COMMUNITY HEALTH

NURSING
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
 (Mark 10:45)

Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be
served
But to serve and to give His life as a
ransom for many.
COVERAGE FOR LOCAL
BOARD EXAM : CHN
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
1. Family-based Nursing
Services(Family Health Nursing
Process)
2. Population Group-based Nursing
Services
3. Community-based Nursing
Services/Community Health
Nursing Process
4. Community Organizing
5. Public Health Programs
I. Research and Quality
Improvement

3. Research in the Community

4. National Health Situation
5. Vital Statistics
6. Epidemiology
7. Demography
I. Management of Resources
& Environment and Records
Management
2. Field Health Services And
Information System
3. Target-setting
4. Environmental Sanitation
I. Ethico-Moral-Legal
Responsibility
2. Socio-cultural values, beliefs, and
practices of individuals, families,
groups and communities
3. Code of Ethics for Government
Workers
4. WHO, DOH, LGU policies on health
5. Local Government Code
 Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance,
methods and tools
2. Strategies and methods of
updating one’s self, enhancing
competence in community health
nursing and related areas.
 HISTORY OF CHN
Date Event
1901 - Act # 157 ( Board of Health of the
Philippines) ; Act # 309 ( Provincial and Municipal
Boards of Health) were created.
1905 - Board of Health was abolished; functions
were transferred to the Bureau of Health.
1912 – Act # 2156 or Fajardo Act created the
Sanitary Divisions, the forerunners of present
MHOs; male nurses performs the functions of
doctors
1919 – Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1st Fil. Nurse supervisor
under Bureau of Health
Oct. 22, 1922 – Filipino Nurses Organization
(Philippine Nurses’ Organization) was
• 1923 – Zamboanga General Hospital School
of Nursing & Baguio General Hospital
were established; other government
schools of nursing were organized several
years after.
• 1928- 1st Nursing convention was held
• 1940 – Manila Health Department was
created.
• 1941 – Dr. Mariano Icasiano became the
first city health officer; Office of Nursing
was created through the effort of Vicenta
Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)
• Dec. 8, 1941 – Victims of World War II were
treated by the nurses of Manila.
• July 1942 – Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31
Filipino nurses in Bilibid Prison as prisoners of
war by the Japanese.
• Feb. 1946 – Number of nurses decreased from 556
– 308.
• 1948 – First training center of the Bureau of Health
was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos,
and Zenaida Nisce composed the training
staff.
• 1950 – Rural Health Demonstration and
Training Center was created.
• 1953 – The first 81 rural health units were
organized.
• 1957 – RA 1891 amended some sections of
RA 1082 and created the eight categories
of rural health unit causing an increase
in the demand for the community health
personnel.
• 1958-1965 – Division of Nursing was
abolished (RA 977) and Reorganization Act
(EO 288)
• 1961 – Annie Sand organized the National
League of Nurses of DOH.
• 1967 – Zenaida Nisce became the nursing
program supervisor and consultant on the six
special diseases (TB, leprosy, V.D., cancer,
filariasis, and mental health illness).
• 1975 – Scope of responsibility of nurses and
midwives became wider due to restructuring of
the health care delivery system.
• 1976-1986 – The need for Rural Health Practice
Program was implemented.
• 1990- 1992- Local Government Code of 1991 (RA
7160)
• 1993-1998 – Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
• Jan. 1999 – Nelia Hizon was positioned as
the nursing adviser at the Office of
Public Health Services through Department
Order # 29.
• May 24, 1999 – EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph
Estrada.
 LAWS AFFECTING
PUBLIC HEALTH AND
PRACTICE OF
COMMUNITY HEALTH
NURSING
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions
and responsibilities to the local government
both rural & urban.The Code aims to transform
local government units into self-reliant
communities and active partners in the
attainment of national goals thru’ a more
responsive and accountable local government
structure instituted thru’ a system of
decentralization. Hence, each province, city
and municipality has a LOCAL HEALTH
BOARD ( LHB ) which is mandated to propose
annual budgetary allocations for the operation
and maintenance of their own health facilities.
 Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer – vice chair
3. Chair , Committee on Health of
Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
 Composition of LHB
City and Municipal Level
2. Mayor – chair
2. MHO – vice chair
3. Chair, Committee on Health of
Sangguniang
Bayan
4. DOH rep
5. NGO rep
 EFFECTIVE LHS DEPENDS
ON:

1. the LGU’s financial capability

2. a dynamic and responsive political
leadership
3. community empowerment
R.A. 2382 – Philippine Medical Act. This act defines the
practice of medicine in the country.

R.A. 1082 – Rural Health Act. It created the 1st 81 Rural

Health Units.
-amended by RA 1891 ; more physicians,
dentists, nurses, midwives and sanitary inspectors will
live in the rural areas where they are assigned in order
to raise the health conditions of barrio people ,hence
help decrease the high incidence of preventable
diseases
R.A. 6425 – Dangerous Drugs Act. It
stipulates that the sale, administration,
delivery, distribution and transportation of
prohibited drugs is punishable by law.
R.A. 9165 – the new Dangerous Drug Act of
2002

P.D. No. 651 – requires that all health

workers shall identify and encourage the
registration of all births within 30 days
following delivery.
P.D. No. 996 – requires the compulsory
immunization of all children below 8 yrs. of
age against the 6 childhood immunizable
diseases.
P.D. No. 825 – provides penalty for improper
disposal of garbage.
R.A. 8749 – Clean Air Act of 2000
P.D. No. 856 – Code on Sanitation. It provides
for the control of all factors in man’s
environment that affect health including the
quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and
recreation facilities, noise, pollution and
R.A. 6758 – standardizes the salary of government
employees including the nursing personnel.
R.A. 6675 – Generics Act of 1988 which promotes,
requires and ensures the production of an adequate
supply, distribution, use and acceptance of drugs
and medicines identified by their generic name.
R.A. 6713 – Code of Conduct and Ethical Standards of
Public Officials and Employees. It is the policy of the
state to promote high standards of ethics in public
office. Public officials and employees shall at all
times be accountable to the people and shall
discharges their duties with utmost responsibility,
integrity, competence and loyalty, act with patriotism
and justice, lead modest lives uphold public interest
over personal interest.
R.A. 7305 – Magna Carta for Public Health
Workers. This act aims: to promote and
improve the social and economic well-being of
health workers, their living and working
conditions and terms of employment; to
develop their skills and capabilities in order that
they will be more responsive and better
equipped to deliver health projects and
programs; and to encourage those with proper
qualifications and excellent abilities to join and
remain in government service.
R.A. 8423 – created the Philippine Institute of
Traditional and Alternative Health Care.
P.D. No. 965 – requires applicants for marriage license
to receive instructions on family planning and
responsible parenthood.

P.D. NO. 79 – defines , objectives, duties and functions

of POPCOM
• RA 4073 – advocates home treatment for
leprosy

• Letter of Instruction No. 949 – legal basis

of PHC dated OCT. 19, 1979
– - promotes development of health programs
on the community level
• RA 3573 – requires reporting of all cases
of communicable diseases and
administration of prophylaxis

• Ministry Circular No. 2 of 1986 – includes

AIDS as notifiable disease
R.A. 7875 – National Health Insurance Act
R.A. 7432 – Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 – Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWD’s,
provides their rehabilitation, self-
development and self-reliance and
integration into the mainstream of society
• A. O. No. 2005-0014- National Policies
on Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr
after birth
2. Infants be exclusively breastfeed for 6
mos.
3. Infants be given timely, adequate and
safe complementary foods
4. Breastfeeding be continued up to 2 years
and beyond
• EO 51- Phil. Code of Marketing of
Breastmilk Substitutes
• R.A.- 7600 – Rooming In and
Breastfeeding Act of 1992
• R.A. 8976- Food Fortification Law
• R.A. 8980- prolmulgates a comprehensive
policy and a national system for ECCD
• A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Immunization for Infants
• R.A. 7846- mandates Compulsory
Hepatitis B Immunization among infants
and children less than 8 yrs old
• R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act
( February)
• A.O. No. 2006-0012- specifies the
Revised Implementing Rules and
Regulations of E.O. 51 or Milk Code,
Relevant International Agreements,
Penalizing Violations thereof and for other
purposes
 Public Health
• -” science and art of preventing diasease,
prolonging life, promoting health and efficiency
thru’ organized community effort for the
sanitation of the environment, control of
communicable diseases, the education of
individuals in personal hygiene, the organization
of medical and nursing services for the early
diagnosis and preventive treatment of diseases
and the development of social machinery to
ensure everyone a standard of living adequate
for the maintenance of health, so organizing
these benefits as to enable every citizen to
realize his birthright off birth and longevity” ( DR.
C.E. Winslow)
 Community Health Nursing
• - 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 Expert
Committee of Nursing )
 CHN
• - a learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of the
client’s optimum level of functioning thru’
teaching and delivery of care ( Jacobson )
• - a service rendered by a professional nurse to
IFCs, population groups in health centers,
clinics, schools , workplace for the promtion of
health, preventionof illness, care of the sick at
home and rehabilitation (DR. Ruth B. Freeman)
 Concepts
• The primary focus of community health
nursing is health promotion.
• Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life cycle.
• Knowledge on different fields (biological
and social sciences, clinical nursing, and
community health organizations) is used.
• Nursing process in community health
nursing changes based on the needs of the
community.
 Goal
• To elevate the level health of the
multitude.
Philosophy
• Worth and dignity of man.
Principles
1.The need of the community is the basis
of community health nursing.
2.The community health nurse must
understand fully the objectives and
policies of the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of
race,creed and socioeconomic status
5. The CHN works as a member of the health
team
6. There must be provision for periodic
evaluation of community health nursing
services
7. Opportunities for continuing staff
education programs for nurses must be
provided by the community health nursing
agency and the CHN as well
8. The CHN makes use of available
9. The CHN taps the already existing active
organized groups in the community
10. There must be provision for educative
supervision in community health nursing
11. There should be accurate recording and
reporting in community health nursing
12. Health teaching is the primary
responsibility of the community health nurse
 Standards in CHN
I. Theory
Applies theoretical concepts as basis for
decisions in practice
II. Data Collection
Gathers comprehensive , accurate data
systematically
 Standards
III. Diagnosis
Analyzes collected data to determine the
needs/ health problems of IFC
IV. Planning
At each level of prevention, develops plans
that specify nursing actions unique to
needs of clients
 Standards
V. Intervention
Guided by the plan, intervenes to promote,
maintain or restore health, prevent illness
and institute rehabilitation
VI. Evaluation
Evaluates responses of clients to
interventions to note progress toward goal
achievement, revise data base, diagnoses
and plan
 Standards
VII. Quality Assurance and Professional
Development
Participates in peer review and other
means of evaluation to assure quality of
nursing practice
Assumes professional development
Contributes to development of others
 Standards
VIII. Interdisciplinary Collaboration

Collaborates with other members of the

health team, professionals and community
representatives in assessing, planning,
implementing and evaluating programs for
community health
 Standards
I. Research
Indulges in research to contribute to theory
and practice in community health
nursing
LEVELS OF CARE/ PREVENTION
• 1. PRIMARY

• 2. SECONDARY

• 3. TERTIARY
 Types of Clientele
• 1. INDIVIDUALS
• 2. FAMILIES
• 3. COMMUNITIES
• 4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark,
1995:5) e.g. children . elderly, women, workers
etc.
 Phil.Health Care Delivery
System
• 1.PRIMARY LEVEL FACILITIES

