* NLE * NCLEX * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY * MED TECH

COMMUNITY HEALTH NURSING

Prepared by: Mabel M. Oamil, BSN, RN, MAN, CHA

I. NURSING PRACTICE IN THE COMMUNITY

A. Community Health Nursing.
1. Description
a. It promotes and preserves the health of populations.
b. The knowledge is relevant to both nursing and public health.
c. It is comprehensive, general and continuous.
d. It has different clients: individuals, families and groups.
e. The dominant responsibility is the population as a whole.

2. Philosophy
a. Based on the worth and dignity of man (Shetland).

3. Concepts
a. Primary focus is health promotion
b. Benefits not only the individual but the whole family and community.
c. Community health nurses are generalists in terms of practice.
d. Contact with the client/family is continuous over a long period of time.
e. It involves all ages and all types of health care.
f. The nature of CHN utilizes current knowledge derived from biological and social sciences, ecology, clinical
nursing and community health organizations.
g. Involves dynamic process of assessment, planning, implementation and evaluation

4. Goal
a. The ultimate goal of CHN is to raise the level of citizenry.

5. Objectives
a. Participate in the development of over-all health plan.
b. Provide quality nursing services to individuals, families and communities.
c. To coordinate nursing services to various members of the health team.
d. To participate in and/or conduct research relevant to community health for the improvement of health care.
e. Provide community health personnel with opportunities for professional growth and continuing education.

6. Principles
a. It is based on recognized needs of communities, families, groups and individuals.
b. The nurse should understand fully the objectives and policies of the agency he/she represents.
c. The family is the unit of service.
d. CHN must be available to all regardless of race, creed and socioeconomic status.
e. Primary responsibility is health teaching.
f. Community health nurse works as a part of the health care team.
g. Provision for period evaluation of the community health services.
h. The CHN agency should provide opportunities for continuing education. The nurse is also responsible for
his/her own professional growth.
i. Makes use of available resources.
j. Utilizes the existing active organized groups in the community.
k. Provision for educative supervision.
l. Accurate recording, documentation and reporting.

7. Subspecialties of CHN

a. Occupational Health Nursing. This practice focuses on promotion, protection and restoration of worker’s
health within the context of a safe and healthy work environment. (American Association of Occupational
Health Nurses). It is aimed at assisting workers in all occupations to cope with actual and potential stresses in
relation to their work and work environment (PNA-ANSAP).
b. School Health Nursing. It aims at promoting the health of school children and preventing health problems
that would hinder their learning and performance.

8. Clients of Community Health Nursing

a. Individuals. These are individuals – either sick or well. These are the people who consult at the health center
and receive health services. He/She is considered as an entry point in working with the whole family.

TOP RANK REVIEW ACADEMY, INC. Page 1 | 23

 b. Family. It is considered as the basic unit of care in community health nursing and has two functions –
reproduction and socialization. It was defined by Friedman as “composed of two or more persons who are
joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the
family.”

c. Population Group/Aggregate. It is a group of people who share common characteristics, developmental

stage, or common exposure to particular environmental factors which results to common health problems.

d. Community. It is a group of people sharing common geographic boundaries and/or common values and
interests.

9. Concepts in Community Health Nursing

a. Health. State of complete physical, mental and social well-being, not merely the absence of disease or
infirmity (WHO). It is considered as the goal of PHN, in general and CHN, in particular.

b. Factors that Affects Health:

i. Political Influences. Political jurisdictions have the power and authority to regulate health.
▪ Safety
▪ Oppression
▪ People empowerment

ii. Behavioral Influences. These are habits, lifestyles and practices which are greatly affected by culture.
▪ Culture
▪ Habits
▪ Mores
▪ Customs

iii. Heredity. These pertain to genetic materials and describe the process how genetic traits are transmitted.
▪ Genetic endowment such as defects

iv. Health Care Delivery System. This includes PHC in the provision of health services which are
community based, accessible, acceptable affordable and sustainable.
▪ Promotive
▪ Preventive
▪ Curative
▪ Rehabilitative

v. Environmental Influences. Diseases today are largely manmade.

▪ Pollution (air, water and land)
▪ Poor sanitation
▪ Industrial wastes
▪ Noise and radiation

vi. Socioeconomic Influences. People from lower income groups are served mostly by public health
services because they have greater number of health problems compared to those in the higher income
groups.
▪ Employment
▪ Education
▪ Housing

c. Determinants of Health:
i. Income and Social Status
ii. Education
iii. Physical Environment
iv. Employment and Working Conditions
v. Social Support Networks
vi. Culture
vii. Genetics
viii. Personal Behavior and Coping Skills
ix. Health Services
x. Gender

d. Public Health
i. Science and art of preventing disease, prolonging life, promoting health and efficiency through organized
community effort for the (1) sanitation of the environment; (2) control of communicable disease; (3)
education of individuals in personal hygiene; (4) organization of medical and nursing services; and (5) the
development of social machinery, so organizing these benefits as to enable every citizen to realize his
birthright of health and longevity (Winslow).
ii. Art of applying science in the context of politics so as to reduce inequalities in health while ensuring the
best health for the greatest number (WHO).

TOP RANK REVIEW ACADEMY, INC. Page 2 | 23

 iii. It is dedicated to the common attainment of the highest level of physical, mental and social well-being and
longevity consistent with available knowledge and resources at a given time and place (Hanlon).

e. Public Health Nursing. It was coined by Lilian Wald which denotes a service that was available to all people.
i. Special field of nursing that combines the skills of nursing, public health and some phases of social
assistance and functions as part of the total public health program for the promotion of health, the
improvement of the conditions in the social and physical environment, rehabilitation of illness and
disability (WHO).
ii. It refers to the practice of nursing in national and local government health departments (which includes
health centers and RHU) and public schools. It is CHN practiced in the public sector (NLPGN, 2005).

f. Community Health Nursing

i. A service rendered by a professional nurse with communities, groups, families, individuals at home, in
health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness,
care of the sick at home and rehabilitation (Freeman).
ii. It is broader than PHN because it encompasses nursing practice in wide variety of community services
and consumer advocate areas, and in a variety of roles, at times including independent practice. It is not
confined to public health agencies (Jacobson).

g. Difference of PHN and CHN: “Setting of work as dictated by funding” is the only difference of PHN and
CHN according to the standards created by the National League of Philippine Government Nurses.

h. Public Health Nurse. It refers to the nurses in the local/national health departments or public schools
whether their official position title is PHN or nurse or school nurse (NLPGN, 2005).

II. PHILIPPINE HEALTH CARE DELIVERY SYSTEM

A. Department of Health. E.O. 102 mandates the DOH with its new role as the national authority on health providing
technical and other resource assistance to concerned groups.

1. Roles and Functions

a. Leadership in Health
i. National policy and regulatory institution from which LGU’s, NGO’s will anchor their thrusts and directions
for health.
ii. Provide leadership in the formulation, monitoring, and evaluation of health policies, plans and programs.
iii. Advocate in the adoption of health policies, plans and programs.

b. Enabler and Capacity Builder

i. Innovate new strategies in health.
ii. Oversight functions in monitoring and evaluating the national health plans, programs and policies.
iii. Ensure highest achievable standards of quality health care, health promotion and protection.

c. Administrator of Specific Services

i. Manage selected health facilities and hospitals.
ii. Administer direct services for emergent health concerns.
iii. Administer health emergency response services.

2. Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040
3. Mission: To lead the country in the development of a productive, resilient, equitable and people-centered health
system for Universal Health Care
4. Goal: Health Sector Reform Agenda

a. Framework for Implementation: FOURmula ONE for Health. It intends to implement critical interventions as a
single package backed by effective management infrastructure and financing arrangements following sector
wide approach.
i. Goals
▪ Better Health Outcomes
▪ More Responsive Health Systems
▪ Equitable Health Care Financing

ii. Elements
▪ Health Financing. Foster greater, better and sustained investments in health.
▪ Health Regulation. Ensure quality and affordability of health goods and services.
▪ Health Service Delivery. Improve and ensure the accessibility and availability of basic and essential
health care.
▪ Good Governance. Enhance health system performance at the national and local levels.

b. National Health Insurance Program. The main lever to effect desired changes and outcomes in the
FOURmula ONE for Health implementation strategy.
B. Primary Health Care
1. WHO/UNICEF definition: Essential health care made universally accessible to individuals and families in the
community by means acceptable to them through their full participation and at a cost that the community and
country can afford at every stage of development in the spirit of self reliance and self determination.

