Community Health Nursing Review (edited)

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

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2.

3.

4. 5.

Family-based Nursing Services(Family Health Nursing Process) Population Group-based Nursing Services Community-based Nursing Services/Community Health Nursing Process Community Organizing Public Health Programs

I.

3. 4. 5. 6. 7.

Research and Quality Improvement Research in the Community National Health Situation Vital Statistics Epidemiology Demography

I.

2.

3. 4.

Management of Resources & Environment and Records Management

Field Health Services And Information System Target-setting Environmental Sanitation

I.

Ethico-Moral-Legal Responsibility

2.

Socio-cultural values, beliefs, and practices of individuals, families, groups and communities Code of Ethics for Government Workers WHO, DOH, LGU policies on health Local Government Code Issues

3. 4. 5. 6.

Personal And Professional Development

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2.

Self-assessment of CHN competencies, importance, methods and tools 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 organized.

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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)

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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.

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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)

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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)

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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 control of nuisance.

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

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RA 4073 – advocates home treatment for leprosy

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Letter of Instruction No. 949 – legal basis of PHC dated OCT. 19, 1979 

- promotes development of health programs on the community level

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RA 3573 – requires reporting of all cases of communicable diseases and administration of prophylaxis

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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 selfreliance 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 

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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

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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)

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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 

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- 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 

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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 

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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 community health resources

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 Research Indulges in research to contribute to theory and practice in community health nursing I.

LEVELS OF CARE/ PREVENTION 

1. PRIMARY

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2. SECONDARY

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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

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2. SECONDARY LEVEL FACILITIES

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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.

2.

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). 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.

2.

3.

4.

Universal access to basic health services must be ensured. The health and nutrition of vulnerable groups must be prioritized. The epidemiological shift from infection to degenerative diseases must be managed. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals 1.

2.

3. 4. 5.

Increasing investment for Primary Health Care. Development of national standards and objectives for health. Assurance of health care. Support to the local system development. Support for frontline health workers.

PHC as a Strategy

PRIMARY HEALTH CARE (PHC) 

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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 of the community. 

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   

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• 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 selfreliance. • Maximizing the contribution of the other sectors for the social and economic development of the community.

MISSION:

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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.

4.

Barangay Health Workers - trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. 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

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3. People are the center, object and subject of development.

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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

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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.

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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 1.Five-leaf Chaste tree (Lagundi)

Indications 1. 2. 3. 4.

Asthma Cough Body Pain Fever

Dosage Divide the decoction into 3 parts: For asthma and cough, drink 1 part 3 times a day. For fever and body pains, drink 1 part every 4 hrs. 

2. Marsh-Mint; Peppermint (Yerba Buena)

3. Sambong

1.

Body pain

Swelling 2. Inducing diuresis ( antiurolithiasis) 1.

Divide decoction into 2 parts and drink 1 part every 3 hours. 

Divide decoction into 3 parts and drink 1 part 3 times a day. 

4. Tsaang Gubat

5. Ulasimang Bato/PansitPansitan

1.

Stomachache

1.

Gouty Arthritis

Drink the warm decoction. If it persists, or if there is no improvement an hour after drinking the decoction, consult a doctor. Divide the decoction into 3 parts and drink 1 part 3 times a day after meals. 

6. Garlic

7. NiyogNiyogan

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2.

Hypertension Htperlipidemia

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Ascariasis

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1.

Eat 6 cloves of garlic together with meals Chew and swallow only dried seeds 2 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.

2.

Cleaning wounds Mouth wash for mouth infection, sore gums & tooth decay

For wound cleaning, use decoction for washing the wound 2 times a day For tooth decay and swelling of gums, gargle with warm decoction 3 times a day 

9. Akapulko

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Ring worm Apply the juice on the affected area 1 to 2 times a day Athlete’s If the person develops an allergy foot while using the above preparation, Scabies 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. Bitter Gourd/ Melon (Ampalaya)

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Mild NonInsulin Dependent Diabetes Mellitus

Drink ½ cup of cooled or warm decoction 3 times a day after meals. 

