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COMMUNITY HEALTH NURSING

BY: LEA D. FOY-OS, R.N. (MAN in progress)

HOW TO ANSWER QUESTIONS RELATED TO COMMUNITY HEALTH NURSING

FOCUS ON THE FOLLOWING PRINCIPLES (H-E-A-L-T-H)

HEALTH SCREENING
EPI
ASSESSMENT OF RISK FACTORS
LEARN THE BASICS IN CHN
THERAPEUTIC DIET
HERBAL MEDICINE

HEALTH

MODERN CONCEPT: O.L.O.F. of individuals, families and communities

Families from the lower income groups are the ones mostly served
GOAL of Public Health: to contribute to the most effective total development and life of the
individual and his society.

ECO-SYSTEM influences the OLOF

FACTORS:
Political
Behavioral
Heredity
Health care delivery system
Environment
Socioeconomic influence

Community Health Nursing

GOAL:
GOAL: Promotion of OLOF thru teaching and delivery of care
PHILOSOPHY:
PHILOSOPHY: based on the WORTH & DIGNITY of man
Primary FOCUS:
FOCUS: Health Promotion
NURSES:
NURSES: Generalists
Based on recognized needs of communities, families, groups and individuals
FAMILY:
FAMILY: Unit of Service
HEALTH TEACHING:
TEACHING: Primary responsibility of the community Health Nurse.

FIVE FOLD MISSION OF CHN:

1. Health Promotion
2. Health Protection
3. Health Balance
4. Disease Prevention
a. Primary prevention
b. Secondary Prevention
c. Tertiary Prevention
5. Social Justice

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RURAL HEALTH MIDWIFE

Under the general supervision of the PHN
Works with the PHN in planning and evaluating health services at the Barangay level
Plans for activities in the clinic BHS; follow-up in homes and field visit in the community
Mobilizes community for health action

QUALIFICATIONS:

Supervising Public Health Nurse:

Nurse: at least FIVE YEARS experience as PHN
Nurse Instructor II:
II: MAN, 3 years experience as CHN
Regional Training Nurse:
Nurse: six years nursing experience , three of which in training or
Nursing education
Regional Nurse Supervisor:
Supervisor: at least FIVE YEARS experience in CHN, TWO years of
which are in supervisory position
Nursing Program Supervisor:
Supervisor: at least SEVEN years in CHN training
Chief Nurse:
Nurse: at least FIVE YEARS experience in CHN - 3 either as supervisor or
assistant chief nurse

CHN CLINIC VISIT

PRE-CONSULTATION CONFERENCE:
Clinical Hx taking
Vital signs
Physical assessment
Lab exams and documentation
MEDICAL EXAMINATION:
Ensure privacy, safety and comfort of the patient throughout procedure
POST-CONSULTATION:
Explain findings & needed care
Refer as needed
Make appointment for next clinic/home visit

HOME VISIT

Professional face-to-face contact made by a nurse to a patient or the family to provide

necessary health care activities and to further attain an objective of the agency
Should have a PURPOSE/ OBJECTIVE
Planning for a home visit should make use of all available information about the patient
and his/her family.

Frequency of Home Visit

A - acceptance of the family & ability to recognize own needs

P - physical, psychological & educational needs

O - other health agencies involved
P - Policy of a given agency
E - Evaluate of past services given to the family

BAG TECHNIQUE

TOOL making use of the public health bag through which the nurse during the visit can
perform nursing procedures with ease and deftness,
deftness, saving time & effort at the end in
view of rendering effective nursing care.
PUBLIC HEALTH BAG – essential & indispensable equipment
PRINCIPLES:
To minimize if not totally prevent the spread of infection;
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Save TIME & EFFORT
Special consideration: HAND WASHING
Contents of the bag:
BP apparatus & stethoscope are carried separately;
Medicines include: betadine, 70% alcohol, benedict’s solution
Place waste paper bag outside of work area to prevent contamination of clean area

INTRAVENOUS THERAPY

Refers to the insertion of a needle/catheter/cannula into a vein based on physician’s

written prescription

ANSAP (Association of Nursing Service Administration of the Phil)

- accrediting body

INDICATIONS
Maintenance/correction of dehydration in px unable to tolerate adequate volumes of
oral fluid medications;
Parenteral nutrition
Administration of drugs
Blood transfusion
CONTRAINDICATIONS
Administration of irritant fluids/drugs through peripheral access (e.g. Sodium chloride;
Hypertonic potassium chloride)

DEPARTMENT OF HEALTH
VISION
Health for all Filipinos (old)
“THE LEADER OF HEALTH FOR ALL IN THE PHILIPPINES” (new)

MISSION
Enhance accessibility & quality of health care to improve the quality of life of all
Filipinos, especially the poor (old)
Guarantee equitable, sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.” (new)

BASIC PRINCIPLES
Ensured universal access to basic health services
Health & nutrition of vulnerable groups must be prioritized
PRIMARY STRATEGIES
S –support to local health system & frontliners
A - assurance of health care
I - increased investment for PHC
D - dev’t of national standards & objectives for health

PRIMARY HEALTH CARE

Essential health care made universally accessible to individuals & families in the
community by means acceptable to them.
GOAL
Health for all Filipinos & Health in the Hands of the People by the year 2020.
MISSION
To strengthen the health care system by increasing opportunities & supporting the
conditions wherein people will manage their own health care.