• 2. SECONDARY LEVEL FACILITIES

• 3. TERTIARY LEVEL FACILITIES

 Classify as to what level the ff.
belong
• 1. Teaching and Training Hospitals
• 2. City Health Services
• 3. Emergency and District Hospitals
• 4. Private Practitioners
• 5. Heart Institutes
• 6. Puericulture Centers
• 7. RHU
 THE DEPARTMENT OF
HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality
of health care to improve the quality of
life of all Filipinos, especially the poor.
 NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality of
life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism,
Sexually Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries & Periodontal
Diseases, Cardiovascular Diseases, Cancer,
Diabetes, Asthma & Chronic Obstructive Pulmonary
Diseases, Nephritis & Chronic Kidney Diseases,
Mental Disorders, Protein Energy Malnutrition, Iron
Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health
problems:
• Schistosomiasis
• Malaria
• Filariasis
• Leprosy
• Rabies
• Measles
• Tetanus
• Diphtheria & Pertussis
• Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet
& nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life &
prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
special populations through child, adolescent
& youth, adult health, women’s health, health
of older persons, health of indigenous people,
health of migrant workers and health of
different disabled persons and of the rural &
urban poor.
7. Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces,
establishments and communities towns
and cities.
 Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection
to degenerative diseases must be
managed.
4. The performance of the health sector
must be enhanced.
 Primary Strategies to Achieve
Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system
development.
5. Support for frontline health workers.
PHC as a Strategy
 PRIMARY HEALTH CARE (PHC)

• May 1977 -30th World Health Assembly

decided that the main health target of the
government and WHO is the attainment of a
level of health that would permit them to
lead a socially and economically productive
life by the year 2000.
• September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia
(USSR) The Alma Ata Declaration stated that
PHC was the key to attain the “health for all”
goal
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by
Pres. Ferdinand E. Marcos,
which adopted PHC as an approach towards
the design, development and implementation of
programs focusing on health development at
community level.
☛ RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

• Magnitude of Health Problems

• Inadequate and unequal distribution of
health resources
• Increasing cost of medical care
• Isolation of health care activities from
other development activities
 ☛DEFINITION OF PRIMARY HEALTH CARE
 essential health care made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at cost that
the community can afford at every stage of
development.
a practical approach to making health benefits
within the reach of all people.
an approach to health development, which is
carried out through a set of activities and
whose ultimate aim is the continuous
improvement and maintenance of health status
 GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year
2000 AND HEALTH IN THE HANDS OF THE
PEOPLE by the year 2020.

An improved state of health and quality of life for

all people attained through SELF-RELIANCE.
 KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people -
permeate as the core strategy in the effective
provision of essential health services that are
community based, accessible, acceptable, and
sustainable, at a cost, which the community and the
government can afford.
 OBJECTIVES OF PRIMARY HEALTH CARE
∀ • Improvement in the level of health care of the community
∀ • Favorable population growth structure
∀ • Reduction in the prevalence of preventable, communicable
and other disease.
∀ • Reduction in morbidity and mortality rates especially among
infants and children.
∀ • Extension of essential health services with priority given to the
underserved sectors.
∀ • Improvement in Basic Sanitation
∀ • Development of the capability of the community aimed at self-
reliance.
∀ • Maximizing the contribution of the other sectors for the social
and economic development of the community.
MISSION:
• To strengthen the health care system by
increasing opportunities and supporting
the conditions wherein people will
manage their own health care.
TWO LEVELS OF PRIMARY HEALTH CARE
WORKERS
3. Barangay Health Workers - trained community
health workers or health auxiliary volunteers or
traditional birth attendants or healers.
4. Intermediate level health workers include the Public
Health Nurse, Rural Sanitary Inspector and
midwives.
 PRINCIPLES OF PRIMARY HEALTH CARE
∀1. 4 A's = Accessibility, Availability,
Affordability & Acceptability,
Appropriateness of health services. The
health services should be present where
the supposed recipients are. They should
make use of the available resources within
the community, wherein the focus would be
more on health promotion and prevention
of illness.
∀2. COMMUNITY PARTICIPATION
=heart and soul of PHC
• 3. People are the center, object and subject
of development.
• Thus, the success of any undertaking that aims at
serving the people is dependent on people’s
participation at all levels of decision-making; planning,
implementing, monitoring and evaluating. Any
undertaking must also be based on the people’s
needs and problems (PCF, 1990)
• Part of the people’s participation is the partnership
between the community and the agencies found in the
community; social mobilization and decentralization.
• In general, health work should start from where the
people are and building on what they have. Example:
Scheduling of Barangay Health Workers in the health
center
BARRIERS OF COMMUNITY INVOLVEMENT

• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community
people
• Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community
and the health agencies in the
provision of quality of life.
Providing linkages between the
government and the non-
government organization and people’s
organization.
 6. Recognition of interrelationship
between the health and development
HEALTH
• is not merely the absence of disease. Neither it is only
a state of physical and mental well-being. Health
being a social phenomenon recognizes the interplay of
political, socio-cultural and economic factors as its
determinant. Good Health therefore, is manifested by
the progressive improvements in the living conditions
and quality of life enjoyed by the community residents
(PCF, DEVELOPMENT is the quest for an improved
quality of life for all. Development is multi-
dimensional. It has a political, social, cultural,
institutional and environmental dimensions(Gonzales
1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
 7. SOCIAL MOBILIZATION
It enhances people participation or
governance, support system provided by
the Government, networking and
developing secondary leaders.

8. DECENTRALIZATION
 MAJOR STRATEGIES OF PRIMARY HEALTH
CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE
AND SUSTAINED NATIONAL EFFORTS.
• Attaining Health for all Filipino will require
expanding participation in health and health related
programs whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is really the desired
outcome.
• Advocacy must be directed to National and Local
policy making to elicit support and commitment to
major health concerns through legislations, budgetary
and logistical considerations.
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED HEALTH CARE

The health in the hands of the

people brings the government
closest to the people. It
necessitates a process of capacity
building of communities and
organization to plan, implement and
evaluate health programs at their
levels.
 C. INCREASING EFFICIENCIES IN THE
HEALTH SECTOR
• Using appropriate technology will make
services and resources required for their
delivery, effective, affordable, accessible and
culturally acceptable. The development of
human resources must correspond to the
actual needs of the nation and the policies it
upholds such as PHC. The DOH will continue
to support and assist both public and private
institutions particularly in faculty development,
enhancement of relevant curricula and
development of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL
HEALTH RESEARCH
Essential National Health
Research (ENHR) is an integrated
strategy for organizing and
managing research using
intersectoral, multi-disciplinary and
scientific approach to health
programming and delivery.
• FOUR CORNERSTONES/ PILLARS IN
PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
 HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH

Name Indications Dosage

1.Five-leaf 1. Asthma •Divide the decoction
Chaste tree 2. Cough into 3 parts:
(Lagundi) 3. Body Pain For asthma and
4. Fever cough, drink 1 part 3
times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh-Mint; 1. Body pain •Divide
Peppermint decoction into
(Yerba 2 parts and
Buena) drink 1 part
every 3 hours.