11. Ginger (Zingiber officinale)

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Motion sickness, sore throat, nausea & vomiting, migraine headaches, arthritis

An abortifacient if taken in large amounts; should not be used by persons with cholelithiasis unless directed by the physician; may increase the risk of bleeding when used 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 

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- 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)    

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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  

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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 

2.

3.

4.

Family structure, Characteristics, and Dynamics

Members of the household and relationship to the head of the family Demographic data – age, sex, civil status, position in the family 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

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2.

Income and Expenses 

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3. 4.

Socio-economic and Cultural Characteristics

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

Educational attainment of each other Ethnic background and religious affiliation

1.

2.

Significant Others – role(s) they play in family’s life Relationship of the family to larger community – Nature and extent of participation of the family in community activities

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Home and Environment

Housing   

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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.

2.

3.

Kind of neighborhood, e.g. congested, slum, etc. Social and health facilities available Communication and transportation facilities available

 2.

3.

Health Status of each Family Member

Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness 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. 4. 5.

Immunization status of family members Healthy lifestyle practices. Specify. Adequacy of:   



6.

rest and sleep exercise use of protective measures- e.g. adequate footwear in parasite-infested areas; relaxation and other stress management activities

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.

4.

Family history of hereditary condition, e.g. diabetes Threat of cross infection from a communicable disease case

1.

2.

Family size beyond what family resources can adequately provide 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 conditionInadequate living space Lack of food storage facilities Polluted water supply Presence of breeding sites of vectors of disease Improper garbage





  

Unsanitary waste disposal Improper drainage system Poor ventilation Noise pollution Air pollution

1. 2.

Unsanitary food handling and preparation Unhealthful lifestyles and personal habitsAlcohol 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.

2.

3.

4.

Inherent personal characteristics – e.g. poor impulse control Health history which induce the occurrence of a health deficit, e.g. previous history of difficult labor Inappropriate role assumption – e.g. child assuming mother's role, father not assuming his role 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.

4.

5.

Illness states, regardless of whether it is diagnosed or by medical practitioner Failure to thrive/ develop according to normal rate 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 Pregnancy Parenthood Additional member Abortion Entrance at school Adolescence Divorce

9. Menopause 10. Loss of job 11. Hospitalization of a family member 12. Death of a manner 13. Resettlement in a new community 14. illegitimacy

Second Level Assessment 

 c.

d.

e.

f.

g.

Focus on determining family’s capacity to perform the health tasks Statements on family health nursing problem: Inability to recognize the presence of the condition or problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family Inability to provide a home environment conducive to health maintenance or personal development 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 with the end in view of rendering effective nursing care 

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  2.

3.

Qualifications Bachelor of Science in Nursing Registered Nurse of the Philippines

 2.

3.

4.

5.

Planner/Programmer Identifies needs, priorities, and problems of individuals, families, and communities Formulates municipal health plan in the absence of a medical doctor Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel Provides technical assistance to rural health midwives in health matters

 2.

3.

Provider of Nursing Care Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace Develops the family’s capability to take care of the sick, disabled, or dependent member

 2.

3.

4.

5.

6.

Manager/Supervisor Formulates individual, family, group, and community-centered plan Interprets and implements programs, policies, memoranda, and circulars Organizes work force, resources, equipments, and supplies at local level Provides technical and administrative support to Rural Health Midwives (RHM) Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments

 2.

3.

Community Organizer Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services Initiates and participates in community development activities

 2.

3.

Coordinator of Services Coordinates with individuals, families, and groups for health related services provided by various members of the health team Coordinates nursing program with other health programs like environmental sanitation, health education, dental health, and mental health

 2.

3. 4.

5.

6.

Trainer/Health Educator Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots Conducts training for RHMs and hilots on promotion and disease prevention Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and healthrelated services Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes Conducts pre-marital counseling

 2.

Health Monitor 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 

 2.

Change Agent 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

 2.

3.

Researcher Participates in the conduct of survey studies and researches on nursing and health-related subjects Coordinates with government and non-government organization in the implementation of studies/research

Community Organizing  b. c. d.