CONCEPT
Core Strategy:
Strategy: PARTNERSHIP & EMPOWERMENT towards SELF-RELIANCE

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PHC components/elements

C - CDD/ Control of Communicable Diseases

H - Health Education
E - Environmental Sanitation
I - Immunization

PHC cornerstones/Pillars
M multisectoral linkages
A Active community participation
U Use of appropriate technology
S Support mechanism made available

PRIMARY HEALTH WORKERS

The higher the level the more qualified the health personnel & the more sophisticated the
health equipment
Concept: TEAMWORK

TWO levels:
Village/BHWs – trained community health workers, health auxillary volunteers, traditional
birth attendants, healers
Intermediate Level – professional group

HRDP CO-PAR
COMMUNITY ORGANIZING
A continuous process of awareness building, organizing and mobilizing community
members towards community development.

PHASES AND ACTIVITIES

I. PRE-ENTRY PHASE
Preparation of the staff
Site selection
II. ENTRY PHASE
integration with the community
Courtesy calls
Information campaigns
Identification of potential leaders
III. CORE-GROUP FORMATION & MOBILIZING
integration with core group
IV. ORGANIZATION-BUILDING
Organizing Barrio Health committees
Setting up community organization
V. CONSOLATION & EXPANSION PHASE
Networking, linkages
Implementation of livelihood projects
developing secondary leaders

ALTERNATIVE THERAPIES

HERBAL MEDICINES

10 herbal medicines being advocated by the DOH

• L LAGUNDI
• U ULASIMANG BATO
• B BAWANG
• B BAYABAS
• Y YERBA BUENA

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• S SAMBONG
• A AMPALAYA
• N NIYOG-NIYOGAN
• T TSAANG GUBAT
• A AKAPULKO

1. LAGUNDI
S SKIN DISEASES
H HEADACHE
A ASTHMA, COUGH, FEVER
R RHEUMATISM, SPRAIN, INSECT BITES
E ECZEMA
D DYSENTERY
2. ULASIMANG BATO
o U Uric acid excretion
2. BAWANG
o BawHaT: Bawang for HYPERTENSION & TOOTHACHE
3. BAYABAS
o DIARRHEA
o WASHING OF WOUNDS
o GARGLE TO RELIEVE TOOTHACHE
4. YERBA BUENA
o S SWOLLEN GUMS
o P PAIN
o I INSECT BITES
o T TOOTHACHE
o M MENSTRUAL & GAS PAIN
o A ARTHRITIS
o N NAUSEA & FAINTING
o D DIARRHEA
5. SAMBONG (A-D-A)
o A ANTI-EDEMA
o D DIURETIC
o A ANTI-UROLITHIASIS
6. AMPALAYA
o Mild Diabetes Mellitus (NIDDM)
7. NIYUG-NIYOGAN
o Anti-helmithic: ASCARIASIS
8. TSAANG-GUBAT
o STOMACHACHE
o TSAANG GUBAT
o DIARRHEA
9. AKAPULKO
o Anti-fungal

GINGER ALE: stimulant

GINSENG: stamina; immune booster; Tonic
EUCALYPTUS: anti-inflammation; steam inhalation
LEMON GRASS: sedative: acne

Reminders (BONUS)
Boiling: remove cover
One kind of plant for each type of sx
No insecticides
Use clay pot and plant part advocated
Stop in case of untoward reactions; seek consultation if s/sx not relieved after 2-3 doses

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ACUPRESSURE

QI Principle: traditional Chinese medicine – upon birth life energy enters the body
HEALTH: state of balance of the YIN and YANG
YIN: cold, yielding, feminine, negative force
YANG: warm, dominating masculine positive force
Posture:
Lying down; sitting-up
Frequency:
Usually once a day; or every four hours
2-3x a week for those with chronic illness
CONTRAINDICATIONS:
o Pregnancy
o Full stomach
o Cardiac ailments
FOODS TO AVOID (during treatment)
o C cold/iced beverages/ food
o A alcoholic beverages
o P peanuts
o S sour food
o S seafood
o S salty food

AHSHI POINTS
Painful spots/ nodes taken as Acupressure points
TSUN MEASUREMENT: use of the patients hands/fingers/palms

ACUPUNCTURE

GOAL: Manipulation of energy flow throughout the body following a thorough assessment
by a practitioner

HSUEH POINTS: Anatomic points being stimulated

INDICATIONS:
• MOTION disabilities
• ACUTE/CHRONIC PAIN

PRECAUTIONS
• PREGNANCY
• HEMOPHILIA
• ACUTE CVD
•

AROMATHERAPY

USE OF ESSENTIAL OILS OF PLANTS TO TREAT SYMPTOMS

Based on olfactory stimuli used to help balance the DOSHAS
DOSHAS: Mediators between the physiologic & psychologic processes

INDICATIONS
• INSOMNIA
• STRESS/RELAXATION
• INDUCE SLEEP

REPUBLIC ACT NO. 8423

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T.A.M.A. OF 1997
(TRADITIONAL AND ALTERNATIVE MEDICINE ACT)
Created PITAHC (Phil. Institute of Traditional & Alternative Health Care)
- scientific research & development of traditional & alternative health care
system that have impact on public health care.