TOP RANK REVIEW ACADEMY, INC. Page 3 | 23

 2. Legal Basis
a. It was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on
September 6-12, 1978. The goal was “Health for All by the year 2020.”

b. This was adopted in the Philippines through the Letter of Instruction 949 signed by President Marcos on
October 19, 1979 which has a theme of “Health in the Hands of the People by 2020.”
3. Concepts of Primary Health Care
a. Community-based
b. Accessible
c. Acceptable
d. Affordable
e. Sustainable
4. Elements/Components of Primary Health Care
a. Environmental Sanitation
b. Locally Endemic Diseases
c. Expanded Program on Immunization
d. Maternal and Child Health and Family Planning
e. Essential Drugs
f. Nutrition
g. Treatment (Medical Care and Emergency)
h. Sanitation
5. Strategies
a. Reorientation and reorganization of the national health care system.
b. Effective preparation and enabling process for health actions.
c. Mobilization of the people to know their communities and identifying their health needs leading to self-reliance
and self-determination.
d. Development and utilization of appropriate technology.
e. Organization of communities.
f. Increase opportunities for community participation.
g. Development of intra-sectoral linkages.
h. Emphasizing partnership between health workers and community leaders/members.
6. Four Cornerstones/Pillars
a. Active community participation
b. Intra and inter-sectoral linkages
c. Use of appropriate technology
d. Support mechanism made available
7. Types of Primary Health Workers
a. Village/Barangay Health Workers. Trained community health workers or health auxiliary volunteer or a
traditional birth attendant or healer.
b. Intermediate Level Health Workers. General medical practitioners, PHN’s, rural sanitary inspectors and
midwives.
8. Levels of Health Care and Referral System
a. Primary Level of Care. This is the health care provided by center physicians, PHN’s, rural health midwives,
BHW’s and traditional healers. This is the first contact between the community members and other levels of
health facility.
b. Secondary Level of Care. This serves as a referral center for the primary health facilities and is capable of
performing minor surgeries and simple laboratory examinations. This includes health facilities either privately
owned or government operated such as infirmaries, municipal and district hospitals and OPD’s of provincial
hospitals.
c. Tertiary Level of Care. This is rendered by health facilities such as medical centers, regional and provincial
hospitals, and specialized hospitals (National Kidney Institute and Philippine Heart Center). These facilities
handle complicated cases and patients who need intensive care.

III. PUBLIC HEALTH NURSE

A. Public Health Nurse

1. Qualifications and Functions

a. Management Function. This function is inherent in the practice of PHN. This is achieved through the
execution of five management functions: (1) planning; (2) organizing; (3) staffing; (4) directing; and (5)
controlling. This function is performed when the nurse organizes the “nursing service.”

i. Program Management. The nurse is responsible for the delivery of the package of services provided by
the program to the target clientele.

b. Supervisory Function. The PHN is the supervisor of the midwives and other auxiliary health workers. The
nurse formulates a supervisory plan and conducts supervisory visits to implement the plan.

c. Nursing Care Function. This is inherent in the function of the nurse because this practice is based on the
science and art of caring. The PHN uses his/her knowledge and skills in the nursing process.

d. Collaborating and Coordinating Functions. It brings activities systematically into proper relation of
harmony with each other. They are the care coordinators for communities and their members. He/She

TOP RANK REVIEW ACADEMY, INC. Page 4 | 23

 establishes linkages and collaboration with other health professionals, agencies and organizations whose
resources are available and which can be tapped in the implementation of individual, family and community
health care.

e. Health Promotion and Education Function. The PHN advocates the creation of supportive environment
through policies and reengineering of physical environment. The nurse provides clients with information that
allows them to make healthier choices and practices.

f. Training Function. The PHN initiates the formulation of staff development and training programs for
midwives and other auxiliary workers. He/She does the training needs assessment and the evaluation of
training outcomes.

g. Research Function. The PHN participates in the conduct of research and utilizes research findings in her
practice.

h. Disease Surveillance. It is the research activity of the nurse and is the continuous collection and analysis of
data of cases and deaths. The purposes are:
i. Measure the magnitude of the problem.
ii. Measure the effect of the control program.

B. Nurse in the Organization

1. Public Health Nurse II. He/She is the frontline health worker and prime mover for all health programs and
activities.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines

2. Public Health Nurse III. When assigned with PHN II in the same health center, the PHN III acts as the nurse-in-
charge.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines

3. Roles of a PHN II and III

a. Planner/Programmer
i. Identifies needs, priorities and problems of individuals, families and community
ii. Formulates nursing component of health plan.
iii. Implements nursing plans and programs.
iv. Provides technical assistance to RHM.

b. Provider of Nursing Care

i. Provides nursing care.
ii. Develops the family’s capability to care of the sock, disabled and dependent members.
iii. Provides continuity of patient care.

c. Manager/Supervisor
i. Formulates nursing car plan focused on individuals, families, groups and community.
ii. Interprets and implements program policies.
iii. Organizes work force, resources, equipments and supplies and delivery of health care at local levels.
iv. Allocates and distributes medicine, supplies, records and record equipment.
v. Provides technical and administrative support to RHM’s.
vi. Supervises RHM’s through visits and gives feedback on their performance.

d. Community Organizer
i. Motivates community participation.
ii. Initiates and participates in community development activities.

e. Coordinator of Services
i. Coordinates health services with GO’s and NGO’s.
ii. Coordinates nursing program with other health programs.

f. Trainer/Health Educator/Counselor
i. Identifies training needs and formulates training programs for RHMs, BHWs and hilots.
ii. Provides learning experience and trainings for RHMs, BHWs and other health workers.
iii. Conducts pre and post consultation conferences for clinic patients.
iv. Resource speaker on health and health related services.
v. Participates in the development of IEC materials (Information, Education and Communication)
vi. Initiates use of indigenous resources for health education purposes.
vii. Conducts premarital counseling.

g. Health Monitor
i. Monitors health of the individuals, families and communities.
ii. Utilizes different forms of data gathering to monitor health status of individuals, families and communities.

TOP RANK REVIEW ACADEMY, INC. Page 5 | 23

 h. Role Model
i. An example or model of healthful living to the community.

i. Change Agent
i. Motivates changes in health behavior and lifestyles of individuals, families and communities.

j. Recorder/Reporter/Statistician
i. Prepares and submits reports and records.
ii. Ensures adequate, accurate and complete reporting and recording.
iii. Reviews, validates and analyzes reports and records.
iv. Prepares statistical data/charts for presentations in staff meetings, conferences and seminars.

k. Researcher
i. Participates and assists in conducting surveys and researches regarding nursing and health related
subjects.
ii. Coordinates with GO’s and NGO’s in the implementation of studies and research.

