Bongskhie D.

Gocotano, BSN
BUKIDNON STATE UNIVERSITY
COLLEGE OF NURSING

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
6. Family-based Nursing Services(Family
Health Nursing Process)
7. Population Group-based Nursing
Services
8. Community-based Nursing
Services/Community Health Nursing
Process
9. Community Organizing
10. Public Health Programs
II. Research and Quality Improvement
1. Research in the Community
2. National Health Situation
3. Vital Statistics
4. Epidemiology
5. Demography
III. Management of Resources & Environment and
Records Management
1. Field Health Services And Information System
2. Target-setting
3. Environmental Sanitation
IV. Ethico-Moral-Legal Responsibility
1. Socio-cultural values, beliefs, and practices of
individuals, families, groups and communities
2. Code of Ethics for Government Workers
3. WHO, DOH, LGU policies on health
4. Local Government Code
5. Issues
V. Personal And Professional Development
1. Self-assessment of CHN competencies,
importance, methods and tools
2. Strategies and methods of updating
ones 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 , 1
st
Fil. Nurse
supervisor under Bureau of Health
Oct. 22, 1922 Filipino Nurses Organization
(Philippine Nurses Organization) was
organized.
1923 Zamboanga General Hospital School
of Nursing & Baguio General Hospital
were established; other government
schools of nursing were organized several years
after.
1928- 1
st
Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the
first city health officer; Office of Nursing
was created through the effort of Vicenta
Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)
Dec. 8, 1941 Victims of World War II were
treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of
31 Filipino nurses in Bilibid Prison as
prisoners of war by the Japanese.
Feb. 1946 Number of nurses decreased from
556 308.
1948 First training center of the Bureau of
Health was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela
Gabatin, Costancia Tuazon, Ms. Bugarin,
Ms. Ramos, and Zenaida Nisce
composed the training staff.
1950 Rural Health Demonstration and
Training Center was created.
1953 The first 81 rural health units were
organized.
1957 RA 1891 amended some sections of
RA 1082 and created the eight
categories of rural health unit causing an
increase in the demand for the community
health personnel.
1958-1965 Division of Nursing was abolished
(RA 977) and Reorganization Act (EO 288)
1961 Annie Sand organized the National
League of Nurses of DOH.
1967 Zenaida Nisce became the nursing
program supervisor and
consultant on the six special diseases (TB,
leprosy, V.D., cancer, filariasis, and mental
health illness).
1975 Scope of responsibility of nurses and
midwives became wider due to
restructuring of the health care delivery
system.
1976-1986 The need for Rural Health Practice
Program was implemented.
1990- 1992- Local Government Code of 1991
(RA 7160)
1993-1998 Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
Jan. 1999 Nelia Hizon was positioned as the
nursing adviser at the Office of Public
Health Services through Department
Order # 29.
May 24, 1999 EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph
Estrada.
LAWS AFFECTING PUBLIC HEALTH AND
PRACTICE OF COMMUNITY HEALTH NURSING
R.A. 7160 - or the Local Government Code. This involves
the devolution of powers, functions and responsibilities
to the local government both rural & urban.The Code
aims to transform local government units into self-
reliant communities and active partners in the
attainment of national goals thru a more responsive
and accountable local government structure instituted
thru a system of decentralization. Hence, each province,
city and municipality has a LOCAL HEALTH BOARD ( LHB )
which is mandated to propose annual budgetary
allocations for the operation and maintenance of their
own health facilities.
Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer vice chair
3. Chair , Committee on Health of Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
Composition of LHB
City and Municipal Level
1. 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 LGUs 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 1
st
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 mans 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
RA 4073 advocates home treatment for
leprosy
Letter of Instruction No. 949 legal basis of PHC
dated OCT. 19, 1979
- promotes development of health
programs on the community level
RA 3573 requires reporting of all cases
of communicable diseases and
administration of prophylaxis
Ministry Circular No. 2 of 1986 includes AIDS
as notifiable disease
R.A. 7875 National Health Insurance Act
R.A. 7432 Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWDs, provides their
rehabilitation, self-development and self-reliance and
integration into the mainstream of society
A. O. No. 2005-0014- National Policies on Infant
and Young Child Feeding:
1.All newborns be breastfeed within 1 hr after birth
2. Infants be exclusively breastfeed for 6 mos.
3. Infants be given timely, adequate and safe
complementary foods
4. Breastfeeding be continued up to 2 years and beyond
EO 51- Phil. Code of Marketing of Breastmilk
Substitutes
R.A.- 7600 Rooming In and Breastfeeding Act
of 1992
R.A. 8976- Food Fortification Law
R.A. 8980- prolmulgates a comprehensive policy
and a national system for ECCD
A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Immunization for Infants
R.A. 7846- mandates Compulsory Hepatitis B
Immunization among infants and children less
than 8 yrs old
R.A. 2029- madates Liver Cancer and Hepatitis B
Awareness Month Act ( February)
A.O. No. 2006-0012- specifies the Revised
Implementing Rules and Regulations of E.O. 51
or Milk Code, Relevant International
Agreements, Penalizing Violations thereof and
for other purposes
Public Health
- science and art of preventing diasease,
prolonging life, promoting health and efficiency thru
organized community effort for the sanitation of the
environment, control of communicable diseases, the
education of individuals in personal hygiene, the
organization of medical and nursing services for the
early diagnosis and preventive treatment of diseases and
the development of social machinery to ensure everyone
a standard of living adequate for the maintenance of
health, so organizing these benefits as to enable every
citizen to realize his birthright off birth and longevity (
DR. C.E. Winslow)
Community Health Nursing
- special field of nursing that combines the skills
of nursing, public health and some phases of
social assistance and functions as part of the
total public health program for the promotion of
health, the improvement of the conditions in
the social and physical environment,
rehabilitation of illness and disability ( WHO
Expert Committee of Nursing )
CHN
- a learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of
the clients optimum level of functioning thru
teaching and delivery of care ( Jacobson )
- a service rendered by a professional nurse to
IFCs, population groups in health centers, clinics,
schools , workplace for the promtion of health,
preventionof illness, care of the sick at home
and rehabilitation (DR. Ruth B. Freeman)
Concepts
The primary focus of community health nursing
is health promotion.
Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life cycle.
Knowledge on different fields (biological and
social sciences, clinical nursing, and community
health organizations) is used.
Nursing process in community health nursing
changes based on the needs of the community.
Goal
To elevate the level health of the multitude.
Worth and dignity of man.
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
IX. Research
Indulges in research to contribute to theory and practice
in community health nursing
LEVELS OF CARE/ PREVENTION
1. PRIMARY
2. SECONDARY
3. TERTIARY
Types of Clientele
1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark, 1995:5)
e.g. children . elderly, women, workers etc.
Phil.Health Care Delivery System
1.PRIMARY LEVEL FACILITIES
2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES
Classify as to what level the ff. belong
1. Teaching and Training Hospitals
2. City Health Services
3. Emergency and District Hospitals
4. Private Practitioners
5. Heart Institutes
6. Puericulture Centers
7. RHU
THE DEPARTMENT OF HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality of health
care to improve the quality of life of all Filipinos,
especially the poor.
NATIONAL OBJECTIVES
1. Improve the general health status of the
population (reduce infant mortality rate, reduce
child morality rate, reduce maternal mortality
rate, reduce total fertility rate, increase life
expectancy & the quality of life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism,
Sexually Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries & Periodontal
Diseases, Cardiovascular Diseases, Cancer,
Diabetes, Asthma & Chronic Obstructive
Pulmonary Diseases, Nephritis & Chronic Kidney
Diseases, Mental Disorders, Protein Energy
Malnutrition, Iron Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet &
nutrition, physical activity & fitness, personal hygiene,
mental health & less stressful life & prevent violent &
risk-taking behaviors.
6. Promote the health & nutrition of families & special
populations through child, adolescent & youth, adult
health, womens health, health of older persons, health
of indigenous people, health of migrant workers and
health of different disabled persons and of the rural &
urban poor.
7. Promote environmental health and sustainable
development through the promotion and maintenance
of healthy homes, schools, workplaces, establishments
and communities towns and cities.
Basic Principles to Achieve Improvement in
Health
1. Universal access to basic health services must be
ensured.
2. The health and nutrition of vulnerable groups
must be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector must be
enhanced.
Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
PHC as a Strategy
PRIMARY HEALTH CARE (PHC)
May 1977 -30
th
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.
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
G 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.
G a practical approach to making health benefits
within the reach of all people.
G 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
Improvement in the level of health care of the
community
Favorable population growth structure
Reduction in the prevalence of preventable,
communicable and other disease.
Reduction in morbidity and mortality rates
especially among infants and children.
Extension of essential health services with
priority given to the underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the
community aimed at self-reliance.
Maximizing the contribution of the other
sectors for the social and economic
development of the community.
MISSION:
To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
1. Barangay Health Workers - trained community
health workers or health auxiliary volunteers or
traditional birth attendants or healers.
2. Intermediate level health workers include the
Public Health Nurse, Rural Sanitary Inspector
and midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A's = Accessibility, Availability, Affordability
& Acceptability, Appropriateness of health
services. The health services should be present
where the supposed recipients are. They
should make use of the available resources
within the community, wherein the focus
would be more on health promotion and
prevention of illness.
2. COMMUNITY PARTICIPATION =heart and
soul of PHC
3. People are the center, object and subject of
development.
Thus, the success of any undertaking that aims
at serving the people is dependent on peoples
participation at all levels of decision-making;
planning, implementing, monitoring and
evaluating. Any undertaking must also be based
on the peoples needs and problems (PCF, 1990)
Part of the peoples participation is the
partnership between the community and the
agencies found in the community; social
mobilization and decentralization.
In general, health work should start from where
the people are and building on what they have.
Example: Scheduling of Barangay Health
Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT
Lack of motivation
Attitude
Resistance to change
Dependence on the part of community people
Lack of managerial skills