DOH PROGRAMS
MONTHLY HEALTH ACTIVITIES
JANUARY:
Cancer Consciousness Week
FEBRUARY:
Dental Health Week
Leprosy Control week
MARCH:
Women’s Health Month
Burn Injury Prevention Month
Rabies Awareness Month
World TB Day (24)
APRIL:
Garantisadong Pambata
World Health Day (7)
MAY:
National Family Planning Month
Cervical Cancer Awareness Month
Safe Motherhood Week (10-16)
JUNE:
Kidney Month
No smoking month
Dengue Awareness Month
Prostate Cancer Awareness Month
World Environment Day (5)
JULY:
Nutrition Month
National Voluntary Blood Donation Month
National Disaster Preparedness Month
AUGUST:
National Lung Month
Sight-Saving Month
Family Planning Day (1)
Hospital as Centers of Wellness Week
Asthma Week
SEPTEMBER:
Liver Cancer Awareness Month
Generics Awareness Month
OCTOBER:
Elderly Filipino Week
National Mental Health Week
National Newborn Screening
NOVEMBER
Substance Abuse Prevention Week
DECEMBER
OPLAN IWAS PAPUTOK
World AIDS Day (1)

HEALTH ACTIVITIES
Family planning/ Reproductive Health
Nutrition
Women’s Health and Safe Motherhood
Adolescent Health
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Breastfeeding: Milk Code
Dental Health
Integrated Management of Childhood Illnesses (IMCI)
Newborn screening
CDD: Control of Diarrheal Diseases
Health Programs for Older Person
Environmental health
Occupational Health: Industrial Hygiene
Cardiovascular Disease, Visual Health
Cancer, Asthma, COPD
Diabetes, Osteo, Arthritis, Musculoskeletal
Community Base Rehabilitation
Rabies
Philippine Registry for Disabled Persons

REPRODUCTIVE HEALTH
Exercise of reproductive right with responsibility
VISION
Reproductive health practice as a way of life for every man & woman
throughout life
GOALS
3 Es
Every pregnancy should be intended
Every birth should be healthy
Every sex act should be free of coercion & infection
A - Achieve a desired family size

FRAMEWORK
INTERNATIONAL
Focus on WOMEN’S HEALTH
Ultimate Goal: QUALITY OF LIFE
LOCAL
Both Men and Women; based on its elements

Components of RH
MATERNAL & CHILD HEALTH
FAMILY PLANNING
PREVENTION & CONTROL OF RTI INCLUDING STDs/HIV/AIDS
ADOLESCENT SEXUAL & REPRODUCTIVE HEALTH
PREVENTION OF ABORTION & MGT OF ITS COMPLICATIONS
MEN’S REPRODUCTIVE HEALTH
PREVENTION OF REPRODUCTIVE TRACT CANCER & OTHER GYNECOLOGICAL
PROBLEMS
COUNSELING & EDUCATION FOR HUMAN SEXUALITY
INFERTILITY MANAGEMENT
VIOLENCE AGAINST WOMEN (VAW)

FAMILY PLANNING

Planning intended to determine the number of children based on a couple’s beliefs, health
and economic circumstances
Proper spacing of child
Giving birth at the right age and at the right time

Importance of FP
For the health of the mother
For health of the new borne
For the health of the entire providing
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Executive Order 199: created the PFPP (Philippine Family Planning Program)

NATURAL FP
CERVICAL MUCUS METHOD/ BILLING’S OVULATION
Sensations & mucus
BASAL BODY TEMPERATURE
LACTATIONAL AMENORRHEA METHOD
SYMTO-THERMAL METHOD
Makes use of the woman’s BBT, cervical mucus at the vulva & other signs

Advantages of natural FP
N no physical side effects
E effect is reversible
E enables woman to know more about her body
C can lead to early diagnosis of some gynecological disorder

ARTIFICIAL FP

TEMPORARY
ORAL CONTRACEPTIVES: composed of synthetic hormones which when taken
regularly, prevents pregnancy
IUD - small plastic sterile device that is introduction into the uterus to prevent preganancy.
Depo-Medroxyprogesterone Acetate (DMPA) effective for 3 months
Condom
Diaphragm

PERMANENT
Tubal ligation
blocking of fallopian tubes to prevent sperm & egg
Vasectomy
tying & cutting of vas deference

STATISTICS
10 leading causes: MORBIDITY
Diarrhea
Bronchitis/Bronchiolitis
Pneumonias
Influenza
Hypertension
PTB
Diseases of the Heart
Malaria
Measles
Chickenpox

10 leading causes: MORTALITY

Diseases of the Heart
Diseases of the vascular system
Pneumonia
Malignant neoplasm
Accidents
TB, all forms
COPD
Diabetes Mellitus
Other diseases of the respiratory system
Kidney Failure

MORTALITY among Immunizable Diseases

Measles
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Tetanus
TB of meninges
Diphtheria
Other TB
Acute poliomyelitis

MATERNAL MORTALITY: main cause

Normal delivery and other complications r/t pregnancy occurring in the course of labor,
delivery and peurperium
PIH/ Hypertension
Postpartum hemorrhage
Pregnancy with abortive outcome
Hemorrhage r/t pregnancy

PNEUMONIA: top leading cause of child mortality

LIFE EXPECTANCY:

Male: 66.93 y/o

Female: 72.18 y/o

STOP TB: D.O.T.S.

A Primer for Health Workers

Most common sign of TB: Cough lasting for 2 weeks

Biggest threat to economic development in the Philippines.
1997 Prevalence Survey:
more than 16 million Filipinos are infected with TB and 600, 000 TB cases are actively
spreading the disease.

ELEMENTS:
Microscopes
Anti-TB drugs
Health Care Providers/ Treatment Partners
Reporting Books
Funding & Support

Quality service through DOTS

S - Screening; supervise sputum collection
E - Examination of sputum specimens
R - Recording, Reporting; Referral
V - Verbalize with Px at the level of his understanding
I - Instruct the Px & Tx partner on the importance of compliance
C - Counseling on Compliance
E - Enlighten community & gov’t on DOTS

What DOTS can do:

Cure TB patients: cure rate 95%
Prevents new infections. (every TB case will infect 10 others within a year)
Prevents Resistance to anti-TB drugs
No hospitalization required
Saves money (WHO: the most cost effective of all health interventions)

TB Tx Regimen

category I II III

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Indication New cases (+) Relapses New cases
sputum; Failures sputum (-) 3x;
Seriously ill PTB minimal;Not
serious extra-
pulmonary
Intensive RIPE RIPES (2mos) RIP
2 mos RIPE (1 mo.) 2 mos
Mainte-nance RI RIE RI
4 mos 5 mos 2 mos
Duration 6 months 8 months 4 months

Rabies: P.R.O.
Pinoy Responsible Owner of Dog
DOH primer

350-400 Filipinos die of rabies every year.