4. Supervising Public Health Nurse/Nurse Supervisor at Provincial or City Level. Assesses needs and
formulates health plan for CHN services in the provincial or city level.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Nursing or Public Health
iv. At least 5 years experience as PHN

5. Nurse Instructor II. Implements training programs for nurses and midwives and plans for the regional health
training center technical staff.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Nursing
iv. Three years experience as CHN
v. Special training on the functions of the Nurse Instructor

6. Regional Training Nurse. Assesses training needs and develops training programs for nursing and midwifery
staff, both hospital and public health.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Nursing or Public Health
iv. Six years nursing experience, three years of which are in training or nursing education

7. Regional Nurse Supervisor/Regional Public Health Nurse (Nurse V). Prepares the regional nursing
supervisory plan and participates in the administration of nursing service in the region.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Public Health/Master of Arts in Nursing, Major in Community Health Nursing
Administration and Supervision
iv. At least five years experience in CHN, two years of which are in supervisory position

8. Nursing Program Supervisor (Nurse VI). The functions of Nurse VI whose positions are attached to different
services in the DOH such as Maternal and Child Health, Family Planning, Communicable/Non-Communicable
Disease Control are basically the same but differ according to the special programs/projects of the respective
service.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Public Health/Master’s degree in Nursing major in Public Health Nursing
Administration and Supervision
iv. At least seven years experience in CHN/training

9. Chief Nurse in Selected City Health Departments and Health Offices (Nurse VII). Assesses needs for CHN
services as part of the total health program and participates in the overall planning of the city health department
programs.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Nursing major in Community Health Nursing/Master’s degree in Public Health major in
Community Health Nursing Administration
iv. At least five years experience in CHN, three years of which have been either in supervisory or Assistant
Chief Nurse position

TOP RANK REVIEW ACADEMY, INC. Page 6 | 23

 10. Assistant Chief Nurse in Selected City Health Departments. Participates with the Chief Nurse in the
assessment of nursing needs.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Master’s degree in Nursing major in Community Health Nursing/Master’s degree in Public Health major in
Nursing Administration
iv. At least five years experience in CHN, two years of which have been in supervisory position

11. Occupational Health Nurse. Participates in developing an adequate health program for workers and laborers.
a. Qualifications:
i. Bachelor of Science in Nursing
ii. Registered Nurse in the Philippines
iii. Preferably with training or units in OHN

C. Community Health Nursing Process

1. Assessment. It provides an estimate of the degree to which a family, group or community is achieving the level of
health and identifies health problems or guidance needed.

a. Collection of Data
i. Data from the Family, Groups and Community:
▪ Demographic data
▪ Vital health statistics
▪ Community dynamics including power structure
▪ Studies of disease surveillance
▪ Economic, cultural and environmental characteristics
▪ Utilization of health services
ii. Data from the Individuals and Families:
▪ Health status
▪ Education
▪ Socio-cultural
▪ Religious and occupational background
▪ Family dynamics
▪ Environment and patterns of coping
iii. Methods:
▪ Community surveys
▪ Interview
▪ Observation of health-related behaviors
▪ Review of statistics
▪ Epidemiological and relevant studies
▪ Individual and family health records
▪ Laboratory and screening tests
▪ Physical examinations

b. Categories of Health Problems

i. Health Deficit. Instances of failure in health maintenance and occurs when there is a gap between actual
and achievable health status.
▪ Illness states, regardless whether diagnosed or undiagnosed by medical practitioner
▪ History of repeated infections or miscarriages
ii. Health Threats. These are conditions that are conducive to disease or accident or failure to realize one’s
health potential.
▪ Inadequate immunization
▪ Improper garbage disposal
▪ Polluted water supply
▪ Presence of breeding sites of vectors
iii. Foreseeable Crisis. These are anticipated periods of unusual demand in terms of adjustment or
resources.
▪ Pregnancy, labor and puerperium
▪ Death, illness or hospitalization of a family member
▪ Unemployment
iv. Health Need. There is a health problem that can be alleviated with medical or social technology.
v. Health Problem. There is demonstrated health need combined with actual or potential resources to apply
remedial measures.

2. Planning. This is based on the actual or potential problems that were identified and prioritized.

a. Goal Setting
i. Goal. This is the declaration of purpose or intent that gives essential direction to action.
ii. Objectives. These are stated in behavioral terms such as:
▪ Specific
▪ Measurable

TOP RANK REVIEW ACADEMY, INC. Page 7 | 23

 ▪ Attainable
▪ Realistic
▪ Time bounded.
b. Constructing a Plan of Action
i. Choosing among the possible courses of action.
ii. Selecting appropriate types of nursing interventions.
iii. Identifying appropriate and available resources for care developing an operational plan.
iv. Consider the ability of the family to cope or solve its own problems and make decisions on health matters.
v. The most appropriate action selected are those that:
▪ The clients could not perform themselves.
▪ Facilitate actions that remove barriers to care.
▪ Improve the capacity of the clients to act in their behalf.
c. Developing an Operational Plan
i. The public health nurse must establish priorities, phase and coordinate activities.
ii. Plans of care are prioritized in order of urgency.
iii. Development of evaluation parameters.
3. Implementation. This involves various nursing interventions which have been determined by goals and
objectives.
a. Role of the Nurse
i. Involves the patient and his/her family in the care provided.
ii. Motivate the patient to assume responsibility for his/their care.
iii. Teach and maintain a desired level of function.
iv. Clarify doubts.
v. Maximize the client’s confidence and ability to care for himself/themselves.
vi. Utilize support system (friends, neighbors, etc.).
vii. Monitor health services provided.
viii. Make proper referrals.
b. Documentation
i. This provides data which is needed to plan the client’s care and ensure its continuity.
ii. It is an important communication tool for the health team members.
iii. Written evidence of the quality of care that the clients received as well as their responses.
iv. Determines revisions made and whether the interventions were effective.
v. Serves as legal records to protect the agency and the health care providers.
vi. Provides data for research and education purposes.
4. Evaluation. The evaluation of the effectiveness of nursing care is through the Quality Assurance.
a. Structural Elements. These include the physical settings, instrumentalities and conditions through which
nursing care is given. This can be examined from the standpoint of the community in which the patient lives
and from the public health agency in which he/she receives care.
i. Philosophy
ii. Objectives
iii. Buildings
iv. Organizational structure
v. Budget
vi. Equipment
vii. Manpower or staff
b. Process Elements. These include the steps of nursing process. This can be examined by focusing on the
actions and decisions of the PHN in providing care.
i. Assessment
▪ Taking family health data
▪ Performing physical examination
▪ Making nursing diagnosis
ii. Planning
▪ Determining nursing goals
▪ Writing NCP
iii. Implementation
▪ Performing nursing interventions
▪ Coordination of services
iv. Evaluation
▪ Measuring success of nursing interventions
c. Outcome Elements. These are changes in the client’s health status that result from nursing interventions.
This is examined through the results of the care provided.
i. Modification of signs and symptoms
ii. Changes in knowledge and attitude
iii. Increased skill level and compliance in the treatment regimen
iv. Satisfaction of the patients and the other members of the health team

D. Nursing Procedures
1. Blood Pressure Measurement
a. Make sure that the client has rested for at least 5 minutes and should not have smoked or ingested caffeine
30 minutes before taking the BP.
b. Apply cuff around the upper arm 2-3 cms. above the brachial artery.
c. Use the bell (or diaphragm for obese) of the stethoscope to auscultate pulse.
d. Inflate the cuff rapidly by pumping the bulb until the column/needle reaches 30 mmHg above the palpated
systolic BP.

TOP RANK REVIEW ACADEMY, INC. Page 8 | 23

 e. Deflate cuff at rate of 2-3 mmHg/beat.
f. Note the appearance of the first clear tapping sounds and record this as systolic BP (Korotkoff phase I).
g. Note the disappearance of the clear sound and record this as diastolic BP (Korotkoff phase V). If there is
softening/muffling sounds noted, record this as Korotkoff phase IV.
h. To record the BP, take the mean of 2 readings obtained at least 2 minutes apart.
i. If the first 2 readings differ by 5 mmHg, obtain a 3rd reading and include this on the average.
j. In recording the BP, document in this format: Korotkoff phase I – IV – V.

2. Home Visit. This is the family nurse contact which allows the nurse to assess the home and family situations in
order to provide the necessary nursing care.
a. Purpose of Home Visit
i. Give nursing care to the sick, postpartum mother and her newborn.
ii. Assess the living conditions and their health practices.
iii. Give health teachings regarding prevention and control of diseases.
iv. Establish close relationships.
v. Make use of inter-referral system and promote utilization of community services.
b. Principles Involved in Preparing for a Home Visit
i. It must have purpose or objective.
ii. Should make use of available information through family records.
iii. Give priority to the essential needs.
iv. Should involve the individual and family in planning and delivery of care.
v. Plan should be flexible.
c. Guidelines to Consider regarding the Frequency of Home Visit
i. Physical, psychological and educational needs of the client.
ii. Acceptance of the family, their interest and willingness.
iii. Policy of the agency and the emphasis of their health programs.
iv. Consider other health agencies and the number of health personnel already involved.
v. Evaluation of past services given and how the family availed these services.
vi. Ability of the patient and his family to recognize their needs and make use of available resources.
d. Steps in conducting Home Visits
i. Establish rapport through greeting the client and introducing yourself.
ii. State the purpose of home visit.
iii. Assess the health needs.
iv. Perform bag technique.
v. Perform nursing interventions and health teachings needed.
vi. Document important data, observation and care given.
vii. Make appointment for your next visit.