Approaches to community devt.: Welfare approach Technological approach 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 MANAGEMENTVaccine 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 Age of 1st Dose

BCG (Bacillus Calmette Guerin)

Birth or anytime after birth School entrants



Number Minimum Reason of Doses Interval Between Doses BCG is given 1

at the earliest possible age protects against the possibility of TB infection from the other family members

2. DPT (Diphtheria Pertusis Tetanus)

6 weeks

3. OPV (Oral Polio Vaccine)

6 weeks

4. Hepatitis B

6 weeks

5. Measles

9 months

3

4 weeks An early start with

3

4 weeks The extent of

3

4 weeks

1

DPT reduces the chance of severe pertussis

protection against polio is increased the earlier OPV is given. An early start of Hepatitis B reduces the chance of being infected and becoming a carrier. At least 85% of measles 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 undernutrition

plenty

of

food

to

prevent

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

Age

ORESOL TREATMENT

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

< 24 months

50-100 ml.

500 ml./day

2– 10 years

100-200 ml.

1000 ml./day

10 As much as years up wanted

2000 ml./day

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

APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS

AGE

WEIGHT KG

ORS 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. 2. 3.

4.

5.

6.

7.

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

3.

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 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.

2.

Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants. 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.

2.

Breastfeeding decreases incidence rate by 8-20% and mortality by 24-27% in infants under 6 months of age. When to wean? 4-6 months – soft mashed foods 2x a day 6 months – variety of foods 4x a day

Summary of WHO-CDD recommended strategies to prevent diarrhea 1. Improved Nutrition - exclusive breastfeeding for the first 4-6 months of life and partially for at least one year. - Improved weaning practices 2.Use of safe water - collecting plenty of water from the cleanest source - protecting water from contamination at the source and in the home 1.

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

Vaccine

TT1

Minimum Age Interval

Percent Protected

As early as possible during pregnancy

80%

Duration of Protection

TT2

At least 4 weeks later

80% Infants born to the mother will be protected from neonatal tetanus. Gives 3 years protection for the mother from tetanus.

TT3

At least 6 months later

90%

Infants born to the mother will be protected from neonatal tetanus. Gives 5 years protection for the mother.

TT4

At least year later

1

99%

Gives 10 protection for the mother

TT5

At least 1 year later

99%

Gives 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

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1.

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.

WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS? GP offers the following: 1.1 Routine Health Services:

Health Service

Dosage

Route of Target Administra Population tion Vitamin A 200,000 IU Orally by 12-59 or 1 capsule drops months old, capsule nationwide 100,000 IU or ½ cap or 3 9-12 month old infants drops receiving AMV nationwide

Ferrous Sulfate (25 mg. Elemental Iron per ml; 30 ml. Bottle as taken home medicine with instructions)

0.3ml(2-6 mos) once a day 0.6ml(611mos) once a day

Orally 2-11 months old by drops infants in Mindanao area, including evacuation centers in armed conflict areas.

Nationwide

Routine Immunizati on -BCG* -DPT* -OPV* -AMV* -Hepa B (if available)

0.05ml 0.5ml 2 drops 0.5ml 0.5ml

Intradermal on right deltoid Intramuscularly on anterior thigh Orally Subcutaneously on deltoid Intramuscularly

0-11 mos

0-11 mos 0-11 mos 9-11 mos 0-11 mos

Dewormin g drug (if available) 1 tablet as single dose

Weighing

Orally

36-59 mos, nationwide

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) b) c) d)

e)

Helps the body to regulate itself Necessary in energy metabolism Vital in brain cell formation and mental development Necessary in the body immune system to protect the body from severe infection. 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.

 a.

b.

c.

d.

e.

For the Mother

Reduces a woman’s risk of excessive blood loss after birth Provides a natural method of delaying pregnancies. Reduces the risk of ovarian and breast cancers and osteoporosis.  For the Family and Community Conserves funds that otherwise would be spent on breast milk substitute, supplies and fuel to prepare them. Saves medical costs to families and governments by preventing illnesses and by providing immediate postpartum contraception.

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COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLD What are Complementary Foods?

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. c.



g.

Why is there a Need to Give Complementary Foods?

breastmilk can be a single source of nourishment from birth up to six months of life.

a.

b.

c.

d.

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 Breastmilk should be supplemented with other foods so that the child can get additional nutrients Introduction of complementary foods will accustom him to new foods that will also provide additional nutrients to make him grow well Breastfeeding, however, should continue for as long as the mother is able and has milk which could be as long as two years



b.

c.

d. e.