4.SELF-RELIANCE
5.Partnership between the community and the health
agencies in the provision of quality of life.
Providing linkages between the government and
the non-government organization and peoples
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.
MAJOR STRATEGIES OF PRIMARY HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE
AND SUSTAINED NATIONAL EFFORTS.
Attaining Health for all Filipino will
require expanding participation in health and
health related programs whether as service
provider or beneficiary. Empowerment to
parents, families and communities to make
decisions of their health is really the desired
outcome.
Advocacy must be directed to National
and Local policy making to elicit support and
commitment to major health concerns through
legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING
COMMUNITY MANAGED HEALTH CARE
The health in the hands of the people
brings the government closest to the people. It
necessitates a process of capacity building of
communities and organization to plan, implement and
evaluate health programs at their levels.
C. INCREASING EFFICIENCIES IN THE HEALTH
SECTOR
Using appropriate technology will make
services and resources required for their
delivery, effective, affordable, accessible and
culturally acceptable. The development of
human resources must correspond to the actual
needs of the nation and the policies it upholds
such as PHC. The DOH will continue to support
and assist both public and private institutions
particularly in faculty development,
enhancement of relevant curricula and
development of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL HEALTH
RESEARCH
Essential National Health Research
(ENHR) is an integrated strategy for organizing and
managing research using intersectoral, multi-disciplinary
and scientific approach to health programming and
delivery.
FOUR CORNERSTONES/ PILLARS IN PRIMARY
HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
ELEMENTS OF PRIMARY HEALTH CARE:

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.
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
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 mans 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
mans environment. Water is necessary for the
maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic
promotion of health.
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.