3. Bag Technique. It is a tool that will help the nurse perform nursing procedures with ease and to save time and
effort with the goal of rendering effective nursing care.
a. Public Health Bag. It is essential and indispensable equipment of a PHN which he/she carries during a home
visit.
b. Principles of Bag Technique
i. It will minimize, if not prevent the spread of infection.
ii. It saves time and effort.
iii. It shows the effectiveness of total care given.
iv. It can be performed in a variety of ways as long as principle of avoiding transmission of infection is
observed.
c. Important Points to Consider in the Use of Bag
i. It should contain all the necessary articles, supplies and equipments.
ii. The bag and its content should be cleaned very often, the supplies replaced and ready for use anytime.
iii. Consider the bag and its content as clean and sterile while those articles that belong to the patients are
dirty and contaminated.
iv. Arrange the content of the bag according to the convenience of the user.
d. Important Steps in Bag Technique
i. Place bag on table lined with a clean paper. The clean side must be out and the folded part touching the
table.
ii. Handwashing before performing nursing procedures.
iii. Take out apron and put it on with the right side out.
iv. Put out the necessary articles and perform nursing procedures.
v. Handwashing after performing nursing procedures.
vi. In removing apron, the soiled side in and the clean side out.
vii. Document important data, observation and care given.
viii. Make appointment for your next visit.

E. Community Organizing. It brings about social and behavioral changes which empowers and builds the capability of
the people for future community action.
1. Stage I: Community Analysis. This is also termed as “Community Diagnosis” or “Community Needs
Assessment.” This is the process of assessing and defining needs, opportunities and resources involved in
initiating community health action programs (Haglund).

a. Components:
i. Demographic, social and economic profile
ii. Health risk profile

TOP RANK REVIEW ACADEMY, INC. Page 9 | 23

 ▪ Social (unemployment and low education)
▪ Behavioral (dietary habits and lifestyles)
▪ Environmental
iii. Health/Wellness outcomes profile (morbidity/mortality)
iv. Current health promotion programs
v. Studies conducted in target groups
b. Steps:
i. Define the geographic boundaries of the community.
ii. Collect and analyze data.
iii. Assess the capacity of leaders, organizations, programs which may facilitate or hinder the advocated
changes.
iv. Assess for barriers such as features of new programs which are not aligned with the people’s customs
and traditions and the ability of the people to adapt to change.
v. Assess people’s readiness for change.
vi. Provide a community profile of needs and resources and then set priorities.

2. Stage II: Design and Initiation

a. Establish a 5 to 8 committed members of the community to become the core planning group and select a
local organizer.
b. Choose an organizational structure.
c. Select organizational members from different groups and organization sectors.
d. Define the organization’s goals and objectives.
e. To avoid overlapping of functions, assign roles and responsibilities between members.
f. Provide skills development training and recognize program’s accomplishment and individual contributions to
its success.
3. Stage III: Implementation It puts design plans into actions.
a. Encourage citizen’s participation.
b. Develop plans of activities.
c. Utilize comprehensive and integrated strategies.
d. Incorporate community’s language, values and norms into the programs and materials.
4. Stage IV: Program Maintenance – Consolidation. At this point, the organization and program has gained
acceptance in the community.
a. Integrate intervention activities into community networks.
b. Establish a positive environment to maintain cooperation and thus, prevents fast turnover of members.
c. Establish a continuous recruitment and training of new members.
d. Provide continuous feedback to the community.
5. Stage V: Dissemination – Reassessment. Evaluation and continuous assessment is done to provide
modification of strategies and activities.
a. Continuously update the community analysis.
b. Utilize quantitative and qualitative methods of evaluation in assessing effectiveness of
interventions/programs.
c. Identify future revisions of goals and objectives and development of new strategies.
d. Disseminate results and information to further boost the community’s support.

F. Epidemiology

1. Definition
a. It is the study of occurrence and distribution of health conditions such as disease, death, deformities or
disabilities on human population.
b. It is also concerned with the study of distribution and determinants of health as well as probable factors that
influence the development of different health conditions.
c. Involves two main areas:
i. Study of distribution of disease
ii. Search for determinants or causes of the disease
d. Backbone of the prevention of the disease.

2. Epidemiologic Triangle

TOP RANK REVIEW ACADEMY, INC. Page 10 | 23

 a. Agent. It is an element, substance or force, either animate or inanimate, the presence or absence of which
may serve as stimulus to initiate a disease process.
Agent Example
Biological ▪ Virus, bacteria, parasite, fungus
Chemical ▪ Lead, mercury, insecticide
Physical ▪ Humidity, radiation, atmospheric
pressure
Mechanical ▪ Stab and trauma
Nutritive ▪ Increased cholesterol, iron/iodine
deficiency
b. Host. It is an organism that harbors and provides nourishment for another organism.

c. Environment. It is the sum total of all external conditions and influences that affect the life and development
of an organism.
i. Physical Environment. It is composed of the inanimate surroundings such as the geophysical conditions
or climate.
ii. Biological Environment. It makes up the living things around us such as plant and animal life.
iii. Socio-economic Environment. This maybe in the form of level of economic development of the
community or in the presence of social disruptions.
3. Epidemiological Variables
a. Time. It refers both to the period which the cases of disease being studied were exposed to the source of
infection and the period during which the illness occurred.
i. Epidemic Period. A period during which the reported number of cases exceed the expected or usual
number for that period.
b. Person. It refers to the characteristics of the individual who were exposed and who contacted the infection or
the disease.
i. Age. It is the considered the single most useful variable associated in describing the occurrence and
distribution of disease.
ii. Sex and Occupation
▪ Mortality: Males > Females
▪ Morbidity: Females > Males
c. Place. It refers to the features, factor or conditions which existed in or described the environment in which the
disease occurred.
4. Patterns of Occurrence and Distribution
a. Sporadic. It is the intermittent occurrence of a few isolated and unrelated cases in a given locality (e.g.
Rabies).
b. Endemic. It is the continuous occurrence throughout a period of time, of the usual number of cases in a given
locality. It is always occurring in the locality (e.g. PTB, Schistosomiasis in Leyte and Samar, Filariasis in
Sorsogon).
c. Epidemic. It is unusually large number of cases in a relatively short period of time. The number of cases is
not itself necessarily big, but such number of cases when compared with the usual number of cases may
constitute an epidemic (Dengue and Cholera).
d. Pandemic. It is the simultaneous occurrence of epidemic of the same disease in several countries.
5. Public Health Surveillance. It is an ongoing systemic collection, analysis, interpretation and dissemination of
health data. The cycle begins when diseases are reported by health care providers to the public health agencies.
a. Role of the Nurse in the Surveillance
i. Surveillance. It is a continuous collection and analysis of data of cases and death.
ii. Disease Surveillance. It is the area where public health nurse function as researcher.
iii. Objectives:
▪ Measure the magnitude of the problem
▪ Measure the effect of the control program
b. National Epidemic Sentinel Surveillance System. It is a hospital based information system that monitors
the occurrence of infectious diseases with outbreak potential. It serves a supplemental information system of
the DOH.
i. Objectives
▪ Provide earl warning on outbreaks
▪ Provide information so that control measures can be instituted
ii. Steps
▪ Prepare for field work.
▪ Establish the existence of an outbreak.
▪ Verify diagnosis.
▪ Define and identify cases.
▪ Perform descriptive epidemiology (describing the disease as to person, place and time
characteristics).
▪ Develop hypothesis.
▪ Evaluate hypothesis by comparing with established facts and by using analytical epidemiology
(attempts to analyze the causes or determinants of disease through hypothesis testing).
▪ Refine hypothesis and execute additional studies.
▪ Implement control and prevention measures.
▪ Communicate findings.
▪ Follow-up recommendations.
iii. Functions of the Nurse
▪ Implement public health surveillance.
▪ Monitor local health personnel.