WHAT TO DO IF BITTEN BY A DOG
Wash wound immediately with soap & water.
Consult a health worker at the nearest health center.
Observe the dog for 14 days for any change in behavior.
If the dog cannot be observed (stray) or if suspected to be rabid, consult your physician
immediately for immunization.
If dog shows s/sx of rabies, it usually dies within 3-7 days.

Pinoy Responsible Pet Owner

P.R.O.
Have your pet immunized against rabies at 3 months old & every year thereafter

Current WHO Guide for Rabies Pre & Post Exposure Tx

General considerations in Post-exposure Tx:
WHO advocates the use of modern vaccines for PET
Abandon the production of BRAIN-TISSUE VACCINES
Immediate washing/flushing & disinfection of the wound
Disinfecting with ETHANOL (700ml) or Iodine tincture
Rapid administration of purified Ig

TREATMENT MODALITIES
CATEGORY I II III

INDICATION Touching, Minor scratches/ Single/ multiple

feeding animals, abrasions transdermal
lick intact skin without bites,
bleeding/ licks scratches,
on broken skin contamination
of mucous
membrane with
saliva

NURSING No exposure; no Use vaccine Use Ig + vaccine

INTERVENTION Tx alone

Administration of RIG
Infiltrate into the depth of the wound & around the wound
Any remaining amount, administer IM to distal part (e.g. anterior thigh)
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Quantities/vol. Of RIG
20 IU/kg for Human RIG
40 IU/kg for Equine RIG
If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be used to
dilute it 2 to 3 fold to permit thorough infiltration.

Post exposure Tx IM
TWO IM schedule for modern vaccine
Vaccine shouldn’t be injected into the gluteal region

CLASSICAL 5 DOSE IM (“Essen” regimen)

1 dose: days 0, 3, 7, 14 & 28 Deltoid
antero-lateral thigh: children

Post exposure Tx IM
ALTERNATIVE: the 2-1-1 regimen
2 doses: day 0 deltoid, R & L
1 dose : deltoid on day 7
1 dose : on day 21
Post exposure Tx Intradermal
Economical: use 1 ml syringe & short hypodermic needles
3 vaccines:
HDCV (Human Diploid Cell Vaccine) RABIVAC
PVRV (Purified Verocell Vaccine)
VERORAB, IMOVAX, Rabies vero
PCECV (Purified Chick Embryo Cell Vaccine)
RABIPUR

8 SITE ID METHOD: 8-0-4-0-1-1 for use with HDC (Rabivac); PCECV (Rabipur)
When no RIG is available in emergency
For use: Rabivac & Rabipur 0.1ml per ID site
2 SITE ID: 2-2-2-0-1-1 for use with:
PVRV (Verorab, Imovax, Rabies Vero, TRC verorab) 0.1ml
PCECV (Rabipur) 0.2ml

ID minimum value of 2.5IU/ampule

Control of Acute Respiratory Infection (CARI)

OBJECTIVE:
To decrease pneumonia mortality among under fives
45,000 children die every year because of pneumonia

STRATEGIES (TENA)
Training of workers with the standard management of ARI
Enable BHW to identify & refer cases for treatment
NGO mobilization
Advocacy and Social Mobilization

Contributory Fx to Pneumonia
Mother’s failure to recognize early s/sx
Indiscriminate use of antibiotics
Not standardized management by health workers

IMCI: Integrated Management of Childhood Illness

ASSESS & CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

Check for GENERAL DANGER SIGNS

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Vomits everything
Convulsion/seizure
Difficulty drinking/breastfeeding
Drowsiness/lethargy/difficult to awaken

Assess COUGH/ DIFFICULTY BREATHING

Cough/ difficulty breathing: HOW LONG?
Fast breathing
Chest Indrawing
Stridor in calm child

COLOR SYSTEM
PINK ROW: severe classification; needs immediate attention and referral
Any general SEVERE PNEUMONIA or Give first dose of appropriate
danger sign VERY SEVERE DISEASE antibiotics

Chest indrawing Give Vit. A

Stridor in calm Treat the child to prevent low

child blood sugar

Refer URGENTLY to hospital

YELLOW ROW: needs appropriate antibiotic/ other treatment

FAST PNEUMONIA Give an appropriate antibiotic
BREATHING for 5 days

Soothe the throat & relieve the

cough with safe remedy

Advise mother when to return

immediately

Follow-up in two days

GREEN ROW: no need for specific medical treatment such as antibiotics

NO signs NO PNEUMONIA If coughing more than 30
Of pneumonia or days, refer for assessment
very severe disease COUGH/ COLD
Soothe the throat & relieve the
cough with safe remedy

Advise mother when to return

immediately
Follow-up in 5 days if not
improving

POSITIVE FAST BREATHING

 0-2 mos >60bpm
 2mos – 1 yr 50bpm
 1-5y/o 40bpm
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Age LESS THAN 2 MONTHS

VERY SEVERE DISEASE
SEVERE PNEUMONIA
NO PNEUMONIA/ COUGH/COLD

LESS THAN 2 MOS: NO PNEUMONIA MANAGEMENT

Keep WARM
Breastfeed frequently
Clear nose if it interferes with feeding
Return quickly if:
Breathing becomes FAST & DIFFICULT
Feeding becomes a problem
Becomes SICKER