This focuses on the information campaign on
the utilization and acquisition of drugs.
In response to this campaign, the
GENERIC ACT of the Philippines is enacted . It includes
the following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin,
INH(isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
FAMILY HEALTH NURSING
- that level of CHN practice directed to the
FAMILY as the unit of care with HEALTH as the
goal and NURSING as the medium, channel or
provider of care
Family Case Load
- the no. and kind of families a nurse handles at
any given time
- variable for cases are added or dropped based
on the need for nursing care and supervision
Types of Families
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
Types of Families
8. Single adult living alone
9. Cohabiting/ Living in
10. No- kin
11. Compound
12. Gay
14. Commune
Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest retirement)
8. Period from retirement to Death of both
spouses
HEALTH TASKS OF THE FAMILY( Freeman, 1981)
1. recognizing interruptions of health or
development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled
and dependent member of the family
5. maintaining a home environment conducive
to good health and personal development
6. maintaining a reciprocal relationship with the
community and health institutions
Family Nursing Problem
Arises when the family cannot effectively
perform its health tasks
Nurses Roles in Family Health Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR FAMILY NURSING
PRACTICE
Family structure, Characteristics, and Dynamics
1. Members of the household and relationship to
the head of the family
2. Demographic data age, sex, civil status,
position in the family
3. 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
5. Dominant family members in terms of decision-
making, especially in matters of health care
6. General family relationship/dynamics
presence of any readily observable conflict
between members; characteristics
communication patterns among members
Socio-economic and Cultural Characteristics
1. Income and Expenses
Occupation, place of work and income
of each working members
Adequacy to meet basic necessities
Who makes decisions about money and
how it is spent
2. Educational attainment of each other
3. Ethnic background and religious affiliation
4. Significant Others role(s) they play in familys
life
5. Relationship of the family to larger community
Nature and extent of participation of the
family in community activities
Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of
vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership,
portability
Toilet facility type, ownership, sanitary
condition
Drainage system type, sanitary
condition
2. Kind of neighborhood, e.g. congested, slum, etc.
3. Social and health facilities available
4. Communication and transportation facilities
available
Health Status of each Family Member
1. Medical and nursing history indicating current or
past significant illnesses or beliefs and practices
conducive to health illness
2. 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:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g.
adequate footwear in parasite-infested
areas;
relaxation and other stress management
activities
4. Use of promotive-preventive health services
A TYPOLOGY OF NURSING PROBLEMS IN FAMILY
NURSING PRACTICE
FIRST-LEVEL ASSESSMENT
I. 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 clients
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 clients 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 clients unfolding of mystery
through harmonious
interconnectedness that comes
from inner strength/sacred
source/GOD (NANDA 2001)
Others,
2. 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 ones health potential.
Examples of these are the following:
1. Family history of hereditary condition, e.g.
diabetes
2. Threat of cross infection from a communicable
disease case
3. Family size beyond what family resources can
adequately provide
4. Accidental hazards
4 Broken stairs
4 Sharp objects, poison, and medicines
improperly kept
4 Fire hazards
5. 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
6. Stress-provoking factors
Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family
members
Care-giving burden
O Inadequate living space
O Lack of food storage facilities
O Polluted water supply
O Presence of breeding sites of vectors of disease
O Improper garbage
8. Unsanitary food handling and
preparation
8. Unhealthful lifestyles and personal habits-
w Alcohol drinking
w Cigarette smoking
w Inadequate footwear
w Eating raw meat
w Poor personal hygiene
w Self-medication
w Sexual promiscuity
w Engaging in dangerous sports
w Inadequate rest
w Lack of inadequate exercise
w Lack of relaxation activities
w Non-use of self protection measures
10. Inherent personal characteristics e.g. poor
impulse control
11. Health history which induce the occurrence of a
health deficit, e.g. previous history of difficult
labor
12. Inappropriate role assumption e.g. child
assuming mother's role, father not assuming his
role
13. Lack of immunization/ inadequate immunization
status specially of children
14. Family disunity
g Self-oriented behavior of member(s)
g Unresolved conflicts of member(s)
g Intolerable disagreement
g Other
15. Other
III. Presence of Health Deficits instances of failure
in health maintenance.
Examples include:
1. Illness states, regardless of whether it is
diagnosed or by medical practitioner
2. Failure to thrive/ develop according to normal
rate
3. Disability whether congenital or arising from
illness; temporary
IV. 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:
1. Marriage 9.
Menopause
2. Pregnancy 10. Loss of
job
3. Parenthood 11.
Hospitalization of a
4. Additional member family member
5. Abortion 12. Death
of a manner
6. Entrance at school 13.
Resettlement in a
7. Adolescence new community
8. Divorce 14.
illegitimacy
Second Level Assessment
Focus on determining familys capacity to
perform the health tasks
Statements on family health nursing problem:
a. Inability to recognize the presence of the
condition or problem
b. Inability to make decisions with respect to taking
appropriate health action
c. Inability to provide adequate nursing care to the
sick, disabled , dependent or vulnerable
member of the family
d. Inability to provide a home environment
conducive to health maintenance or personal
development
e. Failure to utilize community resources for
health care
Scale for Ranking Health Conditions and
Problems according to priorities
Criteria:
a. 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 clients 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 clients 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
physicians 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 peoples attitudes, customs, and
habits in relation to health and everyday living.
It should be recognized as the basic function of
all health workers.
It takes place in the home, in the school, and in
the community.
It is a cooperative effort requiring all categories
of health personnel to work together in close
teamwork with families, groups, and the
community.
It meets the needs, interests, and problems of
the people affected.
It finds means and ways of carrying out plans by
encouraging individual and community
participation.
It is a slow, continuous process that involves
constant changes and revisions until objectives
are achieved.
Makes use of supplementary aids and devices to
help with the verbal instructions.
It utilizes community resources by careful
evaluation of the different services and
resources found in the community.
It is a creative process requiring methods and
techniques with various characteristics, not
following a rigid and flexible pattern.
It aims to help people make use of their own
efforts and education to improve their
conditions of living,
It makes careful evaluation of the planning,
organization, and implementation of all health
education programs and activities.
THE COMMUNITY HEALTH NURSE
Qualifications
1. Bachelor of Science in Nursing
2. Registered Nurse of the Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems of
individuals, families, and communities
2. Formulates municipal health plan in the absence
of a medical doctor
3. Interprets and implements nursing plan,
program policies, memoranda, and circular for
the concerned staff personnel
4. Provides technical assistance to rural health
midwives in health matters
Provider of Nursing Care
1. Provides direct nursing care to sick or disabled in
the home, clinic, school, or workplace
2. Develops the familys capability to take care of
the sick, disabled, or dependent member
Manager/Supervisor
1. Formulates individual, family, group, and
community-centered plan
2. Interprets and implements programs, policies,
memoranda, and circulars