TOP RANK REVIEW ACADEMY, INC. Page 11 | 23

 ▪ Conduct outbreak investigation.
▪ Assist in the conduct of surveillance during disasters.
▪ Assists in conduct of surveys, program evaluation and epidemiological studies.

G. Vital Statistics. It is a tool used in estimating the extent or magnitude of health needs and problems in the
community. It is a systematic approach of obtaining, organizing and analyzing numerical facts used to draw
conclusions.
1. Uses of Vital Statistics
a. Indices of health and illness status of the community.
b. Bases for planning, implementing, and evaluating CHN programs and services.
2. Epidemiological Indicators

a. Crude Birth Rate. A measure of one characteristic of the natural growth or increase of a population.

Total no. of live births

CBR = ------------------------------------ X 1000
Midyear population (July 1)

b. Crude Death Rate. A measure of one mortality from all causes which may result in decreased population.

Total no. of deaths

CDR = ------------------------------------ X 1000
Midyear population (July 1)

c. Infant Mortality Rate. Measures the risk of dying during the first year of life.

Total no. of deaths under 1 year of age

IMR = ---------------------------------------------------- X 1000
Total no. of registered live births

d. Maternal Mortality Rate. Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium.

Total no. of deaths from maternal causes

MMR = ------------------------------------------------------- X 1000
Total no. of registered live births

e. Fetal Death Rate. Measures pregnancy wastes. Death of the product of conception prior to expulsion,
irrespective of duration of pregnancy.
Total no. of fetal deaths
FDR = ------------------------------------------- X 1000
Total no. of registered live births

f. Neonatal Death Rate. Measures the risk of dying in the first month of life.

Total no. of deaths under 28 days of age

NDR = ------------------------------------------------------- X 1000
Total no. of registered live births

g. Specific Death Rate. Describes more accurately the risk of exposure of certain classes or groups to
particular diseases.

Total no. of deaths in a specified group

SDR = -------------------------------------------------------- X 1000
Midyear population (July 1) of same group

i. Cause Specific Death Rate

Total no. of deaths from specific cause

CSDR = ------------------------------------------------- X 1000
Midyear population (July 1)

ii. Age Specific Death Rate

Total no. of deaths in a particular age

ASDR = ------------------------------------------------- X 1000
Midyear population of same age group

TOP RANK REVIEW ACADEMY, INC. Page 12 | 23

 iii. Sex Specific Death Rate

Total no. of deaths in a certain sex

SSDR = ---------------------------------------------- X 1000
Midyear population of same sex

h. Incidence Rate. Measures the frequency of occurrence of the phenomenon during a given period of time.

Total no. of new cases in a specified time

IR = -------------------------------------------------------- X 1000
Midyear population (July 1)

i. Prevalence Rate. Measures the proportion of the population which exhibits the particular disease at a
particular time and deals with total (new and old) number of cases.

Total no. of new and old cases in a given time

PR = ------------------------------------------------------------ X 1000
Total no. of persons examined at same given time

j. Attack Rate. A more accurate measurement of risk of exposure.

Total no. of persons acquiring a disease

AR = ----------------------------------------------------------- X 1000
Total no. of persons exposed to same disease
k. Proportionate Mortality. Shows numerical relationship between deaths from all causes/age with the total
number of deaths from all causes in all ages taken together.

Total no. of deaths from specific cause or age

PM = ----------------------------------------------------------- X 1000
Total no. of deaths from all causes, in all ages

l. Case Fatality Ratio. Index of a killing power of a disease.

Total no. of deaths from a specific disease

CFR = ---------------------------------------------------------- X 1000
Total no. of registered cases from same disease

m. Swaroop’s Index

Total no. of deaths among 50 years of age

SI = ---------------------------------------------------------- X 1000
Total no. of deaths in the same year

3. Presentation of Data
a. Line/Curved Graph. This shows peaks, valleys and seasonal trends.
b. Bar Graph. This represents a quantity in terms of rates or percentages.
c. Pie Chart. Shows relative importance of parts to the whole.
H. Field Health Services and Information System (FHSIS)
1. Objectives
a. Provides summary of data on health services delivery and selected program accomplished.
b. Provides data used for program monitoring and evaluation purposes.
c. Provides standardized, facility level data base.
d. Ensures data reported to the FHSIS are useful and accurate and disseminated in a timely and easy to use
manner.
e. Minimizes recording and reporting burden.
2. Components
a. Family Treatment Record. This is the fundamental building block or foundation of the FHSIS. This is the
document where the chief complaint, diagnosis and treatment are recorded.
b. Target/Client Lists. This is the second building block of the FHSIS and has the following purposes:
i. To plan and carry out patient care and service delivery.
ii. To facilitate monitoring and supervision for services.
iii. To report services delivered.
iv. To provide a clinic level data base.
c. Tally/Reporting Forms. These constitute the only mechanism through which data are routinely transmitted
from one facility to another. These are prepared and submitted either monthly or quarterly.
d. Output Reports/Table. These will be produced at the provincial health FHSIS disseminated down to the
RHU/Main health center and up through the DOH system to the regional health office. Its objective is to make
the reports useful for monitoring/management purpose at each level of DOH management.

TOP RANK REVIEW ACADEMY, INC. Page 13 | 23

 Family
Treatment
Records

Target/

Tally/

Reporting
Forms

Output

IV. FAMILY HEALTH

A. Maternal Health Program
1. Background

a. To achieve its millennium development goals, the Philippines is tasked to reduce the MMR by three-quarters
by 2015.
b. 2000 Philippine Health Statistics revealed that causes of maternal deaths include:
i. 25% due to hypertension
ii. 20.3% due to postpartum hemorrhage
iii. 9% due to abortion
c. Basic Emergency Obstetric Care (BEMOC). This entails the establishment of facilities that provide
emergency obstetric care for every 125,000 population and which are strategically located.

2. Antenatal Registration. Pregnant women should have at least four prenatal visits.

Prenatal
Period of Pregnancy
Visits
1st visit ▪ As early in pregnancy
or in the 1st trimester
2nd visit ▪ 2nd trimester
3rd visit ▪ 3rd trimester
Every 2 ▪ After 8th month of
pregnancy until
weeks
delivery

3. Tetanus Toxoid Immunization. Prevention against neonatal tetanus.

a. 2 TT vaccines should be given to pregnant mothers one month before delivery.
b. 3 booster doses of TT vaccines following recommended schedules

Duration
Minimum Age Percent
Vaccine of
Interval Protected
Protection
▪ As early as
TT 1 possible during ▪ 80%
pregnancy
▪ 1 month after
TT 2 ▪ 80% ▪ 3 yeas
TT 1
▪ 6 months after
TT 3 ▪ 90% ▪ 5 years
TT 2
▪ 1 year after TT ▪ 10
TT 4 ▪ 99%
3 years
▪ 1 year after TT
TT 5 ▪ 99% ▪ Lifetime
4

c. If the woman received 3 doses of DPT vaccine on her infancy, these should be considered as TT 1 and TT 2.
The succeeding doses will be TT 3 and so forth.
4. Micronutrient Supplementation.
a. Vitamin A. Dose is 10,000 IU given twice a week starting on the fourth month of pregnancy. This is not given
prior to the fourth month to prevent congenital problems.
b. Iron. Dose is 60 mg/400 ug tablet which is given daily.