3. Sambong 1. Swelling •Divide

2. Inducing decoction into
diuresis 3 parts and
( anti- drink 1 part 3
times a day.
urolithiasis)
4. Tsaang 1. Stomachache •Drink the warm
Gubat decoction. If it
persists, or if there is
no improvement an
hour after drinking the
decoction, consult a
doctor.
5. 1. Gouty Arthritis •Divide the
Ulasimang decoction into 3
Bato/Pansit- parts and drink 1
Pansitan part 3 times a day
after meals.
6. Garlic 1. Hypertension •Eat 6 cloves of
2. Htperlipidemia garlic together
with meals
7. Niyog- 1. Ascariasis •Chew and swallow
only dried seeds 2
Niyogan hours after dinner
according to the
following:
• ADULTS = 8-10
seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
8. Guava 1. Cleaning •For wound cleaning,
wounds use decoction for
2. Mouth wash washing the wound 2
for mouth times a day
infection, •For tooth decay and
sore gums & swelling of gums,
tooth decay gargle with warm
decoction 3 times a day
9.  Ring worm •Apply the juice on the affected
Akapulko  Athlete’s area 1 to 2 times a day
foot •If the person develops an allergy
 Scabies while using the above preparation,
prepare the following:
oPut 1 cup of chopped fresh leaves
in an earthen jar. Pour in 2 glasses
of water and cover it.
oBoil the mixture until the 2
glasses of water originally poured
have been reduced to 1 glass of
water
oStrain the mixture. Use it while it
is warm.
oApply the warm decoction on the
affected area 1 to 2 times a day.
10. 1. Mild Non- •Drink ½ cup
Bitter Gourd/ Insulin of cooled or
Melon Depende warm
(Ampalaya) nt decoction 3
Diabetes times a day
Mellitus after meals.
11. 1. Motion •An abortifacient if taken
Ginger sickness, in large amounts; should
(Zingiber sore throat, not be used by persons
officinale) nausea & with cholelithiasis unless
vomiting, directed by the physician;
migraine may increase the risk of
headaches, bleeding when used
arthritis concurrently with
anticoagulants &
antiplatelets.
•Chop and Mash a piece of
ginger root, and mix in a glass
of water
•Boil the mixture
•Drink the cooled or warm
decoction as needed.
ELEMENTS OF PRIMARY HEALTH
CARE:
Education For Health
Is one of the potent methodologies
for information dissemination. It
promotes the partnership of both the
family members and health workers in
the promotion of health as well as
prevention of illness.
Locally Endemic Disease
Control
The control of endemic disease
focuses on the prevention of its
occurrence to reduce morbidity
rate. Example Malaria Control
and Schistosomiasis Control
 Expanded Program on
Immunization
This program exists to control the
occurrence of preventable illnesses
especially of children below 6 years
old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and
other preventable disease are given
for free by the government and
ongoing program of the DOH
 Maternal and Child Health and
Family Planning
The mother and child are the most
delicate members of the community.
So the protection of the mother and
child to illness and other risks would
ensure good health for the
community. The goal of Family
Planning includes spacing of children
and responsible parenthood.
 Environmental Sanitation and
Promotion of Safe Water Supply
Environmental Sanitation is defined as the
study of all factors in the man’s environment,
which exercise or may exercise deleterious
effect on his well-being and survival.
Water is a basic need for life and one factor in
man’s environment. Water is necessary for
the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for
basic promotion of health.
Nutrition and Promotion of Adequate
Food Supply
One basic need of the family is food. And
if food is properly prepared then one may
be assured healthy family. There are
many food resources found in the
communities but because of faulty
preparation and lack of knowledge
regarding proper food planning,
Malnutrition is one of the problems that we
have in the country.
 Treatment of Communicable
Diseases and Common Illness
The diseases spread through direct
contact pose a great risk to those who can
be infected. Tuberculosis is one of the
communicable diseases continuously
occupies the top ten causes of death. Most
communicable diseases are also
preventable. The Government focuses on
the prevention, control and treatment of
these illnesses.
 Supply of Essential Drugs
This focuses on the information campaign on the utilization and
acquisition of drugs.
In response to this campaign, the GENERIC ACT of the
Philippines is enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
 FAMILY HEALTH NURSING
• - that level of CHN practice directed to
the FAMILY as the unit of care with
HEALTH as the goal and NURSING as
the medium, channel or provider of care
 Family Case Load
• - the no. and kind of families a nurse
handles at any given time
• - variable for cases are added or dropped
based on the need for nursing care and
supervision
 Types of Families
• 1. Nuclear
• 2. Extended
• 3. Three generational
• 4. Dyad
• 5. Single- Parent
• 6. Step- Parent
• 7. Blended or reconstituted
 Types of Families
• 8. Single adult living alone
• 9. Cohabiting/ Living –in
• 10. No- kin
• 11. Compound
• 12. Gay
• 14. Commune
 Stages of Family Life Cycle
• 1. Newly married couple
• 2. Childbearing
• 3. Preschool age
• 4. Schoolage
• 5. Teenage
• 6. Launching
• 7. Middle-aged ( empty nest –retirement)
• 8. Period from retirement to Death of both
spouses
HEALTH TASKS OF THE FAMILY(
Freeman, 1981)
• 1. recognizing interruptions of health or
development
• 2. seeking health care
• 3. managing health and non-health crises
• 4. providing nursing care to the sick, disabled
and dependent member of the family
• 5. maintaining a home environment conducive to
good health and personal development
• 6. maintaining a reciprocal relationship with the
community and health institutions
 Family Nursing Problem
• Arises when the family cannot effectively
perform its health tasks
Nurse’s Roles in Family Health
Nursing
• 1. HEALTH MONITOR
• 2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
• 3. COORDINATOR OF FAMILY
SERVICES
• 4. FACILITATOR
• 5. TEACHER
• 6. COUNSELOR
 INITIAL DATA BASE FOR FAMILY
NURSING PRACTICE
• Family structure, Characteristics, and
Dynamics
2. Members of the household and relationship
to the head of the family
3. Demographic data – age, sex, civil status,
position in the family
4. Place of residence of each member –
whether living with the family or elsewhere
4. Type of family structure – e.g.
matriarchal or patriarchal, nuclear or
extended
2. Dominant family members in terms of
decision-making, especially in matters
of health care
3. General family relationship/dynamics –
presence of any readily observable
conflict between members;
characteristics communication patterns
among members
 • Socio-economic and Cultural
Characteristics
2. Income and Expenses
– Occupation, place of work and income of
each working members
– Adequacy to meet basic necessities
– Who makes decisions about money and
how it is spent
3. Educational attainment of each other
4. Ethnic background and religious
affiliation
1. Significant Others – role(s)
they play in family’s life
2. Relationship of the family to
larger community – Nature
and extent of participation of
the family in community
activities
 • Home and Environment
2. Housing
– Adequacy of living peace
– Sleeping arrangement
– Presence of breeding or resting sites of
vectors of diseases
– Presence of accidents hazards
– Food storage and cooking facilities
– Water supply – source, ownership, portability
– Toilet facility – type, ownership, sanitary
condition
– Drainage system – type, sanitary condition
1. Kind of neighborhood, e.g.
congested, slum, etc.
2. Social and health facilities
available
3. Communication and
transportation facilities
available
• Health Status of each Family Member
2. Medical and nursing history indicating
current or past significant illnesses or
beliefs and practices conducive to health
illness
3. Nutritional assessment
– Anthropometric data: Measures of nutritional
status of children, weight, height, mid-upper
arm circumference: Risk assessment
measures of obesity: body mass index, waist
circumference, waist hip ratio
– Dietary history specifying quality and quantity
of food/nutrient intake per day
– Eating/ feeding habits/ practices
3. Developmental assessments of infants,
toddlers, and preschoolers – e.g., Metro
Manila
4. Risk factor assessment indicating presence
of major and contributing modifiable risk
factors for specific lifestyles, cigarette
smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking and other substance
abuse
5. Physical assessment
indicating presence of illness
state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
 • Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.
Examples include:
3. Immunization status of family members
4. Healthy lifestyle practices. Specify.
5. Adequacy of:
– rest and sleep
– exercise
– use of protective measures- e.g. adequate
footwear in parasite-infested areas;
– relaxation and other stress management
activities
6. Use of promotive-preventive health
services
 A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
FIRST-LEVEL ASSESSMENT
 Presence of Wellness Condition – stated as
Potential or Readiness- a clinical or nursing
judgment about a client in transition from a
specific level of wellness or capability to a
higher level. Wellness potential is a nursing
judgment on wellness state or condition based
on client’s performance, current competencies
or clinical data but no explicit expression of
client desire. Readiness for enhanced
wellness state is a nursing judgment on
wellness state or condition based on client’s
current competencies or performance, clinical
data explicit expression of desire to achieve a
higher level of state or function in specific area
on health promotion and maintenance.
• Examples of these are the following:
1. Potential for Enhanced Capability for:
 Healthy lifestyle – e.g. nutrition/diet,
exercise/ activity
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being – process of a client’s
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
 Others,
1. Readiness for Enhanced Capability
for:
 Healthy Lifestyle
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being
 Others,
I. Presence of Health Threats –
conditions that are conducive to
disease, accident or failure top
realize one’s health potential.
Examples of these are the following:
3. Family history of hereditary
condition, e.g. diabetes
4. Threat of cross infection from a
communicable disease case
1. Family size beyond what family
resources can adequately
provide
2. Accidental hazards
 Broken stairs
 Sharp objects, poison, and
medicines improperly kept
 Fire hazards
1. Faulty nutritional habits or
feeding practices.
Inadequate food intake both in
quality & quantity
Excessive intake of certain
nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
1. Stress-provoking factors –
Strained marital relationship
Strained parent-sibling
relationship
Interpersonal conflicts
between family members
Care-giving burden
1. Poor home condition-
 Inadequate living  Unsanitary
space waste disposal
 Lack of food storage  Improper
facilities drainage
 Polluted water supply system
 Presence of breeding  Poor ventilation
sites of vectors of  Noise pollution
disease
 Air pollution
 Improper garbage
1. Unsanitary food handling and preparation
2. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
1. Inherent personal characteristics – e.g.
poor impulse control
2. Health history which induce the
occurrence of a health deficit, e.g.
previous history of difficult labor
3. Inappropriate role assumption – e.g.
child assuming mother's role, father
not assuming his role
4. Lack of immunization/ inadequate
immunization status specially of
children
1. Family disunity –
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
2. Other
I. Presence of Health Deficits –
instances of failure in health
maintenance.
Examples include:
3. Illness states, regardless of whether
it is diagnosed or by medical
practitioner
4. Failure to thrive/ develop according
to normal rate
5. Disability – whether congenital or
arising from illness; temporary
I. Presence of stress Points/ Foreseeable Crisis
Situations – anticipated periods of unusual
demand of the individual or family in terms of
family resources.
Examples of these include:
 Marriage 9. Menopause
 Pregnancy 10. Loss of job
 Parenthood 11. Hospitalization of a
 Additional member family member
 Abortion 12. Death of a manner
 Entrance at school 13. Resettlement
in a
 Adolescence new community
 Divorce 14. illegitimacy
 Second Level Assessment
• Focus on determining family’s capacity to perform the
health tasks
• Statements on family health nursing problem:
c. Inability to recognize the presence of the condition or
problem
d. Inability to make decisions with respect to taking
appropriate health action
e. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the
family
f. Inability to provide a home environment conducive to
health maintenance or personal development
g. Failure to utilize community resources for health care
 Scale for Ranking Health
Conditions and Problems according
to priorities
• Criteria:
b. Nature of the condition or problem presented
( wellness state, health deficit, health threat,
forseeable crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not
immediate, not perceived as a problem)
 COMMUNITY HEALTH CARE
PROCESS
• Assessment
Purpose : To identify the health needs of the people
• Planning of nursing actions
Purpose : To act on the determined needs of the
community people
• Implementation
Purpose : To achieve the optimum level of health of
the community people
• Evaluation
Purpose : To determine the effectiveness of health care
programs
 NURSING PROCEDURES
• CLINIC VISIT
- process of checking the client’s health
condition in a medical clinic
• HOME VISIT
- a professional face to face contact made by
the nurse with a patient or the family to
provide necessary health care activities
and to further attain the objectives of the
agency
• BAG TECHNIQUE
-a tool making of the public health bag
through which the nurse during the home
visit can perform nursing procedures with
ease and deftness saving time and effort
• THERMOMETER TECHNIQUE
-to assess the client’s health condition
through body temperature reading
• NURSING CARE IN THE HOME
- giving to the individual patient the nursing
care required by his/her specific illness or
trauma to help him/her reach a level of
functioning at which he/she can maintain
himself/herself or die peacefully in dignity
• ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client
with communicable disease to prevent the
spread of infection:
2. frequent washing and airing of beddings
and other articles and disinfections of room
3. wearing a protective gown , to be used only
within the room of the sick member
4. discarding properly all nasal and throat
discharges of any member sick with
communicable disease
5. burning all soiled articles if could be or
contaminated articles be boiled first in
water 30 minutes before laundering
• INTRAVENOUS THERAPY
- insertion of a needle or catheter into a
vein to provide medication and fluids
based on physician’s written prescription
- can be done only by nurses accredited by
ANSAP
 PRINCIPLES OF HEALTH
EDUCATION
• It considers the health status of the
people, which is determined by the
economic and social conscience of the
country.
• It is a process whereby people learn to
improve their personal habits and
attitudes, to work responsibly for the
improvement of health conditions of the
family, community, and nation.
• It involves motivation, experience,
and change in conduct and thinking,
while stimulating active interest. It
develops and provides experience
for change in people’s attitudes,
customs, and habits in relation to
health and everyday living.
• It should be recognized as the basic
function of all health workers.
• It takes place in the home, in the
school, and in the community.
• It is a cooperative effort requiring
all categories of health
personnel to work together in
close teamwork with families,
groups, and the community.
• It meets the needs, interests,
and problems of the people
affected.
• It finds means and ways of
carrying out plans by
encouraging individual and
community participation.
• It is a slow, continuous
process that involves
constant changes and
revisions until objectives are
achieved.
• Makes use of supplementary
aids and devices to help with
the verbal instructions.
• It utilizes community resources by
careful evaluation of the different
services and resources found in the
community.
• It is a creative process requiring
methods and techniques with
various characteristics, not following
a rigid and flexible pattern.
• It aims to help people make use of
their own efforts and education to
improve their conditions of living,
• It makes careful evaluation of the
planning, organization, and
implementation of all health
education programs and activities.
 THE COMMUNITY HEALTH
NURSE
• Qualifications
2.Bachelor of Science in
Nursing
3.Registered Nurse of the
Philippines
• Planner/Programmer
2. Identifies needs, priorities, and problems of
individuals, families, and communities
3. Formulates municipal health plan in the absence
of a medical doctor
4. Interprets and implements nursing plan, program
policies, memoranda, and circular for the
concerned staff personnel
5. Provides technical assistance to rural health
midwives in health matters
• Provider of Nursing
Care
2. Provides direct nursing care to sick or
disabled in the home, clinic, school, or
workplace
3. Develops the family’s capability to take
care of the sick, disabled, or
dependent member
• Manager/Supervisor
2. Formulates individual, family, group, and
community-centered plan
3. Interprets and implements programs,
policies, memoranda, and circulars
4. Organizes work force, resources,
equipments, and supplies at local level
5. Provides technical and administrative
support to Rural Health Midwives (RHM)
6. Conducts regular supervisory visits and
meetings to different RHMs and gives
feedback on accomplishments
• Community Organizer
2. Motivates and enhances
community participation in
terms of planning, organizing,
implementing, and evaluating
health services
3. Initiates and participates in
community development
activities
• Coordinator of Services
2. Coordinates with individuals,
families, and groups for health
related services provided by
various members of the health
team
3. Coordinates nursing program with
other health programs like
environmental sanitation, health
education, dental health, and
• Trainer/Health Educator
2. Identifies and interprets training needs
of the RHMs, Barangay Health Workers
(BHW), and hilots
3. Conducts training for RHMs and hilots
on promotion and disease prevention
4. Conducts pre and post-consultation
conferences for clinic clients; acts as a
resource speaker on health and health-
related services
5. Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
education purposes
6. Conducts pre-marital counseling
• Health Monitor
2. Detects deviation from health
of individuals, families,
groups, and communities
through contacts/visits with
them
• Role Model
2.Provides good
example of healthful
living to the
members of the
community
• Change Agent
2. Motivates changes in health
behavior in individuals,
families, groups, and
communities that also
include lifestyle in order to
promote and maintain health
• Recorder/Reporter/Statistician
 Prepares and submits required
reports and records
 Maintain adequate, accurate, and
complete recording and reporting
 Reviews, validates, consolidates,
analyzes, and interprets all records
and reports
 Prepares statistical data/chart and
other data presentation
• Researcher
2. Participates in the conduct of
survey studies and researches on
nursing and health-related
subjects
3. Coordinates with government and
non-government organization in
the implementation of
studies/research
 Community Organizing
• Approaches to community devt.:
b. Welfare approach
c. Technological approach
d. Transformatory approah
 Community Organizing
• Principles of CO:
• 1. People esp. the oppressed, exploited
and deprived sectors are most open to
change, have the capacity to change and
are able to bring about change. Hence ,
CO is based on the ff:
• A. Power must reside in the people
• B. Devt. is from the people to the people
• C. People participation
 Principles of CO
• 2.-must be based on the poorest sectors
of society. The solutions of problems
commonly shared by these sectors must
be focused on collective organizations,
planning and action
• 3. – should lead to self-reliant
communities
THE HRDP-COPAR PROCESS
• 1. PRE-ENTRY PHASE
• 2. ENNTRY PHASE
• 3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
• 4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
• 5. COMMUNITY ACTION PHASE
• 6. SUSTENANCE AND
STRENGTHENING PHASE
 Classify the ff. CO activities as to
phase of COPAR each belong:
• 1.Conducts community meetings to draw up
guidelines for the organization of CHO
• 2. Trains BHWs
• 3. Sets up of linkages/network and referral
systems
• 4. PIME of health services and or community
devt. Projects
• 5. Provides continuing education to leaders or
residents
• 6. Trains secondary leaders
• 7. Selects site for adoption
• 8. Identifies key leaders
 Continued….
• 9. Develops criteria for site selection
• 10. Forms the core group
• 11.Conducts SALT
• 12.Selects members of the research team
• 13. Assists the research team in presenting
results during the general assembly
• 14. Helps the people identifying the community
needs and health problems
• 15. Facilitates for the formulation and ratification
of the constitution and by-laws of the
organization
Public Health Programs
COMPREHENSIVE MATERNAL
AND CHILD HEALTH
PROGRAM
 EPI (Expanded Program on
Immunization)
 CDD (Control of Diarrheal
Diseases)
 CARI (Control of Acute
Respiratory Infections)
 UFC (Under-Five Clinics)
 MC (Maternal Care)
 BF (Breastfeeding)
 MRP (Malnutrition Rehabilitation
Program)
 VAD ( Vitamin A Deficiency)
 IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency
Anemia)
 FP (Family Planning)
 EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
• TARGET SETTING:
 INFANTS 0-12 MONTHS
 PREGNANT AND POST PARTUM WOMEN
 SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS
OLD

• OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
• ELEMENTS OF EPI:
 TARGET SETTING
 COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
maintained under proper environmental
condition until the time of administration.
 IEC
 Assessment and evaluation of Over-all
performance of the program
 Surveillance and research studies
 EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Numbe Minimum Reason
Age of 1st r of Interval
Dose Doses Between
Doses
 BCG Birth or 1 BCG is given
(Bacillus at the earliest
anytime possible age
Calmette after protects
Guerin)
birth against the
possibility of
School TB infection
entrants from the other
family
members
 2. DPT 6 weeks 4 weeks An early start with
(Diphtheria 3 DPT reduces the
Pertusis
Tetanus)
chance of severe
pertussis

3. OPV 6 weeks 4 weeks The extent of

(Oral Polio 3 protection against
Vaccine)
polio is increased
the earlier OPV is
given.
4. 6 weeks 4 weeks An early start of
Hepatitis B 3 Hepatitis B reduces
the chance of being
infected and becoming
a carrier.
5. Measles 9 months At least 85% of measles
1 can be prevented by
immunization at this age.
 CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
DIARRHEA

A. NO DEHYDRATION
• Condition – well, alert
• Mouth and Tongue – moist
• Eyes – normal
• Thirst – drinks normally, not thirsty
• Tears – present
• Skin pinch – goes back quickly
• TREATMENT PLAN A- HOME TTT.
 THREE RULES FOR HOME
TREATMENT
1.Give the child more fluids than
usual
• use home fluid such as cereal gruel
• give ORESOL, plain water
2. Give the child plenty of food to prevent
undernutrition
• continue to breastfeed frequently
• if child is not breastfeed, give usual milk
• if child is less than 6 months and not yet
taking solid food, dilute milk for 2 days
• if child is 6 months or older and already
taking solid food, give cereal or other starchy
food mixed with vegetables, meat or fish; give
fresh fruit juice or mashed banana to provide
potassium; feed child at least 6 times a day.
After diarrhea stops, give an extra meal each
day for two weeks.
3. Take the child to the health worker
if the child does not get better in 3
days or develops any of the following:
• many watery stools
• repeated vomiting
• marked thirst
• eating or drinking poorly
• fever
• blood in the stool
 ORESOL TREATMENT
Age Amount of Amount of ORS to
ORS to give provide for use at
after each home
loose stool
< 50-100 500 ml./day
24 ml.
months
2– 100-200 1000 ml./day
10 ml.
years
10 As much as 2000 ml./day
years wanted
up
B. SOME DEHYDRATION
• Condition – restless, irritable
• Mouth and Tongue – dry
• Eyes – sunken
• Thirst – thirsty, drinks eagerly
• Tears – absent
• Skin pinch – goes back slowly
• WEIGH PT, TTT. PLAN B
 APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS
AGE WEIGHT ORS
KG ML
4 MOS. 5 200-400

4-11MOS 5-7.9 400-600

12-23MOS 8-10.9 600-800

2-4YRS 11-15.9 800-1200

5-14YRS 16-29.9 1200-2200

15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed,
give 100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then continue
giving ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS , give
plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be
used for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition – lethargic or unconscious; floppy
Eyes – very sunken and dry
Tears – absent
Mouth and tongue – very dry
Thirst- drinks poorly or not able to drink
Skin pinch – goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal
Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
 ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM

1. Two problems in CDD

• 1. High child mortality due to
diarrhea
• 2. High diarrhea incidence
among under fives
 Highest incidence in age 6 – 23
months

 Highest mortality in the first 2 years of

life

 Main causes of death in diarrhea :

– DEHYDRATION
– MALNUTRITION
1. To prevent dehydration, give home fluids
“am” as soon as diarrhea starts and if
dehydration is present, rehydrate early,
correctly and effectively by giving ORS

3. For undernutrition, continue feeding

during diarrhea especially breastfeeding.
 Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
1. Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed
infants.
2. Advantages of breastfeeding in relation
to CDD
1.Breast milk is sterile
2.Presence of antibodies protection
against diarrhea
3.Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
1. Breastfeeding decreases incidence
rate by 8-20% and mortality by 24-
27% in infants under 6 months of
age.
2. When to wean?
4-6 months – soft mashed foods 2x a
day
6 months – variety of foods 4x a day
1. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest
source
- protecting water from contamination at the
source and in the home
 3.Good personal and domestic
hygiene
- handwashing
- use of latrines
- proper disposal of stools of young
children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12
mos. – less than 50 per minute; 12 mos. – 5
years – less than 40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for
assessment
2. Assess and treat ear problems/sore throat if
present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
3. Feed the child during illness
4. Increase feeding after illness
5. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
2. offer the child extra to drink
3. Increase breastfeeding
3. SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A
SAFE REMEDY
4. WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY
OCCUR
2. Breathing becomes difficult
3. Breathing becomes fast
4. Child is not able to drink
5. Child becomes sicker
B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min
or more ; 2-12 mos. – 50/min or more; 12
mos. – 5 years – 40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the child’s condition gets worst,refer
urgently to hospital; if improving, finish 5 days
of antibiotic.
ANTIBIOTICS RECOMMENDED BY
WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
 C. Severe Pneumonia
• Chest indrawing
• Nasal flaring
• Grunting ( short sounds made with the
voice)
• Cyanosis
TTT.
6. Refer urgently to hospital
7. Treat fever ( paracetamol), wheezing
( salbutamol)
 D. Very Severe Disease

•Not able to drink

•Convulsions
•Abnormally sleepy or difficult to wake
•Stridor in calm child
•Severe undernutrition
TTT.
Refer urgently to hospital
 ASSESSMENT OF RESPIRATORY
INFECTION
ASK THE MOTHER:
2. How old is the child?
3. Is the child coughing? For how long?
4. Age 2 months up to 5 years: Is the child able
to drink?
Age less than 2 months: Has the young infant
stopped feeding well?
6. Has the child had fever? For how long?
7. Has the child had convulsions?
• LOOK, LISTEN:
1. Count the breaths in one minute.
Age0 Fast Breathing
Less than 2 months 60/minute or more
2 months – 12 months 50/minute or more
12 months – 5 years 40/minute or more

2.Look for chest in drawing.

3.Look and listen for stridor.
Stridor occurs when there is a narrowing of the
larynx, trachea or epiglottis which interferes
with air entering the lungs.
4. Look and listen for wheeze
Wheeze is a soft musical noise
which shows signs that breathing
out(exhale) is difficult.
5. See if the child is abnormally sleepy
or difficult to wake. (Suspect
meningitis)
6. Feel for fever or low body
temperature.
7. Check for severe under nutrition
 MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS – tender swelling behind the
ear (in infants, swelling may be above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION – pus draining
from the ear for less than 2 weeks, ear
pain, red, immobile ear drum (Acute Otitis
Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or
Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION – pus draining from
the ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the
ear dry by wicking.
Paracetamol maybe given for pain or high fever.
Precautions for a child with a draining ear:
 Do not leave anything in the ear such as cotton,
wool between wicking treatments.
 Do not put oil or any other fluid into the ear.
 Do not let the child go swimming or get water in
the ear.
Maternal and Child Health
Nursing
Philosophy
• Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
• Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
• MCN is FAMILY CENTERED- the father is as
important as the mother
• Goals
• To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear
healthy children

• That every child lives and grows up in a

family unit with love and security, in healthy
surroundings, receives adequate
nourishment, health supervision and efficient
medical attention and is taught the elements
of healthy living
 Classification of pregnant
women
• Normal – healthy pregnancy
• With mild complications- frequent home
visits
• With serious or potentially serious cx –
referred to most skilled source of medical
and hospital care
 Home Based Mother’s Record
( HBMR )

• Tool used when rendering prenatal care

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

• 1. any type of vaginal bleeding

• 2. headache, dizziness, blurred vision
• 3. puffiness of face and hands
• 4. pallor
 Prenatal Care
• Schedule of Visits
• 1st – as early as pregnancy, 1st trimester

• 2nd - 2nd trimester

• 3rd & subsequent visits - 3rd trimester

• More frequent visits for those at risk with cx

 TETANUS TOXOID IMMUNIZATION
SCHEDULE FOR WOMEN

Vaccin Minimum Age Percent Duration of

e Interval Protecte Protection
d
As early as possible
TT1 during pregnancy 80%
TT2 At least 4 Infants born to
weeks later the mother will be
80%
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
 At least 6 Infants born to the
TT3 months 90%
later mother will be protected
from neonatal
tetanus.
Gives 5 years protection
for the mother.
TT4 At least 1 99% Gives 10
year later protection
for the
mother
TT5 At least 1 year 99% Gives
later lifetime
protection for
the mother.
All infants
born to that
mother
will be
protected.
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
 Components of Prenatal Visits
• History – taking
• Determination of obstetrical score- G, P,
TPAL,AOG,EDD
• U/A for Proteinuria, glycosuria and infxtn
• Dental exam
• Wt. Ht. BP taking
• Exam of conjunctiva and palms for pallor
• Abdominal exam - fundic ht, Leopold’s
maneuver and FHT
• Exam of breasts, face, hands and feet for
edema and neck for thyroid enlargement
• Health teachings- nutrition, personal hygiene,
common complaints
• Tetanus toxoid immunization
• Iron supplementation – from 5th mo. of
pregnancy - 2 mos. Postpartum
• In goiter endemic areas – iodized capsule once
a year
• In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk for the
whole duration of pregnancy
 • UNDER FIVE CLINIC

The first five years of life form the

foundations of the child’s physical and mental
growth and development. Studies have shown
the mortality and morbidity are high among this
age group. The Department of Health
established the Under Five Clinic Program to
address this problem.
• PROGRAM OBJECTIVES AND GOALS:

•Monitor growth and development of the

child until 5 years of age.