2 MOS-5 YEARS: PNEUMONIA MANAGEMENT

Antibiotics for FIVE DAYS
Mothers told to bring back the child after 2 days for reassessment/ earlier if condition
worsens
Home care
COTRIMOXAZOLE
BID for FIVE DAYS
PROCAINE PENICILLIN
OD for FIVE DAYS (IM)
• <2 MOS (<5kg) 200, 000 units
• 2-12 MOS (6-9kg) 400, 000 units
• 12 MOS- 5 YRS 800, 000 units
(10-19 kg)

C.D.D.: CONTROL OF DIARRHEAL DISEASES

TYPES OF DIARRHEA
ACUTE : < 14DAYS
PERSISTENT: 14 DAYS or more
DYSENTERY: Blood in the stool; with or without mucus

CLASSIFY DEHYDRATION

SEVERE DEHYDRATION
Two of the ff:
• Abnormally sleepy
• Sunken eyes
• Drinks poorly
• Skin pinch goes very slowly
Tx PLAN C: Referral to hospital for IVF!!!
SOME DEHYDRATION
Two of the ff:
• Restless, irritable
• Sunken eyes
• THIRSTY: drinks eagerly
• Skin pinch goes back
Tx PLAN B
O.R.S: first 4hours after assessment
200-400ml 0-4mos
400-700ml 4-12mos
700-900ml 1-2 yrs
900ml-1L 2-5yrs
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NO DEHYDRATION
Not enough signs to classify some or severe
Tx PLAN A
Give extra fluids
50-100ml after each watery stool (0-2y/o)
100-200ml (2 y/o & above)
as tolerated (10y/o & above)
Continue feeding
Return if with danger sign/s

LEPROSY CONTROL PROGRAM

“KILATIS KUTIS PROGRAM”
”
MOT: prolonged skin-to-skin; droplet
Prev./Control & Rehab:
BCG
Avoid MOT
Hygiene
Adequate nutrition
Health education

SCHISTOSOMIASIS CONTROL PROGRAM

Endemic area
Bicol
Samar
Leyte
Davao

PREVENTION
Proper excreta disposal
Toilet facilities
Use of footware protection
Mollucides
Environmental sanitation
Drug of choice: PRAZIQUANTEL

MALARIA CONTROL PROGRAM

NATIONAL SITUATION
An average of 3 Filipinos die daily due to malaria despite government’s intensified efforts
to control the occurrence of the ailment.
THREE causes of Malarial treatment failure in the Philippines
Drug resistance
Non-compliance of patients
Deficient drug absorption
Other reasons:
Self-medication
Resorting to herbal remedies
Seeking help when the disease is already severe

MOSTLY AFFECTED: MALE YOUNG ADULTS

MOST VULNERABLE GROUPS:

PREGNANT
CHILDREN
CURRENT INITIATIVES
Global funding
Infectious disease control and surveillance

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PROGRAM THRUST:
VISION:
Malaria-free Philippines by the year 2020.
MISSION:
To empower the health workers, the population ar risk, and all concerned to eliminate
malaria in the Philippines.
GOAL:
Malaria is eliminated as a public health problem in all endemic provinces.

STRATEGIES
Provision of early diagnosis and prompt treatment
Planning and implementation of selective & sustainable preventive measures
Early detection, containment, prevention of malaria epidemics

MAJOR CHALLENGES
Improving the managerial and technical capacities of the MCP
Working beyond the health sector to reach out to remote communities
Empowering the communities at risk, including the indigenous people to become active
partners and not just passive recipients of health services
Detecting and expanding early to control outbreaks and preventing its occurrence
Combating drug resistance

MANAGEMENT (mosquito-borne)
A. PREVENTION
Prophylactic drugs (e.g. Chloroquine, Mefloquine)
CLEAN program of the DOH
C - chemically treated mosquito nets
L - larvae-eating fish
E - Environmental sanitation
A - Anti-mosquito soaps
N - Neem tree
B. CONTROL - fumigation

HIV/AIDS PREVENTION PROGRAM

PREVENTION (-MASS)
M- monogamy
A avoid promiscuous activity
S- sterilization
S- screening of blood donors

4Cs
COMPLIANCE
COUNSELING / EDUCATION
CONTACT TRACING
CONDOMS
Nurse’s Role
PREVENTION
Case finding
Supportive Care

FUNCTIONS OF THE COMMUNITY HEALTH NURSE IN COMMUNICABLE DISEASE

CONTROL PROGRAM

Assists family in recognizing & solving health problems

Provides nursing care
Supervision in recognizing need to medical care/ treatment
Referral
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I.E.C.
Collaborates services

Expanded Program on Immunization

OBJECTIVE:
To reduce the morbidity & mortality among infants and children caused by the seven
childhood immunizable diseases
ELEMENTS (TICAS)
TARGET SETTING
I.E.C.
Cold chain logistics mgt
Assessment & evaluation of overall performance
Surveillance, studies & research
PRINCIPLES
Based on EPIDEMIOLOGICAL SITUATION
Mass approach
Immunization is a basic health service (it is integrated into the health system)

PD 996
“Providing for compulsory basic immunization for infants & children below 8 y/o”
Presidential Proclamation No.6
“Implementing a United Nations goal on Universal Child Immunization
R.A. 7846
“An act requiring compulsory immunization against Hepa B for infants & children
below 8y/o”