How to Give Complementary Foods for Babies 6-11 Months Old? Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed beans, flaked fish/chicken/ground meat and oil. Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and number of feeding until the full recommended amount is consumed Give bite-sized fruit separately 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. 3. 4. 5.

Basal Body Temperature Method Cervical Mucus Method Sympto-Thermal Method 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. 2. 3.

Male and Female Condom Intrauterine Device 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

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 

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

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

 

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. 2.

3. 4.

5.

Eat at least 3 meals/day Eat more fruits, vegetables, grain and cereals e.g. rice, noodles and potato If you use butter or margarine, pat it on thinly Choose low fat substitute i.e. replace whole milk with skimmed milk, low fat cheese Become a label reader. Look for foods that have less than 5 g /100 g of product

1.

2.

3.

4.

5.

Eat less high fat snacks and take away potato chips, sausage rolls or breaded meats Cut all visible fat from meat, remove skin from chicken fat drippings and cream sauces Aim for thin palm-size serving of lean meat, poultry and fish/ meal Grill, bake, steam, stew, stir –fry and microwave, try not to fry 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 Vitamin A

FUNCTIONS 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.

Folic acid

Help in the formation of DNA and new blood cells including red blood cells; prevent anemia and some amino acids.

Vitamin B 12

Help in the formation of the new cells; maintain nerve cells, assist in the metabolism of fatty acids and amino acids.

Vitamin C

Help in the formation of protein, 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.

Vitamin E

Strong anti-oxidant; help prevent arteriosclerosis; protect neuromuscular system; important for normal immune function.

Vitamin K

Involve in the synthesis of blood clotting proteins and a bone protein that regulates blood calcium level.

MINERALS

Calcium

Chloride

FUNCTIONS Mineralization of bones and teeth, regulator 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 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.

Fluoride

Involve in the formation of bones and teeth; prevents tooth decay.

Iodine

As part of the two thyroid hormones, 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

Iron

Essential in the formation of blood. It 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 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 1.

SECONDARY CAUSES 1.

2. 3. 4.

Early weaning of child and improper introduction of supplementary food Incomplete immunization of babies and children Bad eating habits Poor hygiene and environmental sanitation: a. b. c.

lack of potable water lack of sanitary toilet poor waste disposal

FORMS OF MALNUTRTION 

Protein-Energy Malnutrition (PEM) is a nutritional problem resulting from a prolonged inadequate intake of bodybuilding and/or energy-giving food in the diet. Kinds: a.)MARASMUS b.) KWASHIORKOR

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! a)

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 Preschoolers Post Partum mos) (12-83 mos) Mother

Give 1 Dose

100,000 IU

200,000 IU

200,000 IU Within one month

Give after 6 months High risk Condition Present

100,000 IU

200,000 IU

After delivery of each child only

SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY Schedule Infants (6-11 Preschoolers (12mos.) 83 mos.) Give Today

100,000 IU

200,000 IU

Give Tomorrow

100,000 IU

200,000 IU

Give After 2 Weeks

100,000 IU

200,000 IU

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 Requirements

Dosage

Infants ( 6-12 months)

0.7 mg. Daily

Children ( 12-59 months)

1 mg daily

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 ( in endemic areas)

Iodine capsules (200mg) 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.

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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. 3.

4.

5. 6. 7.

Eat a variety of food everyday. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods while continuing breastfeeding. Maintain children’s normal growth through proper diet and monitor their growth regularly. Consume fish, lean meat, poultry or dried beans. Eat more vegetables, fruits, and root crops. Eat foods cooked in edible/cooking oil daily.

Consume milk, milk products or other calciumrich 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 

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Selected Concepts 

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



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 

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

 

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 

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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.

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Assist in the deworming activities for the school children and targeted groups. Effectively and efficiently coordinate programs/projects/activities with other government and nongovernment agencies.

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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.

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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

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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 At birth to early childhood Early to late childhood

Early Adulthood

Middle age to old age

TYPE OF CVD Congenital Heart Disease Rheumatic Fever / Rheumatic Heart Disease

PREVALENCE 2 / 1000 school children (aged 5 – 15 y.o.) 1 / 1000 school children (aged 5 – 15 y.o.)