•Identify factors that may hinder the growth

and development of the child.
• ACTIVITIES AND STRATEGIES:
1. Regular height and weight determination/
monitoring until 5 years old.
0-1 year old=monthly
1 year old and above =quarterly
2. Recording of immunization, vitamins
supplementation,
deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts,
toys) that promote and enhance child’s proper
growth and development.
4. Provision of a safe and learning – oriented
environment for the child.
5. Monitoring and Evaluation.
• BREASTFEEDING/ LACTATION MANAGEMENT
EDUCATION TRAINING
Breastfeeding practices has been proved to be
very beneficial to both mother and baby thus the
creation of the following laws support the full
implementation of this program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of 1992
• PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of
breastfeeding and lactation
management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM

A. EO 51 THE MILK CODE – protection and

promotion of breastfeeding to ensure the safe
and adequate nutrition of infants through
regulation of marketing of infant foods and
related products. (e.g. breast milk
substitutes, infant formulas, feeding bottles,
teats etc. )
B. RA 7600 THE ROOMING –IN and
BREASTFEEDING ACT of 1992
=An act providing incentives to government
and private health institutions promoting and
practicing rooming-in and breast-feeding.
=Provision for human milk bank.
=Information, education and re-education drive
=Sanction and Regulation
2. CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:

MOTHER
∀• Oxytocin help the uterus contracts
∀• Uterine involution
∀• Reduce incidence of Breast Cancer
∀• Promote Maternal-Infant Bonding
∀• Form of Family planning Method
(Lactational Amenorrhea)
BABY
∀ • Provides Antibodies
∀ • Contains Lactoferin (binds with
Iron)
∀ • Leukocytes
∀• Contains Bifidus factor-
promotes growth of the Lactobacillus-
inhibits the growth of pathogenic
bacilli
• POSITIONS IN BF THE BABY:
• 1. Cradle Hold = head and neck are supported
• 2. Football Hold
• 3. Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
• GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week long
delivery of a package of health services to children
between the ages of 0-59 months old with the purpose
of reducing morbidity and mortality among under fives
through the promotion of positive Filipino values for
proper child growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED

IN GP AND WHO ARE THE TARGETS?
GP offers the following:
1.1 Routine Health Services:
 Health Dosage Route of Target
Service Administr Population
ation
Vitamin A 200,000 IU Orally by 12-59
capsule or 1 capsule drops months
100,000 IU old,
or ½ cap or nationwide
3 drops 9-12 month
old infants
receiving
AMV
nationwide
Ferrous
Sulfate
(25 mg. 0.3ml(2-6 Orally 2-11 months old
Elemental mos) by infants in
Iron per ml; once a day drops Mindanao area,
30 ml. Bottle including
as taken evacuation
home 0.6ml(6- centers in armed
medicine 11mos) once conflict areas.
with a day
instructions)
Routine Nationwide
Immunizat
ion 0-11 mos
-BCG*
0.05ml
Intradermal on right
deltoid
-DPT* Intramuscularly on
0.5ml 0-11 mos
anterior thigh
-OPV* Orally
2 drops 0-11 mos
0.5ml Subcutaneously on 9-11 mos
-AMV*
deltoid
-Hepa B (if
available) 0.5ml Intramuscularly 0-11 mos
Dewormi
ng drug
(if
available) 1 tablet 36-59 mos,
Orally
as nationwide
single
dose

Weighing 0-59 mos,

nationwide
• * The child should not have received
megadose of Vit. A above the
recommended dosage within the past 4
weeks except if the child has measles or
signs and symptoms of Vit A. deficiency.
• ** For any child between 12-23 months,
who missed any of his routine
immunization, the health worker should
give the child the necessary antigen to
complete FIC and shall be recorded as
such.
 GARANTISADONG PAMBATA
Sangkap Pinoy

- Vitamin A, Iron and Iodine

-Sources: green leafy and yellow
vegetables, fruits, liver, seafoods, iodized
salt, pan de bida and other fortified
foods.
These micronutrients are not produced
by the body, and must be taken in the
food we eat; essential in the normal
process of growth and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental
development
d) Necessary in the body immune system to protect
the body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent and
control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder
 • BREASTFEEDING
Breast milk is best for babies up to 2
years old. Exclusive breastfeeding is
recommended for the first six months of
life. At about six months, give carefully
selected nutritious foods as
supplements.
Breastfeeding provides physical and
psychological benefits for children and
mothers as well as economic benefits for
families and societies.
 BENEFITS :
For infants
c.Provides a nutritional complete food for
the young infant.
d.Strengthens the infant’s immune system,
preventing many infections.
e.Safely rehydrates and provides essential
nutrients to a sick child, especially to
those suffering from diarrheal diseases.
f. Reduces the infant’s exposure to infection.
 – For the Mother
a. Reduces a woman’s risk of excessive blood
loss after birth
b. Provides a natural method of delaying
pregnancies.
c. Reduces the risk of ovarian and breast
cancers and osteoporosis.
– For the Family and Community
d. Conserves funds that otherwise would be
spent on breast milk substitute, supplies and
fuel to prepare them.
e. Saves medical costs to families and
governments by preventing illnesses and by
providing immediate postpartum
 COMPLEMENTARY FEEDING FOR BABIES 6-11
MONTHS OLD
• What are Complementary Foods?
c.foods introduced to the child at the age
6 months to supplement breastmilk
e.given progressively until the child is used to
three meals and in-between feedings at the age
of one year.
• Why is there a Need to Give Complementary
Foods?
g.breastmilk can be a single source of
nourishment from birth up to six months of life.
a. The child’s demands for food increases as he
grows older and breastmilk alone is not
enough to meet his increased nutritional
needs for rapid growth and development
b. Breastmilk should be supplemented with other
foods so that the child can get additional
nutrients
c. Introduction of complementary foods will
accustom him to new foods that will also
provide additional nutrients to make him grow
well
d. Breastfeeding, however, should continue for
as long as the mother is able and has milk
which could be as long as two years
• How to Give Complementary Foods for
Babies 6-11 Months Old?
b.Prepare mixture of thick lugao/ cooked rice, soft
cooked vegetables. Egg yolk, mashed beans,
flaked fish/chicken/ground meat and oil.
c.Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and
number of feeding until the full recommended
amount is consumed
d.Give bite-sized fruit separately
e.Give egg alone or combine with above food
mixture
 FAMILY PLANNING
The Philippine Family Planning Program is a
national program that systematically provides
information and services needed by women of
reproductive age to plan their families according to
their own beliefs and circumstances.
GOALS AND OBJECTIVES:
• Universal access to family planning information,
education and services.
MISSION:
• To provide the means and opportunities by which
married couples of reproductive age desirous of
spacing and limiting their pregnancies can realize their
reproductive goals.
 TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
• 2. Tubal Ligation
 WARNING SIGNS
Pills
• Abdominal pain ( severe)
• Chest pain ( severe)
• Headache ( severe)
• Eye problems ( blurred vision, flashing
lights, blindness)
• Severe leg pain ( calf or thigh )
• Others: depression, jaundice, brest lumps
 WARNING SIGNS
IUD
*Period late, no symptoms of pregnancy,
abnormal bleeding or spotting
*Abdominal pain during intercourse
*Infection or abnormal vaginal discharge
*Not feeling well, has fever or chills
*String is missing or has become shorter
or longer
 WARNING SIGNS
• INJECTABLES
• Dizziness
• Severe headache
• Heavy bleeding
 WARNING SIGNS
BTL
• Fever
• Weakness
• Rapid pulse
• Persistent abdominal pain
• Vomiting
• Dizziness
• Pus or tenderness at incision site
• Amenorrhea
 WARNING SIGNS
Vasectomy

• Fever
• Scrotal blood clots or excessive swelling
 Nutrition

• Goal
To improve the nutritional
status, productivity and quality
of life of the population thru
adoption of desirable dietary
practices and healthy lifestyle
• Objectives
• Increase food and dietary energy
intake of the average Filipino
• Prevent nutritional deficiency
diseases and nutrition-related
chronic degenerative diseases
• Promote a healthy well-balanced
diet
• Promote food safety
Nutrition is a state of well-being achieved by
eating the right food in every meal and the
proper utilization of the nutrients by the body.
Proper nutrition is important because:
• it helps in the development of the brain, especially
during the first years of the child’s life.
• It speeds up the growth and development of the body
including the formation of teeth and bones
• It helps fight infection and diseases
• It speeds up the recovery of a sick person
• It makes people happy and productive
• Proper nutrition is eating a balanced diet in every meal
Balanced diet is made up of a
combination of the 3 basic groups
eaten in correct amounts. The
grouping serves as a guide in
selecting and planning everyday
meals for the family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body –building food which are rich in
protein and needed by the body for:
< normal growth and repair of worn-out body
tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are: fish;
pork; chicken; beef; cheese; butter; kidney
beans; mongo; peanuts; bean curd; shrimp;
clams
• 2. Energy-giving food which are rich in
carbohydrates and fats and needed by the
body for:
• < providing enough energy to make the body
strong
• < Examples of energy-giving food are: rice;
corn; bread; cassava; sweet potato;
banana; sugar cane; honey; lard; cooking
oil; coconut milk; margarine; butter
• 3. Body-regulating food which are rich in
Vitamins and minerals and needed by the
body for:
• < normal development of the eyes, skin,
hair, bones, and teeth
• < increased protection against diseases
• < Examples of body-regulating food are:
tisa; ripe papaya; mango; guava; yellow
corn; banana; orange; squash; carrot
 Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and
cereals e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on
thinly
4. Choose low fat substitute i.e. replace
whole milk with skimmed milk, low fat
cheese
5. Become a label reader. Look for foods that
have less than 5 g /100 g of product
1. Eat less high fat snacks and take away
potato chips, sausage rolls or breaded
meats
2. Cut all visible fat from meat, remove skin
from chicken fat drippings and cream
sauces
3. Aim for thin palm-size serving of lean
meat, poultry and fish/ meal
4. Grill, bake, steam, stew, stir –fry and
microwave, try not to fry
5. Drink lots of water all day- it’s a food
quencher
 Ambulate
• Start by walking for 10 min.
• Build up to 30-40 min/day
• Go for 3-4 times / week of any exercise
you enjoy
 Filipino Food Pyramid
• Drink a lot- water, clear broth
• Eat most – rice, root crops, corn, noodles,
bread and cereals
• Eat more – vegetables, green salads,
fruits or juices
• Eat some – fish, poultry, dry beans, nuts,
eggs, lean meats, low fat dairy
• Eat a little – fats, oils, sugar, salt
IMPORTANT VITAMINS AND
MINERALS
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision, skin
health, bone and tooth
growth reproduction and
immune function; prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
camotetops; ampalaya tops
Thiamine Help release
energy from
nutrients; support
normal appetite
and nerve function,
prevent beri-beri.
Riboflavin Helps release energy from
nutrients, support skin health,
prevent deficiency manifested by
cracks and redness at corners of
mouth; inflammation of the tongue
and dermatitis.

Niacin Help release energy from nutrients;

support skin, nervous and digestive
system, prevents pellagra.
Biotin Help energy and
amino acid
metabolism; help in
the synthesis of fat
glycogen.
Pantothenic Help in energy
metabolism.
 Help in the formation of DNA
Folic acid and new blood cells including
red blood cells; prevent anemia
and some amino acids.

Help in the formation of the new

Vitamin B cells; maintain nerve cells,
12 assist in the metabolism of fatty
acids and amino acids.
 Help in the formation of protein,
Vitamin C collagen, bone, teeth cartilage,
skin and scar tissue; facilitate in
the absorption of iron from the
gastrointestinal tract; involve in
amino acid metabolism; increase
resistance to infection, prevent
scurvy.
Food sources:
Guava;pomelo;lemon;orange;
calamansi; tomato; cashew
Vitamin D Help in the
mineralization of
bones by enhancing
absorption of
calcium.
 Strong anti-oxidant; help prevent
Vitamin E arteriosclerosis; protect neuro-
muscular system; important for
normal immune function.