3. Organizes work force, resources, equipments,
and supplies at local level
4. Provides technical and administrative support
to Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and
meetings to different RHMs and gives feedback
on accomplishments
Community Organizer
1. Motivates and enhances community
participation in terms of planning, organizing,
implementing, and evaluating health services
2. Initiates and participates in community
development activities
Coordinator of Services
1. Coordinates with individuals, families, and
groups for health related services provided by
various members of the health team
2. Coordinates nursing program with other health
programs like environmental sanitation, health
education, dental health, and mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW), and
hilots
2. Conducts training for RHMs and hilots on
promotion and disease prevention
3. Conducts pre and post-consultation
conferences for clinic clients; acts as a resource
speaker on health and health-related services
4. Initiates the use of tri-media (radio/TV, cinema
plugs, and print ads) for health education
purposes
5. Conducts pre-marital counseling
Health Monitor
1. Detects deviation from health of individuals,
families, groups, and communities through
contacts/visits with them
Role Model
1. Provides good example of healthful living to the
members of the community
Change Agent
1. 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
1. Prepares and submits required reports and
records
2. Maintain adequate, accurate, and complete
recording and reporting
3. Reviews, validates, consolidates, analyzes, and
interprets all records and reports
4. Prepares statistical data/chart and other data
presentation
Researcher
1. Participates in the conduct of survey studies and
researches on nursing and health-related
subjects
2. Coordinates with government and non-
government organization in the implementation
of studies/research
Community Organizing
Approaches to community devt.:
a. Welfare approach
b. Technological approach
c. 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
1. EPI (Expanded Program on Immunization)
2. CDD (Control of Diarrheal Diseases)
3. CARI (Control of Acute Respiratory Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition Rehabilitation Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency Disorders/ Iron
Deficiency Anemia)
10. FP (Family Planning)
EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
TARGET SETTING:
1. INFANTS 0-12 MONTHS
2. PREGNANT AND POST PARTUM WOMEN
3. 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:
1. TARGET SETTING
2. COLDCHAIN LOGISTIC MANAGEMENT- Vaccine
distribution through cold chain is designed to
ensure that the vaccine were maintained under
proper environmental condition until the time
of administration.
3. IEC
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
DIARRHEA
A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not thirsty
Tears present
Skin pinch goes back quickly
TREATMENT PLAN A- HOME TTT.
THREE RULES FOR HOME TREATMENT
1.Give the child more fluids than usual
use home fluid such as cereal gruel
give ORESOL, plain water
2. Give the child plenty of food to prevent
undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual milk
if child is less than 6 months and not yet
taking solid food, dilute milk for 2 days
if child is 6 months or older and already
taking solid food, give cereal or other starchy food mixed
with vegetables, meat or fish; give fresh fruit juice or
mashed banana to provide potassium; feed child at least
6 times a day. After diarrhea stops, give an extra meal
each day for two weeks.
3. Take the child to the health worker if the child
does not get better in 3 days or develops any of the
following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
ORESOL TREATMENT
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 1
ST
4 HRS
1. If the child wants more ORS than shown, give
more
2. Continue breastfeeding
3. For infants below 6 mos. who are not
breastfeed, give 100-200 ml clean water during
the period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then
continue giving ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS ,
give plain water or breast milk, Resume ORS
when puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for dysentery and
suspected cholera
Antiparasitic drugs should only be used for amoebiasis
and giardiasis
C. SEVERE DEHYDRATION
Condition lethargic or unconscious; floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to drink
Skin pinch goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE CONTROL OF
DIARRHEAL DISEASES PROGRAM
1. Two problems in CDD
1. High child mortality due to
diarrhea
2. High diarrhea incidence among under fives
2. Highest incidence in age 6 23 months
3. Highest mortality in the first 2 years of life
4. Main causes of death in diarrhea :
DEHYDRATION
MALNUTRITION
5. 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
6. For undernutrition, continue feeding during
diarrhea especially breastfeeding.
7. 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
8. Risk of severe diarrhea 10-30x higher in bottle
fed infants than in breastfed infants.
9. 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.
10. Breastfeeding decreases incidence rate by 8-
20% and mortality by 24-27% in infants under 6
months of age.
11. When to wean?
4-6 months soft mashed foods 2x a day
6 months variety of foods 4x a day
12. Summary of WHO-CDD recommended strategies
to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months of life
and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest source
- protecting water from contamination at the source and
in the home
3.Good personal and domestic hygiene
- handwashing
- use of latrines
- proper disposal of stools of young children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos-
<60/min,2-12 mos. less than 50 per minute; 12 mos.
5 years less than 40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for
assessment
2. Assess and treat ear problems/sore throat if
present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
1. Feed the child during illness
2. Increase feeding after illness
3. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
1. offer the child extra to drink
2. 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
1. Breathing becomes difficult
2. Breathing becomes fast
3. Child is not able to drink
4. 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 childs 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.
1. Refer urgently to hospital
2. 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:
1. How old is the child?
2. Is the child coughing? For how long?
3. 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?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.
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.
G Paracetamol maybe given for pain or high
fever.
G Precautions for a child with a draining ear:
1. Do not leave anything in the ear such as cotton,
wool between wicking treatments.
2. Do not put oil or any other fluid into the ear.
3. 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 Mothers 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
1
st
as early as pregnancy, 1
st
trimester
2
nd
- 2
nd
trimester
3
rd
& subsequent visits - 3
rd
trimester
More frequent visits for those at risk with cx
TETANUS TOXOID IMMUNIZATION SCHEDULE
FOR WOMEN
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, Leopolds
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 5
th
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 childs 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 childs proper growth and
development.
4. Provision of a safe and learning oriented
environment for the child.
5. Monitoring and Evaluation.
BREASTFEEDING/ LACTATION MANAGEMENT
EDUCATION TRAINING
Breastfeeding practices has been
proved to be very beneficial to both mother and baby
thus the creation of the following laws support the full
implementation of this program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act
of 1992
PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of breastfeeding
and lactation management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM
A. EO 51 THE MILK CODE protection and promotion of
breastfeeding to ensure the safe and adequate nutrition
of infants through regulation of marketing of infant
foods and related products. (e.g. breast milk
substitutes, infant formulas, feeding bottles, teats etc. )
B. RA 7600 THE ROOMING IN and BREASTFEEDING
ACT of 1992
=An act providing incentives to government and private
health institutions promoting and practicing rooming-in
and breast-feeding.
=Provision for human milk bank.
=Information, education and re-education drive
=Sanction and Regulation
2. CONDUCT ORIENTATION/ADVOCACY MEETINGS TO
HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:

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

1. WHAT ARE THE HEALTH SERVICES OFFERED IN GP
AND WHO ARE THE TARGETS?
GP offers the following:
1.1 Routine Health Services:
* The child should not have received megadose
of Vit. A above the recommended dosage within
the past 4 weeks except if the child has measles
or signs and symptoms of Vit A. deficiency.
** For any child between 12-23 months, who
missed any of his routine immunization, the
health worker should give the child the
necessary antigen to complete FIC and shall be
recorded as such.
GARANTISADONG PAMBATA
Sangkap Pinoy

- Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables, fruits, liver,
seafoods, iodized salt, pan de bida and other fortified
foods.
These micronutrients are not produced
by the body, and must be taken in the food we eat;
essential in the normal process of growth and
development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental
development
d) Necessary in the body immune system to
protect the body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent and
control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder

BREASTFEEDING
Breast milk is best for babies up to 2
years old. Exclusive breastfeeding is recommended for
the first six months of life. At about six months, give
carefully selected nutritious foods as supplements.
Breastfeeding provides physical and
psychological benefits for children and mothers as well
as economic benefits for families and societies.
BENEFITS :
For infants
a. Provides a nutritional complete food for the
young infant.
b. Strengthens the infants immune system,
preventing many infections.
c. Safely rehydrates and provides essential
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
d. Reduces the infants exposure to infection.
For the Mother
e. Reduces a womans risk of excessive blood loss
after birth
f. Provides a natural method of delaying
pregnancies.
g. Reduces the risk of ovarian and breast cancers
and osteoporosis.
For the Family and Community
h. Conserves funds that otherwise would be spent
on breast milk substitute, supplies and fuel to
prepare them.
i. Saves medical costs to families and governments
by preventing illnesses and by providing
immediate postpartum contraception.
COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS
OLD
What are Complementary Foods?
a. foods introduced to the child at the age
6 months to supplement breastmilk
a. given progressively until the child is used to
three meals and in-between feedings at the age
of one year.
Why is there a Need to Give Complementary
Foods?
c. breastmilk can be a single source of
nourishment from birth up to six months of life.
d. The childs 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
e. Breastmilk should be supplemented with other
foods so that the child can get additional
nutrients
f. Introduction of complementary foods will
accustom him to new foods that will also
provide additional nutrients to make him grow
well
g. Breastfeeding, however, should continue for as
long as the mother is able and has milk which
could be as long as two years
How to Give Complementary Foods for Babies
6-11 Months Old?
a. Prepare mixture of thick lugao/ cooked rice, soft
cooked vegetables. Egg yolk, mashed beans,
flaked fish/chicken/ground meat and oil.
b. Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and number
of feeding until the full recommended amount is
consumed
c. Give bite-sized fruit separately
d. Give egg alone or combine with above food
mixture
FAMILY PLANNING
The Philippine Family Planning Program
is a national program that systematically provides
information and services needed by women of
reproductive age to plan their families according to their
own beliefs and circumstances.
GOALS AND OBJECTIVES:
Universal access to family planning information,
education and services.
MISSION:
To provide the means and opportunities by which
married couples of reproductive age desirous of spacing
and limiting their pregnancies can realize their
reproductive goals.
TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation
WARNING SIGNS
Pills
Abdominal pain ( severe)
Chest pain ( severe)
Headache ( severe)
Eye problems ( blurred vision, flashing lights,
blindness)
Severe leg pain ( calf or thigh )
Others: depression, jaundice, brest lumps
WARNING SIGNS
IUD
*Period late, no symptoms of pregnancy, abnormal
bleeding or spotting
*Abdominal pain during intercourse
*Infection or abnormal vaginal discharge
*Not feeling well, has fever or chills
*String is missing or has become shorter or longer
WARNING SIGNS
INJECTABLES
Dizziness
Severe headache
Heavy bleeding
WARNING SIGNS
BTL
Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea
WARNING SIGNS
Vasectomy
Fever
Scrotal blood clots or excessive swelling
Nutrition
Goal
To improve the nutritional status, productivity
and quality of life of the population thru adoption of
desirable dietary practices and healthy lifestyle
Objectives
Increase food and dietary energy intake of the
average Filipino
Prevent nutritional deficiency diseases and
nutrition-related chronic degenerative diseases
Promote a healthy well-balanced diet
Promote food safety
Nutrition is a state of well-being achieved by eating the
right food in every meal and the proper utilization of the
nutrients by the body.
Proper nutrition is important because:
it helps in the development of the brain, especially
during the first years of the childs life.
It speeds up the growth and development of the body
including the formation of teeth and bones
It helps fight infection and diseases
It speeds up the recovery of a sick person
It makes people happy and productive
Proper nutrition is eating a balanced diet in every meal
Balanced diet is made up of a combination of the 3 basic
groups eaten in correct amounts. The grouping serves
as a guide in selecting and planning everyday meals for
the family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body building food which are rich in protein and
needed by the body for:
< normal growth and repair of worn-out body tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are: fish; pork;
chicken; beef; cheese; butter; kidney beans; mongo;
peanuts; bean curd; shrimp; clams
2. Energy-giving food which are rich in
carbohydrates and fats and needed by the body
for:
< providing enough energy to make the body
strong
< Examples of energy-giving food are: rice;
corn; bread; cassava; sweet potato; banana;
sugar cane; honey; lard; cooking oil; coconut
milk; margarine; butter
3. Body-regulating food which are rich in
Vitamins and minerals and needed by the body
for:
< normal development of the eyes, skin, hair,
bones, and teeth
< increased protection against diseases
< Examples of body-regulating food are: tisa;
ripe papaya; mango; guava; yellow corn;
banana; orange; squash; carrot
Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and cereals
e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on thinly
4. Choose low fat substitute i.e. replace whole milk
with skimmed milk, low fat cheese
5. Become a label reader. Look for foods that have
less than 5 g /100 g of product
6. Eat less high fat snacks and take away potato
chips, sausage rolls or breaded meats
7. Cut all visible fat from meat, remove skin from
chicken fat drippings and cream sauces
8. Aim for thin palm-size serving of lean meat,
poultry and fish/ meal
9. Grill, bake, steam, stew, stir fry and microwave,
try not to fry
10. Drink lots of water all day- its 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
MALNUTRITION
MALNUTRITION
An abnormal condition of the body resulting from the
lack or excess of one or more nutrients like protein,
carbohydrates, fats, vitamins and minerals.
PRIMARY CAUSE: POVERTY
1. Lack of money to buy food
Majority of the victims of malnutrition comes from
families of farmers, fisherfolk, and laborers who cannot
afford to buy nutritious foods.
2. Lack of food supply
3. Lack of information on proper nutrition and food
values
SECONDARY CAUSES
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and children
3. Bad eating habits
4. Poor hygiene and environmental sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
FORMS OF MALNUTRTION
1. Protein-Energy Malnutrition (PEM) is a
nutritional problem resulting from a prolonged
inadequate intake of body-building and/or
energy-giving food in the diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right amount and
kind of energy food. She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
b) KWASHIORKOR
This child does not get enough body-building
food, although she/he may be getting enough energy.
She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of Vitamin A in the body is
low.
Causes:
not eating enough foods rich in vitamin A e.g.
yellow vegetables and yellow fruits
lack of fat or oil in the diet which help the body
absorb Vitamin A.
poor absorption or rapid utilization of Vitamin A
during illness
Eye Signs
night blindness (early stage); total blindness
(later stage)
bitots 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 FOR TREATMENT OF VITAMIN A
DEFICIENCY
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
Treatment of Iron Deficiency
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
CHECKING THE NUTRITIONAL STATUS
WEIGHT
1.1 Weight is a very important indicator of a
persons nutritional status. It is measured in
relation to either AGE or HEIGHT. Normally, a
well-nourished child gains weight as she/he
grows older.
1.2 On the other hand, a malnourished child
either decreases in weight or maintains his/her
previous weight.
1.3 The nutritional status of a person can also
be checked by looking for specific signs and
symptoms of the different forms of nutritional
deficiencies.
IMPORTANT:
1.1Weigh the child in minimal clothing, with no
shoes, clogs or slippers on; and hands and
pockets free of objects.
1.2The same type of scale should be used for
subsequent weighing.
1.3Observe the proper maintenance of the
weighing scale.
1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD TOGETHER WITH
THE PARENTS TO THE HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD REGULARLY AND
MONITOR HIS/HER WEIGHT.
< ADVISE PARENTS AND THE WHOLE COMMUNITY
ABOUT BETTER NUTRITION AND PROPER FEEDING
ESPECIALLY OF INFANTS, CHILDREN AND SICK
PERSONS.
NUTRITIONAL GUIDELINES
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods while
continuing breastfeeding.
3. Maintain childrens normal growth through
proper diet and monitor their growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other calcium-
rich foods such as small fish and dark green leafy
vegetables everyday. Use iodized salt, but avoid
excessive intake of salty foods.
8. 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 (countrys 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
Mens Reproductive Health
Adolescent Reproductive Health
Violence Against Women
Prevention and Treatment of Infertility
and Sexual Disorders
Selected Concepts
RH is the exercise of reproductive right
with responsibility
It means safe pregnancy and delivery,
the right of access to appropriate health
information and services
It includes protection from unwanted
pregnancy by having access to safe and
acceptable methods of family planning
of their choice
It includes protection from harmful
reproductive practices and violence
It ensure sexual health for the purpose
of enhancement of life and personal
relations and assures access to
information on sexuality to achieve
sexual enjoyment
Goal
To achieve healthy sexual development
and maturation
To achieve their reproductive intention
To avoid diseases, injuries and
disabilities related to sexuality and
reproduction
To receive appropriate counseling and
care of RH problems
Strategies
Increase and improve the use of more
effective or modern contraceptive
methods
Provision of care, treatment and
rehabilitation for RH
RH care provision should be focused on
adolescents, men and unmarried and
other displaced people with RH
problems
Strengthen outreach activities and
referral system
Prevent specific RH problems through
information dissemination and
counseling of clients
HEALTH AND SANITATION
Environmental Sanitation is still a health
problem in the country.
Diarrheal diseases ranked second in the leading causes
of morbidity among the general population.
Other sanitation related diseases :
tuberculosis, intestinal parasitism, schistossomiasis,
malaria, infectious hepatitis, filariasis and dengue
hemorrhagic fever