Diseases of Heart Muscles Essential Hypertension

10 / 100 adults

Coronary Artery Disease Cerebrovascular Accident

5 / 100 adults

CVD Diseases

Causes / Risk factors

Congenital Heart Disease

Rheumatic Fever/Rheumatic Heart Disease

Maternal Infections, Drug intake, Maternal Disease, Genetic Frequent Streptoccocal Sore Throat

Essential Hypertension

Heredity, High Salt Intake

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

Primary Prevention: CVD Disease

Primordial

Congenital - Prevention of Heart viral infection and Disease intake of harmful drugs during pregnancy. - Avoidance of marriage between blood relatives

Specific Protection - Adequate treatment of viral infection during pregnancy. - Genetic counseling of blood related married couples.

Rheumatic Heart - Prevention of Disease recurrent sore throat thru adequate environmental sanitation; avoidance of overcrowding; adequate treatment

- Identification of cases of rheumatic fever - Prophylaxis with penicillin or erythromycin

Essential Hypertension

- From early - Continued low childhood salt diet and adequate exercise > low salt diet > adequate physical exercise

Coronary Heart Disease(Heart Attack)

- Prevention of development/ acquisition of risk factors > cigarette smoking > high fat intake > high salt intake

- cessation of smoking - control /treatment of diabetes, hypertension -weight reduction -change to proper diet -Adjustment of activities

Cerebrovascular - all measures to Accident (Stroke) prevent hypertension & arteriosclerosis

- all measures to control hypertension & progression of arteriosclerosis

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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:       

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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 Lung Uterine Cervical Liver

Prevention No smoking Monogamy Safe sex Hep B vaccination Less aalcohol intake Avoidance of moldy foods

Detection None Pap’s smear every 1-3 yrs None

Colon Rectum

High fiber diet Low fat intake

Regular medical check-up after 40 yrs of age Fecal occult blood test DRE Sigmoidoscopy

Mouth

No smoking, Regular dental betel nut chewing check-ups Oral hygiene

Breast

none

Skin

No excessive sun Assessment of exposure skin none Digital transrectal exam

Prostate

Monthly SBE Yearly exam by doctor Mammography for 50 yrs old and above females

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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

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3. Nat’l Diabetes Prevention and Control Program

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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

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4. Prevention and Control of Kidney Disease

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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.

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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.

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5. Program on Mental Health and Mental Disorders

6. Program on Drug Dependence/ Substance Abuse 

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7.Community-Based Rehabilitation Program

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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.

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8. Program on the Elderly/Geriatric Nursing Services

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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

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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   

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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 

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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) 

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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 

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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

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Communicable diseases 

National Tuberculosis Control Program – key policies Case finding – direct Sputum Microscopy and Xray 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.)

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Category 2-previously-treated patients with relapses or failures.

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Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x-ray result of PTB minimal

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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 extrapulmonary 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

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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

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Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x-ray result of PTB minimal

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Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide

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Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

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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.

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TB is the number one infectious killer in the world. One TB suspect can infect another 10 healthy persons

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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. 

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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. 

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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 selfrespecting member of society.

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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

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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 

Malaria – infection caused by the bite of the female Anopheles mosquito, 

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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

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Programs on Measles. Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus –focused on health information campaigns and intensive immunization of children in barangays.

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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 

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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

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Mgt. of Rabies

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Wash wound with soap and water, betadine or alcohol may be applied If dog is healthy observe for 14 days. If nothing happensno 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

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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  

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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:

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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 

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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

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II. School Health Nursing School Health Triad :

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1. SERVICE

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2. EDUCATION

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3. ENVIRONMENT

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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

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School Health Team:

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Psychologist/ Counselor Teacher Nutritionist Nurse Social Workers Maintenance Personnel

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Targets in SHN

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Family Students Teachers Supportive Personnel Community

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School Health Nurse’s Roles:

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EDUCATOR CONSULTANT /RESEARCHER STUDENT, FAMILY AND STAFF ADVOCATE/CHANGE AGENT HEALTH SCREENER HEALTH CARE PROVIDER

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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 

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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?”

Don’t give up loving, don’t give up your goodness even if people around you sting…

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T HE END