Involve in the synthesis of blood

Vitamin K clotting proteins and a bone
protein that regulates blood
calcium level.
MINERALS FUNCTIONS
Mineralization of bones and teeth, regulator
Calcium of many of the body’s biochemical
processes, involve in blood clotting, muscle
contraction and relaxation, nerve
functioning, blood pressure and immune
defenses.

Maintain normal fluid and electrolyte

Chloride balance.
Chromium Work with insulin and is
required for release of energy
from glucose.

Copper Necessary for absorption and

use of iron in the formation of
hemoglobin.
 Involve in the formation of bones
Fluoride and teeth; prevents tooth decay.

As part of the two thyroid hormones,

Iodine iodine regulates growth, physical and
mental development and metabolic
rate.
Aids in the development of the brain and
body especially in unborn babies
Food sources:
Seaweeds;squids;shrimps;crabs;
fermented shrimp;mussels;snails;
dried dilis; fish
 Essential in the formation of blood. It
Iron is involved in the transport and
storage of oxygen in the blood and
is a co-factor bound to several
non-hemo enzymes required for
the proper functioning of cells.
Food sources:
Pork; beef; chicken; liver and other
internal organs; dried dilis; shrimp;
eggs; pechay; saluyot; alugbati
Magnesium Mineralization of
bones and teeth,
building of proteins,
normal muscle
contraction, nerve
impulse transmission,
maintenance of teeth
and functioning of
immune system.
Manganese Facilitate many cell
processes.

Molybdenum Facilitate many cell

processes.
Phosphorus Mineralization of bones
and teeth; part of every
Cell; used in energy
transfer and
maintenance of acid-
base balance.
Selenium Work with vitamin E to
protect body compound
from oxidation.
Selenium Work with vitamin E to
protect body compound
from oxidation.

Sodium Maintain normal fluid and

electrolyte balance,
assists nerve impulse
insulin.
Sulfur Integral part of vitamins,
biotin and thiamine as well
as the hormone.

Zinc Essential for normal

growth, development
reproduction and
immunity.
 MALNUTRITION
MALNUTRITION
An abnormal condition of the body
resulting from the lack or excess
of one or more nutrients like
protein, carbohydrates, fats,
vitamins and minerals.
 PRIMARY CAUSE: POVERTY
1. Lack of money to buy food
Majority of the victims of malnutrition comes
from families of farmers, fisherfolk, and
laborers who cannot afford to buy nutritious
foods.
3. Lack of food supply
4. Lack of information on proper nutrition and
food values
 SECONDARY CAUSES
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and
children
3. Bad eating habits
4. Poor hygiene and environmental sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
 FORMS OF MALNUTRTION

 Protein-Energy Malnutrition (PEM) is

a nutritional problem resulting from a
prolonged inadequate intake of body-
building and/or energy-giving food in
the diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right amount
and kind of energy food. She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
a) KWASHIORKOR
This child does not get enough body-building food,
although she/he may be getting enough energy.
She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
 2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of Vitamin A
in the body is low.
Causes:
• not eating enough foods rich in vitamin A
e.g. yellow vegetables and yellow fruits
• lack of fat or oil in the diet which help the
body absorb Vitamin A.
• poor absorption or rapid utilization of
Vitamin A during illness
Eye Signs
• night blindness (early stage); total
blindness (later stage)
• bitot’s spot (foamy soapsuds-like spots on
white part of the eye)
• dry, hazy and rough appearing cornea
• crater-like defect on cornea
• softened cornea; sometimes bulging
Other Manifestations
• increased cases of childhood sickness, and
death and decreased resistance to infection
• susceptibility to childhood malnutrition and
infection (measles, diarrhea and pneumonia)
Prevention
• eating foods rich in Vitamin A, such as liver,
eggs, milk, crab meat, cheese, dilis,
malunggay, gabi leaves, kamote tops,
kangkong, alugbati, saluyot, carrots,
squash, ripe mango, including fats and oils
• breastfeeding the child
• immunizing the child
• taking correct dose of Vitamin A capsules
as prescribed
VAD is most common in children
suffering from PEM and other
infectious diseases. Bottle-fed infants
are also at risk of VAD especially if
the milk formula used is not fortified
with Vitamin A.
• Common among preschoolers and
infants
( FNRI)
SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO
INFANTS PRESCHOOLERS AND MOTHERS
Schedule Infants(6-11 Preschoole Post
mos) rs(12-83 Partum
mos) Mother

Give 1 100,000 IU 200,000 IU 200,000 IU

Dose Within one
month

Give after 6 100,000 IU 200,000 IU After

months delivery of
High risk each child
Condition only
Present
 SCHEDULE FOR TREATMENT OF VITAMIN A
DEFICIENCY
Schedule Infants (6-11 Preschoolers
mos.) (12-83 mos.)

Give Today 100,000 IU 200,000 IU

Give Tomorrow 100,000 IU 200,000 IU

Give After 2 100,000 IU 200,000 IU

Weeks
3. ANEMIA - a condition characterized by the lack
of iron in the body resulting in paleness.
• S/S: paleness of the eyelids, inner cheeks, palms
and nailbeds; frequent dizziness and easy
fatigability
• Common cause: inadequate intake of food rich
in iron ; can also be caused by blood loss during
menstruation, pregnancy and parasitic infections.
• Prevention:

Eating iron-rich food such as liver and other

internal organs; green leafy vegetables; and
foods rich in Vitamin C
 Prevention of Iron
Deficiency
Recommended Iron Dosage
Requirements

Infants ( 6-12 months) 0.7 mg. Daily

Children ( 12-59 1 mg daily

months)
 Treatment of Iron Deficiency
Dosage
Children 0-59 month 3-6 mg./kg. Body
wt./day
 4.GOITER
- enlargement of thyroid gland due to
lack of iodine in the body.

-common in areas where the iodine

content in the soil, water and food are
deficient.
- Effect of Iodine deficiency to fetus:
may be born mentally and physically
retarded.
- Goiter can be prevented by:
< daily intake of food rich in iodine
< use of iodized salt
 Iodine Supplementation

Dosage
Children 0-59 months Iodine capsules (200mg)
( in endemic areas) potassium iodate in oil
orally once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
• 1.1 Weight is a very important indicator of a
person’s nutritional status. It is measured in relation
to either AGE or HEIGHT. Normally, a well-
nourished child gains weight as she/he grows older.
• 1.2 On the other hand, a malnourished child
either decreases in weight or maintains his/her
previous weight.
• 1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms
of the different forms of nutritional deficiencies.
• IMPORTANT:
• 1.1Weigh the child in minimal clothing, with
no shoes, clogs or slippers on; and hands
and pockets free of objects.
• 1.2The same type of scale should be used
for subsequent weighing.
• 1.3Observe the proper maintenance of the
weighing scale.
• 1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD
TOGETHER WITH THE PARENTS TO THE
HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD
REGULARLY AND MONITOR HIS/HER
WEIGHT.
< ADVISE PARENTS AND THE WHOLE
COMMUNITY ABOUT BETTER NUTRITION
AND PROPER FEEDING ESPECIALLY OF
INFANTS, CHILDREN AND SICK PERSONS.
NUTRITIONAL GUIDELINES
2. Eat a variety of food everyday.
3. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods
while continuing breastfeeding.
4. Maintain children’s normal growth through
proper diet and monitor their growth regularly.
5. Consume fish, lean meat, poultry or dried
beans.
6. Eat more vegetables, fruits, and root crops.
7. Eat foods cooked in edible/cooking oil daily.
 Consume milk, milk products or other
calcium-rich foods such as small fish and dark
green leafy vegetables everyday. Use iodized
salt, but avoid excessive intake of salty foods.
 Use iodized salt, avoid excessive intake of
salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition,
exercise regularly, do not smoke, avoid
drinking alcoholic beverages.
 AIMS AND RATIONALE OF EACH OF
THE GUIDELINES

Guideline No. 1 is intended to give the

message that no single food provides all
the nutrients the body needs. Choosing
different kinds of foods from all food
groups is the first step to obtain a well-
balanced diet. This will help correct the
common practice of confining of choice
to a few kinds of foods, resulting in an
unbalanced diet.
Guidelines No.2 is entitled to promote exclusive
breastfeeding from birth to 4-6 months and to
encourage the continuance of breastfeeding for as
long as two years or longer. This is to ensure a
complete and safe food for the newborn and the
growing infant besides imparting the other benefits
of breastfeeding. The guideline also strongly
advocates the giving of appropriate complementary
food in addition to breast milk once the infant is
ready for solid foods at 6 months. Malnutrition
most commonly occurs between the age of 6
months to 2 years, therefore there is a need to pay
close attention to feeding the child properly during
this very critical period.
Guideline No. 3 gives advise on
proper feeding of children. In
addition, the guideline promotes
regular weighing to monitor the
growth of children, as it is a simple
way to assess nutritional status.
Guidelines No. 4,5,6 and 7 are intended to correct
the deficiencies in the current dietary pattern of
Filipinos. Including fish, lean meat, poultry and dried
beans, which will provide good quality protein and
dietary energy, as well as iron and zinc, key nutrients
lacking in the diet of Filipinos as a whole. Eating more
vegetables, fruits and root crops will supply the much
needed vitamins, minerals and dietary fiber that are
deficient in our diet. In addition, they provide defense
against chronic degenerative diseases. Including
foods cooked in edible oils will provide additional
dietary energy as a partial remedy to calorie deficiency
of the average Filipino. Including milk and other
calcium-rich foods in the diet will serve to supply not
only calcium for healthy bones but to provide high
quality protein and other nutrients for growth.
Guideline No. 8 promotes the use of
iodized salt to prevent iodine
deficiency, which is a major cause of
mental and physical
underdevelopment in the country. At
the same time, the guideline warns
against excessive intake of salty
foods as a hedge against
hypertension, particularly among
high-risk individuals.
Guideline No.9 is intended
to prevent food-borne
diseases. It explains the
various sources of
contamination of our food
and simple ways to prevent it
from occurring.
Finally, Guideline No. 10 promotes
a healthy lifestyle through regular
exercise, abstinence from smoking
and avoiding consumption. If
alcohol is consumed, it must be
done in moderation. All these
lifestyle practices are directly or
indirectly related to good nutrition.
NUTRIENTS IN FOOD

Nutrients are chemical substances

present in the foods that keep the body
healthy, supply materials for growth and
repair of tissues, and provide energy for
work and physical activities.
The major nutrients include the
macronutrients, namely; proteins,
carbohydrates and fats; the micronutrients,
namely vitamins such as A, D, E and K, the
B complex vitamins and C and minerals
such as calcium, iron, iodine, zinc, fluoride
and water.
 Reproductive Health
• - a state of complete physical, mental
and social well-being and not merely
the absence of disease/ infirmity in all
matters relating to the reproductive
system and to its functions and
processes.
• Basic RH Rights

– Right to RH information and health care

services for safe pregnancy and childbirth
– Right to know different means of
regulating fertility to preserve health and
where to obtain them
– Freedom to decide the number and timing
of birth of children
– Right to exercise satisfying sex life
• Factors/ determinants of RH
– Socioeconomic conditions – education,
employment, poverty, nutrition, living
condition/ environment, family environment
– Status of women – equal right in education
and in making decisions about her own
RH; right to be free from torture and ill
treatment and to participate in politics
– Social and Gender Issues
– Biological (individual knowledge of
reproductive organs and their functions),
cultural (country’s norms, RH practices)
and psychosocial factors
• Elements

– Maternal and Child Health Nutrition

– Family Planning
– Prevention and Management of Abortion
Complications
– Prevention and Treatment of
Reproductive Tract Infections, including
STDs, HIV and AIDS
– Education and Counseling on Sexuality
and Sexual Health
• Elements