LIGTAS TIGDAS 2004

Target: 9 mos - <8 y/o
All shall be vaccinated
Main component: PMEC
PMEC- Phil. Measles Elimination Campaign
Includes co tinuing routine vaccination of infants @ 9 months old after LIGTAS TIGDAS
2004
May be repeated every 4 or 5 years
BAKUNADOORS: vaccination team
COMMON QUESTIONS
My child has been vaccinated against measles. Is she exempted?
Ans: NO. this will increase her protection from measles
My child had measles previously. Is she exempted?
Ans: NO. there are many measles like disease. This won‘t harm
Is there any overdose?
Ans. NONE. Antibodies in the blood which provide protection against the disease decrease
as the child grows older
What will happen to my child after receiving the measles immunization?
Ans: NOTHING, some develop SLIGHT FEVER (1-2days)
Give Paracetamol q 4 hours
increase fluids; rest, sleep

The ROOMING-IN & BREASTFEEDING ACT of 1992

RA 7600
ADVANTAGES of breastfeeding
Infant-maternal bonding
First preventive health measure to the child at birth
economical
APPLICABILITY
NSD: room in the ff within 30 min:
Well infants regardless of AOG
With low birth weight but can suck
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Caesarean
Within 3 to 4 hours after birth
NSD outside health institutions
Immediately on admission

EXEMPTIONS: mothers who are:

Seriously ill
Taking medications contraindicated to breastfeeding
Violent psychotics
Other conditions as determined by the doctor

Complicated births
Sick baby/mother or both
Breastfeed first with:
EBM: expressed breast milk
Wet-nursing
SICK INFANTS
Breastmilk, especially colostrum: given as tolerated
Newborn: No prelacteal feeds:
Sterile water
Glucose water
Milk formula

Acceptable medical condition for supplemental feeding

Special milk formula: inborn errors of metabolism

Galactosemia; phenylketonuria
Continue breastfeeding for mild to moderate mother’s illness:
Malaria
STD
Diabetes
CHD
TB (-) sputum

The ff DO NOT permit rooming-in & breastfeeding

Seriously illl (eclampsia, CHD class IV, severe infection)
Taking meds contraindicated to nursing (e.g. anticancer)
Bromocriptine
Cimetidine
Chloramphenicol
Corticosteroids: Dexamethasone
Hypnotics & sedatives (Diazepam)
Lithium
Thiouracil
Reserpine
Sex hormones: Estradiol, Stilbestrol

Fresh refrigerated unsterilized milk can be used within 24 hours

If to be frozen: 00F (-180C) refrigerator freezer: can be kept for a month

MILK CODE: EO 51
NOT PERMITTED:
USE of professional services for teaching parents/staff in promoting branded milk
products

Common breastfeeding problem

Breast engorgement
Sore nipples
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Mastitis
------Continue breast feeding!!!

GMA 50%
DOH undertaking to effect the SONA pledge of PGMA
Primary goal
Ensure that
A Affordable
S Safe
H High quality
E Effective
Drugs & meds are always available, especially to the poor.

Sample comparative price

Asthma: SALBUTAMOL
(Ventolin/ Ventorlin)
100mcg/ dose x 200 doses
Price in private outlets: P 294.75
Price in DOH hospital: P197.60
Price difference: 97.15

Doctors to the Barrios Program

DttB
Doctors to the Barrios Prog
Deployment of doctors as Rural Health Physicians to doctorless municipalities
OBJECTIVES
Ensure quality health care services (depressed, marginalized, underserved areas)
Effect changes in the approach to Health Care Delivery by the stakeholders in Health

SENTRONG SIGLA MOVEMENT

SSM
GOAL
Improvement of the Quality of Services provided by HEALTH CENTERS through
accreditation of health centers that are able to provide services according to standards
set by the DOH
AIM
To promote availability of quality services in health centers and hospitals and to make
these services accessible to every Filipino
Main component
CERTIFICATION RECOGNITION PROGRAM
Develops and promotes standards for health facilities

FOUR PILLARS (Q-GAH)

QUALITY ASSURANCE PILLAR
GRANTS & TECHNICAL ASSISTANCE
HEALTH PROMOTION
AWARDS

Standard list: evaluation of:

Nutrition supplements
Environmental health & sanitation
FP
EPI
Disease Surveillance
CARI
CDD
Control of STD
Cancer Control

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DENTAL HEALTH PROGRAM

VISION: A lifetime of oral health and no tooth decay for the next generation.
GENERAL OBJECTIVE
TO PREVENT & CONTROL DENTAL DISEASES AND CONDITIONS.
STRATEGIES
SOCIAL MOBILIZATION
Coordination & partnership with sectoral groups
Networking
Capability building & work value formation
Monitoring feedback
Operation research studies
DIRECT SERVICES
Dental Health Promotion & Advocacy
Dental Preventive Prog
Dental Curative Prog
Oral Rehabilitation
SUPPORT SERVICES
Dental Health Planning
Training Program
Dental Research Prog
Monitoring & Evaluation

“Sang Milyong Sipilyo”

Project for SOCIAL MOBILIZATION
Shall solicit ONE MILLION toothbrushes from concerned citizens through dropboxes
RECIPIENTS: school children in marginalized & depressed areas
AIM:
To emphasize the importance of oral health in relation to total body health
---to increase public awareness on the prevention of common dental diseases.

