concern
 Constant complaint of headaches, weakness of hands and feet and other bodily complaints.
 Persistent seclusion of oneself from other people.
 Frequent attacks of palpitations usually expressed as “nerbiyos” & associated with unexplained
fears.
 Frequent attacks of dizziness & fainting.
 Exaggerated and /or unfounded suspicions
 Persistent worrying, forgetfulness & absentmindedness.

Program on Drug Dependence/ Substance Abuse

Community-Based Rehabilitation Program

 A creative application of the primary health care approach in rehabilitation services, which involves
measures taken at the community level to use and build on the resources of the community with the
community people, including impaired, disabled and handicapped persons as well.
 Goal
 To improve the quality of life and increase productivity of disabled, handicapped persons.

Aim:
 To reduce the prevalence of disability through prevention, early detection and provision of
rehabilitation services at the community level.

Program on the Elderly/Geriatric Nursing Services

Leading causes of illness: elderly

 Influenza, HPN, diarrhea,
 bronchitis, TB, diseases. of the heart,
 pneumonia, malaria,
 malignant neoplasm, chickenpox

Leading causes of death: elderly

 Diseases of heart and vascular system
 Pneumonia, TB, CCOPD
 Malignant neoplasms
 Diabetes
 Nephritis
 Accidents

Programs on Blindness, Deafness and Osteoporosis

 Cataract- main causes of blindness

 VAD- main cause of childhood blindness; most serious eye problem of Filipino children below 6 yrs.
old
 Osteoporosis special problem in women, highest bet. 50—79 yrs. old, MENOPAUSE main cause

Nursing Procedures in the Community

 Clinic Visit
 process of checking the client’s health condition in a medical clinic

Home Visit

 a professional face to face contact made by the nurse with a patient or the family to provide
necessary health care activities and to further attain the objectives of the agency

Bag Technique

 a tool making of the public health bag through which the nurse during the home visit can perform
nursing procedures with ease and deftness saving time and effort with the end in view of rendering
effective

Thermometer Technique

 to assess the client’s health condition through body temperature reading

Nursing Care in the Home

 giving to the individual patient the nursing care required by his/her specific illness or trauma to help
him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in
dignity

Isolation Technique in the Home

1. Separating the articles used by a client with communicable disease to prevent the spread of
infection:
2. Frequent washing and airing of beddings and other articles and disinfections of room
3. Wearing a protective gown, to be used only within the room of the sick member
4. Discarding properly all nasal and throat discharges of any member sick with communicable disease
5. Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes
before laundering

Intravenous Therapy

 Insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s
written prescription
 can be done only by nurses accredited by ANSAP
 Family Planning Program
Overview
 The Philippine Family Planning Program is a national program that systematically provides
information and services needed by women of reproductive age to plan their families according to their
own beliefs and circumstances.

Goals and Objectives

 Universal access to family planning information, education and services.

Mission
 To provide the means and opportunities by which married couples of reproductive age desirous of
spacing and limiting their pregnancies can realize their reproductive goals.

Types of Methods

NATURAL METHODS
a. Calendar or Rhythm Method
b. Basal Body Temperature Method
c. Cervical Mucus Method
d. Sympto-Thermal Method
e. Lactational Amennorhea

ARTIFICIAL METHODS
a. Chemical Methods
i. Ovulation suppressant such as PILLS
ii. Depo-Provera
iii. Spermicidals
iv. Implant
b. Mechanical Methods
i. Male and Female Condom
ii. Intrauterine Device
iii. Cervical Cap/Diaphragm
c. Surgical Methods
i. Vasectomy
ii. Tubal Ligation

Warning Signs

Pills
 Abdominal pain (severe)
 Chest pain (severe)
 Headache (severe)
 Eye problems (blurred vision, flashing lights, blindness)
 Severe leg pain (calf or thigh)
 Others: depression, jaundice, breast lumps

IUD
 Period late, no symptoms of pregnancy, abnormal bleeding or spotting
 Abdominal pain during intercourse
 Infection or abnormal vaginal discharge
 Not feeling well, has fever or chills
 String is missing or has become shorter or longer

Injectables
 Dizziness
 Severe headache
 Heavy bleeding

BTL
 Fever
 Weakness
 Rapid pulse
 Persistent abdominal pain
 Vomiting
 Dizziness
 Pus or tenderness at incision site
 Amenorrhea

Vasectomy
 Fever
 Scrotal blood clots or excessive swelling