– Breast and Reproductive Tract Cancers

and other Gynecological Conditions
– Men’s Reproductive Health
– Adolescent Reproductive Health
– Violence Against Women
– Prevention and Treatment of Infertility and
Sexual Disorders
• Selected Concepts
– RH is the exercise of reproductive right with
responsibility
– It means safe pregnancy and delivery, the right of
access to appropriate health information and
services
– It includes protection from unwanted pregnancy
by having access to safe and acceptable methods
of family planning of their choice
– It includes protection from harmful reproductive
practices and violence
– It ensure sexual health for the purpose of
enhancement of life and personal relations and
assures access to information on sexuality to
achieve sexual enjoyment
• Goal

– To achieve healthy sexual

development and maturation
– To achieve their reproductive
intention
– To avoid diseases, injuries and
disabilities related to sexuality and
reproduction
– To receive appropriate counseling
and care of RH problems
• Strategies

– Increase and improve the use of more effective

or modern contraceptive methods
– Provision of care, treatment and rehabilitation
for RH
– RH care provision should be focused on
adolescents, men and unmarried and other
displaced people with RH problems
– Strengthen outreach activities and referral
system
– Prevent specific RH problems through
information dissemination and counseling of
clients
HEALTH AND SANITATION
Environmental Sanitation is still a health
problem in the country.
Diarrheal diseases ranked second in the
leading causes of morbidity among the
general population.
Other sanitation related diseases :
tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious
hepatitis, filariasis and dengue hemorrhagic
fever
DOH thru’ Environmental Health Services
(EHS)
unit is authorized to act on all issues and
concerns
in environment and health including the very
comprehensive Sanitation Code of the
Philippines (PD 856, 1978).
 WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
• Approved types of water facilities
• Unapproved type of water facility
• Access to safe and potable drinking
water
• Water quality and monitoring
surveillance
• Waterworks/Water system and well
construction
Approved type of water facilities
• Level 1 (Point Source)- a protected well or
a developed spring with an outlet but
without a distribution system
• indicated for rural areas;
• serves 15-25 households; its outreach is
not more than 250 m from the farthest
user
• yields 40-140 L/ min
 Level II ( Communal Faucet or
Stand Posts)
• With a source, reservoir, piped distribution
network and communal faucets
• Located at not more than 25 m from the
farthest house
• Delivers 40-80 L of water per capital per
day to an average of 100 households
• Fit for rural areas where houses are
densely clustered
 Level III ( Individual House
Connections or Waterworks
System)
• With a source, reservoir, piped distributor
network and household taps
• Fit for densely populated urban
communities
• Requires minimum treatment or
disinfection
ENVIRONMENTAL SANITATION
- the study of all factors in man’s
physical environment, which may
exercise a deleterious effect on his
health, well-being and survival.
 Includes:
1.1 Water sanitation
1.2 Food sanitation
1.3 Refuse and garbage disposal
1.4 Excreta disposal
1.5 Insect vector and rodent control
1.6 Housing
1.7 Air pollution
1.8 Noise
1.9 Radiological Protection
1.10 Institutional sanitation
1.11 Stream pollution
PROPER EXCRETA AND SEWAGE DISPOSAL
PROGRAM

EHS sets policies on:

Approved types of toilet facilities :

LEVEL I
◙ Non-water carriage toilet facility – no water
necessary to wash the waste into receiving space e.g.pit
latrines, reed odorless earth closet.
◙ Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
LEVEL II – on site toilet facilities
of the water carriage type with
water-sealed and flush type
with septic vault/tank disposal.
LEVEL III – water carriage types of toilet facilities
connected to septic tanks and/or to sewerage
system to treatment plant.
FOOD SANITATION PROGRAM

-sets policy and practical programs to

prevent and control food-borne diseases to
alleviate the living conditions of the
population
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and other
wastes from hospital which combine them with
the municipal or domestic wastes pose health
hazards to the people.

Hospitals shall dispose their hazardous wastes

thru incinerators or disinfectants to prevent
transmission of nosocomial diseases
 PROGRAM ON HEALTH RISK MINIMIZATION DUE
TO ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to
health (depletion of the stratosphere ozone layer
which increases ultraviolet radiation, climate
change and other conditions)
 NURSING RESPONSIBILITIES AND ACTIVITIES
• Health Education – IEC by conducting
community assemblies and bench conferences.
• The Occupational Health Nurse, School Health
Nurse and other Nursing staff shall impart the
need for an effective and efficient
environmental sanitation in their places of work
and in school.
• Actively participate in the training component of
the service like in Food Handler’s Class, and attend
training/workshops related to environmental health.
• Assist in the deworming activities for the school
children and targeted groups.
• Effectively and efficiently coordinate
programs/projects/activities with other government
and non-government agencies.
• Act as an advocate or facilitator to families in the
community in matters of
program/projects/activities on environmental
health in coordination with other members of Rural
Health Unit (RHU) especially the Rural Sanitary
Inspectors.
• Actively participate in environmental
sanitation campaigns and projects in the
community. Ex. Sanitary toilet campaign
drive for proper garbage disposal,
beautification of home garden, parks
drainage and other projects.
• Be a role model for others in the
community to emulate terms of cleanliness
in the home and surrounding.
Non-Communicable Diseases and
Rehabilitation
• 1. Prevention and Control of Cardiovascular Diseases
• - heart – 1st leading cause of death ; bld vessels - 2nd
• Congenital Heart Disease (CHD): Result of the abnormal
development of the heart that exhibits septal defect, patent
ductus arteriosus, aortic and pulmonary stenosis, and
cyanosis; most prevalent in children
• Causes: envt’l factors, maternal diseases or genetic
aberrations
• Rheumatic Fever or Rheumatic Heart Disease: Systematic
inflammatory disease that may develop as a delayed reaction
to repeated and an inadequately treated infection of the upper
respiratory tract by group A beta-hemolytic streptococci.
• Hypertension: Persistent elevation of the arterial blood
pressure.
• ( primary or essential) ;frequent among females but
severe,malignat form is more common among males
Ischemic Heart Disease/ Atherosclerosis:
Condition usually caused by the occlusion
of the coronary arteries by thrombus or
clot formation.
• higher among males than females for the
latter are protected by estrogen before
menopause
• PF: HPN, DM, Smoking
• Minor RF: stress, strong family history,
obesity
 CVD
PERIOD OF LIFE TYPE OF CVD PREVALENCE

At birth to early childhood Congenital Heart Disease 2 / 1000 school children

(aged 5 – 15 y.o.)

Early to late childhood Rheumatic Fever / 1 / 1000 school children

Rheumatic Heart (aged 5 – 15 y.o.)
Disease

Early Adulthood Diseases of Heart Muscles 10 / 100 adults

Essential Hypertension

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

Cerebrovascular Accident
 CVD
Diseases Causes / Risk factors
Congenital Heart Disease Maternal Infections, Drug
intake, Maternal Disease,
Genetic
Rheumatic Fever/Rheumatic Frequent Streptoccocal Sore
Heart Disease Throat
Essential Hypertension Heredity, High Salt Intake
Coronary Artery Disease Smoking, Obesity,
(Heart Attack) Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life Style
Cerebrovascular Accident Hypertension,
(Stroke) Arteriosclerosis
 Primary Prevention: CVD
Disease Primordial Specific Protection

Congenit - Prevention of - Adequate treatment of

al Heart viral infection and viral infection during
Disease intake of harmful pregnancy.
drugs during - Genetic counseling of
pregnancy. blood related married
- Avoidance of couples.
marriage
between blood
relatives
Rheumatic - Prevention of - Identification
Heart Disease recurrent sore of cases of
throat thru rheumatic fever
adequate - Prophylaxis
environmental with penicillin or
sanitation; erythromycin
avoidance of
overcrowding;
adequate
treatment
Essential - From early - Continued low
Hypertension childhood salt diet and
> low salt diet adequate
> adequate exercise
physical
exercise
Coronary Heart - Prevention of - cessation of
Disease(Heart development/ smoking
Attack) acquisition of - control
risk factors /treatment of
> cigarette diabetes,
smoking hypertension
> high fat intake -weight
> high salt reduction
intake -change to
proper diet
-Adjustment of
activities
Cerebrovascula - all measures - all measures
r Accident to prevent to control
(Stroke) hypertension & hypertension &
arteriosclerosis progression of
arteriosclerosis
• Primary Prevention thru health education
is the main focus of the program:
• 1. maintenance of ideal body wt.
• 2. diet - low fat
• 3. alcohol/smoking avoidance
• 4. exercise
• 5. regular BP check up
2. Cancer Prevention and Early Detection
• Any malignant tumor arising from the
abnormal and uncontrolled division of cells
causing the destruction in the surrounding
tissues.
• Common Cancer: Lung cancer, cervical
cancer, colon cancer, cancer of the mouth,
breast cancer, skin cancer, prostate cancer.
• 3rd leading cause of illness and death ( Phil.)
• Incidence can only be reduced thru
prevention and early detection
 NINE WARNING SIGNS OF
CANCER:
• Change in blood bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in wart or mole
• Nagging cough or hoarseness

• Unexplained anemia
• Sudden unexplained weight loss
 Prevention & Early Detection
CA type Prevention Detection
Lung No smoking None
Uterine Monogamy Pap’s smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber diet Regular
Rectum Low fat intake medical check-
up after 40 yrs
of age
Fecal occult
blood test
DRE
Sigmoidoscopy
Mouth No smoking, Regular dental
betel nut check-ups
chewing
Oral hygiene
Breast none Monthly SBE
Yearly exam by
doctor
Mammography
for 50 yrs old
and above
females
Skin No excessive Assessment of
sun exposure skin
Prostate none Digital trans-
rectal exam
• PRINCIPLES OF TREATMENT OF
MALIGNANT DISEASES
• One third of all cancers are curable if
detected early and treated properly.
Three major forms of treatment of
cancer:
• Surgery
• Radiation Therapy
• Chemotherapy
• 3. Nat’l Diabetes Prevention and Control
Program

• Aim:
• Controlling and assimilating healthy
lifestyle in the Filipino culture ( 2005-
2010) thru IEC
• Main Concern: modifiable risk factors(
diet, body wt., smoking, alcohol, stress,
sedentary living, birth wt. ,migration
• 4. Prevention and Control of Kidney Disease
• Acute or Rapidly Progressive Renal Failure : A
sudden decline in renal function resulting from the
failure of the renal circulation or by glomerular or
tubular damage causing the accumulation of
substances that is normally eliminated in the urine in
the body fluids leading to disruption in homeostatic,
endocrine, and metabolic functions.
• Acute Nephritis: A severe inflammation of the kidney
caused by infection, degenerative disease, or disease
of the blood vessels.
• Chronic Renal Failure: A progressive deterioration of
renal function that ends as uremia and its
complications unless dialysis or kidney transplant is
performed.
• Neprolithiasis: A disorder characterized by the
presence of calculi in the kidney.
• Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into the
urine because of increased permeability of the
glomerular capillary membrane
• Urinary Tract Infection: A disease caused by the
presence of pathogenic microorganisms in the
urinary tract with or without signs and symptoms.
• Renal Tubular Defects: An abnormal condition in
the reabsorption of selected materials back into
the blood and secretion, collection, and
conduction of urine.
• Urinary Tract Obstruction: A condition wherein
the urine flow is blocked or clogged.
• 5. Program on Mental Health and
Mental Disorders
• 6. Program on Drug Dependence/
Substance Abuse
• 7.Community-Based Rehabilitation Program

• A creative application of the primary health care

approach in rehabilitation services, which involves
measures taken at the community level to use and
build on the resources of the community with the
community people, including impaired, disabled
and handicapped persons as well.
• Goal: To improve the quality of life and increase
productivity of disabled, handicapped persons.
• Aim: To reduce the prevalence of disability through
prevention, early detection and provision of
rehabilitation services at the community level.
• 8. Program on the Elderly/Geriatric
Nursing Services