DOH thru Environmental Health Services (EHS)
unit is authorized to act on all issues and concerns
in environment and health including the very
comprehensive Sanitation Code of the Philippines (PD
856, 1978).
WATER SUPPLY SANITATION PROGRAM
EHS sets policies on:
Approved types of water facilities
Unapproved type of water facility
Access to safe and potable drinking water
Water quality and monitoring surveillance
Waterworks/Water system and well
construction
Approved type of water facilities
Level 1 (Point Source)- a protected well or a
developed spring with an outlet but without a
distribution system
indicated for rural areas;
serves 15-25 households; its outreach is not
more than 250 m from the farthest user
yields 40-140 L/ min
Level II ( Communal Faucet or Stand Posts)
With a source, reservoir, piped distribution
network and communal faucets
Located at not more than 25 m from the farthest
house
Delivers 40-80 L of water per capital per day to
an average of 100 households
Fit for rural areas where houses are densely
clustered
Level III ( Individual House Connections or
Waterworks System)
With a source, reservoir, piped distributor
network and household taps
Fit for densely populated urban communities
Requires minimum treatment or disinfection
ENVIRONMENTAL SANITATION
- the study of all factors in mans
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 II on site toilet facilities of the water carriage
type with water-sealed and flush type with septic
vault/tank disposal.
LEVEL III water carriage types of toilet facilities
connected to septic tanks and/or to sewerage system to
treatment plant.
FOOD SANITATION PROGRAM

-sets policy and practical programs to prevent
and control food-borne diseases to alleviate the living
conditions of the population
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and other
wastes from hospital which combine them with the
municipal or domestic wastes pose health hazards to the
people.
Hospitals shall dispose their hazardous wastes thru
incinerators or disinfectants to prevent transmission of
nosocomial diseases
PROGRAM ON HEALTH RISK MINIMIZATION
DUE TO ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to
health (depletion of the stratosphere ozone layer
which increases ultraviolet radiation, climate change
and other conditions)
NURSING RESPONSIBILITIES AND ACTIVITIES
Health Education IEC by conducting
community assemblies and bench conferences.
The Occupational Health Nurse, School Health
Nurse and other Nursing staff shall impart the
need for an effective and efficient
environmental sanitation in their places of work
and in school.
Actively participate in the training component of
the service like in Food Handlers Class, and
attend training/workshops related to
environmental health.
Assist in the deworming activities for the school
children and targeted groups.
Effectively and efficiently coordinate
programs/projects/activities with other
government and non-government agencies.
Act as an advocate or facilitator to families in
the community in matters of
program/projects/activities on environmental
health in coordination with other members of
Rural Health Unit (RHU) especially the Rural
Sanitary Inspectors.
Actively participate in environmental sanitation
campaigns and projects in the community. Ex.
Sanitary toilet campaign drive for proper
garbage disposal, beautification of home
garden, parks drainage and other projects.
Be a role model for others in the community to
emulate terms of cleanliness in the home and
surrounding.
Non-Communicable Diseases and Rehabilitation
1. Prevention and Control of Cardiovascular
Diseases
- heart 1
st leading cause of death
; bld vessels - 2
nd