TOP RANK REVIEW ACADEMY, INC. Page 14 | 23

 5. Treatment of Diseases
a. Postpartum Bleeding
i. Place cupped palm on fundus and feel for contraction.
ii. Massage fundus in circular motion.
iii. Give ergometrine 0.2 mg IM and another dose after 15 minutes. Do not give to mothers with pre-
eclampsia/eclampsia or hypertension
iv. If bleeding still persists, apply bimanual uterine compression.
b. Intestinal Parasite Infection
i. Give mebendazole 500 mg tablet single dose anytime from 4 to 9 months of pregnancy.
ii. Giving mebendazole to pregnant mothers for the 1 to 3 months can cause congenital problems.
c. Malaria
i. Give sulfadoxin-pyrimethamine to women from malaria endemic areas.
6. Newborn Screening. This must be dome 48 hours up to 2 weeks after birth.
7. Postpartum Visits
a. 1st visit should be on 1st week postpartum preferably 3 to 5 days.
b. 2nd visit should be on 6 weeks postpartum.

B. Child Health Programs

1. Infant and Young Child Feeding

a. Global Strategy for Infant and Young Child Feeding. This was issued jointly by the WHO and UNICEF in
2002 which calls for the promotion of breast milk as the ideal food for infants and exclusive breastfeeding for
the first 6 months of life.
b. National Plan of Action for 2005 – 2010 for Infant and Young Child Feeding
i. Goal: Reduce child mortality rate by 2/3 by 2015.
ii. Specific Objectives:
▪ 70% of the newborns are initiated to breastfeeding within 1 hour after birth.
▪ 60% are exclusively breastfed up to 6 months.
▪ 90% are started to complementary feeding by 6 months of age.
▪ Median duration of breastfeeding is 18 months.
iii. Exclusive Breastfeeding. Giving the infant only breast milk and no other liquids nor solids, not even
water.
iv. Complimentary Feeding. These are foods that complement breast milk after 6 months of age. These
should be:
▪ Safe
▪ Timely
▪ Adequate
▪ Properly Fed
2. Breastfeeding and Breast Milk
a. Bonds mother and child
b. Rehydration/Recovery of a sick child
c. Economical and inexpensive
d. Anemia, breast and ovarian cancer risks are reduced
e. Stops excessive bleeding
f. Total food security for the infant’s first 6 months of life
g. Milk Intolerance is very rare
h. Initial immunization of the infant (IgA)
i. Lactating Amenorrhea Method
j. Keeps the child away from diarrhea

3. Laws that Protect the Infant and Young Child Feeding

a. Milk Code (E.O. 51). The Milk code covers the products such as breast milk substitutes including infant
formula, other milk products and bottle-fed complementary foods.
b. Rooming-in and Breastfeeding Act of 1992 (R.A. 7600). This requires both public and private institutions to
promote rooming-in and practice breastfeeding.
c. Food Fortification Law (R.A. 8976). This law requires the mandatory food fortification of staple foods such
as rice, flour, edible oil and sugar.

C. Expanded Program on Immunization

1. Four Major Strategies
a. Sustaining high routine fill immunized child (FIC) coverage of at least 90% in all province and cities.
b. Sustaining a polio-free country for global certification.
c. Eliminating measles by 2008.
d. Eliminating neonatal tetanus by 2008.
2. Immunization. This is the process by which vaccines are introduced into the body before infection sets.
a. It is safe to administer all EPI vaccines on the same day at different sites.
b. Measles vaccine is given as soon as the child is 9 months.
c. If the interval between doses exceeded the recommended interval, the schedule should not be restarted from
the beginning.
d. Vaccines are not contraindicated to infants with moderate fever, malnutrition, mild respiratory infection, cough,
diarrhea and vomiting.
e. DPT 2 or 3 should not be given to infants who had convulsions or shock within 3 days after the previous dose.
It should not be given to infants with uncontrolled epilepsy or encephalopathy.

TOP RANK REVIEW ACADEMY, INC. Page 15 | 23

 f. BCG should not be given to patients who are immunosuppressed such as patients with AIDS or those who
undergo immunosuppressive therapy.
g. Giving vaccines less than the recommended 4 weeks interval may lessen the antibody response.
h. Continue vaccinating even if the patient missed a dose of DPT/Hepa B/OPV/TT. No extra doses must be
given.
i. Never reconstitute the freeze dried vaccines (BCG and Measles) with other diluents except for the diluent
supplied with them.
j. Repeat BCG if the child does not develop a scar after the 1st injection.
k. One syringe, one needle per child.
3. EPI Target Disease
i. Measles
ii. Tuberculosis
iii. Diphtheria
iv. Pertussis
v. Poliomyelitis
vi. Neonatal Tetanus
vii. Hepatitis B

4. Routine Immunization Schedule for Infants

a. Every Wednesday.
b. Fully Immunized Child. The child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of
Hepa B, and one dose of Measles before one year of age.

Vaccin Minimum Age at 1st

Schedule
es dose
▪ Anytime after
BCG ▪ Given once at birth
birth
▪ 1st dose: 1 ½ months (4 weeks interval)
▪ 6 weeks or 1 ½
DPT ▪ 2nd dose: 2 ½ months (4 weeks interval)
months
▪ 3rd dose: 3 ½ months
▪ 1st dose: 1 ½ months (4 weeks interval)
▪ 6 weeks or 1 ½
OPV ▪ 2nd dose: 2 ½ months (4 weeks interval)
months
▪ 3rd dose: 3 ½ months
Hepa ▪ 1st dose: At birth (6 weeks interval)
▪ At birth ▪ 2nd dose (8 weeks interval)
B
▪ 3rd dose
Measl
▪ 9 months ▪ Given once at 9 months
es

5. Vaccine Storage

Temperature Vaccines Characteristics

Freezer ▪ OPV (live attenuated)
(-15oC to - ▪ Most sensitive to heat
▪ Measles (freeze dried)
25oC)
▪ “D” is a weakened toxoid
Body of the ▪ “P” is a killed bacteria
▪ “T” is a weakened toxoid
Refrigerator ▪ Least sensitive to heat
▪ Hepa B
(+2oC to +8oC)
▪ BCG (freeze dried)
▪ Tetanus toxoid

6. Procedures in Giving Vaccines

Vaccine Dose Route Site

▪ 0.05 mL
BCG ▪ ID ▪ Right deltoid muscles
(infants)
DPT ▪ 0.5 mL ▪ IM ▪ Upper outer portion of thigh
OPV ▪ 2 gtts ▪ PO ▪ Mouth
Measles ▪ 0.5 mL ▪ SQ ▪ Outer part of the upper arm
Hepa B ▪ 0.5 mL ▪ IM ▪ Upper outer portion of thigh
Tetanus toxoid ▪ 0.5 mL ▪ IM ▪ Deltoid muscles

7. Procedures in Vaccination

a. BCG
i. In reconstituting BCG, use a 5 mL syringe then aspirate 2 mL of the diluent (saline solution).
ii. Inject the 2 mL diluent to the freeze dried BCG.
iii. Clean the skin with a “cotton moistened with water.”
iv. Lay the syringe with bevel up and needle almost flat along the child’s arm then inject intradermally.

TOP RANK REVIEW ACADEMY, INC. Page 16 | 23

 v. Make a flat wheal on the injection site.

b. OPV
i. Make use of the dropper and put drops of vaccine onto the child’s tongue without letting the dropper
touch the child’s tongue.
ii. Make sure that the child swallows the vaccine and if he/she spits it out, give another dose.

c. Hepatitis B/DPT
i. Clean the skin with a “cotton moistened with water.”
ii. The best site is the outer part of the child’s midthigh.
iii. Aspirate first before injecting the vaccine.

d. Measles
i. In reconstituting Measles, use a 10 mL syringe then aspirate 5 mL of the special diluent.
ii. Protect reconstituted measles from sunlight and wrap it inside a foil.
iii. Clean the skin with a “cotton moistened with water.”
iv. Use the skin on the outer side of the upper arm.
v. Aspirate first before injecting the vaccine.