• 7 humanitarian issues: family, health,

income, security, employment and labor,
social welfare, education, recreation,
culltural activities and housing
 Leading causes of
illness:elderly
• Influenza, HPN, diarrhea,
• bronchitis, TB, diseases. of the heart,
• pneumonia, malaria,
• malignant neoplasm, chickenpox
Leading causes of death:elderly
• Diseases of heart and vascular system
• Pneumonia, TB, CCOPD
• Malignant neoplasms
• Diabetes
• Nephritis
• Accidents
• 9. Programs on Blindness, Deafness and
Osteoporosis
• Cataract- main causes of blindness
• VAD- main cause of childhood blindness; most
serious eye problem of Fil. children below 6
yrs. old
• Osteoporosis special problem in women,
highest bet. 50—79 yrs. old, MENOPAUSE-
main cause
Prevention of NCD/Role of Nursing
in Health Promotion And Advocacy
• Yosi Kadiri- anti smoking
• Edi Exercise/Hataw-regular physical
activity
• Tiya Kulit/ Iwas Sakit Diet-low salt, low fat,
high fiber diet
• Mag HL – exercise, no smoking,
avoidance of alcohol, healthy diet, iwas
stress, watch wt.
 Sentrong Sigla Movement ( SSM)
-a certification recognition program which
develops and promotes standards for
health facilities
- Joint effort bet.:
1.DOH – provides technical and financial
assistance packages for health care
2. LGUs – direct implementers of health
programs & prime developers of health
centers and hospitals making services
accessible to every Filipino
 Pillars of SSM
• 1. Quality Assurance
• 2. Grant and Technical Assistance
• 3. Health Promotion
• 4. Awards
 Expected Outcome: SSM
• Empowered individuals adopting healthy
lifestyle, improved health-seeking
behavior and well-being & increased
demand for quality health services
• Institutions will develop policies, provide
quality services , institute system for
surveillance/ merits and advocate for laws
 Programs: SSM
• EPI
• Disease Surveillance
• CARI
• CDD
• Nutrition/ Micronutrient Supplementation-
*Food Fortification :
Rice –iron; Oil and sugar – Vit. A;
Flour-Vit. A & iron; Salt- iodine
 Integrated Management of
Childhood Illness ( IMCI)
• Integrates management of most common
childhood problems ( diarrhea,
pneumonia, measles, malnutrition, DHF,
malaria)
• Involves family members and community
in the health care process for physical
growth and mental development & disease
prevention
 IMCI: Case Mgt. Process
• 1. Assessing the child or young infant- History
taking, PE
• 2. Classifying the Illness- severity of illness
• 3. Identifying ttt.- classification chart
• 4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to
carry out ttt.
• 5. Counseling the mother- child feeding,foods
and fluids to give & when to bring the child back
to the health center
• 6. Giving of follow-up care
• Communicable diseases
– National Tuberculosis Control Program –
key policies
Case finding – direct Sputum Microscopy and
X-ray examination of TB symptomatics who
are negative after 2 or more sputum exams
Treatment – shall be given free and on an
ambulatory basis, except those with acute
complications and emergencies
Direct Observed Treatment Short Course –
comprehensive strategy to detect and cure TB
patients.
 Category and Treatment
Regimen
• Category 1- new TB patients whose sputum is
positive; seriously ill patients with severe forms
of smear-negative PTB with extensive
parenchymal involvement (moderately- or far-
advanced) and extra-pulmonary TB (meningitis,
pleurisy, etc.)

• Category 2-previously-treated patients with

relapses or failures.

• Category 3 – new TB patients whose sputum is smear-

negative for 3 times and chest x-ray result of PTB
minimal
 – Category 1- new TB patients whose sputum is positive; seriously ill
patients with severe forms of smear-negative PTB with extensive
parenchymal involvement (moderately- or far- advanced) and extra-
pulmonary TB (meningitis, pleurisy, etc.)

Intensive Phase (given daily for the first 2 months)-

Rifampicin + Isioniazid + pyrazinamide + ethambutol.
If sputum result becomes negative after 2 months,
maintenance phase starts. But if sputum is still positive in 2
months, all drugs are discontinued from 2-3 days and a
sputum specimen is examined for culture and drug
sensitivity. The patient resumes taking the 4 drugs for
another month and then another smear exam is done at the
end of the 3rd month.
Maintenance Phase (after 3rd month, regardless of the result
of the sputum exam)-INH + rifampicin daily
• Category 2-previously-treated patients with relapses or failures.

Intensive Phase (daily for 3 months, month 1,2 &

3)-Isioniazid+ rifampicin+ pyrazinamide+
ethambutol+ streptomycin for the first 2 months
Streptomycin+ rifampicin pyrazinamide+
ethambutol on the 3rd month. If sputum is still
positive after 3 months, the intensive phase is
continued for 1 more month and then another
sputum exam is done. If still positive after 4
months, intensive phase is continued for the next 5
months.
Maintenance Phase (daily for 5 months, month
4,5,6,7,& 8)-Isionazid+ rifampicin+ ethambutol
• Category 3 – new TB patients whose sputum is smear-negative for 3
times and chest x-ray result of PTB minimal

• Intensive Phase (daily for 2 months) –

Isioniazid + rifampicin + pyrazinamide
• Maintenance Phase (daily for the next 2
months) - Isioniazid + rifampicin
• Stop TB ; Do it with DOTS
– Advocacy is a planned and continuous effort to
inform people about issue and instigate change.
Advocacy usually takes place over an extended
period of time and includes a variety of strategies to
communicate a specific message.

– TB is the number one infectious killer in the world.

– One TB suspect can infect another 10 healthy
persons
• Leprosy Control Program
– WHO Classification – basis of multi-drug
therapy
• Paucibacillary/PB – non-infectious types. 6-9 months
of treatment.
• Multibacillary/MB – infectious types. 24-30 months of
treatment.
– Multi-drug therapy – use of 2 or more drugs
renders patients non-infectious a week after
starting treatment
• Patients w/ single skin lesion and a negative slit skin
smear are treated w/ a single dose of ROM regimen
• For PB leprosy cases- Rifampicin+Dapsone on Day 1
then Dapsone from Day 2-28. 6 blister packs taken
monthly within a max. period of 9 mos.
– All patients who have complied w/ MDT are
considered cured and no longer regarded as a case
of leprosy, even if some sequelae of leprosy remain.
– Responsibilities of the nurse
• Prevention – health education, healthful living
through proper nutrition, adequate rest, sleep and
good personal hygiene;
• Casefinding
• Management and treatment – prevention of
secondary injuries, handling of utensils; special
shoes w/ padded soles; importance of sustained
therapy, correct dosage, effects of drugs and the
need for medical check-up from time to time;
mental & emotional support
• Rehabilitation-makes patients capable, active and
self-respecting member of society.
• Control of Schistosomiasis – a tropical disease
caused by a blood fluke, Schistosoma Japonicum
; transmitted by a tiny snail Oncomelania
quadrasi
– Preventive measures – health education
regarding mode of transmission and methods
of protection; proper disposal of feces and
urine; improvement of irrigation and agriculture
practices
– Control of patient, contacts and the immediate
environment
– Specific treatment- Praziquantel – drug of
choice
• Programs on Filariasis, Malaria and Dengue Hemorrhagic
Fever
– Filariasis- a chronic prasitic infection caused by a
nematode, Wuchereria bancrofti. Young and adult
worms live in the lymphatic vessels and nodes, while
the micro filariae are in the blood; transmitted
through bites from an infected female mosquito,
Aedes poecilius, that bites at night.
• Treatment: Diethylcarbamazine citrate or Hetrazan
• Elephantiasis and Hydrocoele are handled through
surgery, prevention and supportive care
Malaria – infection caused by the bite of
the female Anopheles mosquito,
– Chemoprophylaxis – Chloroquine taken at
weekly intervals, starting from 1-2 weeks
before entering the endemic area.
– Anti-malarial drugs – sulfadoxine, quiinine
sulfate, tetracycline, quinidine
– Insecticide treatment of mosquito nets,
house spraying, stream seeding and
clearing, sustainable preventive and vector
control meas

Dengue H-fever
4 o’clock habit
• Programs on Measles.
Chickenpox, Mumps,
Diphtheria, Pertusis, Tetanus
–focused on health
information campaigns and
intensive immunization of
children in barangays.
• Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris, Trichuris,
Hookworm) and Paragonimiasis in communities
where eating of fresh or inadequately cooked crab
is a practice

Management:
1. Deworming
2. Health Education re:
• Good personal hygiene
• Use of footwear
• Washing fruits and vegetables well
• Use of sanitary toilets
• Sanitary disposal of garbage
• Boiling drinking water at least 2-3 min. from
boiling point or chlorination
• Prevention and Control on Leptospirosis/
Weil’s Disease/ Mud fever/Flood fever/
Spirochetal Jaundice thru contact with the
skin/ open wound with water or moist soil
contaminated with urine of infected rat
• And Rabies
• Mgt. of Rabies

• Wash wound with soap and water, betadine or

alcohol may be applied
• If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows rabies,
kill then bring head for lab. Exam & consult doctor.
• Active immunization – body develops Ab against
rabies up to 3 yrs.
• Passive I – giving Ab to persons with head and
neck bites, multiple single deep bites, contamination
of mucous membranes or thin covering of the eyes,
lips or mouth to provide immediate protection
• RPO – immunization of pets at 3 mos. of age and
yearly thereafter
• Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most
serious type ‘cause of severe cx. Eg. Massive
liver damage and hepatocarcinoma
- 4 C’s in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
 Other CHN Practice Settings
• I. Occupational Health
• - the application of public health, medical and
engineering practice for the purpose of
conserving, restoring the health and
effectiveness of workers thru their places of
employment
• A. Occupational Health Nursing
• - the application of nursing principles and
procedures in providing health service to
employees in their place of work by means of:
• 1. prompt and efficient nursing care of the
ill and impaired
• 2. participation in teaching health and
safety practices on the job
• 3. cooperation with plant department
administrators
• 4.keeping the health clinic and staff ready
to handle emergencies
• 5. advising workers in the utilization of
community and welfare services
 Objectives of OHN
• To assist, maintain and promote positive
health of laborers and employees thru
early detection and prevention of
occupational diseases and hazards of
industrial processes and by coordinating
and cooperating with activities of other
community health and welfare services
 Nurse’s Role in OHN
• 1. Assists/participates in developing an adequate
health program for workers and laborers including
sound health education activities
• 2. Encourages periodic P.E.
• 3. Cooperates with occupational medical
programs in the prevention of accidents as
well as in the promotion of good working
atmosphere and relationships in the place of work
• 4. Helps in teaching others in giving good nursing
care to the sick or handicapped in their own
homes
• II. School Health Nursing
• School Health Triad :

• 1. SERVICE

• 2. EDUCATION

• 3. ENVIRONMENT
• Mission of School Health Program:

To maximize potential for learning and

participation in the educational process by
promoting optimum health of school-age
children and adolescents
• School Health Team:

• Psychologist/ Counselor
• Teacher
• Nutritionist
• Nurse
• Social Workers
• Maintenance Personnel
• Targets in SHN

• Family
• Students
• Teachers
• Supportive Personnel
• Community
• School Health Nurse’s Roles:

• EDUCATOR
• CONSULTANT /RESEARCHER
• STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
• HEALTH SCREENER
• HEALTH CARE PROVIDER
• Common Health Concerns of
Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders- pimples/acne,
fungal infections, allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
• There was a man who saw a scorpion
floundering around in the water.
• He decided to save it by stretching out his
finger but the scorpion stung him.
• The man still tried to get the scorpion out of
the water but the scorpion stung him again.
• Another man nearby told him to stop saving
the scorpion but the man said, “It’s the
nature of the scorpion to sting. It’s my nature
to love, why should I give up my nature to
love just because it’s the nature of the
scorpion to sting?”