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: envtl 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
CVD
Primary Prevention: CVD
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.
3
rd
leading cause of illness and death ( Phil.)
Incidence can only be reduced thru prevention
and early detection
NINE WARNING SIGNS OF CANCER:
Change in blood bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Unexplained anemia
Sudden unexplained weight loss
Prevention & Early Detection
PRINCIPLES OF TREATMENT OF MALIGNANT
DISEASES
One third of all cancers are curable if
detected early and treated properly.
Three major forms of treatment of cancer:
Surgery
Radiation Therapy
Chemotherapy
3. Natl Diabetes Prevention and Control
Program
Aim:
Controlling and assimilating healthy lifestyle in
the Filipino culture ( 2005-2010) thru IEC
Main Concern: modifiable risk factors( diet, body
wt., smoking, alcohol, stress, sedentary living,
birth wt. ,migration
4. Prevention and Control of Kidney Disease
Acute or Rapidly Progressive Renal Failure : A
sudden decline in renal function resulting from
the failure of the renal circulation or by
glomerular or tubular damage causing the
accumulation of substances that is normally
eliminated in the urine in the body fluids leading
to disruption in homeostatic, endocrine, and
metabolic functions.
Acute Nephritis: A severe inflammation of the
kidney caused by infection, degenerative
disease, or disease of the blood vessels.
Chronic Renal Failure: A progressive
deterioration of renal function that ends as
uremia and its complications unless dialysis or
kidney transplant is performed.
Neprolithiasis: A disorder characterized by the
presence of calculi in the kidney.
Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into the
urine because of increased permeability of the
glomerular capillary membrane
Urinary Tract Infection: A disease caused by the
presence of pathogenic microorganisms in the
urinary tract with or without signs and
symptoms.
Renal Tubular Defects: An abnormal condition
in the reabsorption of selected materials back
into the blood and secretion, collection, and
conduction of urine.
Urinary Tract Obstruction: A condition wherein
the urine flow is blocked or clogged.
5. Program on Mental Health and Mental
Disorders
6. Program on Drug Dependence/
Substance Abuse
7.Community-Based Rehabilitation Program
A creative application of the primary health care
approach in rehabilitation services, which
involves measures taken at the community level
to use and build on the resources of the
community with the community people,
including impaired, disabled and handicapped
persons as well.
Goal: To improve the quality of life and increase
productivity of disabled, handicapped persons.
Aim: To reduce the prevalence of disability
through prevention, early detection and
provision of rehabilitation services at the
community level.
8. Program on the Elderly/Geriatric Nursing
Services
7 humanitarian issues: family, health, income,
security, employment and labor, social welfare,
education, recreation, culltural activities and
housing
Leading causes of illness:elderly
Influenza, HPN, diarrhea,
bronchitis, TB, diseases. of the heart,
pneumonia, malaria,
malignant neoplasm, chickenpox
Leading causes of death:elderly
Diseases of heart and vascular system
Pneumonia, TB, CCOPD
Malignant neoplasms
Diabetes
Nephritis
Accidents
9. Programs on Blindness, Deafness and
Osteoporosis
Cataract- main causes of blindness
VAD- main cause of childhood blindness; most
serious eye problem of Fil. children below 6 yrs.
old
Osteoporosis special problem in women,
highest bet. 5079 yrs. old, MENOPAUSE- main
cause
Prevention of NCD/Role of Nursing in Health
Promotion And Advocacy
Yosi Kadiri- anti smoking
Edi Exercise/Hataw-regular physical activity
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high
fiber diet
Mag HL exercise, no smoking, avoidance of
alcohol, healthy diet, iwas stress, watch wt.
Sentrong Sigla Movement ( SSM)
-a certification recognition program which develops and
promotes standards for health facilities
- Joint effort bet.:
1.DOH provides technical and financial assistance
packages for health care
2. LGUs direct implementers of health programs &
prime developers of health centers and hospitals
making services accessible to every Filipino
Pillars of SSM
1. Quality Assurance
2. Grant and Technical Assistance
3. Health Promotion
4. Awards
Expected Outcome: SSM
Empowered individuals adopting healthy
lifestyle, improved health-seeking behavior and
well-being & increased demand for quality
health services
Institutions will develop policies, provide quality
services , institute system for surveillance/
merits and advocate for laws
Programs: SSM
EPI
Disease Surveillance
CARI
CDD
Nutrition/ Micronutrient Supplementation-
*Food Fortification :
Rice iron; Oil and sugar Vit. A;
Flour-Vit. A & iron; Salt- iodine
Integrated Management of Childhood Illness (
IMCI)
Integrates management of most common
childhood problems ( diarrhea, pneumonia,
measles, malnutrition, DHF, malaria)
Involves family members and community in the
health care process for physical growth and
mental development & disease prevention
IMCI: Case Mgt. Process
1. Assessing the child or young infant- History
taking, PE
2. Classifying the Illness- severity of illness
3. Identifying ttt.- classification chart
4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to
carry out ttt.
5. Counseling the mother- child feeding,foods
and fluids to give & when to bring the child back
to the health center
6. Giving of follow-up care
Communicable diseases
National Tuberculosis Control Program
key policies
O Case finding direct Sputum
Microscopy and X-ray
examination of TB
symptomatics who are negative
after 2 or more sputum exams
O Treatment shall be given free
and on an ambulatory basis,
except those with acute
complications and emergencies
O Direct Observed Treatment
Short Course comprehensive
strategy to detect and cure TB
patients.
Category and Treatment Regimen
Category 1- new TB patients whose sputum is
positive; seriously ill patients with severe forms
of smear-negative PTB with extensive
parenchymal involvement (moderately- or far-
advanced) and extra-pulmonary TB (meningitis,
pleurisy, etc.)
Category 2-previously-treated patients with
relapses or failures.
Category 3 new TB patients whose sputum is
smear-negative for 3 times and chest x-ray
result of PTB minimal
Category 1- new TB
patients whose sputum
is positive; seriously ill
patients with severe
forms of smear-negative
PTB with extensive
parenchymal
involvement
(moderately- or far-
advanced) and extra-
pulmonary TB
(meningitis, pleurisy,
etc.)