D. Nutrition Program
1. Micronutrient Supplementation
a. Vitamin A
i. There is twice a year distribution of Vitamin A capsules through the “Araw ng Sangkap Pinoy,” known as
Garantisadong Pambata. This is the approach adopted to provide supplements to 6 – 71 months old
preschools.

ii. Universal Supplementation

Target Preparation Dose

Infants (6 – 11 months) ▪ 100,000 IU ▪ 1 dose only
Children (12 – 71 months) ▪ 200,000 IU ▪ 1 capsule every six months
▪ 1 capsule 2x a week starting from 4th month of
Pregnant Women ▪ 10,000 IU
pregnancy until delivery
Post-partum Women ▪ 200,000 IU ▪ 1 capsule only within 4 weeks postpartum

iii. High Risk Children

Illness Target Preparation Dose

▪ Infants ▪ 100,000
(6 – 11 mos.) IU ▪ 1 capsule upon diagnosis regardless of when the
Measles
last VAC was given
▪ Pre-school ▪ 200,000
(12 – 71 mos.) IU
Severe ▪ Infants ▪ 100,000
Pneumonia/ (6 – 11 mos.) IU
Persistent
▪ 1 capsule upon diagnosis, except when the child
Diarrhea/ ▪ Pre-school ▪ 200,000 was given VAC less than 4 weeks before diagnosis
Malnutrition (12 – 71 mos.) IU

Malnutrition ▪ School Age ▪ 200,000

(6 – 12 years) IU

iv. Treatment of Xerophthalmia

Target Preparation Dose/Duration

6 – 11 months ▪ 100,000 IU ▪ 1 capsule upon diagnosis, 1 capsule the next day, 1

capsule after 2 weeks
12 – 59 months ▪ 200,000 IU
Pregnant Women with Night blindness ▪ 10,000 IU ▪ 1 capsule a day for 4 weeks upon diagnosis

b. Iron Supplementation
Target Preparation Dose/Duration
Low Birth Weight ▪ Drops: 15 mg/0.6 ▪ 0.3 mL once a day to start at 2 mos. until 6 mos.
Infants (6 – 11 mos.) mL ▪ 0.6 mL once a day for 3 mos.
Children (1 – 5 years) ▪ 1 tbsp. once a day for 3 mos. or 30 mg once a week for 6
▪ Syrup: 30mg/5mL
mos.

TOP RANK REVIEW ACADEMY, INC. Page 17 | 23

 Children (6 – 11 years)
▪ 2 tbsp. once a day for 6 mos.
Anemic & Underweight
▪ 1 tablet once a day for 6 mos. or 180 days during
Pregnant Women ▪ Coated tablet: 60 pregnancy
mg iron + 400 mcg ▪ If consultation is done only during the 2nd or 3rd trimester, 2
folic acid tablets per day
Lactating Women ▪ 1 tablet once a day for 3 mos. or 90 days
Adolescent Girls
(10 – 19 years) ▪ Tablet: 60 mg iron +
▪ One tablet once a day
400 mcg folic acid
Older Persons

c. Iodine Supplementation

Target Preparation Dose/Duration

School Age Children
Women (15 – 45 ▪ Iodized oil
▪ 1 capsule for
capsule with 200
years) 1 year
mg iodine
Adult Males

Study/Critical Thinking Questions:

1. Why is Vitamin A not given to pregnant mothers before the fourth month of pregnancy?
2. How many pre-natal visits are recommended for pregnant mothers before delivery?
3. How many Tetanus Toxoid/s should the mother receive one month before the delivery? If the mother has already
been fully immunized when she was a child, how many doses of Tetanus Toxoid/s should she receive when she
becomes pregnant?
4. An infant was given OPV 1 and 2 at 6 weeks and 10 months respectively, and the mother brought the infant at 16
weeks for OPV 3. As a nurse, you know that interval week for OPV is 4 weeks and the infant was already 2 weeks
late for the OPV 3. What will be your nursing action? Will you continually give OPV 3, or restart the vaccination at the
beginning?
5. Which among the EPI vaccines are stored in the freezer? And which among them is stored in the body? What do you
call the rule practiced to assure that all vaccines are utilized before its expiry date?

V. ENVIRONMENTAL HEALTH AND SANITATION

A. Environmental Health. The study of preventing illnesses by managing the environment and changing people’s
behavior to reduce exposure to agents of disease.

1. Triad of Man-Disease Agent-Environment

a. Man, by manipulating his environment is able to prevent contracting disease by blocking disease agents from
entering his body, thus disease will not occur.
b. Three Preventive Strategies

i. Change the People’s Behavior

▪ Food safety practices
▪ Hand washing
▪ Proper food preparation
ii. Prevent the Production of Disease Agents
▪ Treatment of wastewater
iii. Increasing a Person’s Resistance to Infectious Diseases
▪ Expanded Program on Immunization

TOP RANK REVIEW ACADEMY, INC. Page 18 | 23

 Increase Resistance to
Change people’s
Disease Agent
behavior

Prevent Production of Agents

2. Environmental Sanitation It is the study of all factors in man’s physical environment.

a. Environmental and Occupational Health Office

i. Under the National Center for Disease Prevention and Control Program of the DOH.
ii. Responsible for the promotion of healthy environmental conditions and prevention of environmental
related diseases.
iii. Provides technical assistance on sanitation programs and is geared towards the elimination and control of
environmental factors in disease transmission in all households.
iv. Responsible for conceptualizing new programs or projects with regards to the environmentally related
health problems.
b. Strategies include:
i. Water quality surveillance
ii. Evaluation of food establishments
iii. Proper solid and liquid waste management
iv. Sanitation of public places
v. Sanitation management of disaster areas
vi. Enforcement of sanitation laws
vii. Rules, regulations and standards
B. Major Environmental Health and Sanitation Programs
1. Health and Sanitation
a. Diarrhea diseases ranked first in the leading causes of morbidity among the general population.
2. Water Supply Sanitation Program. Certification of potability of an existing water source Is issued by the
Secretary of Health or by the local health authority.

a. Level I (Point Source)

i. Protected well or developed spring with an outlet but without a distribution system.
ii. Serves 15 to 25 households.
iii. Must not be more than 250 meters from the farthest user.
iv. Discharge is 40 to 140 liters per minute.
b. Level II (Communal Faucet System or Stand Posts)
i. System composed of a source, reservoir, a piped distribution network and communal faucets.
ii. Not more than 25 meters from the farthest house.
iii. Delivers 40 to 80 liters of water per capital per day.
iv. Serves 100 households
v. One faucet per four to six households.
c. Level III (Waterworks System or Individual House Connections)
i. System composed of a source, reservoir, a piped distributor network and household taps.
ii. Suited for densely populated urban areas.
iii. Requires minimum treatment or disinfection.

3. Proper Excreta and Sewage Disposal Program

a. Level I
i. Non-Water Carriage Toilet Facility. No water is necessary to wash the waste into the receiving space.
▪ Pit latrines

TOP RANK REVIEW ACADEMY, INC. Page 19 | 23

 ▪ Reed odorless earth closet
ii.
Toilet facilities requiring small amount of water to wash the waste into the receiving space.
▪ Pour flush toilet
▪ Aqua privies
b. Level II
i. Toilet facilities of the water carriage type with water sealed and flush type with septic vault/tank disposal
facilities.
c. Level III.
i. These are water carriage types of toilet facilities connected to septic tanks and/or sewerage system to
treatment plan.

4. Food Sanitation Programs

a. Rights in Food Safety

i. Right Source
▪ When in doubt of the water source, boil for at least 2 minutes (running boiling).
ii. Right Preparation
▪ Avoid contact between raw and cooked foods.
iii. Right Cooking
▪ Temperature on all parts of the food should reach 70 degrees centigrade when cooking.
iv. Right Storage
▪ Cooked foods should be left at room temperature not more than 2 hours.
▪ Store food under hot conditions (at least or above 60 oC) or in cold conditions (below or equal to
10oC). This is vital if you plan to store food more than 4 to 5 hours.
Study/Critical Thinking Questions:
1. What are the three preventive strategies in the Man-Disease Agent-Environment Triad?
2. In a rural area, a water system is used to supply a 100 household with a communal faucet per 4 to 6 households. It is
located not more than 25 meters from the farthest house. What type of water supply is generated by this community?
a. Level I
b. Level II
c. Level III
d. Level IV
3. Certification of potability of an existing water source in a community is issued by whom?
4. Pit latrines and reed odorless earth closet is an example of what type of toilet facility? What level do these toilet
facilities included?
5. What are the four rights in food safety?