NUTRITIONAL GUIDELINES FOR FILIPINOS

NUTRITION
GOAL
Improvement of the nutritional status, productivity & quality of life of the population,
through adoption of desirable dietary practices and healthy lifestyle

GUIDELINES
Eat variety of food everyday
Breastfeed infants exclusively from birth to 4-6 mos
Maintain children’s normal growth
Consume fish, leanmeat, poultry or dired beans
Eat more vegetables, fruits & rootcrops
Eat foods cooked in edible/ cooking oil daily
Consume milk, milk products/ other calcium-rich foods
Use Iodized salts but avoid excessive intake of salty food
Eat clean & safe food
HEALTHY LIFESTYLE & GOOD NUTRITION:
Exercise regularly
No smoking
Avoid alcoholic beverages

NUTRIENTS
Chemical substances present in the food that keep the body healthy, supply
materials for growth & repair of tissues, and provide energy fro work & physical
activities
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VITAMIN A
Normal vision
Skin health
Bone & tooth growth
Prevents XEROPHTHALMIA
THIAMINE
Release of energy from nutrients
Nerve functioning
Prevents BERI-BERI
RIBOFLAVIN
Skin health
Prevents cracking & redness of mouth corners
Prevents DERMATITIS
NIACIN
Supports skin, nervous & digestive system
Prevents pellagra
BIOTIN
ENERGY & AMINO ACIDS METABOLISM
Synthesis of FAT glycogen
PANTHOTHENIC ACID
ENERGY METABOLISM
FOLIC ACID
Formation of DNA
Formation of new blood cells (RBC)
Prevents anemia
Vitamin B12
Formation of new cells
Maintain nerves cells
Metabolism of fatty & amino acids
VITAMIN C
Formation of protein, collagen, bone, teeth cartillage, skin & skin tissue
Facilitates absorption of IRON
Increases resistance to infection
Prevents SCURVY
VITAMIN D
Mineralization of bones by enhancing calcium absorption
VITAMIN E
Strong ANTI-OXIDANT
Prevents arteriosclerosis
For normal immune function
VITAMIN K
Synthesis of blood clotting protein and a bone protein that regulates blood calcium level

MACRONUTRIENTS
CHO = 55-70%
Fat = 20-30%
CHON= 10-15%
VITAMIN A SUPPLEMENTS
SCHEDULE 6-11MOS 12-83 MOS POST PARTUM
Give 1 dose 100 000 IU 200 000 IU 200 000 IU within
1 month
Give after 6 mos 100 000 IU 200 000 IU After delivery of
Esp if high risk each child only
condition present

VITAMIN A DEFICIENCY
SCHEDULE 6-11MOS 12-83 MOS

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Give today 100 000 IU 200 000 IU

Give tomorrow 100 000 IU 200 000 IU

Give after 2 weeks 100 000 IU 200 000 IU

IRON SUPPLEMENTS
IRON REQUIREMENTS DOSAGE
6 – 12 MOS 0.7 mg daily
Children 12-59 mos 1 mg daily
Tx for iron deficiency
Children 0-59 months 3-6 mg/kg body weight daily

IODINE SUPPLEMENTATION
CHILDREN 0-59 months

IODINE CAPSULE (200mg) POTASSIUM IODATE in oil orally once a year

FLUORIDE (TOOTH DECAY)
Fluoride solution application
FOUR applications (a week apart)
3, 7, 10 and 13 y/o

LIGTAS BUNTIS 2005 CAMPAIGN

GOAL
To increase the visibility of FP as an essential public health service, and to dramatically
improve the access of men, women an couples to FP & safe motherhood services.

POINTERS
Assurance of women’s safety
Advocates to assist Filipino couples to successfully plan their families
Shall provide appropriate services based on the client’s choice of health facilities

Set for February to March 2005

Brings affirmation on women’s co-equal importance in nation building
Prioritizing and supporting the emancipation of Filipino women’s risks (too many, too
frequent & unsafe pregnancy)
Key success features
Good campaign plan & gender-culture sensitive IEC
Realistic target coverage
Availability of adequate logistics & health services
Competent health care providers
Effective supervision

ENVIRONMENTAL SANITATION
Study of all factors in man’s physical environment, which may exercise a deleterious effect
on his health well-being & survival.

Factors included
o W Water sanitation
o A Air pollution
o G Garbage disposal
o E Excreta disposal
o R Radiological protection
o F Food sanitation
o I Institutional sanitation
o N Noise
o I Insect/rodent control
o S Stream pollution
o H Housing
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ENVIRONMENTAL HEALTH SERVICE

Promotion of healthy environmental conditions
Prevention of environmental related diseases
Through appropriate sanitation strategies

HEALTH & SANITATION

Ranked FIRST in the leading causes of morbidity among the general population

PRESIDENTIAL PROCLAMATION 856

SANITATION CODE OF THE PHILIPPINES

WATER SUPPLY SANITATION PROGRAM

o Approved toilet facilities
o Access to safe & potable H2O
o Water quality & monitoring surveillance
o Waterworks/watersystem
o Unapproved toilet facilities

APPROVED TYPES OF H20 SUPPLY

LEVEL 1: POINT SOURCE
 Protected well/ spring with an outlet
 Without distribution system
 15-25 households
 250 meters: farthest user
 40-140 liters
LEVEL II: Communal Faucet System/ Stand-post
Composition
1. Source reservoir
2. Piped distribution network
3. Communal faucet
• 25m away: farthest
• 40-80 liters/capital/day
• Ave: 100 households
• 4-6 households/faucet
• For rural areas with clustered houses
LEVEL III: Waterworks System/ Individual House Connections
Composition
1. Source reservoir
2. Piped distribution network
3. Household taps
• Requires minimum tx disinfection
• For densely populated urban areas

WATER PURIFICATION
 FILTRATION sediments
 CHLORINATION kills microorganism
 FLUORIDATION fortification
 BOILING
 5-10 minutes from boiling point
Drinking water should be replaced every 24 hours

UNAPPROVED TYPES OF H20 SUPPLY

Doubtful sources like:
o OPEN DUG WELL
o UNIMPROVED SPRING
o WELLS that need priming
The community must exert effort to convert to approved type of water supply facility
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WATER QUALITY MONITORING SURVEILLANCE