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

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

Intensive Phase (daily for 3 months, month 1,2 &
3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+
rifampicin pyrazinamide+ ethambutol on the 3
rd
month.
If sputum is still positive after 3 months, the intensive
phase is continued for 1 more month and then another
sputum exam is done. If still positive after 4 months,
intensive phase is continued for the next 5 months.
Maintenance Phase (daily for 5 months, month 4,5,6,7,&
8)-Isionazid+ rifampicin+ ethambutol

Category 3 new TB patients whose sputum is
smear-negative for 3 times and chest x-ray
result of PTB minimal
Intensive Phase (daily for 2 months) Isioniazid
+ rifampicin + pyrazinamide
Maintenance Phase (daily for the next 2 months)
- Isioniazid + rifampicin
Stop TB ; Do it with DOTS
Advocacy is a planned and continuous
effort to inform people about issue and
instigate change. Advocacy usually takes
place over an extended period of time
and includes a variety of strategies to
communicate a specific message.
TB is the number one infectious killer in
the world.
One TB suspect can infect another 10
healthy persons
Leprosy Control Program
WHO Classification basis of multi-
drug therapy
Paucibacillary/PB non-
infectious types. 6-9 months of
treatment.
Multibacillary/MB infectious
types. 24-30 months of
treatment.
Multi-drug therapy use of 2 or more
drugs renders patients non-infectious a
week after starting treatment
Patients w/ single skin lesion
and a negative slit skin smear
are treated w/ a single dose of
ROM regimen
For PB leprosy cases-
Rifampicin+Dapsone on Day 1
then Dapsone from Day 2-28. 6
blister packs taken monthly
within a max. period of 9 mos.
All patients who have complied w/
MDT are considered cured and no
longer regarded as a case of leprosy,
even if some sequelae of leprosy
remain.
Responsibilities of the nurse
Prevention health education,
healthful living through proper
nutrition, adequate rest, sleep
and good personal hygiene;
Casefinding
Management and treatment
prevention of secondary
injuries, handling of utensils;
special shoes w/ padded soles;
importance of sustained
therapy, correct dosage, effects
of drugs and the need for
medical check-up from time to
time; mental & emotional
support
Rehabilitation-makes patients
capable, active and self-
respecting member of society.
Control of Schistosomiasis a tropical disease
caused by a blood fluke, Schistosoma
Japonicum ; transmitted by a tiny snail
Oncomelania quadrasi
Preventive measures health
education regarding mode of
transmission and methods of
protection; proper disposal of feces and
urine; improvement of irrigation and
agriculture practices
Control of patient, contacts and the
immediate environment
Specific treatment- Praziquantel drug
of choice
Programs on Filariasis, Malaria and Dengue
Hemorrhagic Fever
Filariasis- a chronic prasitic infection
caused by a nematode, Wuchereria
bancrofti. Young and adult worms live
in the lymphatic vessels and nodes,
while the micro filariae are in the
blood; transmitted through bites from
an infected female mosquito, Aedes
poecilius, that bites at night.
Treatment: Diethylcarbamazine
citrate or Hetrazan
Elephantiasis and Hydrocoele
are handled through surgery,
prevention and supportive care
Malaria infection caused by the bite of the female
Anopheles mosquito,
Chemoprophylaxis Chloroquine taken
at weekly intervals, starting from 1-2
weeks before entering the endemic
area.
Anti-malarial drugs sulfadoxine,
quiinine sulfate, tetracycline, quinidine
Insecticide treatment of mosquito nets,
house spraying, stream seeding and
clearing, sustainable preventive and
vector control meas
Dengue H-fever
4 oclock habit
Programs on Measles. Chickenpox,
Mumps, Diphtheria, Pertusis, Tetanus
focused on health information
campaigns and intensive immunization
of children in barangays.
Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris, Trichuris,
Hookworm) and Paragonimiasis in communities
where eating of fresh or inadequately cooked
crab is a practice
Management:
1. Deworming
2. Health Education re:
Good personal hygiene
Use of footwear
Washing fruits and vegetables
well
Use of sanitary toilets
Sanitary disposal of garbage
Boiling drinking water at least
2-3 min. from boiling point or
chlorination
Prevention and Control on
Leptospirosis/ Weils Disease/
Mud fever/Flood fever/
Spirochetal Jaundice thru
contact with the skin/ open
wound with water or moist soil
contaminated with urine of
infected rat
And Rabies
Mgt. of Rabies
Wash wound with soap and water, betadine or
alcohol may be applied
If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows
rabies, kill then bring head for lab. Exam &
consult doctor.
Active immunization body develops Ab
against rabies up to 3 yrs.
Passive I giving Ab to persons with head
and neck bites, multiple single deep bites,
contamination of mucous membranes or thin
covering of the eyes, lips or mouth to provide
immediate protection
RPO immunization of pets at 3 mos. of age
and yearly thereafter
Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most
serious type cause of severe cx. Eg. Massive
liver damage and hepatocarcinoma
- 4 Cs in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
Other CHN Practice Settings
I. Occupational Health
- the application of public health, medical and
engineering practice for the purpose of
conserving, restoring the health and
effectiveness of workers thru their places of
employment
A. Occupational Health Nursing
- the application of nursing principles and
procedures in providing health service to
employees in their place of work by means of:
1. prompt and efficient nursing care of the ill
and impaired
2. participation in teaching health and safety
practices on the job
3. cooperation with plant department
administrators
4.keeping the health clinic and staff ready to
handle emergencies
5. advising workers in the utilization of
community and welfare services
Objectives of OHN
To assist, maintain and promote positive health
of laborers and employees thru early detection
and prevention of occupational diseases and
hazards of industrial processes and by
coordinating and cooperating with activities of
other community health and welfare services
Nurses Role in OHN
1. Assists/participates in developing an
adequate health program for workers and
laborers including sound health education
activities
2. Encourages periodic P.E.
3. Cooperates with occupational medical
programs in the prevention of accidents as
well as in the promotion of good working
atmosphere and relationships in the place of
work
4. Helps in teaching others in giving good
nursing care to the sick or handicapped in their
own homes
II. School Health Nursing
School Health Triad :
1. SERVICE
2. EDUCATION
3. ENVIRONMENT
Mission of School Health Program:
To maximize potential for learning and participation in
the educational process by promoting optimum health
of school-age children and adolescents
School Health Team:
Psychologist/ Counselor
Teacher
Nutritionist
Nurse
Social Workers
Maintenance Personnel
Targets in SHN
Family
Students
Teachers
Supportive Personnel
Community
School Health Nurses Roles:
EDUCATOR
CONSULTANT /RESEARCHER
STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
HEALTH SCREENER
HEALTH CARE PROVIDER
Common Health Concerns of Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders- pimples/acne, fungal
infections, allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
There was a man who saw a scorpion
floundering around in the water.
He decided to save it by stretching out his finger
but the scorpion stung him.
The man still tried to get the scorpion out of the
water but the scorpion stung him again.
Another man nearby told him to stop saving the
scorpion but the man said, Its the nature of
the scorpion to sting. Its my nature to love, why
should I give up my nature to love just because
its the nature of the scorpion to sting?