VI. HEALTH PROGRAMS

A. Sentrong Sigla Movement

1. Sentrong Sigla Certification

a. Quality Assurance through SSC is a way of engaging LGUs and communities in assuring quality health
services at the local level.
b. (1998) Quality Assurance Program: Goal of making DOH and LGUs active partners in providing quality health
services.
c. (1999) QAP was renamed Sentrong Sigla Movement or Centers of Vitality Movement also known as SS
Phase I.
d. Goal of SSM: Quality health care, services and facilities.
e. (2001) Effort to raise the quality of health was intensifies leading to the formation of SS Phase II.

2. Guiding Principles
a. Recognition for achieving good quality.
b. Quality improvement is an unending process.
c. Focus shall be on core public health programs.
d. Quality Improvement is a partnership based on trust and transparency.
e. DOH shall give purposive technical assistance to health facilities.
f. Assessment for certification

3. Goals and Objectives

a. Specific Goal: Improve the quality of out-patient health care (public and private) and of public health services
in communities.
b. Objectives:
i. Establish an efficient system.
ii. Raise the average quality of public health services through recognition.
▪ At least 50% of health centers meet revised SS Phase II Basic Certification standards (Level I)
▪ At least 20% of Level I certified health centers successfully meet Phase II Specialty Award standards
(Level II)
iii. Raise public health awareness and client participation in SS certification.

4. Level and Scope of Certification

a. Basis SS Certification. Minimum input, process and output standards for integrated public health services
for four core programs:

TOP RANK REVIEW ACADEMY, INC. Page 20 | 23

 ▪ Facility and System Standards. Ensures that health facility is appropriately equipped with sufficient
manpower, adequate logistics and organized procedures.
▪ Integrated Public Health Functions. Ensures that the health facility and staff promote public health
programs and prevent and control public health problems through direct patient care and support.
▪ Basic Curative Services. Ensures that the health facility and staff provide basic curative services that
consist of primary level outpatient and emergency care for commonly encountered non-program diseases
in the community.
▪ Regulatory Functions. Ensures that the health facility and staff support and provide an environment

b. Specialty Awards. Second level quality standards for selected four core public health programs.
c. Award for Excellence. Highest level quality standards for maintaining level II standards for the four core
public health programs and level II facility systems for at least 3 consecutive years.
d. Validity of certification is two years.

B. Monthly Programs of the Department of Health

1. January
a. National Cancer Consciousness Week
2. February
a. Heart Month
b. Dental Health Month
c. Responsible Parenthood Campaign National Health Insurance Program
3. March
a. Women's Health Month
b. Rabies Awareness Month
c. Burn Injury Prevention Month
d. Responsible Parenthood Campaign
e. Colon and Rectal Cancer Awareness Month
f. World TB Day
4. April
a. Cancer in Children Awareness Month
b. World Health Day
c. Bright Child Week Phase I
d. Garantisadong Pambata
5. May
a. Natural Family Planning Month
b. Cervical Cancer Awareness Month
c. AIDS Candlelight Memorial Day
d. World No Tobacco Day
6. June
a. Dengue Awareness Month
b. No Smoking Month
c. National Kidney Month
d. Prostate Cancer Awareness Month
7. July
a. Nutrition Month
b. National Blood Donation Month
c. National Disaster Consciousness Month
8. August
a. National Lung Month
b. National Tuberculosis Awareness Month
c. Sight-Saving Month
d. Family Planning Month
e. Lung Cancer Awareness Month
9. September
a. Generics Awareness Month
b. Liver Cancer Awareness Month
10. October
a. National Children's Month
b. Breast Cancer Awareness Month
c. National Newborn Screening Week (3-9)
d. Bright Child Week Phase II Garantisadong Pambata
11. November
a. Filariasis Awareness Month
b. Cancer Pain Management Awareness Month

TOP RANK REVIEW ACADEMY, INC. Page 21 | 23

 c. Traditional and Alternative Health Care Month
d. Campaign on Violence Against Women and Children
12. December
a. Firecracker Injury Prevention Campaign: “OPLAN IWAS PAPUTOK”

C. Herbal Medicine (LUBBY SANTA)

1. Lagundi
a. Asthma, cough and fever
b. Dysentery, colds and pain
c. Skin diseases (dermatitis, scabies, ulcer, eczema) and wounds
d. Headache
e. Rheumatism, sprain, contusions and insect bites
f. Aromatic bath
2. Ulasimang Bato (Pansit-Pansitan)
a. Lowers uric acid (rheumatic and gouty arthritis)
3. Bayabas
a. Washing wounds
b. Diarrhea
4. Bawang
a. Hypertension
b. Toothache
5. Yerba Buena
a. Headache and stomachache
b. Rheumatism and arthritis
c. Cough and colds
d. Swollen gums
e. Toothache
f. Menstrual and gas pain
g. Nausea and fainting
h. Insect bites
i. Pruritus
6. Sambong
a. Anti-edema
b. Diuretic
c. Anti-urolithiasis
7. Akapulko
a. Anti-fungal: Tinea flava, Ringworm and Athlete’s foot
b. Scabies
8. Niyug-Niyogan
a. Anti-helminthic
9. Tsaang Gubat
a. Diarrhea
b. Stomachache
10. Ampalaya
a. Lowers blood sugar levels
b. Diabetes Mellitus (NIDDM)
11. Reminders on the Use of Herbal Medicines
a. Avoid use of insecticides.
b. Use clay pot and remove cover while boiling at low heat.
c. Use only the part of the plant being advocated.
d. One kind of herbal plant for each type of symptoms.
e. In case of untoward reaction such as allergy, stop giving the herbal medicine.
f. If signs and symptoms are unrelieved after 2 to 3 does of herbal medicine, consult a physician

VII. LAWS AFFECTING PUBLIC HEALTH NURSING

A. Different Laws Affecting Public Health Nursing

1. Letter of Instruction 949. The legal basis of Primary Health Care dated October 19, 1979.

2. R.A. 7160. The Local government code which transfers the responsibility of delivering the basic health care
services from the national government to the local government.

3. R.A. 7305. The Magna Carta for Public Health Workers which aims to promote and improve the social and
economic well-being of heath workers.

4. R.A. 9173. The Philippine Nursing Act of 2002 which provides for a more responsive nursing profession and
repeals the purpose of R.A. 7164 otherwise known as Philippine Nursing Act of 1991.

5. R.A. 3573. All communicable diseases should be reported to the nearest health station.

TOP RANK REVIEW ACADEMY, INC. Page 22 | 23

 6. R.A. 8749. The Clean Air Act.

7. R.A. 9211. The Tobacco Regulation Act.

8. R.A. 8976. The Philippine Food Fortification Act.

9. R.A. 9255. Provides for illegitimate children to use the surnames of their father.

10. R.A. 7432. Entitles the elderly to a 20% discount in all public establishments and free medical and dental check-
ups and hospitalization in all government hospitals.

11. R.A. 7600. The Rooming-in and Breastfeeding Act which states that babies born in private and government
hospitals should be roomed-in with their mother to promote breastfeeding.

12. R.A. 9288. The Newborn Screening Act.

13. R.A. 9262. The Anti-Violence Against Women and Children Act.

14. R.A. 6675. The Generics Act of 1988 which promotes requires and ensures the production of adequate supply,
distribution, use and acceptance of drugs and medicines identified by their generic names.

15. R.A. 4073. This has liberalized the treatment of leprosy.

16. R.A. 8423. This has created the Philippine Institute of Traditional and Alternative Health Care (PITAHC).

17. R.A. 8504. The Philippine Aids Prevention and Control Act.

18. P.D. 825. Requires penalty for improper disposal of garbage and other forms of uncleanliness.

19. P.D. 856. The Code on Sanitation which provides the control of all factors in man’s environment that affects
health.

20. P.D. 965. Requires applicants for marriage license to receive instruction on family planning and responsible
parenthood.

21. P.D. 996. This requires the compulsory immunization of all children below 8 years of age.

22. E.O. 2009. The Family Code of the Philippines.

TOP RANK REVIEW ACADEMY, INC. Page 23 | 23