DISINFECTION OF WATER SUPPLY
• Newly constructed
• Repaired/improved water facility
• Water sources (+) bacteriologically
• Container disinfection of drinking water collected from:
• Open dug well
• Unimproved springs
• Surface water

WATERWORKS/WATER SYSTEM
WELL SITES: approval
Comply to sanitary requirements
Supply of safe & potable H20
Adequate pressure & volume in the water system distribution
line

PROPER EXCRETA & SEWAGE DISPOSAL PROGRAM

APPROVED TYPES: TOILET FACILITIES
LEVEL 1
Non-water carriage toilet facility
 Pit latrines
 Reed odorless earth closet
Toilets requiring small amount of H20
 Pour flush
 Aqua privies
LEVEL II
 Water-sealed
 Flush type
 Septic vault/ tank disposal facilities
LEVEL III
o Water-carriage type
o Septic tanks
o Sewerage system to treatment plants
o

FOOD SANITATION PROGRAM

 Inspection/approval of food sources, containers, transport vehicles
 Sanitary permit
 Health Certificate for food handlers
 Banning of food unfit for human consumption
 Household sanitation

HOSPITAL WASTE MGT PROG

 Prepare & implement Hospital Waste Mgt Prog. (HWM)
 Use of appropriate technology & indigenous materials
 Training of personnel
 Admin: PUBLIC INFO. CAMPAIGN

METHOD OF DISPOSAL
 DUMPING
 BURIAL
 BURNING
 INCINERATOR

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THE ABC’S OF TRANSCULTURAL NURSING

TRANSCULTURAL NURSING
Refers to the study and practice in nursing which is focused upon differences and
similarities among cultures with respect to human care, health and illness based upon the
peoples’ cultural values, beliefs and practices and to use this knowledge to provide
culturally specific or culturally congruent nursing care.

GOAL
To provide culturally specific care.

CULTURE
Refers to norms and practices of a particular group that are learned and shared and guide
thinking, decisions and actions.

CULTURAL VALUES
Refers to the individuals’ desirable or preferred way of acting or knowing something that is
sustained over a period of time and which governs actions or decisions.

Culturally diverse nursing care

Refers to the variability of nursing approaches needed to provide culturally appropriate

care that incorporates an individuals cultural values, beliefs and practices including
sensitivity to the environment from which the individual comes and to which the individual
ultimately return. (Leininger, 1985)

ETHNOCENTRISM
The perception that ones’ own way is best when viewing the world.

RACE
Refers to distinguishing physical features such as skin color, bone structure and blood
group.

ETHNOGRAPHY: The study of culture

WHO IS THE FILIPINO?

According to: Tomas Andres the Filipino is…

…The imponderable unity and uniqueness of diverse races, richness and idiosyncrasies.

…The monument of the Malays, the Spaniards, the Americans, the Japanese, the
Chinese, the Hindus, the Dutch and the Englishman, all united into one.

F - aithful; Fiesta oriented

I - mitative
L - oving and tender (malambing)
I - ngenius
P - liant
I - nadequate initiative
N - o discipline
O - riented to: Kapalaran, kabuuan, kapayapaan

WHOLISTIC, NON -DUALISTIC AND SUBJECTIVE

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CULTURAL COMPETENCE
Cultural competence, therefore is obtaining cultural information and then applying that
knowledge. This would require the nurse to have :

1. AN UNDERSTANDING OF OWN WORLD VIEW

2. FLEXIBILITY AND RESPECT FOR OTHERS’ VIEW POINT
3. A KNOWLEDGE OF CULTURALLY INFLUENCED HEALTH BEHAVIORS

EXAMPLES OF APPLICATIONS OF TRANSCULTURAL NURSING CONCEPTS

A – dministration of medications must take into consideration some of the patients’ beliefs
and practices.

Examples:

Catholics usually will fast on Ash Wednesday and Good Friday except for sick patients
Muslims will fast during Ramadan
Jehovah’s witnesses-medications are acceptable to the extent necessary·

B – e familiar with some diseases which are common in a specific race.

Examples:

· Africans - sickle cell anemia, hypertension

· Asians – osteoporosis
· Blacks – cervical cancer (female)
prostate cancer (male)
· Jewish – breast cancer
· Whites – testicular cancer

C - ommunicate properly and be familiar with common communication practices across

cultures.

Examples:

· Asians – rarely communicate their need for analgesics since they were taught self
restraint.
· Hispanic women - discussions pertaining to the reproductive organs with male relatives
or health care providers are considered impolite
· Muslim women – prefer to talk to female doctors on matters related to reproductive
problems

D - ietary modifications must be considered when planning nursing care!

Examples:

· Chinese – cold desserts (“YIN”) are served after surgery

· Europeans – main meal is served by midday and is usually followed by coffee
· Jewish – Kosher diet ( no meat and dairy products at the same time)
· Muslim – Halal diet (no pork)

HISPANICS

Present oriented society

Most are Catholics
Body plumpness is ideal
Delivery of a baby is a woman’s job

MIDDLE EASTERN COMMUNITY

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- Expect to receive treatment as soon as possible

- Majority are Muslims
- Emphasis on personal hygiene and a healthy diet
- Patients are told only the GOOD news about their disease
- Maybe embarrassed by questions about their sexual concerns.
- During Ramadan, many patients resist taking medications or eating during daytime.

BLACK AMERICAN COMMUNITY

- God is viewed as the source of both good health and serious illness

ASIANS

- A healthy body is a state of balance

1.Recognizing clinical differences among people of different ethnic and racial groups.
2. Communication
3. Ethics
4. Trust

/ldf05

INVICTUS: I am the captain of my ship, the master of my destiny